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Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses

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Abstract

Background

Heart failure (HF) is an increasingly common condition affecting patients’ health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses.

Methods and results

Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach’s alpha coefficients were generally high (0.83–0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] ‘Physical’ and ‘Social Functioning’) were moderate to strong (0.41–0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from −9.6 (95% confidence interval [CI]: −4.1; −15.2) for placebo to −17.7 (95% CI: −15.3; −20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change.

Conclusions

Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ.

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Abbreviations

ACEI:

Angiotensin-converting enzyme inhibitor

CHFQ:

Chronic Heart Failure Questionnaire

ES:

Effect size

HRQL:

Health-related quality of life

HF:

Heart failure

ICC:

Intra-class correlation coefficient

KCCQ:

Kansas City Cardiomyopathy Questionnaire

LVD-36:

Left Ventricular Dysfunction-36 questionnaire

MLHFQ:

Minnesota Living with Heart Failure Questionnaire

NYHA:

New York Heart Association

QLQ-SHF:

Quality of Life Questionnaire for Severe Heart Failure

6MWT:

Six-minute walk test

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Acknowledgments

This study has been supported by the European Union (QLRI-CT-2000-00551), the CIRIT-Comisio Interdepartamental (2001 Sol·licitud Grups de Recerca 00405), and the Instituto de Salud Carlos III (SAF2002-11009-E). The authors are very grateful to the members of the IQOD Project, managed by the MAPI Research Institute. Furthermore, we would like to thank S Pérez and A Martin for general and editorial assistance in the preparation of this article; and R Elosua, M Cladellas, and J M Valderas for their clinical support.

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Authors and Affiliations

  1. Health Services Research Unit, IMIM—Hospital del Mar, Doctor Aiguader 80, 08003, Barcelona, Spain

    Olatz Garin, Montse Ferrer, Àngels Pont, Montserrat Rué, Anna Kotzeva & Jordi Alonso

  2. CIBER Epidemiología y Salud Pública (CIBERESP), Spain http://www.ciberesp.es/

    Olatz Garin, Montse Ferrer & Jordi Alonso

  3. Universitat Autónoma de Barcelona, Barcelona, Spain

    Montse Ferrer

  4. Universitat de Lleida, Lleida, Spain

    Montserrat Rué

  5. Agència d’Avaluació de Tecnologia i Recerca Mèdiques (AATRM), Catalan Agency for Health Technology Assessment and Research (CAHTAR), C/ Roc Boronat 81-95, 08005, Barcelona, Spain

    Anna Kotzeva

  6. Behavioral Medicine, Astra Hässle Research Laboratories, Mölndal, Sweden

    Ingela Wiklund

  7. Global Health Outcomes GlaxoSmithKline, Stockley Park West, Uxbridge, UK

    Ingela Wiklund

  8. Unité de Pharmacoépidémiologie, Centre Hospitalier Lyon-Sud, Pierre-Benite Cedex, France

    Eric Van Ganse

  9. Universitat Pompeu Fabra, Barcelona, Spain

    Jordi Alonso

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  1. Olatz Garin
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Correspondence to Montse Ferrer.

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Garin, O., Ferrer, M., Pont, À. et al. Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses. Qual Life Res 18, 71–85 (2009). https://doi.org/10.1007/s11136-008-9416-4

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  • DOI: https://doi.org/10.1007/s11136-008-9416-4

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