Hurdle

Kansas City Cardiomyopathy Questionnaire - 12

screening

Digital administration of Kansas City Cardiomyopathy Questionnaire - 12 to collect structured patient inputs for validated score calculation and clinical follow-up.

Kansas City Cardiomyopathy Questionnaire - 12

Clinical intent

The Kansas City Cardiomyopathy Questionnaire (KCCQ), a commonly used instrument for measuring health status in patients with heart faliure. It has excellent psychometric properties and the first version was 23-items long [1]. To support its use in clincial care, creating a shorter and simplear meassure was needed [2]. Therfore, the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) created [3].

References

[1] Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000 Apr;35(5):1245-55. doi: 10.1016/s0735-1097(00)00531-3. PMID: 10758967. [2] Rumsfeld JS. Health status and clinical practice: when will they meet? Circulation. 2002 Jul 2;106(1):5-7. doi: 10.1161/01.cir.0000020805.31531.48. PMID: 12093759. [3] Spertus JA, Jones PG. Development and Validation of a Short Version of the Kansas City Cardiomyopathy Questionnaire. Circ Cardiovasc Qual Outcomes. 2015 Sep;8(5):469-76. doi: 10.1161/CIRCOUTCOMES.115.001958. PMID: 26307129; PMCID: PMC4885562.

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Interactive preview of the questionnaire. Not for clinical use. Responses are not stored.

Kansas City Cardiomyopathy Questionnaire - 12 Questionnaire
Please complete this questionnaire. Your responses help your clinical team assess your symptoms and monitor progress over time.
Showering/bathing
Walking 1 block on level ground
Hurrying or jogging (as if to catch a bus)
Over the past 2 weeks, how many times did you have swelling in your feet, ankles or legs when you woke up in the morning?
Over the past 2 weeks, on average, how many times has fatigue limited your ability to do what you wanted?
Over the past 2 weeks, on average, how many times has shortness of breath limited your ability to do what you wanted?
Over the past 2 weeks, on average, how many times have you been forced to sleep sitting up in a chair or with at least 3 pillows to prop you up because of shortness of breath?
Over the past 2 weeks, how much has your heart failure limited your enjoyment of life?
If you had to spend the rest of your life with your heart failure the way it is right now, how would you feel about this?
How much does your heart failure affect your lifestyle? Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks: Hobbies, recreational activities
Working or doing household chores
Visiting family or friends out of your home