Measuring the Effects of Heart Failure and Treatments on Quality of Life
The content of the Minnesota Living with Heart Failure questionnaire (MLHFQ) was selected to be representative of the ways heart failure and treatments can affect the key physical, emotional, social and mental dimensions of quality of life without being too long to administer during clinical trials or practice.
Sickness Impact Profile
Responses of patients with heart failure to the Sickness Impact Profile, a comprehensive assessment of the impact of illness in general, and the thoughts of several physicians and nurses caring for patients at the University of Minnesota, helped identify pertinent questions for measuring the effects of heart failure on patient's quality of life. The content of other measures of health status and quality of life was considered as well.
Assesses impact of Frequent Physical Symptoms
These efforts to identify the most pertinent content led to questions that assess the impact of frequent physical symptoms - shortness of breath, fatigue, peripheral edema, and difficulty sleeping, and psychological symptoms of anxiety and depression. In addition, the effects of heart failure on physical/social functions including walking, climbing stairs, household work, need to rest, working to earn a living, going places away from home, doing things with family or friends, recreational activities, sexual activities, eating and mental and emotional functions of concentration, memory, loss of self control, and being a burden to others were incorporated into the measure. Since treatments might have side effects in addition to ameliorating symptoms and functional limitations produced by heart failure, questions about side effects of medications, hospital stays and costs of care were included to help measure the overall impact of a treatment on quality of life. A more recent version of the questionnaire asks about side effects of 'treatments' rather than 'medications' to reflect the growing use of non-pharmaceutical treatments for heart failure.
Measures Effects of Medication and Treatment Using a Common Scale for Scoring
To measure the effects of symptoms, functional limitations, psychological distress on an individual's quality of life, the MLHF questionnaire asks each person to indicate using a 6-point, zero to five, Likert scale how much each of 21 facets prevented them from living as they desired. This response format was chosen to be consistent with the concept of quality of life and allows each individual to weigh each item using a common scale. Therefore, one can look at which items had the most effect and the sum of responses reflects the overall effects of heart failure and treatments on the individual's quality of life. Although the MLHFQ incorporates relevant aspects of the key dimensions of quality of life, the questionnaire was not designed to measure any particular dimension separately. Given the conceptual basis for the questionnaire, items on the questionnaire are considered to be 'causal' indicators of quality of life in the sense that they can affect someone's quality of life when they occur, but may not be present when other aspects of heart failure are affecting an individual's quality of life. Classical psychometric methods such as factor analysis and other analytic procedures that assess inter-item correlations may not be appropriate for the MLHFQ. The total score should be taken as the best measure of how heart failure and treatments impact an individual's quality of life even if all of a patient's responses are not internally consistent. A factor analysis of responses that has been confirmed by others did find a highly inter-related subgroup of 8 questions related to the physical symptoms and another inter-related subgroup of 5 emotional domain questions related to the psychological distress. Summation of the responses to these subgroups of questions may be used to help describe the physical and psychological effects of heart failure on quality of life. However, these two factors or dimensions are not sufficient to measure the total impact of heart failure or a treatment on quality of life.
View the MLHFQ Overview Document.