Short and Precise Patient Self-Assessment of Heart Failure Symptoms Using a Computerized Adaptive Test

Abstract

Background— Assessment of dyspnea, fatigue, and physical disability is fundamental to the monitoring of patients with heart failure (HF). A plethora of patient-reported measures exist, but most are too burdensome or imprecise to be useful in clinical practice. New techniques used for computer adaptive tests (CATs) may be able to address these problems. The purpose of this study was to build a CAT for patients with HF. Methods and Results— Item banks of 74 queries (“items”) were developed to assess self-reported physical disability, fatigue, and dyspnea. All queries were administered to 658 adults with HF to build 3 item banks. The resulting HF-CAT was administered to 100 patients with ancillary HF (New York Heart Association I, 11%; II, 53%; III and IV, 36%). In addition, the physical function and vitality domains of the SF-36 Health Survey questionnaire, an established shortness-of-breath scale, and the Minnesota Living with Heart Failure Questionnaire were applied. The HF-CAT assessment took 3:09±1:52 minutes to complete and score. All HF-CAT scales demonstrated good construct validity through high correlations with the corresponding SF-36 Health Survey physical function ( r =−0.87), vitality ( r =−0.85), and shortness-of-breath ( r =0.84) scales. Simulation studies showed a more precise measurement of all HF-CAT scales over a larger range than comparable static tools. The HF-CAT scales identified significant differences between patients classified by the New York Heart Association symptom criteria, similar to the Minnesota Living with Heart Failure Questionnaire. Conclusions— A new CAT for patients with HF was built using modern psychometric methods. Initial results demonstrate its potential to increase the feasibility and precision of patient self-assessments of symptoms of HF with minimized respondent burden. Clinical Trial Registration— URL: http://www.projectreporter.nih.gov . Unique identifier: 1R43HL083622-01.

Relationship between functional capacity, performance and symptoms in hospitalized patients with heart failure

“…The sociodemographic and clinical characteristics of the present study sample resemble those of other studies that also analyzed HF patients (1)(2)(3)(4)(5)10,15,(26)(27)(28)(29)(30) .…”

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi‐experimental study

“…Cardiovascular disease is one of the most common diseases in the Western world, and is characterized by high morbidity and mortality, as well as a high level of re‐admissions . The symptoms of heart failure (HF) are often shortness of breath, fluid retention or ankle oedema due to pulmonary congestion, fatigue, and impaired physical function and health status (HS) . It is expected that patients with HF experience a progression of the disease and thus there is a 20% mortality rate after 1 year and a mean survival time of 2 to 3 years.…”

Prediction and Analysis of Heart Failure Decompensation Events Based on Telemonitored Data and Artificial Intelligence Methods

“…Patient self-assessments are also useful for predicting mortality and hospitalization. In the literature, strong correlations have been observed between the scores and functional class and the number of HF CDEs that require hospitalizations: worse self-assigned scores are associated with increased hospitalization rates, a worse quality of life, and decreased survival [ 33 , 34 , 35 ]. These variables are expected to be the indicators of HF cardiac decompensation because they indicate the worsening of the patient.…”