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Psychometric properties of the MacNew heart disease health-related quality of life instrument in patients with heart failure


Dr Stefan Höfer
Department of Medical Psychology and Psychotherapy
Medical University Innsbruck
Schöpfstr. 23a
A-6020 Innsbruck


Rationale, aims and objectives  Heart failure (HF) is a severe chronic disease and impairs health-related quality of life (HRQL). While validated specific HRQL instruments are required for evaluation of treatment and rehabilitation in patients with HF, a single validated measure to document changes in HRQL for patients with different heart disease diagnoses would be invaluable. The purpose of this analysis was the psychometric analysis of the German MacNew Heart Disease Questionnaire (MacNew) in HF patients, which has previously been shown to be reliable and valid in patients with myocardial infarction, angina pectoris and arrhythmia.

Methods  We recruited 89 patients (61.7 ± 11.5 years; 84.3% male) in two Austrian and one Swiss cardiology department with documented HF (effect sizes 28.9 ± 10.1%). The self-administered MacNew, the Short Form-36 (SF-36) and the Hospital Anxiety and Depression Scale were completed. Internal consistency reliability (Cronbach's α), discriminative and evaluative validity were assessed.

Results  Cronbach's α exceeded 0.80. Each MacNew scale differentiated between patients with and without anxiety (3.9 ± 1.0 vs. 5.3 ± 0.8, all P < 0.001), with and without depression (4.2 ± 1.2 vs. 5.2 ± 0.9 all P < 0.03) and by the SF-36 health transition item (deteriorate = 4.39, no change = 4.95, improve = 5.45, all P < 0.02). Evaluative validity was demonstrated with effect sizes >0.70 for a subsample attending a 12-week outpatient rehabilitation programme.

Conclusions  The German language version of the MacNew demonstrates consistently acceptable psychometric properties of reliability, validity and responsiveness in patients with documented HF. Together with previous documentation of reliability, validity and responsive, these findings strengthen the argument for the MacNew as a potential ‘core’ HRQL measure, at least in the German language.