Validation of PROMIS anxiety item bank computer adaptive test among patients with heart failure

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.

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.

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.

These results support the validity and reliability of PROMIS-A CAT among patients hospitalized for HF.