Rehabilitation Measures Database
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  2. Minnesota Living with Heart Failure Questionnaire

Minnesota Living with Heart Failure Questionnaire

Last Updated

Purpose

21-item survey to assess the extent to which Heart Failure affects the patient’蝉 activities of daily living. 

Link to Instrument

Acronym MLHFQ

Area of Assessment

Activities of Daily Living
Mental Health
Patient Satisfaction
Negative Affect
Quality of Life

Assessment Type

Patient Reported Outcomes

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Fees range from $0 - $15,000 depending on the license required (license agreement and a fee to the University of Minnesota—see link above).

CDE Status

Not a CDE—last checked 10/21/2024. 

Populations

Cardiovascular Disease

Key Descriptions

  • The MLHFQ questionnaire asks each person to indicate using a 6-point (zero to five) Likert scale how much each of 21 facets prevented them from living as they desired.
  • The items are summed and the lower the score, the less severe the limitations on QOL caused by HF. The higher the score, the more severe the limitations.
  • Maximum score = 105

Number of Items

21

Equipment Required

  • Pen & paper

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Luis Troncoso SPT, Omar Magdaleno SPT, Kenneth Miller PT, DPT, MA, GCS, & Leslie Ayres PT, DPT, CCS, University of North Texas

Kevin Fearn, MS, Shirley-Ryan 小恩雅

ICF Domain

Body Function
Body Structure
Activity
Participation

Measurement Domain

Activities of Daily Living
Cognition
Emotion
General Health
Motor
Sensory

Professional Association Recommendation

None found—last searched 10/21/2024.

Cardiovascular Disease

back to Populations

Standard Error of Measurement (SEM)

Heart Failure: (Gonzalez et al., 2019; n =1211, mean age = 76, New York Heart Association (NYHA) stage: I (n = 62); II (n = 707); III (n = 425); IV (n = 17); multicenter study in Spain; Spanish translation of MLHFQ)

  • SEM for MLHFQ at 6 months after discharge (n =1211):
    • Physical Domain: 3.00
    • Emotional Domain: 2.62
    • Total: 6.12

Minimal Detectable Change (MDC)

Heart Failure: (Gonzalez et al., 2019)

  • MDC at 95 % confidence level, 6 months after discharge (n = 1211):
    • Physical Domain: 8.33 
    • Emotional  Domain: 7.27 
    • Total: 16.96 

Minimally Clinically Important Difference (MCID)

Heart Failure: (Rector et al., 1995; n = 101, mean age = 56, age range = 50-75, male = 75%, NYHA stage I (n = 6); II (n = 39); III (n = 53); IV (n = 2)

  • MCID = 5 point improvement on the total LIhFEscore 

 

Heart Failure: (Gonzalez et al., 2019)

  • Anchor question based MCID at 95% CI 6 months after discharge: 
    • Physical Domain: 9.17
    • Emotional Domain: 3.59
    • Total: 19.14

Normative Data

Heart Failure: (Gonzalez et al., 2019)

  • MLHFQ baseline scores
    • Physical Domain Score: 26.14 (9.66)
    • Emotional Domain Score: 11.73 (7.18)
    • Total Score: 55.45 (23.66)

 

Heart Failure: (Supino et al., 2009; n = 50; mean age = 66.2 (15.9); age range = 20-91; male = 58%)

  • MLHFQ mean scores
    • Physical Dimension: 17.9 (13.0)
    • Emotional Dimension: 9.1 (6.9)
    • Total Score: 40.3 (26.9)

Test/Retest Reliability

Heart Failure: (Rector & Cohn, 1992; n = 198; NYHA stage III; ambulatory patients from 20 referral centers)

  • Acceptable test-retest reliability: (ICC = 0.87)

 

Candidates for DC Electrical Cardioversion: (Middel et al., 2001; n = 60; Mean Age = 61.5 (12.7); Female = 21; Male = 39; Mean NYHA Classification = 1.9 (0.6); scores taken at baseline and three months)

  • Acceptable test-retest reliability (n = 19) for MLHFQ Total score (r = 0.73) and Physical dimension (r = 0.70)
  • Poor test-retest reliability (n = 19) for MLHFQ Emotional dimension (r = 0.63)

Internal Consistency

Heart Failure: (Rector & Cohn, 1992)

  • Excellent: Cronbach's α = 0.92*

 

Heart Valve Surgery: (Supino et al., 2009)

  • Excellent internal consistency for Total and by dimension:
    • Total: α = 0.96*
    • Physical Dimension: α = 0.96*
    • Emotional Dimension: α = 0.89

 

Heart Failure: (Chen et al., 2019; n = 841 hospitalized patients; separated into 3 groups based on left ventricular ejection fraction (LVEF): Preserved LVEF (≥50%) (HFpEF, n = 251), Mid-range LVEF (40-49%) (HFmrEF, n = 267), and Reduced LVEF (< 40%) (HFrEF, n = 323); Chinese population) 

  • Excellent internal consistency for Total patients and subgroups:
    • Total patients: n = 841, Cronbach's α = 0.83
    • HFrEF; n = 323, Cronbach's α = 0.92*
    • HFmrEF; n = 267, Cronbach's α = 0.96*
    • HFpEF; n = 251, Cronbach's α = 0.93*

*Scores higher than 0.9 may indicate redundancy in the scale questions.

                                         

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Heart Failure: (Chen et al., 2019; hospitalized Chinese population)

  • Adequate concurrent validity between MLHFQ Physical Domain scores and NYHA class for HFrEF (r =0.59, p < 0.001) and HFmrEF patients (r = 0.537, p < 0.001)
  • Physical Domain scores were not correlated with the NYHA class in HFpEF patients (p = 0.552)

Construct Validity

Convergent validity:

Chagas Cardiomyopathy (ChC): (Trindade et al., 2024; n = 50, mean age = 50.6 (10.1), female = 12 (34.3%), patients with ChC, NYHA I-III, Brazilian Portuguese translation of MLHFQ

  • Adequate to Excellent convergent validity between MLHFQ and all SF-36 domains except for pain (p = 0.118) (r’蝉 = -0.38 to -0.69)
  • Excellent correlation between MLHFQ and Beck Depression Inventory (BDI) (r = 0.748, p < 0.001)
  • Adequate negative correlation between MLHFQ and Human Activity Profile (HAP) (r = -0.558, p = 0.001)

 

Candidates for DC Electrical Cardioversion: (Middel et al., 2001)

  • Excellent convergent validity between MLHF physical dimension and other physical scales:
    • RAND-36 physical functioning (r = -0.65)
    • RAND-36 role – physical (r = -0.60)
    • RAND-36 energy/vitality (r = -0.73)
    • MFI-20 physical (r = 0.63)
  • Adequate convergent validity between MLHF emotional dimension and other emotional scales:
    • RAND-36 mental health (r = -0.46)
    • RAND-36 role – emotional (r = -0.47)
    • HADS anxiety (r = 0.43)
    • HADS depression (r = 0.44)

 

Discriminate validity:

Candidates for DC Electrical Cardioversion: (Middel et al., 2001)

  • Excellent ability of the MLHFQ Total score (p = 0.0003) and Physical dimension score (p = 0.0001) to discriminate between NYHA class I and NYHA class II-III combined groups
  • Adequate ability of the MLHFQ Emotional dimension score (p = 0.01) to discriminate between NYHA class I and NYHA class II-III combined groups 

 

Heart Failure: (Chen et al., 2019)

  • Excellent ability of MLHFQ total score and subscales to discriminate between reduced (< 40%), mid-range (40-49%), and preserved (≥ 50%) LVEF groups (43.1 vs. 36.9 vs. 33.2, respectively, p < 0.001)
  • Significantly lower scores on the MLHFQ emotional (p = 0.03) and physical (p = 0.04) subscales for patients with preserved and mid-range LVEF compared to those with reduced LVEF 

 

Content Validity

Heart Valve Surgery: (Supino et al., 2009)

“Confirmatory factor analysis verified good model fit for physical/emotional domain items (relative chi-squares < 3.0, critical ratios > 2.0), supporting structural validity.”

Floor/Ceiling Effects

Candidates for DC Electrical Cardioversion: (Middel et al., 2001)

  • Adequate floor effects of <20% for MLHFQ Total score and Physical dimension at both Pre- and Post-test
  • Poor floor effects of >20% for MLHFQ Emotional dimension at both Pre- and Post-test
  • Adequate ceiling effects of <20% for MLHFQ Total score, Physical dimension, and Emotional dimension at both Pre- and Post-test

 

Heart Failure: (Gonzalez et al., 2019)

  • Adequate floor and ceiling effects of <15% for all MLFHQ scales both at baseline and six months after discharge. 

Responsiveness

Heart Failure: (Gonzalez et al., 2019)

  • Responsiveness of MLHFQ scales 6 months after discharge based on anchor question:
    • Physical Domain
      • Improved (n = 393): SES (CI 95%) = 1.12 (0.94-1.29)
      • The Same (n = 335): SES (CI 95%) = 0.52 (0.40-0.68)
      • Worsened (n = 238): SES (CI 95%) = 0.16 (0.02-0.30)
    • Emotional Domain
      • Improved (n = 280): SES (CI 95%) = 0.57 (0.43-0.72)
      • The Same (n = 451): SES (CI 95%) = 0.27 (0.15-0.36)
      • Worsened (n = 234): SES (CI 95%) = 0.36 (0.24-0.50)
    • Total 
      • Improved (n = 397): SES (CI 95%) = 0.97 (0.84-1.11)
      • The Same (n = 270): SES (CI 95%) = 0.50 (0.37-0.63)
      • Worsened (n = 296): SES (CI 95%) = 0.10 (0.01-0.22)

 

Heart Failure: (Chen et al., 2019)

  • Five Factors were associated with outcomes: renal function (eGFR), previous myocardial infarction (MI), heart rate, loop diuretics and beta blocker usage. 
    • Participants with eGFR < 90ml/min/1.73 m2 showed better prognosis in the HFpEF and HFmrEF groups compared with the HFrEF group (HFpEF: Hazard Ratio (HR): 0.602, 95% CI: 0.322-0.901; HFmrEF: HR: 0.409, 95% CI: 0.317-0.883, p < 0.001)
    • Patients with previous MI also showed better prognosis in the HFpEF and HFmrEF groups compared with the HFrEF group (HFpEF: HR: 0.409, 95% CI: 0.215-0.866; HFmrEF: HR: 0.362, 95% CI: 0.201-0.994, p = 0.015 
    • Patients with heart rate > 70bpm in the HFmrEF group showed a lower incidence of endpoints compared with the HFrEF group (HR: 0.356, 95%CI: 0.184–0.643, p < 0.001).

 

Bibliography

Chen, X., Xin, Y., Hu, W., Zhao, Y., Zhang, Z., & Zhou, Y. (2019). Quality of life and outcomes in heart failure patients with ejection fractions in different ranges. PLOS ONE, 14(6): e0218983. https://doi.org/10.1371/journal.pone.0218983 

Gonzalez-Saenz de Tejada, M., Bilbao, A., Ansola, L., Quirós, R., García-Perez, L., Navarro, G., & Escobar, A. (2019). Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire. Health and Quality of Life Outcomes, 17:36.

Middel, B., Bouma, J., de Jongste, M., van Sonderen, E., Niemeijer, M. G., & van den Heuvel, W. (2001). Psychometric properties of the Minnesota Living with Heart Failure Questionnaire (MLHF-Q). Clinical Rehabilitation, 15(5), 489–500. 

Rector, T. S., & Cohn, J. N. (1992). Assessment of patient outcome with the Minnesota Living with Heart Failure questionnaire: reliability and validity during a randomized, double-blind, placebo-controlled trial of pimobendan. American Heart Journal, 124(4), 1017–1025.

Rector, T. S., Tschumperlin, L. K., Kubo, S. H., Bank, A. J., Francis, G. S., McDonald, K. M., Keeler, C. A., & Silver, M. A. (1995). Use of the living with heart failure questionnaire to ascertain patients' perspectives on improvement in quality of life versus risk of drug-induced death. Journal of Cardiac Failure, 1(3), 201–206. 

Supino, P. G., Borer, J. S., Franciosa, J. A., Preibisz, J. J., Hochreiter, C., Isom, O. W., Krieger, K. H., Girardi, L. N., Bouraad, D., & Forur, L. (2009). Acceptability and Psychometric Properties of the Minnesota Living With Heart Failure Questionnaire Among Patients Undergoing Heart Valve Surgery: Validation and Comparison With SF-36. Journal of Cardiac Failure, 15(3), 267–277.

Trindade, A. F. V., Silva, W. T., Lima, V. P. et al. (2024). Assessment of Health-Related Quality of Life in Patients with Chagas Cardiomyopathy Using Minnesota Living with Heart Failure Questionnaire: A Validation Study. Tropical Medicine & International Health, 29(1), 6–12.

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