Table 3.

Tools to measure patient reported health-related quality of life outcomes.

Tool	Description	Pros	Cons	Other forms	Relevance to CAD
SF 36 (Short Form Health Survey) (147)	A 36-item, patient-reported survey of patient health. Measures eight health domains: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health.	Widely used and validated (145), including in older patients (148). Sensitive to changes in health status. Includes the notion of positive health. Can be used in cost-utility studies (149).	Can be time-consuming for patients. May be less sensitive to specific disease-related issues as the scoring is done in two major groups: physical health and mental health and the scores cannot be combined to get one health index.	Multiple shorter sub-sets have been validated with similar efficacy: SF-12 (150–152), SF-8, and SF-6D. SF-12 has been validated in CAD patients (153).	SF-36 has been validated in multiple studies for CAD patients (154, 155). More floor effect in CVD patients: is more sensitive in milder forms of the disease (156).
EQ -5D- 5l (EuroQol five dimensions questionnaire) (157)	A standardized instrument for measuring generic health status. Represents 5 health domains: Pain, mood, mobility, self-care and daily activities.	Simple and quick to complete. Generates a self-rated assessment of health status on a visual analog scale. Provides a single index value, and utility values with a higher range. Suitable for cost-effectiveness studies, and cost-utility analysis.	Limited sensitivity to small changes in health status. Higher ceiling effects.	EQ-5D-3l is shorter version	Validated for reliability in CAD. Most commonly used preference-based measure in CAD studies (155, 158). A higher ceiling effect in CVD patients is noted (156, 159, 160).
SIP (Sickness Impact Profile) (161)	Is a descriptive analysis with 3 major groups and 12 categories. The major domains assessed are physical dimension, psychosocial dimension and independent categories such as sleep, eating work.	Can be done both by healthcare worker, patients themselves as well as patient proxy	Complex, tedious.	Shorter version: SIP 68	Although generic, has been used in CAD patients, although not extensively (162).
HUI-III (Health Utilities Index—III) (144)	Eight components are assessed: vision, hearing, speech, ambulation, dexterity, emotion, cognition, pain	Can be both self-administered and conducted via interviews. Provides a single index value. Can be used for cost-utility, health-utility measures.	Does not include any geriatric syndrome. More focused on functional status.	Older versions include HUI 1, HUI 2	Validated in CAD patients
QWB (Quality of Well Being Scale)-Self administered (163)	Includes five sections: presence/absence of chronic disease which include acute physical symptoms as well as mental health symptoms and behaviors; mobility; physical activity and social activity	Responsive to change resulting from treatment interventions	Lengthy and time consuming to complete, about 10–15 min.	–	The QWB can be used to measure health-related quality of life in CAD patients, including the impact of physical and social activities (146, 164).
NHP (Nottingham Health Profile)	Comprised of two parts- the first part asks yes/no questions on six scales: mobility, pain, energy, sleep, emotional reactions, and social isolation; second part assesses the effects of each on domains of daily living	Simple and quick.	Has not yet been validated specifically in elderly patients. Does not provide a comprehensive health assessment. Higher floor and ceiling effects (165).	–	May be inconsistent in grading symptoms of angina and the health burden of severe symptoms (145, 166).
COOP/WONCA charts (The Dartmouth COOP Functional Health Assessment Charts/WONCA) (167)	Set of visual charts that assess the following domains: physical fitness, feelings, daily activities, social activities, changes in health, overall health, and pain.	Validated in elderly population (168). Simple to use and low burden on respondents. Visual format can be helpful for those with literacy barriers.	Less comprehensive than other tools. May have limited sensitivity to small changes	–	Have not been extensively tested in CAD patients.

CAD, coronary artery disease; CVD, cardiovascular diseases; EQ Instrument, Euro-quality of life; SF, short form health survey.