The left ventricular dysfunction questionnaire (LVD-36): reliability, validity, and responsiveness

Abstract

Objective-To examine the reliability, validity, and responsiveness of a new health status measure (LVD-36) for patients with left ventricular dysfunction which was designed with emphasis on content validity, clarity, brevity, and ease of use. Design-At baseline, patients completed the LVD-36 and a range of measures reflecting general health and disease severity. The LVD-36 was repeated after one week. After six months, it was repeated again, along with a transition question to measure global changes in health. Setting-Patients were recruited from the cardiology and general medical clinics at a south west London hospital. Patients-60 patients with chronic left ventricular dysfunction. Interventions-None. Main outcome measures-Short form 36 questionnaire (SF-36), Minnesota living with heart failure questionnaire (LIhFE), New York Heart Association criteria, and exercise performance and echocardiographic tests. Results-The LVD-36 showed good internal consistency ( = 0.95) and repeatability (r i = 0.95). Its scores were significantly associated with SF-36 mental and physical component scores (r = −0.48 and −0.75; p < 0.0001), with exercise capacity (r = −0.52; p < 0.0001), and with systolic shortening fraction (r = −0.27; p < 0.05). Change in the LVD-36 over six months was associated with change in overall health (F = 5.7; p < 0.001). In tests of validity and responsiveness, the LVD-36 performed similarly to or marginally better than the LIhFE. Conclusions-The LVD-36 showed a high level of reliability and validity, and appears to measure changes in health. It provides a short, simple, valid, and reliable measure of health status in patients with left ventricular dysfunction. (Heart 2000;83:634-640) Keywords: health status; quality of life; heart failure; left ventricular dysfunction In patients with chronic diseases, such as congestive cardiac failure, measurement of health status ("quality of life") is becoming an important method of assessing the impact of the disease and the eYcacy of treatment. Three health status questionnaires have been developed for patients with congestive heart failure.1-3 These vary in development process, content, length, and complexity of application.The chronic heart failure questionnaire (CHFQ) 1 was developed by presenting a pool of 123 items to 88 patients, who rated their importance on a five point scale. Item selection was based on frequency and importance ratings to ensure that items were relevant to the population. This method of item selection includes only those items experienced by the majority of the population, and thus may reduce the ability of the questionnaire to detect diVerences in health. In that study, the sample used was not equally balanced in terms of sex (62 male/16 female), and the choice of items is thus more likely to reflect the preferences of male patients and to produce a sex bias within the questionnaire. A section of the CHFQ is individualised, patients being asked to nominate those activities associated with shortness of breath that aVected the...

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