Assessment section
Perceived health following myocardial infarction: cross-validation of the Health Complaints Scale in Danish patients

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Abstract

With an ageing population and a decline in cardiac mortality rates, the number of patients with cardiac disease is increasing, which in turn poses a major challenge for secondary prevention. For this end, appropriate, sensitive, and validated instruments to assess health complaints and quality of life are required. The objectives of the current study were: (1) to cross-validate the Health Complaints Scale (HCS) in a Danish sample of patients with a first myocardial infarction (MI); and (2) to investigate whether perceived health, as measured by the HCS is related to cardiac disease severity. The HCS was originally developed in Belgian patients with coronary artery disease. One-hundred-and-twelve consecutive patients with a first myocardial infarction were assessed by means of a questionnaire four to six weeks post infarction. Clinical measures were sampled from medical records. The factor structure of the HCS and the internal consistency of the Somatic Complaints (α=0.91) and Cognitive Complaints subscales (α=0.94) were confirmed. The construct validity of the scale was confirmed against measures of psychopathology and personality. Patients scored significantly higher on the HCS Somatic and Cognitive scales as compared with self-reports of depression and anxiety (p<0.0001). Health complaints were unrelated to severity of cardiac disease and rather reflected subjective perception of quality of life. These findings show that the HCS is a valid instrument that is equally applicable in Danish cardiac patients to monitor perceived health as a major component of quality of life.

Introduction

Health complaints have been associated with impaired quality of life (QOL) (Pocock, Henderson, Seed, Treasure, & Hampton, 1996) and mortality in patients with coronary artery disease (Shekelle, Vernon, & Ostfeld, 1991). Somatic health complaints are often considered to directly reflect the severity of underlying cardiac disorder, but symptoms like fatigue have been found to be unrelated to disease severity (Kop, Appels, Mendes de Leon & Bär, 1996).

In order to identify cardiac patients with health complaints, who may be at risk of recurrent cardiac events, sensitive measures are required. Although standard measures of psychopathology may be useful to identify high-risk patients, cardiac health complaints constitute disease specific aspects that are not reflected in these measures. Moreover, standard measures may be less sensitive to assess outcome following cardiac rehabilitation, whereas measures developed in and tailored specifically to cardiac patients may be more sensitive to detect such a change (Denollet, 1993).

The objectives of the present study were: (1) To cross-validate the Health Complaints Scale (HCS) in a Danish sample of consecutive patients with a first myocardial infarction (MI). (2) To examine whether health complaints and perceived health as measured by the HCS reflect the severity of underlying cardiac disease.

Section snippets

Sample

Consecutive patients with a first MI were recruited from August 1999 to January 2001 from Aarhus University Hospital, and Horsens Hospital, Denmark. Patients were assessed four to six weeks post-MI. A diagnosis of MI was based on increased levels of troponin T (>0.10 μg/l) and ECG changes, according to the most recent guidelines (Joint European Society of Cardiology/American College of Cardiology Committee, 2000). Ethical approval was obtained from the ethical committees in Aarhus and Vejle

Results

Prior to investigating the separate validity of the somatic and cognitive complaints subscales, we subjected all 24 items of the HCS to a factor analysis. We were able to confirm that the scale measures the five symptom clusters of ‘cardiopulmonary problems’, ‘fatigue’, ‘sleep problems’, ‘health worry’, and ‘illness disruption’ (results not shown).

Six items on the somatic complaints subscale were marked positively (score>0) by the patients in at least 50% of the cases (Table 1). The mean

Discussion

These findings confirm the validity of a Danish version of the HCS in post-MI patients. We were able to replicate the internal-structural validity of the HCS, the internal consistency of the somatic and cognitive subscales, and its construct validity against measures of psychopathology and personality. Although there was some overlap with the latter measures, the shared variance was less than 50%. Overall, these results corroborate that the Danish HCS measures symptoms that are related to but

Acknowledgements

We thank the nurses at Aarhus University Hospital and Horsens Hospital for helping with data collection. Special thanks are extended to Mogens Lytken Larsen (MD, DMSc) for supporting the project, and to project nurse Vibeke Reiche Soerensen for supervising data collection at Aarhus University Hospital. This research was supported by the Danish Heart Foundation (grant no. 99-1-F-22717).

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    Citation Excerpt :

    The HCS is a self-report questionnaire including 12 items assessing somatic complaints (e.g., “pain in heart and chest,” “trouble falling asleep,” and “fatigue”) and 12 items assessing cognitive health complaints (e.g., “worrying about health,”18) In the present study, only the 12-item somatic subscale was administered. This somatic subscale has high internal consistency (Cronbach α was 0.89, 0.91, and 0.90 in the study of Denollet,18 Pedersen and Denollet,19 and the present sample, respectively), adequate test-retest reliability (r = 0.69 in the study of Denollet,18 r = 0.76 in the present study), and is sensitive to improvements during cardiac rehabilitation.18 In previous studies, factor analysis on the 12 items of the somatic subscale of the HCS yielded 3 symptom dimensions comprising cardiac complaints, sleep complaints, and energy complaints.18,19

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