Introduction
Methods
Data collection
The National Health Measurement Study
Clinical Outcomes and Measurement of Health Study
Generic HRQoL measures
Definition of CHD subgroups
Development of proxy score
Minnesota Living with Heart Failure Questionnaire items | Corresponding survey item from NHMS HRQoL instruments | Polychorica correlation |
---|---|---|
Did your heart failure prevent you from living as you wanted during the past month by: | Questions were chosen from SF-36, QWB-SA-SA, and EQ-5D HRQoL measurement instruments | |
1. Causing swelling in your ankles or legs? | N/A to CHD | |
2. Making you sit or lie down to rest during the day? | QWB-SA bed: Over the past 3 days did you spend all or most of the day in a bed, chair, or couch because of physical reasons? | 0.56 |
3. Making your walking about or climbing stairs difficult? | Does your health limit you in these activities? If so, how much? | |
SF 6: Climbing several flights of stairs? | 0.65 | |
QWB-SA walking: Over the past 3 days did you avoid walking, have trouble walking, or walk more slowly than other people your age? | 0.73 | |
4. Making your working around the house or yard difficult? | QWB-SA limit work: Over the past 3 days because of any physical or emotional health reasons, on which days did you avoid, need help with, or were limited in doing some of your usual activities, such as work, school, or housekeeping? | 0.53 |
5. Making your going places away from home difficult? | Does your health limit you in these activities? If so, how much? | |
SF 10: Walking several hundred yards? | 0.60 | |
EQ5D1: Would you say you have no problems in walking about, some problems in walking about, or are you confined to bed? | 0.61 | |
6. Making your sleeping well at night difficult? | QWB-SA sleep: On any of the past 3 days did you have trouble falling asleep or staying asleep? | 0.63 |
7. Making your relating to or doing things with your friends or family difficult? | SF 32: During the past 4 weeks, how much of the time has your physical health or emotional problems interfered with your social activities, like visiting friends, relatives, etc.? | 0.67 |
8. Making your working to earn a living difficult? | SF 16: How much of the time did you have difficulty performing your work or other activities (for example it took extra effort)? | 0.58 |
9. Making your recreational pastimes, sports, or hobbies difficult? | EQ5D3: Would you say you have no problems performing your usual activities, some problems performing your usual activities, or are you unable to perform your usual activities? | 0.46 |
QWB-SA limit social: Over the past 3 days because of physical or emotional health reasons, on which days did you avoid or feel limited in doing some of your usual activities, such as visiting family/friends, hobbies, shopping, recreational, or religious activities? | 0.55 | |
10. Making your sexual activities difficult? | QWB-SA sex: On any of the past 3 days did you have any decrease of sexual interest or performance? | 0.73 |
11. Making you eat less of the foods you like? | QWB-SA diet: On any of the past 3 days did you have to stay on a medically prescribed diet for health reasons? | 0.43 |
12. Making you short of breath? | QWB-SA breathing: On any of the past 3 days did you have shortness of breath or difficulty breathing? | 0.78 |
13. Making you tired, fatigued, or low on energy? | SF 29: How much of the time during the past 4 weeks did you feel worn out? | 0.72 |
SF 31: How much of the time during the past 4 weeks did you feel tired? | 0.77 | |
14. Making you stay in a hospital? | N/A to CHD | |
15. Costing you money for medical care? | N/A | |
16. Giving you side effects from treatments? | N/A | |
17. Making you feel you are a burden to your family or friends? | SF 25: How much of the time during the past 4 weeks have you felt so down in the dumps that nothing could cheer you up? | 0.57 |
18. Making you feel a loss of self-control in your life? | QWB-SA no control: On any of the past 3 days did you have feelings that you had little or no control over events in your life? | 0.71 |
19. Making you worry? | QWB-SA worry: On any of the past 3 days did you have excessive worry or anxiety? | 0.68 |
20. Making it difficult for you to concentrate or remember things? | QWB-SA confuse: On any of the past 3 days did you have confusion, difficulty understanding the written or spoken word, or significant memory loss? | 0.82 |
21. Making you feel depressed? | SF 28: How much of the time during the past 4 weeks have you felt downhearted and depressed? | 0.80 |
Statistical analyses
Results
No CHD | CHD only | CHD + meds | |
---|---|---|---|
N
| 3,350 | 265 | 218 |
Mean age (SD) | 58.9 (14.0) | 69.9 (10.2) | 68.9 (10.7) |
Sex (%) | |||
Male | 41.2 | 57.0 | 49.1 |
Female | 58.8 | 43.0 | 50.9 |
Race (%) | |||
White | 66.2 | 75.9 | 62.4 |
Black | 28.8 | 20.4 | 30.7 |
Other | 4.5 | 3.4 | 6.9 |
Health conditions (%) | |||
Stroke | 3.5 | 15.1 | 21.6 |
Diabetes | 16.1 | 30.2 | 46.8 |
Arthritis | 37.4 | 53.6 | 69.7 |
Sleep disorder | 8.1 | 13.6 | 22.0 |
Chronic respiratory disease | 15.3 | 21.1 | 32.1 |
Thyroid disorder | 11.7 | 14.7 | 17.4 |
Chronic back pain | 16.6 | 25.3 | 43.6 |
Depression (%) | |||
Clinical depression or anxiety | 14.0 | 14.7 | 22.5 |
Take depression/anxiety medication | 8.7 | 8.7 | 16.5 |
Smoking (%) | |||
Ever smoked | 50.8 | 66.8 | 67.0 |
Currently smoke everyday | 15.1 | 12.5 | 13.8 |
Cardiac treatment (%) | |||
Bypass surgery | – | 28.3 | 33.0 |
Coronary angioplasty | – | 37.0 | 52.3 |
Unadjusted | No CHD | CHD w/o meds | CHD with meds | |||
---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | |
Proxy CVD score | 32 | 11 | 37 | 13 | 45 | 16 |
EQ-5D | 0.88 | 0.15 | 0.82 | 0.15 | 0.74 | 0.21 |
QWB-SA | 0.66 | 0.14 | 0.58 | 0.14 | 0.52 | 0.14 |
HUI2 | 0.86 | 0.16 | 0.80 | 0.17 | 0.69 | 0.23 |
HUI3 | 0.82 | 0.23 | 0.75 | 0.25 | 0.56 | 0.35 |
SF-6D | 0.80 | 0.13 | 0.75 | 0.13 | 0.67 | 0.15 |
SF-36 MCS | 54 | 8.5 | 53 | 9.7 | 51 | 12.4 |
SF-36 PCS | 50 | 9.0 | 44 | 10.6 | 35 | 11.8 |
HALex | 0.82 | 0.19 | 0.68 | 0.23 | 0.50 | 0.24 |
No CHD − CHD w/o meds (standard error) | No CHD − CHD with meds (standard error) | P valuec | |
---|---|---|---|
Unadjusted | |||
Proxy CVD score | −4.6 (1.1) | −12 (1.7) | <.0001 |
EQ-5D | 0.055 (0.013) | 0.14 (0.022) | <.0001 |
QWB-SA | 0.095 (0.013) | 0.15 (0.015) | <.0001 |
HUI2 | 0.051 (0.017) | 0.17 (0.024) | <.0001 |
HUI3 | 0.068 (0.024) | 0.26 (0.039) | <.0001 |
SF-6D | 0.048 (0.012) | 0.13 (0.019) | <.0001 |
SF-36 MCS | 0.59 (0.94) | 2.9 (1.2) | 0.018 |
SF-36 PCS | 6.2 (0.96) | 15 (1.4) | <.0001 |
HALex | 0.13 (0.023) | 0.32 (0.027) | <.0001 |
Adjusteda
| |||
Proxy CVD score | −5.7 (1.1) | −13 (1.7) | <.0001 |
EQ-5D | 0.047 (0.013) | 0.12 (0.023) | <.0001 |
QWB-SA | 0.077 (0.012) | 0.13 (0.016) | <.0001 |
HUI2 | 0.050 (0.017) | 0.16 (0.024) | <.0001 |
HUI3 | 0.065 (0.024) | 0.25 (0.040) | <.0001 |
SF-6D | 0.045 (0.012) | 0.12 (0.020) | <.0001 |
SF-36 MCS | 2.0 (0.95) | 3.9 (1.3) | 0.0024 |
SF-36 PCS | 4.2 (0.96) | 13 (1.4) | <.0001 |
HALex | 0.11 (0.024) | 0.29 (0.028) | <.0001 |
Adjustedb
| |||
Proxy CVD score | −5.2 (1.2) | −9.2 (1.6) | <.0001 |
EQ-5D | 0.038 (0.013) | 0.084 (0.020) | <.0001 |
QWB-SA | 0.069 (0.013) | 0.088 (0.014) | <.0001 |
HUI2 | 0.038 (0.018) | 0.12 (0.021) | <.0001 |
HUI3 | 0.047 (0.025) | 0.19 (0.035) | <.0001 |
SF-6D | 0.038 (0.012) | 0.082 (0.017) | <.0001 |
SF-36 MCS | 1.8 (0.97) | 2.6 (1.3) | 0.038 |
SF-36 PCS | 3.6 (0.90) | 9.6 (1.2) | <.0001 |
HALex | 0.098 (0.025) | 0.21 (0.027) | <.0001 |
Index score | Difference between CHD only and no CHDa
| Difference between CHD + meds and CHD onlya
| Difference between CHD + meds and no CHDa
|
---|---|---|---|
Proxy CVD score | 0.51 | 0.62 | 1.13 |
EQ-5D | 0.32 | 0.52 | 0.84 |
QWB-SA | 0.52 | 0.36 | 0.88 |
HUI2 | 0.31 | 0.72 | 1.03 |
HUI3 | 0.28 | 0.81 | 1.09 |
SF-6D | 0.36 | 0.58 | 0.94 |
SF-36 MCS | 0.24 | 0.22 | 0.45 |
SF-36 PCS | 0.49 | 0.97 | 1.46 |
HALex | 0.57 | 0.93 | 1.50 |
Index score | All NHMS participants proxy score | NHMS all CHD proxy score |
---|---|---|
EQ-5D | −0.63 | −0.65 |
QWB-SA | −0.67 | −0.76 |
HUI2 | −0.69 | −0.69 |
HUI3 | −0.68 | −0.69 |
SF-6D | −0.62 | −0.66 |
SF-36 MCS | −0.51 | −0.56 |
SF-36 PCS | −0.57 | −0.54 |
HALex | −0.60 | −0.55 |