What is the Rose questionnaire?

The Rose Questionnaire: A Standardized Tool for Angina Pectoris Assessment

The Rose questionnaire is a standardized diagnostic tool used to identify angina pectoris in epidemiological studies and clinical settings, particularly for patients over 40 years of age who may have coronary heart disease. 1

Purpose and Development

The Rose questionnaire (also known as the London School of Hygiene Cardiovascular Questionnaire) was developed for epidemiological studies to obtain reproducible diagnoses of angina pectoris. It serves as a screening tool that:

• Helps identify patients with possible coronary heart disease
• Provides standardized assessment of chest pain symptoms
• Enables consistent diagnosis across different populations and settings

Structure and Administration

The questionnaire consists of specific questions about chest pain characteristics, focusing on:

1. The presence of chest pain or discomfort
2. Location and radiation of pain
3. Relationship to physical exertion
4. Relief with rest or nitroglycerin
5. Duration of symptoms

The questionnaire is typically administered by certified health interviewers and allows for lateralization of leg symptoms (right, left, or both) when used for peripheral arterial disease assessment. 1

Clinical Applications

Coronary Heart Disease Assessment

• Used in population studies to estimate prevalence of angina pectoris
• Included in national health surveys to track coronary heart disease prevalence
• Applied in the National Health and Nutrition Examination Survey (NHANES) 1

Peripheral Arterial Disease Assessment

• The Rose questionnaire has been adapted for peripheral arterial disease assessment
• It's administered only to survey participants over 40 years of age 1
• Used alongside the ankle-brachial index (ABI) to improve detection of peripheral arterial disease

Diagnostic Performance

The Rose questionnaire has demonstrated:

• Moderate sensitivity (53%) but high specificity (89%) for detecting coronary heart disease 2
• Comparable predictive value to physician diagnosis for mortality outcomes in post-myocardial infarction patients 3
• Consistent performance across different demographic groups, though with some variation in repeatability between racial groups 4

Variations and Adaptations

Several adaptations of the Rose questionnaire exist:

1. Full questionnaire: The complete set of questions as originally designed
2. Three key questions: Focused on chest pain characteristics
3. Single question: About discomfort or pain in the chest
4. Two questions: About complaints when slowing down or stopping activities 5

Research shows that these variations perform similarly in predicting coronary events, suggesting that shortened versions may be as effective as the full questionnaire. 5

Limitations and Considerations

• The questionnaire may have lower repeatability in certain populations (lower kappa statistics in Black populations compared to White populations) 4
• A single positive determination is associated with disease markers, but multiple positive reports indicate more severe disease 4
• Sensitivity may vary by socioeconomic status, with potentially higher sensitivity among people from lower socioeconomic backgrounds 2

Clinical Integration

The Rose questionnaire complements other diagnostic approaches:

• Often used alongside the ankle-brachial index for peripheral arterial disease assessment
• Can be incorporated into comprehensive cardiovascular risk assessment
• Helps identify patients who may benefit from further diagnostic evaluation

When used in clinical practice, the Rose questionnaire provides a standardized approach to assessing angina symptoms, helping clinicians identify patients who may require additional evaluation for coronary heart disease.