Table 4

Instrument Content and Properties

Content CoveredContent ValidityConstruct ValidityReliabilityResponsivenessPerformance Across HF PopulationsFeasibilityInterpretabilityPrognostic ValueNumber of Studies Identified for Appraisal
CHFQIt contains 4 subscales: daily activities; fatigue; emotional function; and mastery (31).The initial 123 items were generated through a review of literature, consultation with experts, and unstructured interviews with patients (31).Yes (31)Yes (32)Yes (33)Used in studies in HF patients of all etiologies (34).Trained interviewer required to administer. 16 items with 7 point Likert scale.
Completion time 10–20 min (31).
Scores for questions within each dimension added to give worst and best function information for each dimension (higher numbers equal worse function). A half-point difference is considered clinically significant (31).No prognostic information available.18
KCCQConsists of 6 domains and 2 summary scores: physical limitation; symptom; symptom stability; self-efficacy; QoL; social limitation; KCCQ clinical summary; and KCCQ overall summary.Initial item generation was based on literature review, examination of HRQOL instruments, and focus groups with HF patients and specialists (22).Yes (22)Yes (35)Yes (36)Used in studies in HF patients of all etiologies. Validation work performed in HFpEF and aortic stenosis (20,37).Self-administered. 23 items with 6 point Likert scale.
Completion time 4–6 min (22).
Recently a 12-item version has been introduced, taking 2–3 min (23).
Each response is assigned a value; lower scores indicate lower level of functioning. Summary scores developed to mirror NYHA (clinical summary score) and all health status domains (overall summary score) (22). Clinically significant differences that are small, moderate, and large = 5, 10, and 20 points (3). A 5-point change is associated with a fully adjusted 10% change in the hazard of death and rehospitalization (24).Low score found to be an independent predictor of poor prognosis in outpatients with HF (38).250
MLHFQCovers 3 domains: physical; socioeconomic; and psychological impairments (12).The items were identified from a list of sickness-related dysfunction on the SIP. Reliability and validity testing in HF patients during development (12).Yes (39)Yes (40)Yes (41)Used in studies in HF patients of all etiologies (42,43).21 items with 6-point Likert scale. Self-administered or interview. Completion time 10 min (12).Single summation of responses, the higher the summed score, the worse the patient’s QoL (12). Clinically significant differences between NYHA I, II, and III, but it does not do well in detecting subtle changes between NYHA III and IV (25). A 5-point increase in score, interpreted as a clinically improved difference in score (44).Independent predictor of cardiac events, death, and future hospitalizations (45).380
CHATCovers 5 domains (symptom activity levels, psychosocial aspects, and emotions) and covers 7 themes of HRQOL (physical ability, emotional state, self-perception, relationships, coping with symptoms, maintaining social/lifestyles status, and cognitive aspects of CHF) (46).The measure was based on patient input. The initial 51 items were generated using in-depth, semistructured interviews with CHF patients (46).Yes (46)Yes (46)No (inadequate data).Used in studies in HF patients of all etiologies (46).51 items with 5-point scale. Self- administered (46). Approximate time to completion 15–20 min.Higher summed score indicates worse QoL (46). No published data on the clinical significance of a given change in score.No prognostic information available.2
SDHFQContent covers dyspnea and fatigue at rest and in relation to physical activities. Also includes questions on chest pain, alcohol consumption, and weight (47).The original development article did not provide detail regarding the development or testing of the SDHFQ (47).Yes (48)No (inadequate data)No (48)Used in studies in HF patients of all etiologies (48).32 items on a 2- to 6-point numerical scale (47). Self-administered. Approximate time to completion 10 min.Functional capacity scored from certain questions. Each letter has a specific numerical value that depends on the question. No published data on the clinical significance of a given change in score.No prognostic information available3
HFFSIContent covers overall functional status level and the frequency and type of symptoms that limit physical function (49).The measure was adapted from a standardized self-report questionnaire that was modified for HF patients (49).Yes (49)Yes (50)No (51)Used in studies in HF patients of all etiologies (50).25 items on a 3-point scale. Self-administered (49). Approximate time to completion 5–7 min.Each item/activity assigned a value per the MET of the task. HFFSI score correlates to the average of the 3 highest MET levels (49). No published data on the clinical significance of a given change in score.No prognostic information available12
QLQ-SHFCovers the following 5 domains: somatic; emotional; cognitive aspect; life satisfaction; and physical limitation (52).The initial 90 items were derived from the work on infarction patients, the results from other studies, and the content of other scales (52).Yes (52)Yes (52)Yes (53)Used in studies in HF patients of all etiologies (52,53).26 items using the Likert scale. Self-administered (52). Approximate time to completion 7–10 min.Score uses the numerical value on the Likert scale; the higher the score, the worse the QoL. No published data on the clinical significance of a given change in score.No prognostic information available3
LVD-36Covers domains of physical limitations, life satisfaction, and emotional well-being (54).Developed using semistructured interviews with HF patient and used information from reviews of published reports and existing questionnaires (54).Yes (54)Yes (54)Yes (55)Used in studies in HF patients of all etiologies (54,56).36 items with dichotomous answers (yes or no) measuring general health status. Self-administered. Approximately 5 min to complete (54).Responses are summed, and sum is expressed as a percentage such that 100 is the worst score. No published data on the clinical significance of a given change in score.No prognostic information available7
MSAS-HFCovers 3 symptom subscales: physical; emotional; and HF-specific symptoms (54).Modified from the original Memorial Symptom Assessment Scale (a scale initially created for QoL in the cancer population) (57). 5 HF-specific symptoms added and 5 cancer symptoms removed after being tested in HF patients (58).Yes (58)Yes (58)Yes (59)Used in studies in HF patients of all etiologies (58).32 items on a 4- to 5-point scale. Self-administered. Approximately 5 min to complete (56).Score summary gives prevalence. Score mean gives burden of HF (56). No published data on the clinical significance of a given change in score.No prognostic information available4

CHF = chronic heart failure; HFpEF = heart failure with preserved ejection fraction; HRQOL = Health-Related Quality of Life; MET = metabolic equivalent; NYHA = New York Heart Association functional class; SIP = Sickness Impact Profile; other abbreviations as in Tables 1, 2, and 3.