1. 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, noon – 1pm
UCLA CMORE Lecture Series

3. Item Characteristic Curve for Polytomous Response Scale
JGIM, 2015, 30 (10),

5. 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

6. 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.

7. Item-Scale Correlations (n = 944)
Item Phy10 Social4 Emot5
swelling 0.56* (1)
sit_ * (2)
stairs_ * (3)
yard_ * (4)
sleeping 0.69* (6)
going_pl 0.79* (5)
recreati 0.73* (9)
sob_ * (12)
fatigue_ 0.72* (13)
friends_ 0.77* (7)
cost_mon * Costing you money for medical care
food_ * Making you eat less of foods u like
earn_liv * Making u working 2 earn living diff.
sex_ * Making sexual activities difficult
sidefx_ * (16)
burden_ * (17)
self_con * (18)
worry_ * (19)
depresse * (21)
hospital (14)
concentr (20)
Note: Estimated correlations among scales are: phys10 with social4 (r = 0.55) and emot5 (r = 0.69), and social4 with emot5 (0.53).

8. 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

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

10. Item Characteristic Curves for Recoded Items

11. Item Characteristic Curves for Physical Health Scale
Very little

12. Item Characteristic Curves for Physical Health Scale

13. Item Characteristic Curves for Recoded Items

14. Item Characteristic Curves for Recoded Items

15. 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”

16. 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.

17. 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

18. 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)

19. Magnitude of Correlations
0.100 is small correlation is medium correlation is large correlation

20. 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)
(.1164)
(.0785)
0.06
(.0503)
Obesity (small)
0.14
0.12
0.13
0.100 = small, = medium, = large

21. MLHFQ Emotional Health CorrelationsG
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, = medium, = large

22. Conclusions

23. 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.