title: Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study of the European Society of Cardiology.
abstract: BACKGROUND
  The aim of this study was to investigate the validity and reliability of the HeartQoL instrument in a population of stable coronary patients.
  
  
  METHODS
  Analyses are based on the cross-sectional EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) survey.
  
  
  METHODS
  Patients with a diagnosis of coronary heart disease were examined and interviewed 6 months to 3 years after their coronary event. During the interview patients were asked to fill out the HeartQoL health-related quality of life questionnaire as well as the EQ-5D and the hospital anxiety and depression scale questionnaire. Psychometric analyses assessing the reliability and validity of the HeartQoL instrument were performed.
  
  
  RESULTS
  A total of 7449 patients completed the HeartQoL instrument. Cronbach's alpha indicated excellent internal consistency for the global HeartQoL scale (α = 0.92) and the physical subscale (α = 0.91) and good internal consistency for the emotional subscale (α = 0.87). Factor analysis confirmed the two-dimensional construct although mixed results were found regarding the model fit. Discriminative validity analysis confirmed better HeartQoL results in men, younger patients and higher educated persons. Likewise, convergent validity was confirmed with moderate to strong correlations among hypothesised constructs.
  
  
  CONCLUSIONS
  Overall, psychometric analyses of the HeartQoL instrument in a population of patients with stable coronary heart disease showed good reliability and validity both at the European as well as the country-specific level. However, further research should focus on the responsiveness of the HeartQoL, the possible ceiling effect of the emotional subscale, construct validity and the minimal clinically important difference.
authors.affiliation: Department of Public Health, Ghent University, Belgium Delphine.desmedt@ugent.be.
authors.forename: Delphine
authors.initials: D
authors.lastname: De Smedt
authors.affiliation: Department of Public Health, Ghent University, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Clays
authors.affiliation: Department of Medical Psychology, Innsbruck Medical University, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Höfer
authors.affiliation: College of Health Sciences, University of Wisconsin-Milwaukee, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Oldridge
authors.affiliation: Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kotseva
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, France.
authors.forename: Aldo Pietro
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Department of Medical Psychology and Psychotherapy, Erasmus University, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Janssen
authors.affiliation: Department of Public Health, Ghent University, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: De Bacquer
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology* / Q000523:psychology; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: EUROASPIRE IV; HeartQoL; coronary heart disease