Abstract

Objectives

To explore the real-world reliability, validity, and applicability of the EuroQol 5-Dimension instrument (EQ-5D) in Chinese patients diagnosed with cardiovascular diseases.

Methods

A cross-sectional exploratory psychometric study was conducted at a Chinese tertiary hospital between April 2024 and April 2025, enrolling 314 hospitalized patients with atrial fibrillation, coronary artery disease, or heart failure. Health-related quality of life was assessed using the EQ-5D with 5 levels. Reliability was assessed by Cronbach’s alpha, and internal convergence by Spearman correlations between the utility index and visual analog scale. Multivariable regression identified patient characteristics associated with discrepancies between the utility index and normalized visual analog scale.

Results

Cronbach’s alpha values for atrial fibrillation, coronary artery disease, and heart failure were 0.750, 0.771, and 0.867, respectively. The Spearman correlation coefficients between the EQ-5D utility index and visual analog scale were 0.384, 0.443, and 0.445, respectively. Factor analysis suggested a stable 2-factor structure of EQ-5D for all groups. In atrial fibrillation, dyspnea (coefficient 0.105, P =.017) and heart failure (coefficient −0.138, P =.011) were associated with utility discrepancies, whereas in coronary artery disease, diabetes (coefficient 0.121, P =.023) was significant.

Conclusions

The EQ-5D appears to demonstrate acceptable reliability and validity in Chinese patients with heart failure, compared with atrial fibrillation and coronary artery disease. Disease-specific symptoms and comorbidities may influence the interpretability and accuracy of utility values measured by EQ-5D in patients with atrial fibrillation and coronary artery disease.