Version 2.78

86483-5 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Showering or bathing

Observation ID in Form

1a

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Showering or bathing was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Showering or bathing
Source
KCCQ_Q1b

Normative Answer List LL4532-9

Answer Code Score Answer ID
Extremely limited 1 LA27701-4
Quite a bit limited 2 LA27702-2
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Not at all limited 5 LA27707-1
Limited for other reasons or did not do the activity 6 LA27708-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86474-4 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Walking 1 block on level ground

Observation ID in Form

1b

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Walking 1 block on level ground was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Walking 1 block on level ground
Source
KCCQ_Q1c

Normative Answer List LL4532-9

Answer Code Score Answer ID
Extremely limited 1 LA27701-4
Quite a bit limited 2 LA27702-2
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Not at all limited 5 LA27707-1
Limited for other reasons or did not do the activity 6 LA27708-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86477-7 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Hurrying or jogging (as if to catch a bus)

Observation ID in Form

1c

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Hurrying or jogging (as if to catch a bus) was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Hurrying or jogging (as if to catch a bus)
Source
KCCQ_Q1f

Normative Answer List LL4532-9

Answer Code Score Answer ID
Extremely limited 1 LA27701-4
Quite a bit limited 2 LA27702-2
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Not at all limited 5 LA27707-1
Limited for other reasons or did not do the activity 6 LA27708-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86479-3 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?

Observation ID in Form

2

Observation Required in Panel

Required

Fully-Specified Name

Component
Swelling in your feet, ankles or legs when you woke up over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
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?
Source
KCCQ_3

Normative Answer List LL4534-5

Answer Code Score Answer ID
Every morning 1 LA27719-6
3 or more times a week, but not every day 2 LA27720-4
1-2 times a week 3 LA14506-2
Less than once a week 4 LA27722-0
Never over the past 2 weeks 5 LA27723-8

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86481-9 Over the past 2 weeks, on average, how many times has fatigue limited your ability to do what you want?

Observation ID in Form

3

Observation Required in Panel

Required

Fully-Specified Name

Component
Fatigue limited your ability to do what you wanted over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
Over the past 2 weeks, on average, how many times has fatigue limited your ability to do what you want?
Source
KCCQ_5

Normative Answer List LL4536-0

Answer Code Score Answer ID
All of the time 1 LA6154-4
Several times per day 2 LA27729-5
At least once a day 3 LA27730-3
3 or more times per week but not every day 4 LA27770-9
1-2 times per week 5 LA13834-9
Less than once a week 6 LA27722-0
Never over the past 2 weeks 7 LA27723-8

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86472-8 Over the past 2 weeks, on average, how many times has shortness of breath limited your ability to do what you wanted?

Observation ID in Form

4

Observation Required in Panel

Required

Fully-Specified Name

Component
Shortness of breath limited your ability to do what you wanted over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
Over the past 2 weeks, on average, how many times has shortness of breath limited your ability to do what you wanted?
Source
KCCQ_7

Normative Answer List LL4536-0

Answer Code Score Answer ID
All of the time 1 LA6154-4
Several times per day 2 LA27729-5
At least once a day 3 LA27730-3
3 or more times per week but not every day 4 LA27770-9
1-2 times per week 5 LA13834-9
Less than once a week 6 LA27722-0
Never over the past 2 weeks 7 LA27723-8

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86485-0 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?

Observation ID in Form

5

Observation Required in Panel

Required

Fully-Specified Name

Component
Sleep sitting up in a chair or with at least 3 pillows to prop you up because of shortness of breath over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
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?
Source
KCCQ_9

Normative Answer List LL4539-4

Answer Code Score Answer ID
Every night 1 LA14806-6
3 or more times a week, but not every day 2 LA27720-4
1-2 times a week 3 LA14506-2
Less than once a week 4 LA27722-0
Never over the past 2 weeks 5 LA27723-8

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86488-4 Over the past 2 weeks, how much has your heart failure limited your enjoyment of life?

Observation ID in Form

6

Observation Required in Panel

Required

Fully-Specified Name

Component
Enjoyment of life limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
Over the past 2 weeks, how much has your heart failure limited your enjoyment of life?
Source
KCCQ_12

Normative Answer List LL4542-8

Answer Code Score Answer ID
It has extremely limited my enjoyment of life 1 LA27745-1
It has limited my enjoyment of life quite a bit 2 LA27746-9
It has moderately limited my enjoyment of life 3 LA27747-7
It has slightly limited my enjoyment of life 4 LA27748-5
It has not limited my enjoyment of life at all 5 LA27749-3

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86489-2 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?

Observation ID in Form

7

Observation Required in Panel

Required

Fully-Specified Name

Component
How would you feel if you had to spend the rest of your life with your heart failure the way it is right now
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61
Order vs. Observation
Observation

Survey Question

Text
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?
Source
KCCQ_13

Normative Answer List LL4543-6

Answer Code Score Answer ID
Not at all satisfied 1 LA27750-1
Mostly dissatisfied 2 LA24976-5
Somewhat satisfied 3 LA27752-7
Mostly satisfied 4 LA24974-0
Completely satisfied 5 LA27754-3

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86491-8 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Hobbies, recreational activities

Observation ID in Form

8a

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in hobbies, recreational activities limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Hobbies, recreational activities
Source
KCCQ_15a

Normative Answer List LL4545-1

Answer Code Score Answer ID
Severely limited 1 LA27761-8
Limited quite a bit 2 LA27760-0
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Did not limit at all 5 LA27764-2
Does not apply or did not do for other reasons 6 LA27765-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86492-6 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Working or doing household chores

Observation ID in Form

8b

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in working or doing household chores limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Working or doing household chores
Source
KCCQ_15b

Normative Answer List LL4545-1

Answer Code Score Answer ID
Severely limited 1 LA27761-8
Limited quite a bit 2 LA27760-0
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Did not limit at all 5 LA27764-2
Does not apply or did not do for other reasons 6 LA27765-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86493-4 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Visiting family or friends out of your home

Observation ID in Form

8c

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in visiting family or friends out of your home limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63
Order vs. Observation
Observation

Survey Question

Text
Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Visiting family or friends out of your home
Source
KCCQ_15c

Normative Answer List LL4545-1

Answer Code Score Answer ID
Severely limited 1 LA27761-8
Limited quite a bit 2 LA27760-0
Moderately limited 3 LA6460-5
Slightly limited 4 LA9605-2
Did not limit at all 5 LA27764-2
Does not apply or did not do for other reasons 6 LA27765-9

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9 Kansas City Cardiomyopathy Questionnaire [KCCQ]

86924-8 Overall summary score [KCCQ-12]

Term Description

KCCQ-12 overall summary score is the sum of responses from all 12 items, with lower scores indicating more significant disease impact. Changes in the summary score are predictive of changes in health status for patients with heart failure.
Source: Regenstrief LOINC

Fully-Specified Name

Component
Overall summary score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ-12

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.63
Last Updated
Version 2.63
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
86923-0 Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]

Example Units

Unit Source
{score} Example UCUM Units