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Coronary revascularisation outcome questionnaire: validation study of the Serbian version

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Abstract

Purpose

To translate, culturally adapt and validate the Coronary Revascularisation Outcome Questionnaire (CROQ), a disease-specific tool for measuring health-related quality of life (HRQoL) in patients with ischaemic heart disease (IHD), into Serbian language (CROQ-S).

Methods

Validation study was performed at the Clinic for Cardiac Surgery and Clinic for Cardiology, University Clinical Centre of Serbia. We included a convenience sample of 600 patients with IHD divided into four groups. Acceptability, reliability and validity of the CROQ-S were assessed.

Results

CROQ-S was acceptable to patients as demonstrated by less than 1% of missing data for each single item. Cronbach's Alpha was higher than the criterion of 0.70 for all scales in each version except the Cognitive Functioning scale which only met this criterion in the CABG pre-revascularisation version. Mean values of item-total correlations were greater than 0.30 for all scales except the Cognitive Functioning scale in both the pre-revascularisation groups. Compared to the original version, exploratory factor analysis in our study showed more factors; however, the majority of items had a factor loading greater than 0.3 on the right scale. Correlations of CROQ-S scales with the 36-Item Short Form Health Survey and Seattle Angina Questionnaire showed the expected pattern whereby scales measuring similar constructs were most highly correlated.

Conclusion

CROQ-S is an acceptable, reliable and valid disease-specific instrument for measuring HRQoL in this sample of Serbian speaking patients with IHD both before and after coronary revascularisation. However, the Cognitive Functioning scale did not meet all the psychometric criteria and further validation of its responsiveness is required.

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Data availability

The data underlying this article cannot be shared publicly for sake of maintaining the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.

References

  1. Global Health Estimates: Life expectancy and leading causes of death and disability. Retrieved from https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates.

  2. Moran, A. E., Forouzanfar, M. H., Roth, G., Mensah, G. A., Ezzati, M., Flaxman, A., Murray, C. J. L., & Naghavi, M. (2014). The global burden of ischemic heart disease in 1990 and 2010: The global burden of disease 2010 study. Circulation, 129, 1493–1501. https://doi.org/10.1161/CIRCULATIONAHA.113.004046

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ilic, M., & Ilic, I. (2017). Ischaemic heart disease mortality in Serbia, 1991–2013; a joinpoint analysis. Indian Journal of Medical Research, 146(6), 746–753. https://doi.org/10.4103/ijmr.IJMR_1935_15

    Article  PubMed Central  Google Scholar 

  4. Khan, M. A., Hashim, M. J., Mustafa, H., Baniyas, M. Y., Al Suwaidi, S. K. B. M., Al Katheeri, R., Alblooshi, F. M. K., Almatrooshi, M. E. A. H., Alzaabi, M. E. H., Al Darmaki, R. S., & Lootah, S. N. A. H. (2020). Global epidemiology of ischemic heart disease: Results from the global burden of disease study. Cureus, 12(7), e9349. https://doi.org/10.7759/cureus.9349

    Article  PubMed  PubMed Central  Google Scholar 

  5. Institute of Public Health of Serbia “Dr Milan Jovanović Batut”. (2019). Incidence and mortality of acute coronary syndrome in Serbia. Serbian Acute Coronary Syndrome Registry.

  6. Windecker, S., Kolh, P., Alfonso, F., Collet, J. P., Cremer, J., Falk, V., Filippatos, G., Hamm, C., Head, S. J., Jüni, P., Kappetein, A. P., Kastrati, A., Knuuti, J., Landmesser, U., Laufer, G., Neumann, F. J., Richter, D. J., Schauerte, P., Uva, M. S., Task Force members, et al. (2014). 2014 ESC/EACTS guidelines on myocardial revascularisation: The task force on myocardial revascularisation of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal, 35, 2541–2619. https://doi.org/10.1093/eurheartj/ehu278

    Article  PubMed  Google Scholar 

  7. Thuijs, D. J. F. M., Kappetein, A. P., Serruys, P. W., Mohr, F. W., Morice, M. C., Mack, M. J., Holmes, D. R., Jr., Curzen, N., Davierwala, P., Noack, T., Milojevic, M., Dawkins, K. D., da Costa, B. R., Jüni, P., Head, S. J., SYNTAX Extended Survival Investigators, et al. (2019). Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet, 394(10206), 1325–1334. https://doi.org/10.1016/S0140-6736(19)31997-X

    Article  CAS  PubMed  Google Scholar 

  8. Ben-Yehuda, O., Chen, S., Redfors, B., McAndrew, T., Crowley, A., Kosmidou, I., Kandzari, D. E., Puskas, J. D., Morice, M. C., Taggart, D. P., Leon, M. B., Lembo, N. J., Brown, W. M., Simonton, C. A., Dressler, O., Kappetein, A. P., Sabik, J. F., Serruys, P. W., & Stone, G. W. (2019). Impact of large periprocedural myocardial infarction on mortality after percutaneous coronary intervention and coronary artery bypass grafting for left main disease: An analysis from the EXCEL trial. European Heart Journal, 40(24), 1930–1941. https://doi.org/10.1093/eurheartj/ehz113

    Article  CAS  PubMed  Google Scholar 

  9. Holm, N. R., Mäkikallio, T., Lindsay, M. M., Spence, M. S., Erglis, A., Menown, I. B. A., Trovik, T., Kellerth, T., Kalinauskas, G., Mogensen, L. J. H., Nielsen, P. H., Niemelä, M., Lassen, J. F., Oldroyd, K., Berg, G., Stradins, P., Walsh, S. J., Graham, A. N. J., Endresen, P. C., … NOBLE investigators. (2020). Percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: Updated 5-year outcomes from the randomised, non-inferiority NOBLE trial. Lancet, 395(10219), 191–199. https://doi.org/10.1016/S0140-6736(19)32972-1

    Article  PubMed  Google Scholar 

  10. Thompson, D. R., & Yu, C. M. (2003). Quality of life in patients with coronary heart disease-I: Assessment tools. Health and Quality of Life Outcomes, 1, 42. https://doi.org/10.1186/1477-7525-1-42

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fatima, K., Yousuf-Ul-Islam, M., Ansari, M., Bawany, F. I., Khan, M. S., Khetpal, A., Khetpal, N., Lashari, M. N., Arshad, M. H., Amir, R. B., Kakalia, H. R., Zaidi, Q. H., Mian, S. K., & Kazani, B. (2016). Comparison of the postprocedural quality of life between coronary artery bypass graft surgery and percutaneous coronary intervention: A systematic review. Cardiology Research and Practice, 2016, 7842514. https://doi.org/10.1155/2016/7842514

    Article  PubMed  PubMed Central  Google Scholar 

  12. Währborg, P. (1999). Quality of life after coronary angioplasty or bypass surgery. 1-year follow-up in the coronary angioplasty versus Bypass Revascularization investigation (CABRI) trial. European Heart Journal, 20(9), 653–658. https://doi.org/10.1155/2016/7842514

    Article  PubMed  Google Scholar 

  13. Lavoie, L., Khoury, H., Welner, S., & Briere, J. B. (2016). Burden and prevention of adverse cardiac events in patients with concomitant chronic heart failure and coronary artery disease: A literature review. Cardiovascular Therapeutics, 34, 152–160. https://doi.org/10.1111/1755-5922.12180

    Article  PubMed  Google Scholar 

  14. Peric, V. M., Borzanovic, M. D., Stolic, R. V., Jovanovic, A. N., & Sovtic, S. R. (2006). Severity of angina as a predictor of quality of life changes six months after coronary artery bypass surgery. Annals of Thoracic Surgery, 81, 2115–2120. https://doi.org/10.1016/j.athoracsur.2006.01.033

    Article  Google Scholar 

  15. Spertus, J. A., Nerella, R., Kettlekamp, R., House, J., Marso, S., Borkon, A. M., & Rumsfeld, J. S. (2005). Risk of restenosis and health status outcomes for patients undergoing percutaneous coronary intervention versus coronary artery bypass graft surgery. Circulation, 111, 768–773. https://doi.org/10.1161/01.CIR.0000155242.70417.60

    Article  PubMed  Google Scholar 

  16. Huber, A., Oldridge, N., & Hofer, S. (2016). International SF-36 reference values in patients with ischemic heart disease. Quality of Life Research, 25(11), 2787–2798. https://doi.org/10.1007/s11136-016-1316-4

    Article  PubMed  PubMed Central  Google Scholar 

  17. EuroQol Group. (1990). EuroQol–a new facility for the measurement of health-related quality of life. Health Policy, 16(3), 199–208.

    Article  Google Scholar 

  18. Schroter, S., & Lamping, D. L. (2006). Responsiveness of the coronary revascularisation outcome questionnaire compared with the SF-36 and Seattle Angina Questionnaire. Quality of Life Research, 15(6), 1069–1078. https://doi.org/10.1007/s11136-005-5993-7

    Article  PubMed  Google Scholar 

  19. Spertus, J. A., Winder, J. A., Dewhurst, T. A., Deyo, R. A., Prodzinski, J., McDonell, M., & Fihn, S. D. (1995). Development and evaluation of the Seattle Angina Questionnaire: A new functional status measure for coronary artery disease. Journal of the American College of Cardiology, 25(2), 333–341. https://doi.org/10.1016/0735-1097(94)00397-9

    Article  CAS  PubMed  Google Scholar 

  20. Schroter, S., & Lamping, D. L. (2004). Coronary revascularisation outcome questionnaire (CROQ): Development and validation of a new, patient based measure of outcome in coronary bypass surgery and angioplasty. Heart, 90, 1460–1466. https://doi.org/10.1136/hrt.2003.021899

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Schroter, S., Miles, R., Green, S., & Jackson, M. (2017). Psychometric validation of the Coronary Revascularisation Outcome Questionnaire (CROQv2) in the context of the NHS Coronary Revascularisation PROMs Pilot. British Medical Journal Open, 7(2), e015915. https://doi.org/10.1136/bmjopen-2017-015915

    Article  Google Scholar 

  22. Seki, S., Kato, N., Ito, N., Kinugawa, K., Ono, M., Motomura, N., Yao, A., Watanabe, M., Imai, Y., Takeda, N., Inoue, M., Hatano, M., & Kazuma, K. (2011). Translation and validation study of the Japanese versions of the Coronary Revascularisation Outcome Questionnaire (CROQ-J). European Journal of Cardiovascular Nursing, 10, 22–30. https://doi.org/10.1016/j.ejcnurse.2010.03.005

    Article  PubMed  Google Scholar 

  23. Shahali, S. H., Shaterzadeh, Y. M. J., Goharpey, S. H., & Rahim, F. (2008). Reliability of the Persian version of Coronary Revascularization Qutcome Questionnaire (CROQ) in cardiac patients undergoing CABG and PTCA procedures. Journal of Clinical and Diagnostic Research, 2, 919–924.

    Google Scholar 

  24. Takousi, M. G., Schmeer, S., Manaras, I., Olympios, C. D., Fakiolas, C. N., & Makos, G. (2016). Translation, adaptation and validation of the Coronary Revascularization Outcome Questionnaire into Greek. European Journal of Cardiovascular Nursing, 15(2), 134–141. https://doi.org/10.1177/1474515115592250

    Article  PubMed  Google Scholar 

  25. Kim, M., Seo, J., Hwang, J. Y., & Park, K. S. (2017). Reliability and validity of the Korean version of the coronary revascularization outcome questionnaire. Health and Quality of Life Outcomes, 15(1), 37. https://doi.org/10.1186/s12955-017-0615-y

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Guillemin, F., Bombardier, C., & Beaton, D. (1993). Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. Journal of Clinical Epidemiology, 46, 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n

    Article  CAS  PubMed  Google Scholar 

  27. Acquadro, C., Conway, K., Hareendran, A., Aaronson, N., European Regulatory Issues and Quality of Life Assessment (ERIQA). (2008). Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health, 11, 509–521. https://doi.org/10.1111/j.1524-4733.2007.00292.x

    Article  PubMed  Google Scholar 

  28. Schafer, J. L. (1999). Multiple Imputation: A primer. Statistical Methods in Medical Research, 8(1), 3–15. https://doi.org/10.1177/096228029900800102

    Article  CAS  PubMed  Google Scholar 

  29. Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). McGraw-Hill.

    Google Scholar 

  30. Aaronson, N., Alonso, J., Burnam, A., Lohr, K. N., Patrick, D. L., Perrin, E., & Stein, R. E. (2002). Assessing health status and quality-of-life instruments: Attributes and review criteria. Scientific Advisory Committee of the Medical Outcomes Trust. Quality of Life Research, 11, 193–205. https://doi.org/10.1023/a:1015291021312

    Article  PubMed  Google Scholar 

  31. Field, A. (2013). Discovering statistics using SPSS (4th ed., p. 2013). SAGE.

    Google Scholar 

  32. Fayers, P. M., & Machin, D. (1998). Factor analysis. In M. J. Staquet, R. D. Hays, & P. M. Fayers (Eds.), Quality of life assessment in clinical trials: Methods and practice (pp. 191–223). Oxford University Press.

    Google Scholar 

  33. Li, L., Wang, H. M., & Shen, Y. (2003). Chinese SF-36 health survey: Translation, cultural adaptation, validation, and normalisation. Journal of Epidemiology & Community Health, 57(4), 259–263. https://doi.org/10.1136/jech.57.4.259

    Article  CAS  Google Scholar 

  34. Lillevik, S. A., Schroter, S., & Hanssen, T. A. (2018). Translation and validation of the Norwegian version of the Coronary Revascularisation Outcome Questionnaire. European Journal of Cardiovascular Nursing, 17(1), 36–44. https://doi.org/10.1177/1474515117715841

    Article  PubMed  Google Scholar 

  35. Pintor Pinna, P., Schroter, S., Colangelo, S., Dilaghi, B., Arpinelli, F., Fonzo, D., Torta, R., Sheiban, I., & Bobbio, M. (2002). Assessment of acceptability and comprehension of the Italian version of the coronary revascularisation outcome questionnaire (CROQ. Hippokratia, 6(Suppl. 1), 27–30. https://doi.org/10.1177/147451511559225

    Article  Google Scholar 

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Funding

This study was supported by the Ministry of Education and Science of the Republic of Serbia (Grant No. 200110).

Author information

Authors and Affiliations

  1. Clinic for Cardiac Surgery, University Clinical Center of Serbia, 11000, Belgrade, Serbia

    Nemanja Aleksic, Svetozar Putnik, Mina Zlatkovic, Ilija Bilbija & Milos Matkovic

  2. BMA House, Tavistock Square, London, WC1H 9JR, UK

    Sara Schroter

  3. Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000, Belgrade, Serbia

    Vedrana Pavlovic

  4. Clinic for Urology, University Clinical Center of Serbia, 11000, Belgrade, Serbia

    Uros Bumbasirevic

  5. Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Visegradska 26A, 11000, Belgrade, Serbia

    Aleksa Jovanovic, Tatjana Pekmezovic & Gorica Maric

Authors
  1. Nemanja Aleksic
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  2. Svetozar Putnik
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  3. Sara Schroter
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  4. Vedrana Pavlovic
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  5. Uros Bumbasirevic
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  6. Mina Zlatkovic
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  9. Aleksa Jovanovic
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  10. Tatjana Pekmezovic
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  11. Gorica Maric
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NA, SP, SS and VP. The first draft of the manuscript was written by GM and TP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gorica Maric.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Ethics Committees of the Faculty of Medicine, University of Belgrade and University Clinical Centre of Serbia in Belgrade. The investigation conforms with the principles outlined in the Declaration of Helsinki. All study participants provided a written informed consent for participation in the study.

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Aleksic, N., Putnik, S., Schroter, S. et al. Coronary revascularisation outcome questionnaire: validation study of the Serbian version. Qual Life Res 31, 1883–1895 (2022). https://doi.org/10.1007/s11136-021-03064-0

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