Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patients

Jarno Kotajärvi; Anna-Maija Tolppanen; Juha Hartikainen; Heikki Miettinen; Marketta Viljakainen; Janne Martikainen; Risto P. Roine; Piia Lavikainen

doi:10.1371/journal.pone.0266101

Peer Review History

Original SubmissionJune 17, 2021
2 Nov 2021 Decision Letter - Filipe Prazeres, Editor PONE-D-21-19920Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patientsPLOS ONE Dear Dr. Lavikainen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ACADEMIC EDITOR: Please address all comments from both referees. Also, please rewrite lines 97-104 since those are the same sentences from the following article: Jari Heiskanen, Anna-Maija Tolppanen, Risto P Roine, Juha Hartikainen, Mikko Hippeläinen, Heikki Miettinen, Janne Martikainen, Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients, European Heart Journal - Quality of Care and Clinical Outcomes, Volume 2, Issue 3, July 2016, Pages 193–200, https://doi.org/10.1093/ehjqcco/qcw002 Please submit your revised manuscript by Dec 17 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. Thank you for stating the following in the Competing Interests/Financial Disclosure* (delete as necessary) section: “I have read the journal's policy and the authors of this manuscript have the following competing interests: Prof Martikainen is a founding partner of ESiOR Oy and a board member of Siltana Oy. These companies were not involved in carrying out this research. No other disclosures were reported” We note that one or more of the authors are employed by a commercial company: name of commercial company. a. Please provide an amended Funding Statement declaring this commercial affiliation, as well as a statement regarding the Role of Funders in your study. 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The specific roles of these authors are articulated in the ‘author contributions’ section.” If your commercial affiliation did play a role in your study, please state and explain this role within your updated Funding Statement. b. Please also provide an updated Competing Interests Statement declaring this commercial affiliation along with any other relevant declarations relating to employment, consultancy, patents, products in development, or marketed products, etc. Within your Competing Interests Statement, please confirm that this commercial affiliation does not alter your adherence to all PLOS ONE policies on sharing data and materials by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests) . If this adherence statement is not accurate and there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include both an updated Funding Statement and Competing Interests Statement in your cover letter. We will change the online submission form on your behalf. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript aims to investigate the correlation between the change in patient-reported CCS and the generic 15D HRQoL score. The manuscript is structured but is regular written. The results present new and useful data for researchers and clinicians. The reviewer appreciates the effort of the authors. However, some parts need to be corrected. My specific comments are appended below. Keywords: -Rewrite “angina pectoris” as “Angina Pectoris” and “health-related quality of life” as “Health-Related Quality Of Life”. This is a MeSH term, and the first letter must be capitalized -CCS and 15D are not a MeSH terms. I suggest you to change these terms as MeSH terms. - I suggest you to keep keywords in alphabetical order Introduction: -In the first three paragraphs, the authors mention the importance of specific assessment of symptoms and HRQOL for economic analysis in health, but this is not the focus of the article, and there is no need to mention it repeatedly. -I suggest the authors cite the study hypothesis. Material and methods: -I Suggest to separate ethical issues from the “Study design and population”. I suggest placing an item “Informed consent and ethical considerations” with the phrase of lines 89-91. Results: -It was not clear how the population was divided among those who completed each questionnaire. Since two instruments are being correlated, it is necessary for the studied population to complete the two questionnaires at both times. -It would be important for the authors to explain the variation in participants, since 1,271 were included in the study, but different amounts filled each instrument (CCS and 15D). -It would also be important to explain how many completed each instrument only at the first moment and why there were missing values and whether this would be a limitation for the study. Maybe na algorithm explain the included population would be helpfull. -Suggestion line 148: put the percentage next to the number of patients -S2 Table: Hearing dimension in the colun “95%” the autors wrote “0.00” I suggest change to “<0.01” -The authors correlate HRQOL with procedures performed for angina (OMT, PCI, CABG), but sociodemographic characteristics (ie years of education, income) and clinical features (ie comorbidities, treatments for other diseases) affect HRQOL. It would be important to include this information in the results. -Table 2: describe age ≥70 years, but they are a minority (45.5%) I suggest putting the majority Discussion -Line 195-196: The autors wrote 15D is influenced not only by heart health but also by other dimensions of life, such as concomitant illnesses. I suggest that in the results the authors describe whether the participants in this study had comorbidities i.e hypertension, diabetes. -I suggest that the authors explain the criteria for selecting the age groups ≥70 / ≥ 70 years. -I suggest discussing the results based on group age differences (≥70 / ≥ 70 years). Reviewer #2: Methodology should be more clear.. and explained-well. Under statistical analysis, only statistical methodology should be discussed/explained NOT the overall/general scoring etc etc. Discussion should be re-written/revised appropriately matching with the objectives and the findings obtained, not just like expanding the intro part. all the obtained results must be discussed in detail and by referring to/with earlier studies using same/similar research tools. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Priscila Moreno Sperling Cannavan Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0266101.r001
Revision 1
17 Dec 2021 Author Response Response to Reviewers Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: No ________________________________________ 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ________________________________________ 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ________________________________________ 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript aims to investigate the correlation between the change in patient-reported CCS and the generic 15D HRQoL score. The manuscript is structured but is regular written. The results present new and useful data for researchers and clinicians. The reviewer appreciates the effort of the authors. However, some parts need to be corrected. My specific comments are appended below. Keywords: -Rewrite “angina pectoris” as “Angina Pectoris” and “health-related quality of life” as “Health-Related Quality Of Life”. This is a MeSH term, and the first letter must be capitalized -CCS and 15D are not a MeSH terms. I suggest you to change these terms as MeSH terms. - I suggest you to keep keywords in alphabetical order Our response: We thank the Reviewer for commenting on this. We have rewritten the terms according to MeSH terms. We would prefer to include also 15D and CCS as key words although they are not MeSH terms but leave the final decision on this to the Editor. We have also sorted the keywords to alphabetical order. Introduction: -In the first three paragraphs, the authors mention the importance of specific assessment of symptoms and HRQOL for economic analysis in health, but this is not the focus of the article, and there is no need to mention it repeatedly. Our response: We agree with the Reviewer and have modified the introduction so that health economics analyses are emphasized less. -I suggest the authors cite the study hypothesis. Our response: We would rather refrain from stating an exact hypothesis, because we did not have an a priori hypothesis for what we expected to find. Our aim was to assess whether the change measured by these two patient-reported instruments is correlated. However, we have revised the last paragraph of the introduction so that the rationale for our study is stated more clearly. The revised paragraph reads as follows: “Previous studies have assessed the correlation between clinician measured CCS grading or New York Heart Association (NYHA) functional classification and patient-reported generic HRQoL, mainly in cross-sectional designs [16–18]. Therefore, it is unknown whether the change in symptom severity evaluated by the CCS is associated with the change in generic HRQoL. Further, the earlier studies have usually compared physician-evaluated CCS to a patient-reported generic HRQoL instrument. Therefore, it is unknow whether the change in self-reported CCS correlates with the change in self-reported generic HRQoL. To evaluate this, we investigated the correlation between the change in patient-reported CCS and the generic 15D HRQoL score among patients with coronary artery disease.” Material and methods: -I Suggest to separate ethical issues from the “Study design and population”. I suggest placing an item “Informed consent and ethical considerations” with the phrase of lines 89-91. Our response: In accordance with the suggestion of the Reviewer, we have separated ethical issues to a new paragraph with a heading “Informed consent and ethical considerations”. Results: -It was not clear how the population was divided among those who completed each questionnaire. Since two instruments are being correlated, it is necessary for the studied population to complete the two questionnaires at both times. Our response: We agree with the Reviewer and have clarified the number of people in the correlation analysis in the revised manuscript (lines183-184) as follows: “Altogether 805 (63.3%) patients had both CCS and 15D index scores reported at both timepoints and were included in these analyses.” We have also specified the number of patients included in the analyses assessing the changes in individual instruments on lines 167-168 and 174-175. -It would be important for the authors to explain the variation in participants, since 1,271 were included in the study, but different amounts filled each instrument (CCS and 15D). Our response: Please, see our answer to the previous comment. -It would also be important to explain how many completed each instrument only at the first moment and why there were missing values and whether this would be a limitation for the study. Maybe na algorithm explain the included population would be helpfull. Our response: We have reported the number (proportion) of missing data at baseline and after 12 months for both instruments in table 2. In addition, the number of patients with data available at both timepoints is reported in the table and Results section of the manuscript (lines 167-168, 174-175 and 183-184). Unfortunately, we have no data on the reasons for missing data. -Suggestion line 148: put the percentage next to the number of patients Our response: In line with the recommendation of the Reviewer, we have added the proportions next to the number of patients on lines 167, 174 and 183. -S2 Table: Hearing dimension in the colun “95%” the autors wrote “0.00” I suggest change to “<0.01” Our response: In accordance with the suggestion of the Reviewer, we have corrected the correlation coefficient as “<0.01”. -The authors correlate HRQOL with procedures performed for angina (OMT, PCI, CABG), but sociodemographic characteristics (ie years of education, income) and clinical features (ie comorbidities, treatments for other diseases) affect HRQOL. It would be important to include this information in the results. Our response: We thank the Reviewer for the comment. Unfortunately, we have no data on sociodemographic characteristics or clinical features. -Table 2: describe age ≥70 years, but they are a minority (45.5%) I suggest putting the majority Our response: In line with the recommendation of the Reviewer, we have changed the age to describe the majority, i.e., patients <70 years. Discussion -Line 195-196: The autors wrote 15D is influenced not only by heart health but also by other dimensions of life, such as concomitant illnesses. I suggest that in the results the authors describe whether the participants in this study had comorbidities i.e hypertension, diabetes. Our response: We agree that describing the comorbidities would inform on the comorbidities of the study population, but we would prefer to keep the tables and manuscript in the current form. The main aim of our manuscript was to illustrate whether the changes in symptom-specific CCS and generic 15D instrument are consistently correlated (i.e., how much they measure the same phenomenon, can 15D capture the patient-reported change in CCS). As all participants had coronary artery disease, most of them had hypertension and/or diabetes and thus reporting the prevalence of these comorbidities would not result to a meaningful improvement in the manuscript. -I suggest that the authors explain the criteria for selecting the age groups ≥70 / ≥ 70 years. Our response: The aim was to study the treatment effect in two age groups (young and old) with approximately equal size (quantiles). As the median age in the study population (n=1271) was 69 years, rounding it to the nearest tenth resulted in two age groups (<70 and ≥70 years) with approximately same size (54.5 % and 45.5% of the study population). -I suggest discussing the results based on group age differences (≥70 / ≥ 70 years). Our response: In accordance with the suggestion of the Reviewer, we have added to the discussion section as follows (lines 267-272): ”The prevalence of elderly patients with coronary artery disease is increasing. Elderly patients have greatest morbidity and mortality as well as high prevalence of comorbidities [30], which may influence the perceived effect of treatment [31]. Indeed, in our study CCS class improved in 46% of patients in the younger age groups whereas only in 40% in the older age group. However, using the generic instrument (15D), the impact of age was less obvious; 15D improved in 48% and 46% in of the younger and the older population, respectively.“ Reviewer #2: Methodology should be more clear.. and explained-well. Under statistical analysis, only statistical methodology should be discussed/explained NOT the overall/general scoring etc etc. Our response: We thank the Reviewer for the comment. We have restructured the section of statistical analyses according to the suggestion of the Reviewer. Discussion should be re-written/revised appropriately matching with the objectives and the findings obtained, not just like expanding the intro part. all the obtained results must be discussed in detail and by referring to/with earlier studies using same/similar research tools. Our response: We thank the Reviewer for the suggestion and hope that the modification of the Introduction section as suggested by the Reviewer 1 above has removed some of the overlap. We also agree that the Discussion to some extent “expands” the Introduction as the aim of the Introduction is to provide the context for performing the study, including a brief introduction to earlier studies related to the topic. We have rewritten and reorganized the Discussion in the revised manuscript. We hope that in the revised form the discussion of our results in the context of earlier studies on this topic is more evident. The following text has been added to the Discussion: “Although the correlation between CCS grade and 15D was only moderate, the proportion of patients with clinically meaningful improvement of symptoms was almost the same with both instruments; 47.2% of patients reported a clinically meaningful improvement in HRQoL measured with the 15D and 43.0% with the CCS. The correlation between CCS and 15D was weakened by the discrepancy in patients reporting worsening of symptoms or no benefit. Less than 10% of the patients reported increasing symptom severity (CCS grade), while every third patient reported worsening of generic HRQoL (15D). Correspondingly, using the CCS instrument, half of the patients did not experience any benefit, whereas this was the case on in only one fifth of patients when 15D was applied. This difference between CCS and 15D suggests that not only the severity of angina pectoris symptoms, but also other dimensions of health captured by the generic instrument are important aspects of quality of life. The proportion of CAD patients with deterioration of overall HRQoL was comparable with that reported in a previous study [28] demonstrating the external validity of our results. In earlier studies, the association between CCS and NYHA class and generic instruments, such as EQ-5D and SF-6D have been somewhat controversial. In line with us, in the study by Goldsmith et al. one class increase of CCS grade, i.e. worsening of symptoms, was associated with a decrease in HRQoL measured with the EQ-5D instrument among CAD and heart failure patients [17]. Similarly, in heart failure patients the EQ-5D and SF-6D instrument’s utility scores decreased with increasing disease severity [16]. On the other hand, positive changes in EQ-5D and SF-6D instruments have been reported without co-occurring changes in the NYHA functional status [16]. This demonstrates that when assessing the overall therapeutic effect of a treatment, not only disease specific symptoms but also wider perspective of the patient’s quality of life are needed.” ________________________________________ 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Priscila Moreno Sperling Cannavan Reviewer #2: No Attachments Attachment Submitted filename: PONE_Point_by_point_response_161221.docx https://doi.org/10.1371/journal.pone.0266101.r002
9 Feb 2022 Decision Letter - Filipe Prazeres, Editor PONE-D-21-19920R1Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patientsPLOS ONE Dear Dr. Lavikainen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. I also suggest that the authors review the order of the references throughout the manuscript. Some paragraphs were redacted, but the reference number did not change. Please submit your revised manuscript by Mar 26 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Filipe Prazeres, MD, MSc, Ph.D. Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: (No Response) Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: (No Response) Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: (No Response) Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: (No Response) Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) Reviewer #2: They have revised it, and in this form it could be accepted. Appreciated the revised version. May proceed ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-21-19920R1_01.2022.docx https://doi.org/10.1371/journal.pone.0266101.r003
Revision 2
14 Feb 2022 Author Response Response to Reviewers: 1- The authors made several corrections and as the manuscript was sent for a new evaluation, there is no way to evaluate it, because the corrections and the first version of the manuscript are together in the same version, the correction with marking (ie: manuscript), leaving it confusing for the correction. I suggest a new submission, only with the second version of the manuscript and that the authors highlight what was changed (i.e: manuscript). Our response: We apologize for the inconvenience. However, the revised manuscript is submitted with tracked changes (utilizing “Track changes” tool in Microsoft Word) as suggested by the journal. In addition, the submission includes a clean version without tracked changes. 2- I also suggest that authors review the order of references in the introduction. The paragraphs were redacted, but the reference number did not change. Our response: We are grateful for the Reviewer for noticing this. We have reviewed and corrected the order of the references. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0266101.r004
15 Mar 2022 Decision Letter - Filipe Prazeres, Editor Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patients PONE-D-21-19920R2 Dear Dr. Lavikainen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Filipe Prazeres, MD, MSc, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors have reviewed the manuscript and so it can be accepted and published. Appreciated the revised version. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** Priscila Moreno Sperling Cannavan https://doi.org/10.1371/journal.pone.0266101.r005
Formally Accepted
25 Mar 2022 Acceptance Letter - Filipe Prazeres, Editor PONE-D-21-19920R2 Correlation of the disease-specific Canadian Cardiovascular Society (CCS) classification and health-related quality of life (15D) in coronary artery disease patients Dear Dr. Lavikainen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Filipe Prazeres Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0266101.r006

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