Validation of the German HeartQoL: a short health-related quality of life questionnaire for cardiac patients

Abstract

Purpose The aim of this study was to evaluate psychometric properties of the core disease-specific 14-item German HeartQoL questionnaire. Methods As an extension of the international HeartQol Project, cross-sectional and longitudinal health-related quality of life (HRQL) data were collected from 305 patients with angina (N = 101), myocardial infarction (N = 123), or ischemic heart failure (N = 81) in Austria and Switzerland using German versions of the HeartQoL, the Short Form-36 Health Survey (SF-36), and the Hospital Anxiety and Depression Scale. The underlying factor structure was examined with Mokken Scaling analysis; then convergent, divergent, and discriminative validity, internal consistency reliability, and responsiveness were assessed. Results The highest HRQL scores were reported by patients with myocardial infarction followed by ischemic heart failure and then angina. The two-factor structure was confirmed with strong physical, emotional, and global scale H coefficients (> .50). Divergent and convergent validity (from r = .04 to .78) were shown for each diagnosis; discriminative validity was verified as well (partially: age, sex, and disease severity; largely: SF-36 health status/transition; totally: anxiety and depression). Internal consistency reliability was excellent (Cronbach's alpha = .91). In terms of responsiveness, physical and global scale scores improved significantly after percutaneous coronary intervention (p < .01) while after cardiac rehabilitation all scale scores improved significantly (p < .001). Conclusions The German HeartQoL questionnaire is a valid and reliable HRQL instrument with these data supporting its potential use in clinical practice and research to assess and compare HRQL in German-speaking patients with ischemic heart disease. The shortness of the tool may prove to be helpful particularly in clinical practice.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Validation of the Italian HeartQoL: a short health-related quality of life questionnaire for patients with ischemic heart disease

“…Of the total of 84 discriminative validity calculations in the total cohort and each diagnosis, 70 (83%) were fully confirmed; of the 14 calculations that were not significant, 11 (79%) were on the age and 3 (21%) on the sex variables. The discriminative validity of the Italian HeartQoL was fully confirmed for diagnosis as patients with MI reported significantly higher HeartQoL scores than patients with either AP or IHF which is largely consistent with both the original validation study [13] and the German validation study [14] as well as in the English HeartQoL where patients with MI reported higher HRQL scores than did patients with AP. [30] Discriminative validity was also fully confirmed with HADS anxiety/depression scales in the total group and in each diagnosis which is consistent for HADS anxiety and depression in the original study [13] and previously published HeartQoL studies.…”

“…The result was a bifactorial, 14-item questionnaire that was reliable, valid, and responsive in patients with AP, MI, or IHF [13]. These results have been recently confirmed in German [14] and Chinese [15] and also in other clinical contexts, such as atrial fibrillation [16], implantable cardioverter defibrillator recipients [17], and valve surgery [18].…”

“…[30] Discriminative validity was also fully confirmed with HADS anxiety/depression scales in the total group and in each diagnosis which is consistent for HADS anxiety and depression in the original study [13] and previously published HeartQoL studies. [14, 16-18, 30, 32] As reported in the German HeartQoL validation publication [14] the Italian HeartQoL HRQL scores were significantly higher in patients not reporting HADS distress compared to those reporting distress. Discriminative validity was largely confirmed for sex in this study with females reporting significantly better HRQL than males but this is not consistent with the EuroAspire IV study in chronic coronary syndrome patients [32], the German HeartQoL observations in patients with AP, MI or IHF [14] or the studies in Danish patients with atrial fibrillation [16] or following valve surgery [18] where males reported higher HRQL, although not always significant, than females.…”

Coronary Heart Disease and Depression or Anxiety: A Bibliometric Analysis

“…In as early as 2004, researchers investigated the psychometric properties of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for patients with ACS and confirmed that the HADS was useful in assessing symptoms of psychological distress in patients with ACS (Martin et al, 2004 ). Psychometric properties of assorted instruments have been studied in cardiac patients using the Depression in the Medically Ill-18 (DMI-18), the Depression in the Medically Ill-10 (DMI-10), the MacNew Heart Disease HRQL questionnaire (MacNew), the German HeartQoL questionnaire, and the Patient Health Questionnaire (PHQ-9) (Hilton et al, 2006 ; Yu et al, 2008 ; Gholizadeh et al, 2019 ; Huber et al, 2020 ). It can be inferred that the psychometric properties of more instruments will be tested on patients with CHD to determine their validity and reliability of assessing depression and anxiety in a specific group of patients.…”

A two-step, test-guided Mokken scale analysis, for nonclustered and clustered data

“…MSA is especially suitable for constructing quality of life (related) measures, as the NIRT properties are often sufficient for the intended use of the scales [ 12 ]. Recent examples of quality of life questionnaires that have been analyzed using MSA include the Heart disease-specific health-related quality of life (HeartQoL; [ 13 ]), the Participation and Activity Inventory for Children and Youth (PAI-CY; [ 14 ]), and the Rotterdam Diabetic Foot Study Test Battery (RDF [ 15 ]). In these studies, the data were collected using a simple random sample, yielding nonclustered test scores.…”