Introduction
The Rose Angina Questionnaire (RAQ) is a cornerstone instrument designed to standardize the assessment of exertional chest pain symptoms suggestive of angina in epidemiological and population-based studies. First introduced in 1962 by Geoffrey A. Rose, the RAQ has since become an indispensable tool in cardiovascular epidemiology and population health research. Consequently, its primary validation study has amassed over 1,800 citations, underscoring its significant impact and widespread adoption within the cardiovascular research community.
This article serves as an expert guide, meticulously detailing the RAQ's key features, screening and research applications, and research value. Ultimately, it provides researchers and clinicians with the necessary insights for effectively incorporating this instrument into their population-based studies and risk stratification work.
Key Features of the Rose Angina Questionnaire (RAQ)
Purpose and Use
The primary purpose of the Rose Angina Questionnaire (RAQ) is to standardize the assessment of exertional chest pain symptoms suggestive of angina in epidemiological and population-based studies.
Target Population
The RAQ is validated for adults aged 18 years and older. Its target population includes:
Young Adults (18-24 years)Middle-Aged Adults (25-44 years)Older Adults (45-64 years)Seniors (65+ years)Furthermore, it is specifically designed for adults in epidemiological and population-based studies assessing symptoms suggestive of angina or coronary heart disease.
Structure
The RAQ is commonly described as a 7-question instrument using primarily Yes/No response types, with later shortened and adapted versions used in some studies. It systematically covers exertional chest pain symptoms using a structured, pattern-based format that includes pattern-based branching and location selection in some versions. The questionnaire comprehensively assesses:
Presence of chest pain or discomfortExertional component (e.g., occurs when walking uphill or in a hurry)Response to pain (whether the respondent stops or slows down)Relief upon standing stillTime to relief (e.g., 10 minutes or less)Location of the pain (e.g., sternum, left arm) using a diagramThis structure captures the core clinical features of angina within the broader field of cardiology and cardiovascular health, specifically focusing on ischemic heart disease symptoms.
Scoring Method
The RAQ uses an algorithm-based classification rather than a traditional summed total score. The response type is primarily Yes/No, with pattern-based branching and location selection in some versions.
The questionnaire classifies angina according to a defined response pattern for exertional chest pain and related criteria, including:
Provoking activity (e.g., walking uphill or hurrying)Whether the respondent slows down or stops when experiencing painRelief with rest (standing still)Time to relief (10 minutes or less)Pain location (e.g., sternum, left arm)Meeting a specific pattern of responses classifies an individual as having, for example, "Grade 1 Angina" or "Grade 2 Angina." It is important to note that the RAQ does not use cut-off scores in the traditional sense. Instead, it relies on diagnostic criteria where a specific response pattern determines angina classification.
Administration Format
The RAQ is an efficient tool, as it typically takes less than 5 minutes to complete, which is ideal for large-scale studies. Moreover, researchers and healthcare teams can administer the questionnaire via:
Paper-based formsDigital (online) platformsIn-person interviewsSelf-administration needs no training, while interviewer-administration requires basic training.
Applications of the Rose Angina Questionnaire (RAQ)
The RAQ is a versatile tool with several key applications in clinical practice and research:
Screening: It helps identify individuals in a population who may have undiagnosed angina.Research: It serves as a reliable and valid endpoint for cardiovascular epidemiological studies and clinical trials.Risk Stratification: The questionnaire helps classify individuals based on their risk for future ischaemic heart disease at the population level.Languages and availability
Due to its global adoption, the RAQ has been translated and validated in numerous languages, including:
ArabicEnglishMandarin ChineseSpanishFrenchRussianAnd other (Japanese - Bahasa Melayu)The RAQ is also free for clinical and research use and operates under an Open Access license, making it highly accessible.
Reliability and Validity
The psychometric soundness of the RAQ is well-documented. Studies confirm it has moderate reliability and validity, characterized by moderate sensitivity but high specificity. This makes it valuable for ruling out disease in population screening.
The Original Validation Study linkValidation for Arabic version linkValidation for Chinese version linkValidation of Spanish version linkValidation of French version linkValidation of Russian version linkValidation of German version linkValidation of short version of brazil linkValidation of Japanese version linkLimitations and Considerations
Despite its strengths, the RAQ has several important limitations that researchers and clinicians should consider when implementing the instrument in practice or research:
Poor Diagnostic Accuracy: Recent studies confirm it has poor accuracy for diagnosing coronary heart disease in some populations.Narrow Focus (Limited Domains Covered): The questionnaire covers limited domains, focusing strictly on exertional chest pain without addressing other cardiac symptoms.Scoring Complexity: While there is no linear scale, the algorithm-based classification can be confusing for new researchers compared to simple summed scores.Researchers and clinicians should account for these limitations when interpreting results. Consequently, the RAQ should not be used as a stand-alone diagnostic tool for individual patients, but rather as a screening and risk stratification instrument for population-based studies.
Other Versions And Related Questionnaires
Researchers and clinicians should be aware of other versions of the questionnaire:
Shortened 3-Question Version: The questionnaire has been adapted into numerous shorter versions (e.g., the 3-question version) used in countless large-scale studies with minor wording variations.Adapted Versions: Various large-scale studies have implemented adapted versions with minor wording variations, though the core Rose criteria remain the standard.Additionally, the RAQ can be used alongside complementary assessment tools, such as:
Seattle Angina Questionnaire (SAQ): A more detailed, disease-specific health status measure.MRC Dyspnoea Scale: Assesses shortness of breath and is used alongside the Rose questionnaire in some studiesAdditional Resources
The Original Validation Study linkYou can access the questionnaire as a PDF through this linkFor inquiries, contact FC Lampe via email: admin@ucl.ac.ukFrequently Asked Questions (FAQ)
1. Who can use the Rose Angina Questionnaire?
Researchers and clinicians can use the RAQ for adults aged 18 and older, particularly in epidemiological studies and population-based surveillance for cardiovascular risk.
2. How long does it take to complete the RAQ?
Patients and participants typically complete the assessment in less than 5 minutes, making it highly practical for large-scale research.
3. How is the RAQ administered?
Healthcare teams and researchers can administer the questionnaire via paper-based forms, digital platforms, or through an in-person interview format.
4. Is there any cost to using the Rose Angina Questionnaire?
The RAQ is completely free to use and does not require a license or permission, operating under an Open Access model.
A Word from ResRef about the Rose Angina Questionnaire (RAQ)
The Rose Angina Questionnaire (RAQ) is a classic epidemiologic tool for standardized assessment of exertional chest pain suggestive of angina in population studies. Widely used in cardiovascular research and surveillance, it is valuable for screening and population-level risk stratification, but should not be used as a stand-alone diagnostic tool for individual patients.
References
ampally Vijay, Bharat Raj Kidambi, Nitish Naik, Sandeep Singh, Gautam Sharma, Ramakrishnan S, Ambuj Roy, Validation of complete and shortened WHO Rose angina questionnaire to detect coronary heart disease in a tertiary care hospital, Indian Heart Journal,Volume 78, Issue 1, 2026, Pages 20-24, ISSN 0019-4832, linkMoussa, M. E., Gadallah, M., & Mortagy, A. K. (1994). The evaluation of an Arabic version of Rose questionnaire. The Journal of the Egyptian Public Health Association, 69(1-2), 31–46. linkGreaves, K., Chen, Y., Appadurai, V., Hu, Z., Schofield, P., & Chen, R. (2014). The prevalence of doctor-diagnosed angina in 4314 older adults in China and comparison with the Rose angina questionnaire: The 4 province study. International Journal of Cardiology, *177*(2), 627-628. linkCosín, J., Asín, E., Marrugat, J. et al. Prevalence of angina pectoris in Spain. Eur J Epidemiol 15, 323–330 (1999). linkPierre Ducimetière, Jean-Bernard Ruidavets, Michèle Montaye, Bernadette Haas, John Yarnell, on behalf of the PRIME Study Group, Five-year incidence of angina pectoris and other forms of coronary heart disease in healthy men aged 50–59 in France and Northern Ireland: the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study, International Journal of Epidemiology, Volume 30, Issue 5, October 2001, Pages 1057–1062. linkAbernathy, J. R., Thorn, M. D., Trobaugh, G. B., Ekelund, L. G., Maciolowski, M., Lupovetsky, B., Shelnova, S., Zhukovsky, G., Shestov, D., & Deev, A. (1988). Prevalence of ischemic resting and stress electrocardiographic abnormalities and angina among 40- to 59-year-old men in selected U.S. and U.S.S.R. populations. Circulation, *77*(2), 270-278. linkGrüntzig, A., & Galla, J. (1970). Die Ergebnisse eines Fragebogens im Vergleich mit der ärztlichen Diagnose [The results of a questionnaire in comparison to physicians’ diagnosis]. Methods of Information in Medicine, 9(1), 21–27. linkBastos, M.-S., Lotufo, P. A., Whitaker, A. L., & Bensenor, I. M.. (2012). Validação da versão curta do questionário Rose de angina no Brasil. Arquivos Brasileiros De Cardiologia, 99(5), 1056–1059. linkWILLIAM C BLACKWELDER, ABRAHAM KAGAN, TAVIA GORDON, GEORGE G RHOADS, Comparison of Methods for Diagnosing Angina Pectoris: The Honolulu Heart Study, International Journal of Epidemiology, Volume 10, Issue 3, September 1981, Pages 211–215, link