Health status in patients with coexistent COPD and heart failure: a validation and comparison between the Clinical COPD Questionnaire and the Minnesota Living with Heart Failure Questionnaire

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) and heart failure (HF) are both common diseases that coexist frequently. Patients with both diseases have worse stable state health status when compared with patients with one of these diseases. In many outpatient clinics, health status is monitored routinely in COPD patients using the Clinical COPD Questionnaire (CCQ) and in HF patients with the Minnesota Living with Heart Failure Questionnaire (MLHF-Q). This study validated and compared which questionnaire, ie, the CCQ or the MLHF-Q, is suited best for patients with coexistent COPD and HF.MethodsPatients with both COPD and HF and aged ≥40 years were included. Construct validity, internal consistency, test–retest reliability, and agreement were determined. The Short-Form 36 was used as the external criterion. All questionnaires were completed at baseline. The CCQ and MLHF-Q were repeated after 2 weeks, together with a global rating of change.ResultsFifty-eight patients were included, of whom 50 completed the study. Construct validity was acceptable. Internal consistency was adequate for CCQ and MLHF-Q total and domain scores, with a Cronbach’s alpha ≥0.70. Reliability was adequate for MLHF-Q and CCQ total and domain scores, and intraclass correlation coefficients were 0.70–0.90, except for the CCQ symptom score (intraclass correlation coefficient 0.42). The standard error of measurement on the group level was smaller than the minimal clinical important difference for both questionnaires. However, the standard error of measurement on the individual level was larger than the minimal clinical important difference. Agreement was acceptable on the group level and limited on the individual level.ConclusionCCQ and MLHF-Q were both valid and reliable questionnaires for assessment of health status in patients with coexistent COPD and HF on the group level, and hence for research. However, in clinical practice, on the individual level, the characteristics of both questionnaires were not as good. There is room for a questionnaire with good evaluative properties on the individual level, preferably tested in a setting of patients with COPD or HF, or both.

Evaluating the Clinical COPD Questionnaire: A systematic review

“…Finally, there were 43 studies included in this work (Fig. , Table ), of which 7 studies reported the floor and ceiling effect of the CCQ, internal consistency and test‐retest reliability were evaluated by 12 articles, 33 studies assessed validity, 15 studies examined responsiveness and 3 studies calculated MCID.…”

“…Besides, both MRC and modified MRC (mMRC) dyspnoea scale correlated best with functional domain of the CCQ, while one study found that mMRC had no significant correlation with the symptom and mental domain of the CCQ . Moreover, moderate to strong correlations were also found between the total CCQ score and the Chronic Respiratory Questionnaire Self‐Reported (CRQ‐SR), Visual Analogue Scale of the EuroQOL‐5D Questionnaire (EQ‐VAS), Short‐Form 36 (SF‐36), Baseline Dyspnoea Index (BDI) as well as Hospital Anxiety and Depression Scale (HADS) . Among the three domains of the CCQ, both anxiety and depression scales had the best correlation with mental state.…”

“…But, there were controversies on the correlations with FEV 1 , 6MWT, emphysema extent and obstructive grade. Some researchers found that CCQ had statistically significant correlations with FEV 1 , 6MWT, emphysema extent and obstructive grade, while others showed no correlations at all. An explanation for these conflicting results can be the differences in the study population.…”

“…13 The completion rate was a little lower than that of CAT score. 50 Seven studies measured the proportion of patients with the floor and ceiling effect 4, 8,11,13,33,43,49 (Table S3, Supplementary Information). In general, the overall score of the CCQ with its symptom domain were approximately normally distributed while distributions in the functional and mental domains were skewed.…”

Research Needs and Challenges Regarding Palliation for Individuals in Long-Term Care Settings

“…The Minnesota Living with Heart Failure Questionnaire and Clinical COPD Questionnaire are self-report measurement tools used to evaluate symptoms specific to these diseases (Berkhof, Metzemaekers, Uil, Kerstjens, & van den Berg, 2014). Both of these tools have been tested and found to have Cronbach's alpha scores >0.7 and good test-retest reliability scores (Berkhof et al, 2014).…”