Abstract
Background: To explore the structure of the Kansas City Cardiomyothy Questionnaire (KCCQ) and compare it to the published version. The KCCQ is a well-established 5 domain, 23-item instrument evaluating the health status of heart failure patients. This analysis seeks to find the best factor fit for the items and subscale structure, thereby building evidence of the reliability and validity of the tool. Methods and Results: A sample of 280 adults with Stage C heart failure was enrolled from three sites in the northeast US. A principal component factor analysis was performed using Promax rotation, allowing for correlation between the subscales. Cronbach’s α scores were computed on the resulting item clusters. All data was analyzed using SPSS version 17.0. The analysis confirmed a five-factor solution; however, some of the items loaded on different factors from those published. The first five factors with Eigen values >1 explained 67.13% of the variance. The internal consistency/reliability was 0.92 overall and as follows in each domain: social interference (7 items, 0.90), physical limitation (4 items, 0.84), symptoms (8 items, 0.86), independent care (2 items, 0.80) and self-efficacy (2 items, 0.63). Two items related to independent care failed to correspond to a previously identified factor so a new domain was added and the items intending to measure quality of life loaded in the social interference domain. Conclusions: This analysis verifies the reliability and supports the validity of the KCCQ. To strengthen the KCCQ we recommend eliminating the quality of life domain and including those items in the social interference domain, renaming the self-efficacy domain because these items are not consistent with the theoretical definition of the concept, and re-evaluating the two items which address limitations in dressing and bathing. Key Words: heart failure, factor analysis, quality of life, Kansas cardiomyopathy questionnaire (KCCQ).
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