86923-0
Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
Active
Form Coding Instructions
The following questions refer to your heart failure and how it may affect your life. Please read and complete the following questions. There are no right or wrong answers. Please mark the answer that best applies to you
Source: John Spertus, MD, MPH86483-5 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, MPHFully-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
Long Common Name
Showering or bathing was limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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, MPHFully-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
Long Common Name
Walking 1 block on level ground was limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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, MPHFully-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
Long Common Name
Hurrying or jogging (as if to catch a bus) was limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
Swelling in your feet, ankles or legs when you woke up over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
Fatigue limited your ability to do what you wanted over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
Shortness of breath limited your ability to do what you wanted over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
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 [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
Enjoyment of life limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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
Long Common Name
How would you feel if you had to spend the rest of your life with your heart failure the way it is right now [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.61 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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, MPHFully-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
Long Common Name
Participation in hobbies, recreational activities limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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, MPHFully-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
Long Common Name
Participation in working or doing household chores limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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, MPHFully-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
Long Common Name
Participation in visiting family or friends out of your home limited by heart failure over the past 2 weeks [KCCQ]
Basic Attributes
- Class
- SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.61
- Last Updated
- Version 2.63 (MIN)
- Order vs. Observation
- Observation
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] |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org
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.
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 (ADD)
- 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 |
Copyright
- Organization
- John Spertus, MD, MPH
- Copyright
- Copyright © 1996-2005 John Spertus, MD, MPH.
- Terms of Use
- Used with permission.
- URL
- http://www.cvoutcomes.org