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Development and Validation of a Patient-Centered Health-Related Quality-of-life Measure: The Chronic Heart Failure Assessment Tool

Dunderdale, Karen PhD; Thompson, David R. PhD; Beer, Stephen F. MD; Furze, Gill PhD; Miles, Jeremy N.V. PhD

The Journal of Cardiovascular Nursing: July-August 2008 - Volume 23 - Issue 4 - p 364-370
doi: 10.1097/01.JCN.0000317439.82704.e8

Objective: Despite the importance of health-related quality of life (HRQL) as an outcome measure in chronic heart failure (CHF), instruments currently available have been developed by clinicians or researchers; none have been derived from the patient's perspective. The purpose of this study was to develop and validate a patient-derived, disease-specific HRQL measure.

Methods: The psychometric testing of the Chronic Heart Failure Assessment Tool (CHAT) followed 2 phases: testing the psychometric properties (n = 223) of the 51-item version of the CHAT in a postal survey and validation of the CHAT (n = 68) using the Medical Outcomes Study 36-Item Short-Form Health Survey and the Minnesota Living With Heart Failure questionnaire.

Results: The CHAT contains questions measuring 7 themes of HRQL: physical ability, emotional state, self-perception, relationships, coping with symptoms, maintaining social/lifestyle status, and cognitive aspects in respect to CHF. Factor analysis was used to analyze these themes. Four domains emerged: symptoms, activity levels, psychosocial aspects, and emotions.

Conclusion: The CHAT comprises dimensions of HRQL identified by patients in the study population that may more appropriately reflect the concerns of patients. Further work is recommended to develop this tool for use as an HRQL measure in a CHF population.

Karen Dunderdale, PhD Lead Cardiac Specialist Nurse, Cardiac Rehabilitation, Scunthorpe General Hospital, Scunthorpe, United Kingdom.

David R. Thompson, PhD Professor of Cardiovascular Nursing, Department of Health Sciences/Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.

Stephen F. Beer, MD Consultant Physician/Diabetologist, Scunthorpe General Hospital, Scunthorpe, United Kingdom.

Gill Furze, PhD Senior Research Fellow, British Heart Foundation Care and Education Research Group, Department of Health Sciences, University of York, York, United Kingdom.

Jeremy N.V. Miles, PhD Behavioral Scientist, RAND Corporation, Santa Monica, California.

Corresponding author Karen Dunderdale, PhD, Cardiac Rehabilitation, Scunthorpe General Hospital, Scunthorpe DN15 7BH, United Kingdom (

© 2008 Lippincott Williams & Wilkins, Inc.