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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 139-143

Validity of an indigenously developed Sri Jayadeva Institute of Cardiovascular Sciences and Research-Quality of Life Questionnaire in heart failure patients of a tertiary cardiac center


1 Department of Clinical Research, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India
2 Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, Karnataka, India

Date of Submission02-Jun-2021
Date of Decision11-Aug-2021
Date of Acceptance09-Oct-2021
Date of Web Publication24-Dec-2021

Correspondence Address:
Dr. Devaraju Chandagalu Javaregowda
No. 153/4, 3rd Cross Basaveshwaranagar, Hebbal 1st Stage, Mysore - 570 016, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcpc.jcpc_36_21

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  Abstract 


Introduction: Heart failure (HF) causes a high impact on morbidity and mortality; it also affects the quality of life (QOL) and psychometric components. Aim: To develop a simple module to assess QOL including various parameters such as functional status, symptoms, emotional well-being, financial impact, social function, and health-related behavior. Methods: The study was conducted at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysore, which has an annual inpatient admissions of over 12,000 cardiac cases. Two hundred patients were included in the study. All 200 patients were given both Minnesota Living with HF (MLHFQ) Questionnaire and Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) Questionnaire after translation into their native language. Results: Out of 200 patients, 75% were male. 71% of them had ischemic heart disease. The mean questions filled were 18.45 in SJICSR-QOL questionnaire and 20.29 in Minnesota questionnaire. The time taken for the researcher to conduct the interview and for the patient to fill up the SJICSRQOL Questionnaire was significantly less than that needed for the Minnesota Questionnaire. Cronbach's alpha tool was utilized to analyze the reliability. When seven subgroups were considered, the questions showed reliability of 0.879, and when six subgroups were considered, the reliability was found to be 0.898. Conclusion: Both SJICR-QOL and MLQOL are valid and reliable tools of measure of QOL in patients with HF. The time taken was lesser, and more questions were answered in SJCISR-QOL questionnaire. It is a potential tool for future use in both research and clinical practice in congestive HF patients, even in primary care setting.

Keywords: Financial impact, heart failure, psychometric components, Sri Jayadeva Institute of Cardiovascular Sciences and Research-Quality of Life Questionnaire


How to cite this article:
Javaregowda DC, Nanjappa V, Sadananda K S, Manjunath C N. Validity of an indigenously developed Sri Jayadeva Institute of Cardiovascular Sciences and Research-Quality of Life Questionnaire in heart failure patients of a tertiary cardiac center. J Clin Prev Cardiol 2021;10:139-43

How to cite this URL:
Javaregowda DC, Nanjappa V, Sadananda K S, Manjunath C N. Validity of an indigenously developed Sri Jayadeva Institute of Cardiovascular Sciences and Research-Quality of Life Questionnaire in heart failure patients of a tertiary cardiac center. J Clin Prev Cardiol [serial online] 2021 [cited 2022 Nov 26];10:139-43. Available from: https://www.jcpconline.org/text.asp?2021/10/4/139/333705




  Background Top


Quality of life assessment (QOL) is important in heart failure (HF) patients both for modifying treatment and assessing prognosis. Many questionnaires are available such as Minnesota and Kansas City cardiomyopathy questionnaires. There are sparse data of HF-related QOL data in Indian scenario though they constitute significant disease burden. Sri Jayadeva Institute of Cardiovascular Sciences and Research (SJICSR) QOL Questionnaire is a simple and patient-friendly assessment tool for analyzing the QOL in patients with HF patients. It has been tailored to suit the social, financial, and demographics of our Indian patients.


  Introduction Top


HF causes a high impact on morbidity and mortality; it also affects the QOL and psychometric components.

Questionnaires

The Minnesota Living with Heart Failure Questionnaire

Minnesota Living with HF Questionnaire (MLHFQ) is a 21-item questionnaire. It has a 6-point response scale ranging from 0 to 5. The questionnaire asks patients to reflect upon the way they have felt over the last 1 month when choosing responses. A total score is obtained by summing the scores from individual questions (range 0–5) with higher scores indicating poorer HF-related QOL. Selected items provide scores specific to physical and emotional health-related QOL parameters. A change of >5 points is considered clinically meaningful in follow-ups.

Sri Jayadeva Institute of Cardiovascular Sciences and Research-Quality of life

Six dimensions of health are considered inclusive of physical and psychometric components. The six major subgroups are symptom-related, physical activity-related, psychometric-related, emotional component, social component, health-related behavior component, and financial component. There are six subsets of questioning labeled as Q1-Q6 and an additional Q7 question on overall feeling of well-being. It is self-administered simplistic tool and uses Likert type response scale ranging from 0 to 3. Zero score suggests no effect of the disease on QOL, and three – suggests highest effect on QOL. This score assesses the extent score to which the extent of disease has prevented the patient from living his life in the past 4 weeks. Patients diagnosed with HF as inpatients with relevant investigations such as echocardiography, NT-ProBNP, and cardiac magnetic resonance imaging who later come for outpatient follow-ups are included in the study.

The advantage of SJICSR - QOL is subgroup analysis and gender-wise analysis can be done. Two additional questions are included to obtain as feedbacks which are not included in the scoring [Table 1] and [Table 1]a.
Table 1:

Click here to view


Aim

  • To develop a simple module of QOL including various parameters such as functional status, symptoms, emotional well-being, financial impact, social function, and health-related behavior
  • To compare the SJICSR-QOL with MLHFQ.


End points

  1. Time taken for the researcher to conduct the interview
  2. Number of questions filled up by the patients
  3. Comparison of scores between the two questionnaires will be assessed.



  Methods Top


The study was conducted at SJICSR, Mysore, which has an annual inpatient admissions of over 12,000 cardiac cases. Written informed consent was obtained from all participating patients. Each HF patient was given with MLHFQ and SJICSR-QOL to assess the QOL. We have analyzed the data using Cronbach's alpha statistical tool and Pearson's correlation coefficient.

Inclusion criteria

  1. Age ≥18 years
  2. Participants willing to provide written informed consent
  3. Diagnosed with HF
  4. Indian citizen.


Exclusion criteria

  1. Age ≤18 years
  2. Participants not willing to provide written informed consent
  3. Life expectancy <1 year
  4. Unable to answer the QOL due to health condition (mental illness, moribund, etc.).



  Results Top


Two hundred patients were included in the study. All 200 patients were given both Minnesota questionnaire and SJICSR questionnaire after translation into their native language. The time taken to answer the questionnaire was recorded. In case of difficulty in comprehension of any question, the research team helped them understand the question. Answers were recorded by the research team in case patients were illiterate.

Out of 200 patients, 75% were male. About 71% of them had ischemic HF. Dilated cardiomyopathy was seen in 20% cases; rheumatic heart disease was seen in 5% of cases of HF. Valvular heart disease accounted for 21.5% of patients [Table 2].
Table 2: Descriptive statistics

Click here to view


The mean questions filled were 18.45 in SJICSR-QOL Questionnaire. 20.29 questions were filled in Minnesota Questionnaire. The time taken for the researcher to conduct the interview and for the patient to fill up the SJICSR-QOL Questionnaire was significantly less than that needed for the MLHFQ. The number of questions filled up by the patient was also higher [Table 3].
Table 3: Comparison of number of questions filled between Minnesota Living with Heart Failure Questionnaire and Sri Jayadeva Institute of Cardiovascular Sciences and Research Quality of Life

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Pearson correlation analysis showed a strong correlation in the number of questions answered between SJICSR-QOL and Minnesota Questionnaire (correlation coefficient – 0.85). A strong correlation was also found in the time taken to answer the questions [Table 4].
Table 4: Correlation of scoring and time taken between Minnesota living with heart failure questionnaire and Sri Jayadeva institute of cardiovascular sciences and research quality of life (n=200)

Click here to view


Cronbach's alpha tool was utilized to analyze the reliability. When seven subgroups were considered, the questions showed reliability of 0.879, and when six sub-groups were considered, the reliability was found to be 0.898 [Table 5].
Table 5: Reliability statistics

Click here to view


The advantage of SJICSR-QOL is individual subsets can be separately analyzed and scoring can done [Table 6].
Table 6: Analysis of physical, psychometric, and financial impact data of patients (n=200)

Click here to view


The mean clinical score for male gender was 11.44, whereas it was 13.82 in female patients (0–6 – mild disease; 7–12 – moderate disease; and 13–18 – severe disease).

The mean psychometric score was 13.2 for men and 15.6 for women (0–9 – mild; 10–18 – moderate; and 19–27 – severe); and financial impact score for both men and women was almost identical (5.25 vs. 5.28); overall QOL was better in men than women (0.98 vs. 1.12).


  Discussion Top


The validity, consistency, and reliability of MLHFQ have been proven in multiple studies.[1],[2],[3],[4],[5],[6] It is valuable even for follow-up. In comparison with MLHFQ, SJICSR-QOL showed good reliability and validity. The main strength of SJICSR-QOL is data can be interpreted in terms of subsets such as clinical score, psychometric score, financial impact score, and overall QOL scoring.

Patients who completed the SJICSR-QOL questionnaire did with minimal support from the research team. The proportion of patients who did not respond to any of the items was small, indicating good acceptability. Pearson correlation analysis showed a strong correlation in the number of questions answered between SJICSR-QOL and Minnesota Questionnaire (correlation coefficient –0.85).

Pearson correlation analysis showed a strong correlation in the time taken for the patient to fill up the SJICSR-QOL Questionnaire was significantly less than that needed for the MLHFQ (correlation coefficient –0.73). Therefore, the newly developed SJICSR-QOL questionnaire may be used to assess the QOL. It is quick, reliable, and an easy alternative for the MLHFQ and better suited to Indian demographics, social strata, and ethnicity.

The SJICSR-QOL was done on outpatients with HF. Hence, it can be used even at primary health-care level. Subset analysis allows us to channel the treatment and address the social and psychometric issues better which will ensure overall improvement in QOL. Psychological health is a less addressed issue in the treatment of patients with HF in India. This questionnaire may give the much needed insight into the psychometric aspects of patients with HF.


  Conclusion Top


Both SJICR-QOL and MLQOL are valid and reliable tools of measure of QOL in patients with HF. The time taken was lesser, and more questions were answered in SJCISR-QOL questionnaire. It is a potential tool for future use in both research and in clinical practice in congestive HF patients, even in primary care setting. It can be used for follow-up after adequate intervention, though it has not been done in the present study.

Limitations of the study

It is a small sample size.

Follow-up validity of the questionnaire has not been assessed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Garin O, Soriano N, Ribera A, Ferrer M, Pont A, Alonso J, et al. Validation of the Spanish version of the Minnesota Living with Heart Failure Questionnaire. Rev Esp Cardiol 2008;61:251-9.  Back to cited text no. 1
    
2.
Banegas JR, Rodríguez-Artalejo F. Heart failure and instruments for measuring quality of life. Rev Esp Cardiol 2008;61:233-5.  Back to cited text no. 2
    
3.
Rao A, Asadi-Lari M, Walsh J, Wilcox R, Gray D. Quality of life in patients with signs and symptoms of heart failure-does systolic function matter? J Card Fail 2006;12:677-83.  Back to cited text no. 3
    
4.
O'Leary CJ, Jones PW. The left ventricular dysfunction questionnaire (LVD-36): Reliability, validity, and responsiveness. Heart 2000;83:634-40.  Back to cited text no. 4
    
5.
Bennet SJ, Oldridge NB, Eckert GJ, Embree JL, Browning S, Hou N, et al. Discriminant properties of commonly used quality of life measures in heart failure. Qual Life Res 2002;11:349-59.  Back to cited text no. 5
    
6.
Riedinger MS, Dracup KA, Brecht ML, SOLVD Investigatos Studies of Left Ventricular Dysfunction. Quality of life in women with heart failure, normative groups, and patients with other chronic conditions. Am J Crit Care 2002;11:211-9.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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