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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

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 

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

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)

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)

Heart Failure: (Rector & Cohn, 1992)

• Excellent: Cronbach's ¦Á = 0.92*

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

• Excellent internal consistency for Total and by dimension:
  • Total: ¦Á = 0.96*
  • Physical Dimension: ¦Á = 0.96*
  • Emotional Dimension: ¦Á = 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 (¡Ý50%) (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 ¦Á = 0.83
  • HFrEF; n = 323, Cronbach's ¦Á = 0.92*
  • HFmrEF; n = 267, Cronbach's ¦Á = 0.96*
  • HFpEF; n = 251, Cronbach's ¦Á = 0.93*

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

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)

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¡¯²õ = -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 ¨C 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 ¨C 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 (¡Ý 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 

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.¡±

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. 

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¨C0.643, p < 0.001).