UCLA CMORE Lecture Series http://cmore.med.ucla.edu/ Does it Matter How the Minnesota Living with Heart Failure Questionnaire is Scored? Ron D. Hays, Ph.D. UCLA Department of Medicine July 19, 2016 12 noon – 1pm UCLA CMORE Lecture Series http://cmore.med.ucla.edu/

Item Characteristic Curve for Polytomous Response Scale JGIM, 2015, 30 (10), 1511-6.

MLHFQ (Higher Score is Worse) 21-item total (0-105 possible) score Symptoms, mental health, social life, fatigue, appetite, mobility, sleep, sexual activity, work and recreational activities, side effects of treatment 8-item physical health (2-7, 12, 13) 0-40 possible score 5-item emotional health (17-21) 0-25 possible score

Better Effectiveness After Transition—Heart Failure (BEAT-HF) 46% female 54% White; 11% Hispanic; 22% Black; 12% Other 29% 60-64; 35% 65-79; 36% 80 or older Black, J. T., Romano, P. S., Sadeghi, B., Auerbach, A D., Ganiats, T. G., Greenfield, S., Kaplan, S. H., Ong, M. K., and the BEAT-HF Research Group. (2014). A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: Study protocol for the Better Effectiveness After Transition—Heart Failure (BEAT-HF) randomized controlled trial. Trials, 15: 124.

Item-Scale Correlations (n = 944) Item Phy10 Social4 Emot5 --------------------------------------- swelling 0.56* 0.34 0.44 (1) sit_1 0.75* 0.39 0.53 (2) stairs_1 0.76* 0.37 0.47 (3) yard_1 0.78* 0.41 0.54 (4) sleeping 0.69* 0.49 0.53 (6) going_pl 0.79* 0.41 0.57 (5) recreati 0.73* 0.54 0.59 (9) sob_1 0.62* 0.35 0.48 (12) fatigue_ 0.72* 0.46 0.54 (13) friends_ 0.77* 0.51 0.66 (7) cost_mon 0.37 0.51* 0.45 15. Costing you money for medical care food_1 0.47 0.52* 0.42 11. Making you eat less of foods u like earn_liv 0.41 0.66* 0.36 8. Making u working 2 earn living diff. sex_1 0.47 0.64* 0.41 10. Making sexual activities difficult sidefx_1 0.49 0.34 0.55* (16) burden_1 0.55 0.49 0.70* (17) self_con 0.59 0.41 0.76* (18) worry_1 0.59 0.44 0.71* (19) depresse 0.53 0.41 0.65* (21) hospital 0.57 0.41 0.56 (14) concentr 0.46 0.48 0.48 (20) Note: Estimated correlations among scales are: phys10 with social4 (r = 0.55) and emot5 (r = 0.69), and social4 with emot5 (0.53).  

Item Characteristic Curves for Emotional Health Scale Very little Very little Very little Very much Very much Very much No No No Very little Very little Very much Very much No No

Trichotomized Items 0 = 0; 1-4 = 1; 5 = 2 9

Item Characteristic Curves for Recoded Items

Item Characteristic Curves for Physical Health Scale Very little

Item Characteristic Curves for Physical Health Scale

Item Characteristic Curves for Recoded Items

Item Characteristic Curves for Recoded Items

Collapsing Response Options Version 1 (3 categories, 0-2) “0” “1-4” collapsed as “1” “5” recoded to “2” Version 2 (4 categories, 0-3) “1-2” collapsed as “1” “3” recoded to “2” “4-5” collapsed to “3” Version 3 (5 categories, 0-4) “0,” “1,” “2,”, and “3” “4-5” collapsed as “4”

Association with New York Heart Association Classification Class 1 No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). Class 2 Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). Class 3 Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. Class 4 Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest.  If any physical activity is undertaken, discomfort increases.

Physical Health 0-100 Means by New York Heart Association Level F-statistic NYHA Level 2 NYHA Level 3 NYHA Level 4 0-2 21 57 67 72 0-3 29 60 78 0-4 27 54 65 73 0-5 28 56 68 75

Associations with Other Variables Self-rated health (Excellent to Poor) Had hospital admission in 30 days Obesity (CDC definition: BMI = 30+) 15-item Geriatric Depression Scale (Yesavage & Sheikh, 1986)

Magnitude of Correlations 0.100 is small correlation 0.243 is medium correlation 0.371 is large correlation

MLHFQ Physical Health Correlations 0-2 0-3 0-4 0-5 Self-rated health (medium) 0.29 0.28 0.30 Hospital admission in 30 days (trivial) 0.04 (.1164) 0.05 (.0785) 0.06 0.05 (.0503) Obesity (small) 0.14 0.12 0.13 0.100 = small, 0.243 = medium, 0.371 = large

MLHFQ Emotional Health Correlations G MLHFQ 0-2 0-3 0-4 0-5 Self-rated health (medium) 0.26 0.25 0.28 0.27 Geriatric depression scale (medium to large) 0.36 0.35 0.38 0.37 Obesity (trivial) 0.08 0.07 0.100 = small, 0.243 = medium, 0.371 = large

Conclusions

Thank you. BEAT-HF study supported by AHRQ (R01 HS019311), National Heart Lung and Blood Institute (RC2 HL101811), RWJ Foundation (66336), Sierra Health Foundation, and participating institutes.