HeartQoL Validation in Patients With Ischemic Heart Failure
Background: Patient-reported outcome measures are increasingly used in clinical trials as performance measures to evaluate quality of care. Health-related quality of life is an example of a patient-reported outcome measure. The English version of the heart disease-specific HeartQoL health-related quality of life questionnaire has previously been validated in patients with heart disease.
Purpose: To validate the English version of the HeartQoL in patients with ischemic heart failure.
Methods: Patients with ischemic heart failure meeting clinical eligibility criteria and being treated at Aurora St. Luke’s Medical Center (Milwaukee, WI) completed a sociodemographic questionnaire, the HeartQoL, the 36-Item Short Form Health Survey (SF-36, and the Hospital Anxiety and Depression Scale (HADS). The following key psychometric properties of the HeartQoL were assessed: A) factor structure; B) internal consistency reliability; C) convergent validity; and D) discriminative validity.
Results: A total of 83 patients with ischemic heart failure (mean age: 65.8 ± 11.4 years; female gender: 30.1%; New York Heart Association (NYHA) functional class II: 44.7%; NYHA class III: 47%; NYHA class IV: 8.4%) completed the questionnaires. Exploratory factor and Mokken analysis both supported the bidimensional physical and emotional factor structure of HeartQoL. Internal consistency reliability with Cronbach’s α was excellent (global α: 0.92, physical α: 0.91) or good (emotional α: 0.89). Both convergent validity between similar HeartQoL and SF-36 subscales (r ≥ 0.75) and discriminative validity for all 18 a priori hypotheses (NYHA, shortness breath, anxiety and depression per HADS, physical activity, and SF-36 health transition) were confirmed.
Conclusion: The English HeartQoL questionnaire demonstrated satisfactory key psychometric properties of validity and reliability in this heart failure population. This study adds support for the HeartQoL as a core heart-specific health-related quality of life questionnaire in a broad group of patients with heart disease, including patients with angina, myocardial infarction, atrial fibrillation, implantable cardioverter-defibrillator, and valve surgery.