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Cardiac Quality of Life Questionnaire

Improve patient care with our Cardiac Quality of Life Questionnaire, designed to assess physical, emotional, and social well-being in heart disease patients. Our comprehensive tool provides valuable insights for healthcare providers to tailor treatment plans and enhance overall quality of life. Take the first step towards better cardiac care today.

3 minutes to complete

Questions for Cardiac Quality of Life Questionnaire

Questions

1.

What is your age?

The answer should be a single choice:
  1. Under 18
  2. 18–24
  3. 25–34
  4. 35–44
  5. 45–54
  6. 55–64
  7. 65 or older
2.

What is your gender?

The answer should be a single choice:
  1. Male
  2. Female
  3. Prefer not to say
3.

How would you rate your overall physical health in the past month?

The answer should be a single choice:
  1. Excellent
  2. Very good
  3. Good
  4. Fair
  5. Poor
4.

How often have you experienced shortness of breath during daily activities?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
5.

In the past month, how frequently have you felt fatigued or tired?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
6.

How much has your heart condition limited your ability to perform daily activities?

The answer should be a single choice:
  1. Not at all
  2. Slightly
  3. Moderately
  4. Very much
  5. Extremely
7.

How would you describe your emotional well-being over the past month?

The answer should be a single choice:
  1. Very good
  2. Good
  3. Neutral
  4. Poor
  5. Very poor
8.

Have you felt discouraged or downhearted due to your health in the past month?

The answer should be a single choice:
  1. Yes
  2. No
  3. Not sure
9.

How satisfied are you with your current health care and management of your heart condition?

The answer should be a single choice:
  1. Very satisfied
  2. Satisfied
  3. Neutral
  4. Dissatisfied
  5. Very dissatisfied
10.

How often do you engage in physical activity or exercise?

The answer should be a single choice:
  1. Daily
  2. 3-4 times a week
  3. 1-2 times a week
  4. Rarely or never
11.

What is your level of concern about your heart condition affecting your quality of life?

The answer should be a rating.
12.

How often do you feel anxious about your heart health?

The answer should be a single choice:
  1. Never
  2. Rarely
  3. Sometimes
  4. Often
  5. Always
13.

How well do you understand your treatment plan and health goals?

The answer should be a single choice:
  1. Very well
  2. Somewhat well
  3. Not well at all
  4. I have not been provided with a treatment plan or health goals

Scales Similar to Cardiac Quality of Life Questionnaire

  • Cardiac Health Assessment Scale
  • Cardiovascular Quality of Life Inventory
  • Heart Function and Well-being Questionnaire
  • Cardiac Symptom Impact Scale
  • Cardiopulmonary Quality of Life Questionnaire
  • Heart Disease Quality of Life Measure

Here are some FAQs and additional information
on
Cardiac Quality of Life Questionnaire

What is the Cardiac Quality of Life Questionnaire?

The Cardiac Quality of Life Questionnaire is a tool used to assess the impact of cardiac conditions on a person's quality of life.

Is the Cardiac Quality of Life Questionnaire a reliable measure?

Yes, the Cardiac Quality of Life Questionnaire has been validated and shown to be a reliable measure of quality of life in cardiac patients.

How is the Cardiac Quality of Life Questionnaire used in clinical practice?

The Cardiac Quality of Life Questionnaire is used by healthcare providers to assess the impact of cardiac conditions on a patient's quality of life and to guide treatment decisions.

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