title: Development of a questionnaire to measure health-related quality of life (HRQoL) in patients with atrial fibrillation (AF-QoL).
abstract: BACKGROUND
  The Health-Related Quality of Life (HRQoL) assessment in atrial fibrillation (AF) patients has traditionally been carried out in a poorly standardised fashion, or via the use of non disease-specific HRQoL questionnaires. The development of a HRQoL questionnaire with a good measuring performance will allow for a standardised assessment of the impact of this disease on the patient's daily living.
  
  
  METHODS
  A bibliography review was conducted to identify the most relevant domains of daily living in AF patients. Subsequently, a focus group was created with the aid of cardiologists, and 17 patients were interviewed to identify the most-affected HRQoL domains. A qualitative analysis of the interview answers was performed, which was used to develop a pilot questionnaire administered to a 112-patient sample. Based on patient responses, an analysis was carried out following the statistical procedures defined by the Classical Test Theory (CTT) and the Item Response Theory (IRT). Reliablility was assessed via Cronbach's coefficient alpha and item-total score correlations. A factorial analysis was performed to determine the number of domains. For each domain, a Rasch analysis was carried out, in order to reduce and stand hierarchically the questionnaire items.
  
  
  RESULTS
  By way of the bibliography review and the expert focus group, 10 domains were identified. The patient interviews allowed for the identification of 286 items that later were downsized to 40 items. The resultant preliminary questionnaire was administered to a 112-patient sample (pilot study). The Rasch analysis led to the definition of two domains, comprising 7 and 11 items respectively, which corresponded to the psychological and physical domains (18 items total), thereby giving rise to the initial AF-QoL-18 questionnaire. Cronbach's coefficient alpha was acceptable (0.91).
  
  
  CONCLUSIONS
  An initial HRQoL questionnaire, AFQoL-18, has been developed to assess HRQoL in AF patients.
authors.affiliation: IMS Health, Barcelona, Spain. xbadia@es.imshealth.com
authors.forename: Xavier
authors.initials: X
authors.lastname: Badia
authors.forename: Fernando
authors.initials: F
authors.lastname: Arribas
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Ormaetxe
authors.forename: Rafael
authors.initials: R
authors.lastname: Peinado
authors.forename: Miguel Sainz
authors.initials: MS
authors.lastname: de Los Terreros
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001281:Atrial Fibrillation / Q000523:psychology*; D001634:Bibliographies as Topic; D005163:Factor Analysis, Statistical; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D013030:Spain; D011795:Surveys and Questionnaires