Psychometric evaluation of the Symptoms of Acute Coronary Syndromes Inventory in Chinese patients with acute coronary syndromes

Background: A systematic method of symptom assessment in patients with acute coronary syndromes is important for disease recognition and initiation of early treatment. However, such assessment in Chinese people is hindered by the lack of a psychometrically sound instrument. Aims: To develop the Chinese version of the Symptoms of Acute Coronary Syndromes Inventory (SACSI-C) and to evaluate its psychometric properties for Chinese patients. Methods: SACSI was translated from English into Chinese according to Brislin's model. Its content validity and face validity were evaluated. A sample of 114 acute coronary syndromes patients was recruited from the cardiac units of two hospitals in Hong Kong. The reliability was assessed by one-day test-retest reliability. The known-groups validity was evaluated by its ability to differentiate patients with typical versus atypical symptom presentation in older (>= 75 years) and younger (<75 years) groups. Results: The Item-Content Validity Index of the SACSI-C was computed as 0.88-1.00. The Scale-Content Validity Index was computed as 0.99. The intraclass correlation coefficients of all items of the symptom subscale were above 0.75, except for item 16. The kappa values of all items in the symptom location and quality subscales were above 0.663. The test-retest reliability was good. The known-groups validity was evident, as demonstrated by the results of Chi-square test (p=0.007) and logistic regression analysis (odds ratio=2.9, p=0.039), showing that older patients were significantly more likely to have atypical symptom presentation. Conclusion: The psychometric properties of the SACSI-C are satisfactory and could be used to assess acute coronary syndromes symptomatology in Chinese.