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.

BACKGROUND: The aim of this study was to investigate the validity and reliability of the HeartQoL instrument in a population of stable coronary patients. DESIGN: 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. CONCLUSION: 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.

Educational level and risk profile and risk control in patients with coronary heart disease.

BACKGROUND: The purpose of this study was to ascertain way in which conventional risk factors, readiness to modify behaviour and to comply with recommended medication, and the effect of this medication were associated with education in patients with established coronary heart disease (CHD). METHODS: The EUROASPIRE IV (EUROpean Action on Secondary Prevention by Intervention to Reduce Events) study was a cross-sectional survey undertaken in 24 European countries to ascertain how recommendations on secondary CHD prevention are being followed in clinical practice. Consecutive patients, men and women ≤80 years of age who had been hospitalized for an acute coronary syndrome or revascularization procedure, were identified retrospectively. Data were collected through an interview with examinations at least six months and no later than three years after hospitalization. RESULTS: A total of 7937 patients (1934 (24.37%) women) were evaluated. Patients with primary education were older, with a larger proportion of women. Control of risk factors, as defined by Joint European Societies 4 and 5 guidelines, was significantly better with higher education for current smoking (p = 0.001), overweight and obesity (p = 0.047 and p = 0.029, respectively), low physical activity (p < 0.001) and low high-density lipoprotein (HDL)-cholesterol (p = 0.011) in men, and for obesity (p = 0.005), high blood pressure (p < 0.005 and p < 0.001), low physical activity (p = 0.001), diabetes (p < 0.001) and low HDL-cholesterol (p = 0.023) in women. Patients with primary and secondary education were more often treated with diuretics and antidiabetic drugs. Better control of hypertension was achieved in patients with higher education. CONCLUSION: Particular risk communication and control are needed in secondary CHD prevention for patients with lower educational status.