Key result
The PROMIS-A CAT demonstrated strong convergent validity with the GAD-7 (rho = 0.78) and excellent discrimination (AUROC 0.885) for detecting moderate to severe anxiety in hospitalized heart failure patients.
Why the study?
Anxiety is highly prevalent and negatively affects health-related quality of life in heart failure, prompting the need to assess the construct validity and reliability of the PROMIS-Anxiety computer adaptive test in hospitalized patients.
Is the PROMIS-Anxiety CAT a valid and reliable tool for assessing anxiety in patients hospitalized for heart failure compared to GAD-7?
Cross-Sectional (n=333)
Yes
Is the PROMIS-Anxiety CAT a valid and reliable tool for assessing anxiety in patients hospitalized for heart failure compared to GAD-7?
Effect estimate: rho 0.78 (95% CI 0.73-0.82)
p-value: p=<0.001
The PROMIS-Anxiety CAT is a valid and reliable tool for assessing anxiety in patients hospitalized for heart failure, with a T-score of 60 identifying moderate/severe anxiety.
PROMIS-Anxiety CAT shows validity and reliability in hospitalized HF; supports anxiety assessment but leaves open prospective validation before routine clinical use.
Introduction Anxiety is highly prevalent among patients with heart failure (HF), negatively affecting health related quality of life (HRQOL). The Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety item bank computer adaptive testing (CAT) precisely assesses anxiety symptom severity. This study aims to assess construct validity and reliability of PROMIS-Anxiety CAT among patients hospitalized for HF. Methods A cross-sectional convenience sample of adult patients hospitalized for HF, who completed PROMIS-A CAT, generalized anxiety disorder 7 (GAD-7), and other questionnaires electronically. Convergent validity was assessed by Spearman's rank correlation between PROMIS-A CAT, GAD-7, and other legacy measures. Known group analysis compared PROMIS-A CAT and GAD-7 scores between groups expected to have different levels of anxiety. Reliability of PROMIS-A CAT was calculated on the individual and group level from standard error of measurement, according to item response theory. Area under receiver-operating characteristics (ROC) curve and Youden's J statistic were used to identify a T -score cut-off for moderate/severe anxiety. Results Of 333 participants, 87 (26%) had moderate/severe anxiety based on GAD-7 score (≥ 10). Participants completed on average (median [IQR]) 4(1) vs. 7(0) items, with PROMIS-A CAT and GAD-7, respectively. PROMIS-A CAT T -scores were strongly correlated with GAD-7 scores (rho = 0.78) and moderately correlated with other legacy measures. Known-group analysis provided further support for construct validity of PROMIS-A CAT. Individual reliability for PROMIS-A CAT T -scores was >0.9 for 87% of the sample; mean reliability was 0.91. Based on ROC and Youden's J analyses, a T -score of 60 can be used to identify individuals with moderate/severe anxiety. Conclusion These results support the validity and reliability of PROMIS-A CAT among patients hospitalized for HF.
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Marblestone et al. (2025) conducted a cross-sectional in Heart failure (n=333). PROMIS-A CAT vs. GAD-7 was evaluated on Convergent validity (correlation with GAD-7) (rho 0.78, 95% CI 0.73-0.82, p=<0.001). The PROMIS-A CAT demonstrated strong convergent validity with the GAD-7 (rho = 0.78) and excellent discrimination (AUROC 0.885) for detecting moderate to severe anxiety in hospitalized heart failure patients.
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