Even though the CCS classification system is the most common metric with which to quantify patients symptoms and function, as noted previously, it is limited by being from the physician s perspective rather than the patient s. Moreover, it has limitations in its reproducibil- ity and interrater reliability. To obtain a valid, reliable, reproducible, and sensitive assessment of patients symp- toms, function, and quality of life from patients perspectives, the SAQ can be used.435,1226 The SAQ is a 19-item, self- reported questionnaire that takes approximately 5 minutes for most patients to complete and explicitly quantifies patients angina frequency, recent changes in their angina, their phys- ical limitations due to angina, their satisfaction with treat- ment, and their perceptions of how their angina limits their quality of life. Scores on the SAQ have been shown to be associated with subsequent survival. ACS admissions and costs246,247,1227 can be integrated into prognostic models to identify patients warranting more aggressive treatment be- cause of an adverse prognosis. In the CADENCE (Coronary Artery Disease in General Practice) study, conducted in 207 primary care clinics throughout Australia,1228 Beltrame and colleagues found wide variation in anginal symptoms accord- ing to the SAQ. Routine use of the SAQ has been endorsed as a performance measure of quality in SIHD.407,436 6.2.1. Focused Follow-Up Visit: Frequency Patients with SIHD should receive regular follow-up to monitor symptoms and progression or complications of dis- ease. Regular visits with a healthcare provider are also necessary to evaluate patients adherence to and effectiveness of therapy as well as occurrence of any adverse effects. Although there are scant data on which to base a definitive recommendation, the writing committee recommends a clin- ical follow-up evaluation every 4 to 12 months. 