title: Disease-specific health-related quality of life questionnaires for heart failure: a systematic review with meta-analyses.
abstract: BACKGROUND
  Heart failure (HF) is an increasingly common condition affecting patients' health-related quality of life (HRQL). However, there is little literature comparing HF-specific instruments. Our aim was to evaluate and compare data on the conceptual model and metric properties (reliability, validity and responsiveness) of HF-specific HRQL instruments, by performing a systematic review with meta-analyses.
  
  
  RESULTS
  Of 2,541 articles initially identified, 421 were full-text reviewed. Ninety-four reported data on five questionnaires: Minnesota Living with Heart Failure Questionnaire (MLHFQ), Chronic Heart Failure Questionnaire (CHFQ), Quality of Life Questionnaire for Severe Heart Failure (QLQ-SHF), Kansas City Cardiomyopathy Questionnaire (KCCQ) and Left Ventricular Dysfunction (LVD-36) questionnaire. Metric properties (reliability, validity and responsiveness) were summarised using meta-analysis for pools above five estimates. Cronbach's alpha coefficients were generally high (0.83-0.95) for overall scores and scales measuring physical health. Associations with four validity criteria (New York Heart Association [NYHA] class, six-minute walk test [6MWT] and short form-36 [SF-36] 'Physical' and 'Social Functioning') were moderate to strong (0.41-0.84), except for those between two CHFQ domains (fatigue and dyspnoea) and the NYHA (0.19 and 0.22). Pooled estimates of change from eight meta-analyses showed the MLHFQ to be highly responsive, with changes in overall score ranging from -9.6 (95% confidence interval [CI]: -4.1; -15.2) for placebo to -17.7 (95% CI: -15.3; -20.2) for pacing devices. The CHFQ and KCCQ also showed good sensitivity to change.
  
  
  CONCLUSIONS
  Most of the questionnaires studied met minimum psychometric criteria, though current evidence would primarily support the use of the MLHFQ, followed by the KCCQ and CHFQ.
authors.affiliation: Health Services Research Unit, IMIM-Hospital del Mar, Doctor Aiguader 80, 08003, Barcelona, Spain.
authors.forename: Olatz
authors.initials: O
authors.lastname: Garin
authors.forename: Montse
authors.initials: M
authors.lastname: Ferrer
authors.forename: Angels
authors.initials: A
authors.lastname: Pont
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rué
authors.forename: Anna
authors.initials: A
authors.lastname: Kotzeva
authors.forename: Ingela
authors.initials: I
authors.lastname: Wiklund
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
mesh_terms: D006304:Health Status; D006333:Heart Failure; D006801:Humans; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires