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An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis



The symptom burden of heart failure is significant and impacts upon health-related quality of life. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used in clinical practice to measure self-reported health-related quality of life, but the psychometric properties of the instrument are not fully elucidated. To address this gap, we investigated item and person fit, differential item functioning, item thresholds ordering, targeting and dimensionality of the MLHFQ.


Three approaches were used, exploratory factor analysis, Mokken analysis and Rasch analysis, on a convenience sample of 109 participants with a diagnosis of HF from the UK. Participants were typically male (67 %) with a mean age of 68 years (range 41–88).


Findings from the exploratory factor analysis of the MLHFQ revealed three factors (physical, emotional and social) that explained 72 % of the total variance. Mokken analysis confirmed the MLHFQ total scale, and the three subscales, as valid ordinal scales: the total MLHFQ scale [overall Loevinger coefficient (H) = 0.61], physical scale (H = 0.75), emotional scale (H = 0.79) and social scale (H = 0.552). Rasch analysis confirmed the physical scale as a unidimensional scale, but this was not consistent for the total MLHFQ scale which showed poor fit to the Rasch model (χ 2 = 162), df = 42, p < 0.0001). Six items of the total scale were misfitting (7, 8, 10, 14–16) and removing them improved the fit of the total scale. The physical subscale showed fit to the Rasch model (χ 2 = 20.24, df = 16, p = 0.21), and there was evidence of unidimensionality (t tests = 0.09, lower bound 95 % CI 0.04). There was evidence of disordered thresholds for the MLHFQ total and physical scale, and targeting was poor for both the total scale and its subscales.


We confirmed the MLHFQ subscales to be valid ordinal scales supporting the use of sum scores to assess quality of life in people diagnosed with HF. Floor effects were evident indicating that the ability of the instrument to identify differences across populations with mild HF may be suboptimal. The psychometric properties of the MLHFQ total scale may be improved by excluding problematic items from the total scale. Further research is warranted to verify findings from this study.

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Differential item functioning


Minnesota Living with Heart Failure Questionnaire


Heart failure-specific measure of health-related quality of life


Chronic Heart Failure Questionnaire


Questionnaire for severe heart failure


Kansas City Cardiomyopathy Questionnaire


Left Ventricular Dysfunction Questionnaire 36


New York Heart Association


Quality of life


Ischaemic heart disease


Item response theory


Person separation index


Analysis of variance


Standard deviation


Exploratory factor analysis


Root mean square errors of approximation


Mokken model of monotone homogeneity


Comparative fit index


Item response theory


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The authors wish to acknowledge the study participants and thank the EuroQoL Steering Committee for giving access to the UK MLHF data set.

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Correspondence to Felicity Astin.

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Munyombwe, T., Höfer, S., Fitzsimons, D. et al. An evaluation of the Minnesota Living with Heart Failure Questionnaire using Rasch analysis. Qual Life Res 23, 1753–1765 (2014).

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  • Minnesota Living with Heart Failure Questionnaire
  • Heart failure
  • Quality of life
  • Mokken analysis
  • Rasch analysis