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Use of the Minnesota Living With Heart Failure Questionnaire Among Elderly Patients With Aortic Stenosis: Results From a Pilot Study

Sandau, Kristin E. PhD, RN; Boisjolie, Charlene MA, RN; Hodges, James S. PhD

Journal of Cardiovascular Nursing: March/April 2014 - Volume 29 - Issue 2 - p 185–197
doi: 10.1097/JCN.0b013e318279b76f

Background: Past studies of health-related quality of life (HRQL) in aortic stenosis (AS) have focused on valve replacement, using generic or heart failure measures because no disease-specific measure exists. The literature is lacking in both performance of these measures among patients with AS and HRQL outcomes in the nonsurgical elderly AS population.

Objective: The aims of this study were to measure HRQL and test the reliability of the Minnesota Living With Heart Failure Questionnaire (MLHFQ), Geriatric Depression Scale (GDS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp) in persons older than 70 years with AS receiving nonsurgical treatment.

Methods: The prospective, descriptive design in this study included baseline administration of questionnaires to a consecutive convenience sample of patients aged 75 to 97 years (mean, 85 years) enrolled in a clinical trial for AS (n = 25).

Results: Mean aortic valve area was 0.54 cm2 (range, 0.37–0.96 cm2). Patients reported angina (52%) and light-headedness (72%); these 2 items were not included on the MLHFQ but were added as investigator-developed items. Scores for MLHFQ varied widely (median, 52; range, 7–101). Although the median GDS was 4 (range, 1–13), almost half (48%) scored higher than 5, indicating a positive depression screen. Scores for FACIT-Sp were moderately high (median, 37.5; range, 18–45), indicating strong spiritual well-being among many participants. A significant inverse relationship (r = −0.73, P < .0001; 95% confidence interval, −0.87 to −0.48) was found between depression and spiritual well-being. Cronbach α was 0.91, 0.83, and 0.81 for the MLHFQ, GDS, and FACIT, respectively.

Conclusions: The HRQL measures selected had good internal consistency reliability, but use of the MLHFQ alone would have missed common disease-specific concerns (eg, angina, light-headedness); studies for minimally invasive aortic valve replacement should include these items. Because higher spiritual well-being was associated with less depressive symptoms, both should receive further study in HRQL assessment. Larger samples may clarify appropriate education and interventions for depressive symptoms, spiritual well-being, as well as safe physical activity and fall prevention for those with light-headedness.

Kristin E. Sandau, PhD, RN Professor, Department of Nursing, Bethel University, St Paul, Minnesota.

Charlene Boisjolie, MA, RN Section Manager, Structural Heart Disease, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minnesota.

James S. Hodges, PhD Associate Professor, Division of Biostatistics, University of Minnesota, Minneapolis.

The principal investigator for the Radiation Following Percutaneous Balloon Aortic Valvuloplasty to Prevent Restenosis (RADAR) study was Wesley Pedersen, MD, Minneapolis Heart Institute, who received funding from the Abbott Northwestern Hospital Foundation. This work was supported by a grant from the Minnesota Nurses Association Foundation and the Minneapolis Heart Institute Foundation.

The authors have no conflicts of interest to disclose.

Correspondence Kristin E. Sandau, PhD, RN, Department of Nursing, Bethel University, 3900 Bethel Dr, St Paul, MN 55113 (

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins