# Instruments Used to Assess Health-Related Quality of Life in Valvular Heart Disease: A Narrative Review

## TL;DR

This review summarizes tools used to measure quality of life in patients with valvular heart disease, highlighting their strengths and limitations.

## Contribution

The paper provides a descriptive synthesis of validated HRQoL instruments specifically applied to valvular heart disease populations.

## Key findings

- The Minnesota Living with Heart Failure Questionnaire and Kansas City Cardiomyopathy Questionnaire are reliable and sensitive for valvular interventions.
- There is a lack of valve-specific content and cultural validation in current HRQoL instruments for VHD.
- Future work should focus on developing core outcome sets and leveraging digital platforms for better comparability.

## Abstract

Health-related quality of life (HRQoL) has become a pivotal outcome in valvular heart disease (VHD), complementing mortality and readmission. This narrative (non-systematic) review synthesizes validated HRQoL instruments used in VHD, spanning generic tools - the Short Form-36 and derivatives (SF-12, SF-6D), EuroQol 5-Dimensions (EQ-5D), and World Health Organization Quality of Life - Brief (WHOQOL-BREF) - and disease-specific measures such as the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Instruments were included if (i) applied to adult VHD populations or valve interventions or (ii) demonstrated use in VHD cohorts; English-language sources (primarily 2015-2025) were prioritized, retaining seminal pre-2015 validation papers. Pediatric-only cohorts, non-validated tools, and case reports were excluded.

MLHFQ and KCCQ were included on an evidence basis: both have been validated in valvular populations and used as key endpoints in pivotal interventional studies, demonstrating high reliability and sensitivity to change after surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVI), and transcateter edge-to-edge repair (TEER). Their established minimal clinically important differences and the availability of a short form (KCCQ-12) further support feasibility and interpretability in practice. The review is descriptive and therefore psychometric properties (validity, reliability, responsiveness, minimal clinically important differences), covered domains, feasibility, and cultural/linguistic adaptation are summarized from existing studies. Emphasis is placed on domains most germane to VHD recovery - physical function, symptom burden, emotional well-being, and social/role participation - given their sensitivity to peri-interventional change.

Recommendations for clinical integration (e.g., pairing a generic utility measure such as EQ-5D with a disease-specific tool such as KCCQ; standardized assessment at baseline, 30 days, six and 12 months) are evidence-informed (randomized trials, registries, guidelines). Key gaps include limited valve-specific content (e.g., prosthesis noise, anticoagulation burden), heterogeneity in instruments and time points, incomplete cultural validation, and scarce HRQoL data for emerging therapies (e.g. transcatheter mitral valve replacement, contemporary tricuspid interventions). As a narrative (non-systematic) purely descriptive synthesis, no formal risk-of-bias assessment or meta-analysis was conducted. The English-language restriction and heterogeneity across instruments and follow-up time points limit quantitative comparability and preclude definitive head-to-head conclusions. Future work should develop core outcome sets and VHD-specific modules, strengthen cross-cultural validation, and leverage digital patient-reported outcome platforms to improve comparability and clinical uptake.