Stefan Höfer

Validity and reliability of the HeartQoL questionnaire in a large sample of stable coronary patients: The EUROASPIRE IV Study of the European Society of Cardiology

Background The aim of this study was to investigate the validity and reliability of the HeartQoL instrument in a population of stable coronary patients. Design Analyses are based on the cross-sectional EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) survey. Methods Patients with a diagnosis of coronary heart disease were examined and interviewed 6 months to 3 years after their coronary event. During the interview patients were asked to fill out the HeartQoL health-related quality of life questionnaire as well as the EQ-5D and the hospital anxiety and depression scale questionnaire. Psychometric analyses assessing the reliability and validity of the HeartQoL instrument were performed. Results A total of 7449 patients completed the HeartQoL instrument. Cronbach’s alpha indicated excellent internal consistency for the global HeartQoL scale (α = 0.92) and the physical subscale (α = 0.91) and good internal consistency for the emotional subscale (α = 0.87). Factor analysis confirmed the two-dimensional construct although mixed results were found regarding the model fit. Discriminative validity analysis confirmed better HeartQoL results in men, younger patients and higher educated persons. Likewise, convergent validity was confirmed with moderate to strong correlations among hypothesised constructs. Conclusion Overall, psychometric analyses of the HeartQoL instrument in a population of patients with stable coronary heart disease showed good reliability and validity both at the European as well as the country-specific level. However, further research should focus on the responsiveness of the HeartQoL, the possible ceiling effect of the emotional subscale, construct validity and the minimal clinically important difference.

The German Version of the Strengths Use Scale: The Relation of Using Individual Strengths and Well-being

Theoretical perspectives in positive psychology have considered the possession and use of strengths equally but in applied research more studies focused on having them, probably due to the absence of psychometrically adequate scales. Therefore, the aim of this study was to assess the psychometric characteristics of the German language version of the Strengths Use Scale (SUS) and to explore relationships between strengths use and several indicator measures of well-being: the presence of positive and the absence of negative affect, self-esteem as identity aspect, vitality as self-regulatory resource, and stress for capturing the evaluation of difficulties and obstacles impinging on well-being. The original English version of the SUS was translated following recommended independent forward-backward translation techniques. Exploratory and confirmatory factor analyses were conducted, including a German-speaking convenience sample of university students (N = 374). Additionally, the relations of strengths use and well-being indicators were analyzed. Factorial validity revealed a single-factor structure of the German version of the SUS, explaining 58.4% variance (factor loadings: 0.58 to 0.86), approving the scale’s design and showing high internal consistency (Cronbach’s α 0.95). The hypothesized positive relationships of strengths use with positive affect, self-esteem, and vitality were confirmed as well as the negative relationships with negative affect and stress. The German version of the SUS is psychometrically sound and data indicate that individual strengths use and well-being related measures interact. The instrument can be recommended for future research questions such as if and how the promotion of applying individual strengths during education enhances levels of well-being, or how the implementation of strengths use in job-design guidelines or working conditions can result in higher levels of well-being or healthiness.

International SF-36 reference values in patients with ischemic heart disease

PurposeInternational reference data for the SF-36 health survey (version 1) are presented based on a sample of 5508 adult patients with ischemic heart disease.MethodsPatients with angina, myocardial infarction and ischemic heart failure completed the SF-36. Data were analyzed by diagnosis, gender, age, region and country within region and presented as mean ± standard deviation (SD), minimum, maximum, 25th, 50th and 75th percentile of the physical (PCS) and mental component summary (MCS) measures.ResultsMean PCS scores were reported as being more than one SD below the normal range (standardized mean of 50 ± 10) by more than half of the patient subgroups (59 %) with all of the mean MCS scores falling within the normal range. Patients with angina and patients with ischemic heart failure reported the poorest mean PCS scores with both diagnoses reporting scores more than one SD below the standardized mean. Females, older patients (especially >70 years) and patients from Eastern Europe reported significantly worse mean PCS scores than male, younger and non-Eastern European patients. The cardiac diagnosis had no effect on the mean MCS scores; however, females, younger patients (especially <51 years) and patients from Eastern Europe reported significantly worse mean MCS scores than male, older and non-Eastern European patients.ConclusionsThese international reference SF-36 values for patients with IHD are useful for clinicians, researchers and health-policy makers when developing improved health services.

Distinguishing Relational Aspects of Character Strengths with Subjective and Psychological Well-being

Research has shown that character strengths are positively linked with well-being in general. However, there has not been a fine-grained analysis up to date. This study examines the individual relational aspects between the 24 character strengths, subjective well-being (SWB), and different aspects of psychological well-being (PWB) at two times of measurement (N = 117). Results showed that overall the “good character” was significantly stronger related with PWB than with SWB. The character strength “hope” was at least moderately correlated with the PWB aspects meaning, optimism and autonomy, and “zest” with the PWB aspects relationships and engagement. “Persistence” showed the highest correlation with the PWB aspect mastery. Out of the 24 character strengths, the happiness-related strengths (hope, zest, gratitude, curiosity, and love) were more likely to correlate with PWB and SWB than any other character strength. This study offers a more fine-grained and thorough understanding of specific relational aspects between the 24 character strengths and a broad range of well-being aspects. Future studies should take up a detailed strategy when exploring relationships between character strengths and well-being.

The use of HeartQoL in patients with coronary heart disease: Association with risk factors and European reference values. The EUROASPIRE IV study of the European Society of Cardiology.

Background HeartQoL is a recently developed core health-related quality of life instrument for patients with coronary heart disease. The current study aims to investigate its association with patients’ coronary risk profile and to provide reference values for patients with coronary heart disease across Europe. Design Analyses are based on the EUROASPIRE IV (EUROpean Action on Secondary and Primary prevention through Intervention to Reduce Events) cross-sectional survey. Methods Patients with a diagnosis of coronary heart disease were examined and interviewed six months to three years after their coronary event. The HeartQoL questionnaire was completed by 7261 coronary heart disease patients. Reference values were calculated and the association with the coronary risk profile was assessed. Results Significantly worse outcomes were observed in higher-risk patient groups. Both metabolic and behavioural risk factors were associated with worse HeartQoL outcomes. Further, the HeartQoL scores decreased as the number of risk factors increased. The mean global reference values in males were 2.27 ± 0.65 (<60 years), 2.30 ± 0.61 (between 60 and 69 years) and 2.19 ± 0.64 (≥70 years). Likewise, in females, the respective global HeartQoL reference values were 2.02 ± 0.67, 2.01 ± 0.66 and 1.83 ± 0.70. The ceiling effect in males was 11.4%, 10.4% and 7.4% for the three age classes respectively, whereas in females the ceiling effect was 5.2%, 3.5% and 1.9%, respectively. Conclusion HeartQoL scores were associated with patients’ coronary risk profile. The reference values may help other researchers to interpret HeartQoL scores. Further research should focus on the minimal important difference needed to evaluate the effect of therapies and lifestyle changes.

Quality of life in patients with coronary heart disease after myocardial infarction and with ischemic heart failure

Introduction Quality of life measures are useful when interventions or treatments are indicated for several reasons such as improvement of physical functioning, pain relief, to estimate the effectiveness of therapies or to predict mortality. The aim of the current study was to describe quality of life in patients with stable coronary artery disease, myocardial infarction and heart failure and to evaluate the relationship between depression and health-related quality of life. Material and methods Patients after STEMI, with stable coronary artery disease, and heart failure (n = 332) completed the MacNew Heart Disease Health-related Quality of Life Questionnaire and the Hospital Anxiety and Depression Scale. Results Patients with myocardial infarction had significantly higher scores than patients with stable coronary artery disease or heart failure on the MacNew global scale (p < 0.001) and the physical (p < 0.001), emotional (p < 0.001) and social (p < 0.001) subscales. The anxiety scores were significantly higher in the group of patients with stable coronary artery disease than in patients with myocardial infarction (p < 0.05). The depression scores were significantly higher in patients with heart failure (p < 0.01). Conclusions In patients with stable CAD, anxiety correlated mainly with symptoms, i.e. angina, than with the history of MI. Patients with symptoms of angina react to the illness with anxiety more than depression, whereas patients with heart failure with dyspnea react to the illness with depressive symptoms more than anxiety. In patients after MI and with stable CAD, cognitive-behavioral techniques could be useful to quickly reduce the level of anxiety, while patients with heart failure require long-term support therapy to reduce the risk of depressive symptoms.

Associations between the Application of Signature Character Strengths, Health and Well-being of Health Professionals

Previous research has shown a positive relation between character strengths, well-being and health. The aim of this analysis was to identify relations between the application of signature character strengths (ASCS) at work, and well-being and health, among medical students (Study 1) and resident physicians (Study 2). We expected positive direct links between the constructs and indirect effects through emotional exhaustion. To test these hypotheses, 387 medical students in their first year and 136 resident physicians completed five scales measuring well-being, mental/physical health, character strengths, the application of their five individual signature strengths, and emotional exhaustion as an indicator of burnout. Partial correlations were examined, and mediation analyses performed. ASCS at work was positively linked with well-being and mental health but not with physical health. All links were mediated by emotional exhaustion in Study 1 and (except for mental health) also in Study 2. Future studies would therefore do well to investigate the promotion of ASCS at work of people operating in medical education and its potential in fostering well-being and preventing burnout from the outset.