Page 1: Do you live with a heart condition called Heart Failure?

Do you live with a heart condition called Heart Failure?

This means that your heart pump is weak.

We want to find out what questions you have to help people who have problems with their heart pump.

What do you want to know about when things go wrong with your heart pump?

 

Click on the MORE INFO button for helpful pictures.

 

You do not have to fill out this form.

1.1. Do you have any questions about how your body may be feeling when you are not well? Please tick any you would like to know about.

Not sleeping

 

Feeling tired

 

What can I do if my feet/legs swell

Feeling short of breath

 

(Other) Any other questions?

 

2.2. Do you have any questions about how your heart pump not working makes your feel? Please tick important ones.

Feeling low

Feeling angry

Feeling worried

(Other) Any other questions?

 

3.3. Do you want to know more about ways you can be helped to feel better? Please tick the ones that you would like to ask questions about.

Taking tablets

What treatments can I have

Seeing a nurse

Seeing a doctor

What exercise can I do

How can I stay out of hospital

Talking to someone about your feelings

Talking about what happens if things get worse

(Other) Any other questions