Heart failure (HF) is a significant public health challenge in Portugal. According to the recent PORTHOS study (Estudo de Prevalência de Insuficiência Cardíaca em Portugal), HF affects a significant proportion of the adult population >50 years of age (an estimated 16.5%).1 In 2014, HF accounted for 4.7% of all deaths in Portugal2 and was responsible for approximately 19000 hospitalizations nationwide.3 Due to the ominous burden of this dangerous clinical syndrome on the population, experts in Portugal have developed positions papers providing guidance on how best to manage these patients.4,5

Multiple interventions going beyond HF drugs are now offered nationwide to improve the prognosis of this population (reducing HF hospitalizations and, for subsets of patients, mortality), comprising, but not limited to, cardiac rehabilitation,6 discussion and management by multidisciplinary teams,7 and catheter ablation of atrial fibrillation.8 Auditing and local appraisal of services and results by each center is recommended as a part of continuous professional development and quality improvement but is only done sporadically. Hard clinical outcomes like all-cause mortality or hospitalizations may not always be feasible or may not be the best option in that setting. On the other hand, patient reported outcome measures are easy to obtain and provide a more reliable measure of patients’ views on the intervention and treatment they have received. A pragmatic and validated instrument like the Minnesota Living with Heart Failure Questionnaire is ideally suited for that purpose, but for validity purposes a Portuguese translation with an appropriately conducted validation processes is warranted.

In this issue of the Portuguese Journal of Cardiology, Marques et al. undertake this important task for the Portuguese cardiovascular community, utilizing data from a single-center prospective study with two samples of HF patients (294 patients in the validation sample), comprising both patients with reduced and preserved ejection fraction. Translation, cultural adaptation and validation of the Minnesota Living with Heart Failure Questionnaire were performed in the study.9 The Portuguese version of the questionnaire showed a reliable general factor and good internal consistency with all the scores strongly associated with New York Heart Association functional class, and other consensual tools utilized in the HF population, like the Borg fatigue score and the six-minute walking distance.

The authors deserve to be commended for their important contribution to the Portuguese cardiovascular community, as it is expected for this instrument to be widely used in the coming decades. The impact will be important, as it will facilitate the development of auditing, and quality assurance of HF services across the country.