Development of a Novel Adult Congenital Heart Disease-Specific Patient-Reported Outcome Metric

Abstract

Background Patient-reported outcome metrics (PROs) quantify important outcomes in clinical trials and can be sensitive measures of patient experience in clinical practice. Currently, there is no validated disease-specific PRO for adults with congenital heart disease (ACHD). Methods and Results We conducted a preliminary psychometric validation of a novel ACHD PRO. ACHD patients were recruited prospectively from 2 institutions and completed a series of questionnaires, a physician health assessment, and a 6-minute walk test. Participants returned to complete the same questionnaires and assessment 3 months±2 weeks later. We tested the internal consistency and test-retest reliability by comparing responses among clinically stable patients at the 2 study visits. We assessed convergent and divergent validity by comparison of ACHD PRO responses to existing validated questionnaires. We assessed responsiveness by comparison with patient-reported clinical change. One hundred three patients completed 1 study visit and 81 completed both. The ACHD PRO demonstrated good internal consistency in each of its 5 domains (Cronbach's α: 0.87; 0.74; 0.74; 0.90; and 0.89, respectively) and in the overall summary score (0.92). Test-retest reliability was good with an intraclass correlation ≥0.73 for all domains and 0.78 for the Summary Score. The ACHD PRO accurately assessed domain concepts based on comparison with validated standards. Preliminary estimates of responsiveness suggest sensitivity to clinical status. Conclusions These studies provide initial support for the validity and reliability of the ACHD PRO. Further studies are needed to assess its sensitivity to changes in clinical status.

Keywords: adult congenital heart disease; patient‐reported health status; patient‐reported outcome metric; quality of life.

Figure 1. Graphic depiction of the iterative stages in patient‐reported outcome metric development as recommended by the US Food and Drug Administration.

The present work is a part of the third step in development according to this process. ACHD indicates adult congenital heart disease; PRO, patient‐reported outcome metric.

Figure 2. Relationship between patient‐reported change in clinical status as assessed by 15‐item Likert scale and ACHD PRO Summary Score; ρ=0.24, P=0.031.

ACHD PRO indicates adult congenital heart disease patient‐reported outcome metric.