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

Abstract

ObjectiveTo 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. DesignA methodological study based on 3-month follow-up data for evaluating psychometric properties of health-related quality of life (HRQOL) questionnaires. SettingCardiac rehabilitation center at a cardiovascular research institute. ParticipantsEligible patients with HF (N=60). InterventionsExercise training in cardiac rehabilitation. Main Outcome MeasuresThe SF-36, the MacNew Heart Disease questionnaire, and the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and New York Heart Association functional classification. ResultsItems 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. ConclusionsThe 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.