Examining the distinctiveness of the Minnesota Living with Heart Failure Questionnaire from depressive symptoms in patients with heart failure

Abstract

The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is widely used to assess health-related quality of life (HRQOL) in patients with heart failure (HF), but conceptual overlap with depressive symptoms may complicate interpretation of patient-reported outcomes. To evaluate the discriminant validity of the MLHFQ relative to the Patient Health Questionnaire-9 (PHQ-9) and examine the independent association between depressive symptoms and HRQOL. This secondary cross-sectional analysis included 306 patients with cardiologist-confirmed HF in Jordan. Exploratory factor analysis examined the underlying structure of the combined MLHFQ and PHQ-9 items, and hierarchical regression analyses evaluated the association between depressive symptoms and HRQOL after adjustment for sociodemographic and clinical characteristics. Five correlated factors emerged from the combined MLHFQ and PHQ-9 analysis, representing physical HRQOL, emotional HRQOL, treatment burden, Somatic Depressive Symptoms, and social role limitations. Partial conceptual overlap was observed primarily for fatigue, sleep disturbance, and selected emotional items, whereas most HF-specific items loaded on distinct HRQOL factors. Item-level correlations between the MLHFQ and PHQ-9 ranged from weak to moderate ( r = .01–0.61). After adjustment for sociodemographic and clinical characteristics, depressive symptoms explained an additional 25% of the variance in overall HRQOL, 18% in physical HRQOL, and 31% in emotional HRQOL. In a revised physical HRQOL model excluding overlapping items, depressive symptoms remained independently associated with poorer physical HRQOL, explaining an additional 13% of the variance. Depressive symptoms were strongly associated with perceived HRQOL, particularly within the emotional domain, while the MLHFQ captures broader HF-specific aspects of quality of life that remain distinguishable from depression. These findings support the discriminant validity and clinical usefulness of the MLHFQ while highlighting the importance of concurrent assessment of depressive symptoms when evaluating patient-reported outcomes in HF. Not applicable.