About Heart Failure Self Test

If you have been diagnosed with heart failure, take this self-assessment test to find out if you're appropriate for early- or advanced-stage heart failure therapy.

Please read each question and provide a response. Be sure to answer all the questions to the best of your ability, (if you aren't sure of the answer, choose the answer that seems the most appropriate) The Heart Failure section of this website can help you if you are uncertain of how to answer some questions. When you submit your answers at the end you will receive feedback related to your specific condition. This does not constitute a diagnosis of any kind and you should always speak to a health care provider (or physician) before you begin any treatment regimen.

Click Here to order the advanced heart failure information kit


1. How far can you walk without shortness of breath?

Less than a block (For example: If you cannot carry groceries out to the car or walk up a flight of stairs)
Less than 1/2 mile (i.e. 5 blocks)
No Limit

2. How many times have you been admitted to the hospital as a result of your heart failure in the last 12 months?

Greater than one
One
None

3. Are currently taking a Diuretic (water pill) (for example, Lasix® or furosemide)?

Yes
No
Don't Know

4. Are you currently taking and ACE inhibitor and/or beta blocker (heart failure medication)?

Yes
No
Don't Know

5. Do you have a CRT device (cardiac resynchronization therapy) or biventricular pacemaker?

Yes
No
Don't Know

6. Have you been diagnosed with anemia?

Yes
No
Don't Know

7. Have you been told your kidneys are not working normally?

Yes
No
Don't Know

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