Translation, cultural adaptation, and psychometric validation of the Chinese versions of the PROMIS + HF-27 and PROMIS + HF-10 profiles in patients with heart failure

Heart failure (HF) is a prevalent clinical syndrome characterized by dyspnea, fatigue, exercise intolerance, and oedema, significantly impairing patients’ health-related quality of life (HRQoL). The PROMIS + HF profile is a targeted instrument designed to evaluate novel interventions, enhance clinical care and shared decision-making, and assess quality of care. However, a linguistically validated Chinese version is currently lacking. This study aimed to translate and culturally adapt the PROMIS + HF into Chinese and evaluate its psychometric properties among Chinese patients with HF. Following a standardized cross-cultural adaptation process, the psychometric properties of the Chinese PROMIS + HF profiles (PROMIS + HF-27 and PROMIS + HF-10) were evaluated. A cross-sectional study with a longitudinal component was conducted using convenience sampling to recruit eligible patients from tertiary hospitals in China between September 2022 and February 2023. Participants completed a sociodemographic questionnaire, the PROMIS + HF profiles, the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Psychometric evaluation included floor/ceiling effects, construct validity, criterion-related validity, convergent validity, known-groups validity, reliability and responsiveness. A total of 420 patients (mean age 57.68 years) were included. Both profiles exhibited an absence of floor and ceiling effects. Confirmatory Factor Analysis (CFA) supported the construct validity of both profiles, demonstrating acceptable fit indices after modification (PROMIS + HF-27: χ2/df = 3.874, CFI = 0.869, TLI = 0.855, SRMR = 0.055, RMSEA = 0.08; PROMIS + HF-10: χ2/df = 3.408, CFI = 0.958, TLI = 0.940, SRMR = 0.038, RMSEA = 0.073). Criterion-related validity was supported by significant correlations between overall, physical health scores and the 6-Minute Walk Test (6MWT). Convergent validity was demonstrated through strong correlations with KCCQ and MLHFQ scores, and known-groups validity was confirmed by the instruments’ ability to distinguish between New York Heart Association (NYHA) functional classes. Internal consistency was good to excellent for the PROMIS + HF-27 (Cronbach’s α: 0.87–0.95) and acceptable to good for PROMIS + HF-10 (Cronbach’ α/Spearman-Brown: 0.71–0.88). Test-retest reliability was excellent for both instruments (ICC: 0.89–0.97). Responsiveness was demonstrated in the longitudinal subsample, with medium to large effect sizes (Cohen’s d = 0.41–0.66) observed for most domains, except for the psychological and social scores in the PROMIS + HF-10, which showed small change (Cohen’s d = 0.26–0.29). The Chinese versions of the PROMIS + HF-27 and PROMIS + HF-10 profiles demonstrate satisfactory psychometric properties, supporting their use for the comprehensive evaluation of HRQoL in Chinese HF patients. The PROMIS + HF-27 is recommended for academic research requiring high precision, whereas the PROMIS + HF-10 offers a time-efficient alternative for routine screening in clinical practice. Future research should further evaluate their predictive validity for long-term prognosis.