Abstract
Purposes
This study aimed to validate the use of subjective wellbeing (SWB) in patients with heart disease, to explore the complementary vs substitute relationship between SWB and health status utility (HSU), and to reveal which life domains matter for patients with heart disease compared to healthy persons.
Methods
Data were obtained from a large multi-national, multi-instrument comparison survey. Subjective wellbeing instruments (ONS4, PWI, SWLS), health status utility instruments (15D, AQoL-8D, EQ-5D-5L, HUI3 and SF-6D) and a disease-specific quality of life instrument (MacNew) were administered among patients with heart disease (N = 943). Validity and sensitivity of SWBs were studied. Exploratory factor analysis (EFA) was performed to examine the difference in descriptive systems between the SWB, HSU and MacNew. The importance of life domain satisfaction in explaining overall life satisfaction was investigated using regression analysis.
Results
The known-group analysis showed that both SWB and HSU scores differed according to changes in the severity of heart disease. EFA showed that SWB and HSU were generally complementary instruments. The life domains that were significantly important to patients with heart disease were standard of living, followed by achieving in life, personal relationships, personal health, and future security. Compared to the healthy public, personal health and future security were significantly more important life domains.
Conclusions
Assessing SWB provides complementary information on understanding heart patients’ subjective outcome over the use of quality of life instruments alone. Given the adverse psychological impact of heart disease, addressing the important domain revealed by SWB assessment in management planning should be considered.
Similar content being viewed by others
References
Lopez, A. D., & Murray, C. C. (1998). The global burden of disease, 1990–2020. Nature Medicine, 4(11), 1241–1243.
Koch, M. B., Davidsen, M., Andersen, L. V., Juel, K., & Jensen, G. B. (2015). Increasing prevalence despite decreasing incidence of ischaemic heart disease and myocardial infarction. A national register based perspective in Denmark, 1980–2009. European Journal of Preventive Cardiology, 22(2), 189–195.
Rosamond, W., Flegal, K., Furie, K., Go, A., Greenlund, K., Haase, N., et al. (2008). Heart disease and stroke statistics – 2008 update—A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 117(4), E25–E146.
Lloyd-Jones, D., Adams, R. J., Brown, T. M., Carnethon, M., Dai, S., De Simone, G., et al. (2010). Executive summary: Heart disease and stroke statistics-2010 update—A report from the American Heart association. Circulation, 121(7), 948–954.
Nichols, M., Townsend, N., Scarborough, P., & Rayner, M. (2014). Cardiovascular disease in Europe 2014: Epidemiological update. European Heart Journal, 35(42), 2950–2959.
Mommersteeg, P. M. C., Denollet, J., Spertus, J. A., & Pedersen, S. S. (2009). Health status as a risk factor in cardiovascular disease: A systematic review of current evidence. American Heart Journal, 157(2), 208–218.
Rumsfeld, J. S., MaWhinney, S., McCarthy, M., Shroyer, A. L. W., VillaNueva, C. B., O’Brien, M., et al. (1999). Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA-Journal of the American Medical Association, 281(14), 1298–1303.
Spertus, J. A., Jones, P., McDonell, M., Fan, V., & Fihn, S. D. (2002). Health status predicts long-term outcome in outpatients with coronary disease. Circulation, 106(1), 43–49.
Quality-of-Life and Clinical-Trials. (1995). Lancet, 346(8966), 1–2.
Diener, E., Suh, E. M., Lucas, R. E., & Smith, H. L. (1999). Subjective well-being: Three decades of progress. Psychological Bulletin, 125(2), 276–302.
Tessier, P., Lelorain, S., & Bonnaud-Antignac, A. (2012). A comparison of the clinical determinants of health-related quality of life and subjective well-being in long-term breast cancer survivors. European Journal of Cancer Care, 21(5), 692–700.
Steptoe, A., Deaton, A., & Stone, A. A. (2015). Subjective wellbeing, health, and ageing. Lancet, 385(9968), 640–648.
Goodwin, G. M. (2006). Depression and associated physical diseases and symptoms. Dialogues in Clinical Neuroscience, 8(2), 259–265.
Lyubomirsky, S., King, L., & Diener, E. (2005). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131(6), 803–855.
Tanno, K., Sakata, K., Ohsawa, M., Onoda, T., Itai, K., Yaegashi, Y., Tamakoshi, A., & Grp, J. S. (2009). Associations of ikigai as a positive psychological factor with all-cause mortality and cause-specific mortality among middle-aged and elderly Japanese people: Findings from the Japan Collaborative Cohort Study. Journal of Psychosomatic Research, 67(1), 67–75.
Tindle, H. A., Chang, Y. F., Kuller, L. H., Manson, J. E., Robinson, J. G., Rosal, M. C., Siegle, G. J., & Matthews, K. A. (2009). Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative. Circulation, 120(8), 656–662.
U.S. Department of Health and Human Services, FDA (2009). Guidance for industry. Patient-reported outcome measures: Use in medical product development to support labeling claims. Available from: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM193282.pdf. Last Accessed 4, June, 2018.
European Medicines Agency. (2005). Committee for medicinal products for human use. Reflection paper on the regulatory guidance for the use of health-related quality of life (HRQL) measures in the evaluation of medicinal products. Available from: http://www.emea.europa.eu/pdfs/human/ewp/13939104en.pdf. Last Accessed 4, June, 2018.
Dolan, P., Layard, R., & Metcalfe, R. (2011). Measuring Subjective wellbeing for public policy: Recommendations on measures. CEP Special Papers 23, Centre for Economic Performance, LSE.
Cubí-Mollá, P., de Vries, J., & Devlin, N. (2014). A study of the relationship between health and subjective well-being in Parkinson’s disease patients. Value in Health, 17(4), 372–379.
Richardson, J., Iezzi, A., Khan, M. A., Chen, G., & Maxwell, A. (2016). Measuring the sensitivity and construct validity of 6 utility instruments in 7 disease areas. Med Decis Making, 36(2), 147–159.
Personal Well-being user guidance. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/methodologies/personalwellbeingsurveyuserguide. Last accessed 24 August 2018.
International Wellbeing Group. (2013). Personal Wellbeing Index: 5th Edition. Melbourne: Australian Centre on Quality of Life, Deakin University.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49(1), 71–75.
Vautier, S., Mullet, E., & Jmel, S. (2004). Assessing the structural robustness of self-rated satisfaction with life: A sem analysis. Social Indicators Research, 68(2), 235–249.
Pavot, W., Diener, E., Colvin, C. R., & Sandvik, E. (1991). Further validation of the satisfaction with life scale—Evidence for the cross-method convergence of well-being measures. Journal of Personality Assessment, 57(1), 149–161.
De Smedt, D., Clays, E., & De Bacquer, D. (2016). Measuring health-related quality of life in cardiac patients. The European Heart Journal - Quality of Care & Clinical Outcomes, 2(3), 149–150.
Heiskanen, J., Tolppanen, A. M., Roine, R. P., Hartikainen, J., Hippelainen, M., Miettinen, H., & Martikainen, J. (2016). Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients. The European Heart Journal - Quality of Care & Clinical Outcomes, 2(3), 193–200.
Richardson, J., Sinha, K., Lezzi, A., & Khan, M. (2011). Modelling the utility of health states with the assessment of quality of life (AQoL) 8D instrument: Overview and utility scoring algorithm. Available from: http://www.aqol.com.au/papers/researchpaper63.pdf. Last Accessed 4th June 2018.
Richardson, J., Sinha, K., Iezzi, A., & Khan, M. A. (2014). Modelling utility weights for the Assessment of Quality of Life (AQoL)-8D. Quality of Life Research, 23(8), 2395–2404.
EuroQol. https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/.
Devlin, N. J., Shah, K. K., Feng, Y., Mulhern, B., & van Hout, B. (2018). Valuing health-related quality of life: An EQ-5D-5L value set for England. Health Economics, 27(1), 7–22.
Health Utilities Inc. Leaders in health-related quality of life research. Available from: http://www.healthutilities.com. Last Accessed 4th June 2018.
Horsman, J., Furlong, W., Feeny, D., & Torrance, G. (2003). The Health Utilities Index (HUI): Concepts, measurement properties and applications. Health and Quality of Life Outcomes, 1, 54.
Feeny, D., Furlong, W., Torrance, G. W., Goldsmith, C. H., Zhu, Z. L., DePauw, S., Denton, M., & Boyle, M. (2002). Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Medical Care, 40(2), 113–128.
Brazier, J., Roberts, J., & Deverill, M. (2002). The estimation of a preference-based measure of health from the SF-36. Journal of Health Economics, 21(2), 271–292.
Oldridge, N., Guyatt, G., Jones, N., Crowe, J., Singer, J., Feeny, D., Mckelvie, R., Runions, J., Streiner, D., & Torrance, G. (1991). Effects on quality-of-life with comprehensive rehabilitation after acute myocardial-infarction. American Journal of Cardiology, 67(13), 1084–1089.
Lim, L. L. Y., Valenti, L. A., Knapp, J. C., Dobson, A. J., Plotnikoff, R., Higginbotham, N., & Heller, R. F. (1993). A self-administered quality-of-life questionnaire after acute myocardial-infarction. Journal of Clinical Epidemiology, 46(11), 1249–1256.
Valenti, L., Lim, L., Heller, R. F., & Knapp, J. (1996). An improved questionnaire for assessing quality of life after acute myocardial infarction. Quality of Life Research, 5(1), 151–161.
Dixon, T., Lim, L. L. Y., & Oldridge, N. B. (2002). The MacNew heart disease health-related quality of life instrument: Reference data for users. Quality of Life Research, 11(2), 173–183.
Fayers, P., & Machin, D. (2007). Quality of life: The assessment, analysis and interpretation of patient-reported outcomes. New York: Wiley.
Hinkle, D. E., Wiersma, W., & Jurs, S. G. (2003). Applied statistics for the behavioral sciences (5th ed.). Boston: Houghton Mifflin.
McAdams, K. K., Lucas, R. E., & Donnellan, M. B. (2012). The role of domain satisfaction in explaining the paradoxical association between life satisfaction and age. Social Indicators Research, 109(2), 295–303.
Basu, A., & Rathouz, P. J. (2005). Estimating marginal and incremental effects on health outcomes using flexible link and variance function models. Biostatistics, 6(1), 93–109.
Basu, A. (2005). Extended generalized linear models: Simultaneous estimation of flexible link and variance functions. The Stata Journal, 5(4), 501–516.
Gong, Y., Handberg, E. M., Gerhard, T., Cooper-Dehoff, R. M., Ried, L. D., Johnson, J. A., Pepine, C. J., & Investigators, I. (2009). Systolic blood pressure and subjective well-being in patients with coronary artery disease. Clinical Cardiology, 32(11), 627–632.
Richardson, J., Iezzi, A., & Khan, M. A. (2015). Why do multi-attribute utility instruments produce different utilities: The relative importance of the descriptive systems, scale and ‘micro-utility’ effects. Quality of Life Research, 24(8), 2045–2053.
Rozanski, A., & Kubzansky, L. D. (2005). Psychologic functioning and physical health: A paradigm of flexibility. Psychosomatic Medicine, 67(Suppl 1), S47–S53.
Scheier, M. F., & Carver, C. S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Journal of Health Psychology, 4(3), 219–247.
Giltay, E. J., Geleijnse, J. M., Zitman, F. G., Buijsse, B., & Kromhout, D. (2007). Lifestyle and dietary correlates of dispositional optimism in men: The Zutphen Elderly Study. Journal of Psychosomatic Research, 63(5), 483–490.
Kubzansky, L. D., Sparrow, D., Vokonas, P., & Kawachi, I. (2001). Is the glass half empty or half full? A prospective study of optimism and coronary heart disease in the normative aging study. Psychosomatic Medicine, 63(6), 910–916.
Kubzansky, L. D., & Thurston, R. C. (2007). Emotional vitality and incident coronary heart disease: Benefits of healthy psychological functioning. Archives Of General Psychiatry, 64(12), 1393–1401.
Davidson, K. W., Mostofsky, E., & Whang, W. (2010). Don’t worry, be happy: Positive affect and reduced 10-year incident coronary heart disease: The Canadian Nova Scotia Health Survey. European Heart Journal, 31(9), 1065–1070.
Koizumi, M., Ito, H., Kaneko, Y., & Motohashi, Y. (2008). Effect of having a sense of purpose in life on the risk of death from cardiovascular diseases. Journal of Epidemiology, 18(5), 191–196.
Steptoe, A., Wright, C., Kunz-Ebrecht, S. R., & Iliffe, S. (2006). Dispositional optimism and health behaviour in community-dwelling older people: Associations with healthy ageing. British Journal of Health Psychology, 11(Pt 1), 71–84.
Steptoe, A., Dockray, S., & Wardle, J. (2009). Positive affect and psychobiological processes relevant to health. Journal of Personality, 77(6), 1747–1776.
Easterlin, R. A., & Sawangfa, O. (2009). Happiness and domain satisfaction: New directions for the economics of happiness. Happiness, Economics and Politics: Towards a Multi-Disciplinary Approach, 70–94.
Acknowledgements
We thank an anonymous referee who requested us to explore the non-linearity issue.
Funding
Dr Lan Gao is supported by the Alfred Deakin Postdoctoral Research Fellowship funded by Deakin University. Associate Professor Gang Chen is the recipient of an Australian Research Council Discovery Early Career Researcher Award (Project Number DE180100647) funded by the Australian Government.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Gao, L., Moodie, M. & Chen, G. Measuring subjective wellbeing in patients with heart disease: relationship and comparison between health-related quality of life instruments. Qual Life Res 28, 1017–1028 (2019). https://doi.org/10.1007/s11136-018-2094-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-018-2094-y