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



      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.


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


      Cardiac rehabilitation center at a cardiovascular research institute.


      Eligible patients with HF (N=60).


      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.


      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.


      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.


      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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        • Hoekstra T.
        • Jaarsma T.
        • van Veldhuisen D.J.
        • Hillege H.L.
        • Sanderman R.
        • Lesman-Leegte I.
        Quality of life and survival in patients with heart failure.
        Eur J Heart Fail. 2013; 15: 94-102
        • Bennett S.J.
        • Oldridge N.B.
        • Eckert G.J.
        • et al.
        Comparison of quality of life measures in heart failure.
        Nurs Res. 2003; 52: 207-216
        • Pihl E.
        • Cider Å.
        • Strömberg A.
        • Fridlund B.
        • Mårtensson J.
        Exercise in elderly patients with chronic heart failure in primary care: effects on physical capacity and health-related quality of life.
        Eur J Cardiovasc Nurs. 2011; 10: 150-158
        • Höfer S.
        • Schmid J.-P.
        • Frick M.
        • et al.
        Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure.
        J Eval Clin Pract. 2008; 14: 500-506
        • Bessette L.
        • Sangha O.
        • Kuntz K.M.
        • et al.
        Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome.
        Med Care. 1998; 36: 491-502
        • Loonen H.J.
        • Grootenhuis M.A.
        • Last B.F.
        • Koopman H.M.
        • Derkx H.H.
        Quality of life in paediatric inflammatory bowel disease measured by a generic and a disease-specific questionnaire.
        Acta Paediatr. 2002; 91: 348-354
        • Supino P.G.
        • Borer J.S.
        • Franciosa J.A.
        • et al.
        Acceptability and psychometric properties of the Minnesota Living With Heart Failure Questionnaire among patients undergoing heart valve surgery: validation and comparison with SF-36.
        J Card Fail. 2009; 15: 267-277
        • Hanyu N.
        • Toy W.
        • Burgess D.
        • et al.
        Comparative responsiveness of Short-Form 12 and Minnesota Living With Heart Failure Questionnaire in patients with heart failure.
        J Card Fail. 2000; 6: 83-91
        • Johansson P.
        • Agnebrink M.
        • Dahlström U.
        • Broström A.
        Measurement of health-related quality of life in chronic heart failure, from a nursing perspective—a review of the literature.
        Eur J Cardiovasc Nurs. 2004; 3: 7-20
        • Höfer S.
        • Lim L.
        • Guyatt G.
        • Oldridge N.
        The MacNew Heart Disease health-related quality of life instrument: a summary.
        Health Qual Life Outcomes. 2004; 2: 3
        • Höfer S.
        • Anelli-Monti M.
        • Berger T.
        • Hintringer F.
        • Oldridge N.
        • Benzer W.
        Psychometric properties of an established heart disease specific health-related quality of life questionnaire for pacemaker patients.
        Qual Life Res. 2005; 14: 1937-1942
        • Wolinsky F.D.
        • Wyrwich K.W.
        • Nienaber N.A.
        • Tierney W.M.
        Generic versus disease-specific health status measures: an example using coronary artery disease and congestive heart failure patients.
        Eval Health Prof. 1998; 21: 216-243
        • Sneed N.V.
        • Paul S.
        • Michel Y.
        • VanBakel A.
        • Hendrix G.
        Evaluation of 3 quality of life measurement tools in patients with chronic heart failure.
        Heart Lung. 2001; 30: 332-340
        • Rajati F.
        • Mostafavi F.
        • Sharifirad G.
        • et al.
        A theory-based exercise intervention in patients with heart failure: a protocol for randomized, controlled trial.
        J Res Med Sci. 2013; 18: 659
        • Bonow R.O.
        • Mann D.L.
        • Zipes D.P.
        • Libby P.
        Braunwald's heart disease: a textbook of cardiovascular medicine.
        Saunders, Philadelphia2011
        • Sadock B.J.
        Kaplan & Sadock's comprehensive textbook of psychiatry.
        Lippincott Williams & Wilkins, Philadelphia2000
        • Enright P.L.
        ATS statement guidelines for the six-minute walk test. American Thoracic Society.
        Am J Respir Crit Care Med. 2002; 166: 111-117
        • Gary R.
        Exercise self-efficacy in older women with diastolic heart failure: results of a walking program and education intervention.
        J Gerontol Nurs. 2006; 32: 31-39
        • Moghaddam M.H.
        • Aghdam F.B.
        • Jafarabadi M.A.
        • Allahverdipour H.
        • Nikookheslat S.D.
        • Safarpour S.
        The Iranian Version of International Physical Activity Questionnaire (IPAQ) in Iran: content and construct validity, factor structure, internal consistency and stability.
        World Appl Sci. 2012; 18: 1073-1080
        • Lau-Walker M.
        Importance of illness beliefs and self-efficacy for patients with coronary heart disease.
        J Adv Nurs. 2007; 60: 187-198
        • Petosa P.S.
        Use of social cognitive theory to explain exercise behavior among adults [dissertation].
        The Ohio State University, School of Education, Columbus1994: 54 (4103)
        • Resnick B.
        Reliability and validity of the Outcome Expectations for Exercise Scale-2.
        J Aging Phys Act. 2005; 13: 382
        • Wills T.A.
        • Shinar O.
        Measuring perceived and received social support. Social support measurement and intervention: a guide for health and social scientists.
        Oxford Univ Pr, Toronto2000: 86-135
        • Montazeri A.
        • Goshtasebi A.
        • Vahdaninia M.
        • Gandek B.
        The Short Form Health Survey (SF-36): translation and validation study of the Iranian version.
        Qual Life Res. 2005; 14: 875-882
        • Tarlov A.R.
        • Ware J.E.
        • Greenfield S.
        • Nelson E.C.
        • Perrin E.
        • Zubkoff M.
        The Medical Outcomes Study: an application of methods for monitoring the results of medical care.
        JAMA. 1989; 262: 925-930
        • Ware J.E.
        • Kosinski M.
        SF-36 physical & mental health summary scales: a manual for users of version 1.
        2nd ed. Quality Metric Inc, Lincoln2001
        • Ware Jr., J.E.
        SF-36 health survey update.
        Spine. 2000; 25: 3130-3139
        • Collins E.
        • Langbein W.E.
        • Dilan-Koetje J.
        • et al.
        Effects of exercise training on aerobic capacity and quality of life in individuals with heart failure.
        Heart Lung. 2004; 33: 154-161
        • Valenti L.
        • Lim L.
        • Heller R.
        • Knapp J.
        An improved questionnaire for assessing quality of life after acute myocardial infarction.
        Qual Life Res. 1996; 5: 151-161
        • Mortensen O.S.
        • Madsen J.K.
        • Haghfelt T.
        • et al.
        Health related quality of life after conservative or invasive treatment of inducible postinfarction ischaemia.
        Heart. 2000; 84: 535-540
        • Dixon T.
        • Lim L.Y.
        • Oldridge N.
        The MacNew heart disease health-related quality of life instrument: reference data for users.
        Qual Life Res. 2002; 11: 173-183
        • Asadi-Lari M.
        • Javadi H.R.
        • Melville M.
        • Oldridge N.B.
        • Gray D.
        Adaptation of the MacNew quality of life questionnaire after myocardial infarction in an Iranian population.
        Health Qual Life Outcomes. 2003; 1: 23
        • Rector T.S.
        • Cohn J.N.
        Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan.
        Am Heart J. 1992; 124: 1017-1025
        • Hunt S.A.
        • Abraham W.T.
        • Chin M.H.
        • et al.
        ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society.
        Circulation. 2005; 112: e154-e235
        • Nunnally J.C.
        • Bernstein I.H.
        Psychometric theory.
        McGraw-Hill, New York1994
        • Fayers P.
        • Machin D.
        Quality of life: the assessment, analysis and interpretation of patient-reported outcomes.
        John Wiley & Sons, New York2007
        • McGraw K.O.
        • Wong S.
        Forming inferences about some intraclass correlation coefficients.
        Psychol Methods. 1996; 1: 30
        • Nunnally J.C.
        Psychometric theory 3E.
        Tata McGraw-Hill Education, New York2010
        • Terwee C.B.
        • Dekker F.W.
        • Wiersinga W.M.
        • Prummel M.F.
        • Bossuyt P.M.M.
        On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation.
        Qual Life Res. 2003; 12: 349-362
        • Moon J.R.
        • Jung Y.Y.
        • Jeon E.-S.
        • Choi J.-O.
        • Hwang J.M.
        • Lee S.-C.
        Reliability and validity of the Korean version of the Minnesota Living with Heart Failure Questionnaire.
        Heart Lung. 2012; 41: 57-66
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        Routledge Academic, Abingdon-on-Thames1988
        • Middel B.
        • Bouma J.
        • de Jongste M.
        • van Sonderen E.
        • Niemeijer M.G.
        • van den Heuvel W.
        Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q).
        Clin Rehabil. 2001; 15: 489-500
        • Höfer S.
        • Benzer W.
        • Schüßler G.
        • von Steinbüchel N.
        • Oldridge N.B.
        Health-related quality of life in patients with coronary artery disease treated for angina: validity and reliability of German translations of two specific questionnaires.
        Qual Life Res. 2003; 12: 199-212
        • Guyatt G.H.
        • King D.R.
        • Feeny D.H.
        • Stubbing D.
        • Goldstein R.S.
        Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation.
        J Clin Epidemiol. 1999; 52: 187-192
        • Garin O.
        • Soriano N.
        • Ribera A.
        • et al.
        Validation of the Spanish version of the Minnesota living with heart failure questionnaire.
        Rev Esp Cardiol. 2008; 61: 251-259