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From what state are patients suffering now, and how will this change in the future? What events might punctuate this suffering, and at what rate will they accrue? What biological, behavioural and psychosocial traits lead people to these different states? These fundamental questions of prognosis research are as obvious as they are incompletely addressed. Enquiry into the future progression of people with existing disease is, or should be, a cornerstone of clinical practice, and translational medicine, and while we do know much about death after myocardial infarction, we know much less about prognosis in relation to other startpoints and other endpoints.
To illustrate the slow progress in understanding the prognosis of stable angina, imagine that this editorial were written by Warren and Bracket, who in 1812 wrote the first article in the first edition of the New England Journal of Medicine and Surgery,1 entitled “Remarks on angina pectoris.” One suspects that they would have found much of interest in the article by Buckley and Murphy (see page 461) and would have needed only minimal translation to bridge the nearly 200 years separating the articles.2 But they may well have been dismayed to realise that such research was new. There are few, if any, such community-based studies with long-term follow-up of quality of life among patients with …