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Development and validation of an Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) with focus on Health-Related Quality of Life
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.ORCID iD: 0000-0002-4259-3671
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Health-Related Quality of Life (HRQOL) assesses patients’ subjective experiences of illness and treatment and provides valuable information for quality assurance of health care interventions. The purpose was to develop and validate a disease-specific questionnaire evaluating HRQOL in patients with different forms of arrhythmias.

Methods: The Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) HRQOL scale was developed from a literature review and patient interviews. An expert group of cardiologist, nurses and patients was involved in the development. For the validation data was also collected with SF-36. Construct validity was evaluated with item-total correlations and confirmatory factor analyses (CFA) suggesting a physical and mental subscale. Convergent and discriminant validity were evaluated using multitrait-multimethod (MTMM) with Spearman’s correlations. Internal consistency was evaluated using Cronbach´s alpha.

Results: Data on ASTA HRQOL scale and SF-36 were collected from 270 patients, 66% men with a mean age of 59 years (SD ± 12.9). All items reached the expected level of item-total correlations ≥0.30. The CFA demonstrated satisfactory high factor loadings, both for the total scale and the physical and mental subscales. After error variances were allowed to correlate a good fit was reached between model and data.

Convergent validity was confirmed with strongest correlations between ASTA’s physical subscale and SF-36’s physical component summary (PCS) and for ASTA’s mental subscale and SF-36 mental component summary (MCS). Discriminant validity was supported with lower correlations between  ASTA’s physical scale and SF-36 MCS and between ASTA’s mental scale and SF-36 PCS. Internal consistency and lower bound confidence intervals were >0.70 for all of the ASTA HRQOL scales.

Conclusions: The validated ASTA HRQOL scales were found to have good psychometric properties and can be a valuable contribution for HRQOL evaluations in patients with different forms of arrhythmias

Keyword [en]
Arrhythmias, Health-Related Quality of Life, questionnaire development, validation
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-71872OAI: oai:DiVA.org:liu-71872DiVA: diva2:454880
Available from: 2011-11-08 Created: 2011-11-08 Last updated: 2013-09-03Bibliographically approved
In thesis
1. Assessing Symptom Burden and Health-Related Quality of Life in patients living with arrhythmia and ASTA: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia
Open this publication in new window or tab >>Assessing Symptom Burden and Health-Related Quality of Life in patients living with arrhythmia and ASTA: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Health-Related Quality of Life (HRQOL) can be negatively affected in patients living with arrhythmias and many patients experience a pronounced symptom burden. The arrhythmia can cause both uncertainty and limitations, including interference with work, reluctance to perform and plan for leisure activities and leading to self-imposed restrictions in daily life situations. There are patients striving to find strategies to manage the arrhythmia and for some this can become the focus in their lives. Treatment options are often a choice between pharmaceuticals and radiofrequency ablation (RFA) where RFA is an option for many arrhythmia-patients to be cured. In the care of arrhythmia-patients it is of great importance to combine objective examinations with patient-reported outcomes (PROs) to achieve patient’s own experiences of treatment efficacy and arrhythmias interference in daily life situations.

Aims: The overall aims of this thesis were to assess symptom burden and HRQOL in patients with arrhythmias and to develop and validate an arrhythmia-specific questionnaire, suitable for most arrhythmia-patients.

Design and Methods: Studies I and II were single-centre studies including patients referred for RFA, with two different arrhythmia diagnoses. Assessments of patient-reported outcomes (PROs) concerning HRQOL were performed using two questionnaires, SF-36 and EQ-5D (I-II). Further, patients were asked some disease-specific questions (I). Study I describes assessments before the RFA treatment and Study II the follow-up assessments at three and twelve months after RFA. Patients’ scoring of HRQOL was compared to age and gender matched reference groups before and after RFA (I-II). Studies III and IV describe the development and validation of a disease-specific questionnaire ASTA (Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia) assessing symptom burden and HRQOL. Studies III and IV were multicentre studies. Patients planned for DC-conversion, AF patients seeking emergency care and those with different forms of arrhythmias referred for RFA were included.

Results: Patients scored significantly lower HRQOL in seven of SF-36’s eight scales compared to the age and gender matched reference groups before RFA treatment. Frequent arrhythmia attacks had a great negative impact on HRQOL, and female gender and older age were factors contributing to worse HRQOL (I). Treatment with RFA restored the patients’ HRQOL. Most positive effects were seen at three months follow-up. One year after treatment patients and the matched reference group scored their HRQOL to a similar level, assessed with SF-36 and EQ-5D index (II). The validated ASTA questionnaire was found to have good psychometric properties. Construct validity was confirmed with sufficient levels of item-total correlations in the ASTA symptom burden scale and HRQOL scales. The dimensionality of the ASTA HRQOL scale was established with confirmatory factor analysis, supporting a physical and a mental subscale. The internal consistency, demonstrated with Cronbach’s alpha (α), was satisfactory for the ASTA symptom burden scale and the ASTA HRQOL scales, varying from α 0.79 to α 0.91 (III-IV).

Conclusions and clinical implications: The studies in this thesis confirmed how negatively affected the arrhythmia-patients can be with a pronounced symptom burden and impaired HRQOL. Treatment with RFA was demonstrated to restore the patients HRQOL to an equal level of that of the matched reference group. PROs are important to take into consideration in the care of arrhythmia-patients, to achieve the patients’ subjective experiences of their daily life situation.

To the best of our knowledge ASTA is the first arrhythmia-specific questionnaire assessing symptom burden and HRQOL, suitable for most arrhythmia forms. The newly validated ASTA questionnaire can be an important contribution to assessment of PROs in arrhythmia-patients.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2011. 114 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1279
Keyword
Arrhythmias, Symptom burden, Health-Related Quality of Life, Patient-reported outcomes, Validation, Disease-specific questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71873 (URN)978-91-7393-017-8 (ISBN)
Public defence
2011-12-02, Berzeliussalen, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-11-08 Created: 2011-11-08 Last updated: 2013-09-03Bibliographically approved

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Walfridsson, UllaStrömberg, AnnaÅrestedt, Kristofer

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