The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential 'core' HRQL measure, at least in the German language.

Zusammenfassung. Theoretischer Hintergrund: Gesundheitsbezogene Lebensqualität (gLQ) stellt einen wichtigen Aspekt in der Evaluation medizinischer Behandlungen dar. Fragestellung: Der MacNew Heart Disease Lebensqualitätsfragebogen (MacNew) wurde entwickelt, um Gefühle von Patienten zu erfassen, die sich auf eine Reihe von Problemen bei Überlebenden eines akuten Herzinfarktes beziehen. Das Ziel dieser Studie war die Validierung der deutschen Version des MacNew an einer Patientengruppe nach Herzinfarkt. Methode: Der MacNew und die Short Form 36 (SF-36) wurden von 199 Patienten ausgefüllt. Die Retest-Reliabilität, die innere Konsistenz, sowie Valditiätsüberprüfungen und eine konfirmatorische Faktorenanalyse wurden berechnet. Ergebnisse: Mehr als 92% der Items wurden vollständig beantwortetet. Die konvergente Valdität mit den Skalen des SF-36 bewegten sich im Bereich von r = 0.36 bis 0.75 (p < .001). Die diskriminante Validität war zufriedenstellend hoch für alle Skalen (ANOVA, p < .01). Die Faktorenanalyse bestätigte die Drei-Faktoren-Struktur und erklärte 54,25% der Varianz. Reliabilitätskoeffizienten rangierten zwischen rtt = 0.72 und 0.87. Die innere Konsistenz liegt zwischen 0.90 und 0.97 auf. Die geringe Anzahl an fehlenden Daten belegt die hohe Akzeptanz der deutschen Version des MacNew bei Herzinfarktpatienten. Schlussfolgerung: Die Ergebnisse deuten darauf hin, dass die deutsche Version des MacNew ein valides, reliables und sensitives Instrument für die Messung der gLQ darstellt und vergleichbar mit der englischen Originalversion ist.

BackgroundThe goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria.MethodsPatients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D].ResultsAll MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients.Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time.ConclusionThese findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.

These findings provide evidence that the improvements in HRQL and risk factors following cardiac rehabilitation in Austria are clinically important. HRQL should become a standard outcome parameter in cardiac rehabilitation.

Recently, conflicting results have been published about a possible relationship between platelet activity and exercise-induced myocardial ischemia. The present study was performed to investigate platelet behavior during a graded symptom-limited bicycle ergometer test both in relation to the intensity of exercise and to exercise-induced myocardial ischemia. Plasma concentrations of platelet factor 4 (PF4) and β-thromboglobulin (β-TG) were measured by radioimmunoassays in 53 patients who had had acute myocardial infarction 10 weeks before the study and, for comparison, in 9 healthy individuals. In the whole group of the 53 patients there was no significant alteration in platelet-specific proteins during exercise, whereas physical activity induced a 2- to 3-fold increase in β-TG and PF4 levels in the controls. However, on differentiation of the patients as to their individual exercise performance, significant exercise-associated platelet activation was demonstrable in those who reached more than 75% of their calculated maximal working capacity, whereas no correlation was found between platelet activity and exercise-induced myocardial ischemia. Thus, the results from this study indicate that in vivo platelet activation is a physiological phenomenon which occurs when a certain degree of physical intensity is exceeded, independent of the precipitation of myocardial ischemia.