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Comparative Evaluation of Health-Related Quality of Life Questionnaires in Patients With Heart Failure Undergoing Cardiac Rehabilitation: A Psychometric Study

      Abstract

      Objective

      To compare the psychometric properties of 2 heart failure (HF)-specific quality of life questionnaires and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) in patients with HF.

      Design

      A methodological study based on 3-month follow-up data for evaluating psychometric properties of health-related quality of life (HRQOL) questionnaires.

      Setting

      Cardiac rehabilitation center at a cardiovascular research institute.

      Participants

      Eligible patients with HF (N=60).

      Interventions

      Exercise training in cardiac rehabilitation.

      Main Outcome Measures

      The SF-36, the MacNew Heart Disease questionnaire, and the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and New York Heart Association functional classification.

      Results

      Items from the MLHFQ and the MacNew questionnaire had acceptable correlations (r>.30, P<.05). Internal consistency and test-retest reliability were adequate at ≥0.7 for the MLHFQ subscales. Correlations for the MLHFQ and the MacNew with SF-36 similar items ranged from .28 to .50 and from .26 to .60, respectively. Similar scales from the MacNew and MLHFQ showed strong correlations at baseline and follow-up, supporting the convergent validity. Improvement in HRQOL was significant for all MLHFQ subscales (P<.001) and the MacNew emotional (P<.05) and social (P<.001) subscales. The MLHFQ demonstrated the most responsiveness to changes and discriminated disease severity the best. The follow-up scores for all MLHFQ and 2 MacNew subscales were significantly greater in patients who improved compared with those who showed no change or deteriorated.

      Conclusions

      The MLHFQ was more responsive to changes of HRQOL than the MacNew questionnaire over time in patients with HF. The MacNew questionnaire was more responsive to changes than the SF-36.

      Keywords

      List of abbreviations:

      HF (heart failure), HRQOL (health-related quality of life), ICC (intraclass correlation coefficient), MCID (minimum clinically important difference), MCS (mental component summary), MLHFQ (Minnesota Living With Heart Failure Questionnaire), NYHA (New York Heart Association), PCS (physical component summary), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey)
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