Heart Failure and Health-Related Quality of Life: Five Measures for Assessing Post-Implant Left Ventricular Assist Device Patients

Abstract

PurposeAdult heart failure (HF) patients requiring left ventricular assist device (LVAD) implantation undergo life-altering experiences. The Mechanical Circulatory Support: Measures of Adjustment and Quality Of Life Study identified health-related QOL domains for monitoring post-implant LVAD patients. We present the psychometric development of five new measures of those domains.MethodsWe created five item pools: VAD Team Communication-6 items, VAD Self Care-12 items, Being Bothered by VAD Self Care-17 items, Satisfaction with Treatment-10 items, Stigma Mental Health-14 items. Next, we collected responses from a sample of LVAD patients 3 to 24+ months post implant. Then we evaluated item pool dimensionality using item/scale analysis (criterion: Pearson r adjusted-to-total score correlation ≥ .4); exploratory factor analysis (criteria: eigenvalue 1-to-2 ratio ≥ 4; eigenvalue 1 percent of variance accounted for ≥ 50); confirmatory factor analysis (criteria: factor loading ≥ .5; residual correlation ≤ .2; RMSEA < .1, CFI and TLI ≥ .95, SRMR < .08). Finally, for unidimensional item sets, we employed the graded response model to assess item fit (criterion: chi square-to-df ratio ≤ 3) and estimate item parameters.ResultsOur sample (N=678) included adult LVAD patients 3, 6, and > 12 months post implant (n=167, 167, and 344, respectively). After removing 12 non-conforming items, our analyses supported calibrated unidimensional item banks of: VAD Team Communication-6 items, VAD Self Care-12 items, Being Bothered by VAD Self Care-11 items, Satisfaction with Treatment-7 items, Stigma Mental Health-11 items) (see Table). Internal consistency reliability ranged from .88 to .92.ConclusionOur study supported the psychometric soundness of five new LVAD patient-related measures, appropriate for assessing post-implant adjustment to living with an LVAD. The new measures can be administered efficiently using computer adaptive testing and short forms. Adult heart failure (HF) patients requiring left ventricular assist device (LVAD) implantation undergo life-altering experiences. The Mechanical Circulatory Support: Measures of Adjustment and Quality Of Life Study identified health-related QOL domains for monitoring post-implant LVAD patients. We present the psychometric development of five new measures of those domains. We created five item pools: VAD Team Communication-6 items, VAD Self Care-12 items, Being Bothered by VAD Self Care-17 items, Satisfaction with Treatment-10 items, Stigma Mental Health-14 items. Next, we collected responses from a sample of LVAD patients 3 to 24+ months post implant. Then we evaluated item pool dimensionality using item/scale analysis (criterion: Pearson r adjusted-to-total score correlation ≥ .4); exploratory factor analysis (criteria: eigenvalue 1-to-2 ratio ≥ 4; eigenvalue 1 percent of variance accounted for ≥ 50); confirmatory factor analysis (criteria: factor loading ≥ .5; residual correlation ≤ .2; RMSEA < .1, CFI and TLI ≥ .95, SRMR < .08). Finally, for unidimensional item sets, we employed the graded response model to assess item fit (criterion: chi square-to-df ratio ≤ 3) and estimate item parameters. Our sample (N=678) included adult LVAD patients 3, 6, and > 12 months post implant (n=167, 167, and 344, respectively). After removing 12 non-conforming items, our analyses supported calibrated unidimensional item banks of: VAD Team Communication-6 items, VAD Self Care-12 items, Being Bothered by VAD Self Care-11 items, Satisfaction with Treatment-7 items, Stigma Mental Health-11 items) (see Table). Internal consistency reliability ranged from .88 to .92. Our study supported the psychometric soundness of five new LVAD patient-related measures, appropriate for assessing post-implant adjustment to living with an LVAD. The new measures can be administered efficiently using computer adaptive testing and short forms.