以下问题是在最近一个月(4 周)内,您的心力衰竭(心脏状况)对您生活的影响
阅读完每个问题后,在结果的选项0,1, 2,3,4, 5 上划圈,表明您日常生活受到的影响程度
如果问题不适合您,在0上划圈
The following questions ask how much your heart failure (heart condition) affected your life during the past month (4 weeks)
After each question, circle the 0, 1, 2, 3, 4 or 5 to show how much your life was affected
If a question does not apply to you, circle the 0 after that question
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LIVING WITH HEART FAILURE
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1986 Regents of the University of Minnesota, All rights reserved
Do not copy or reproduce without permission
LIVING WITH HEART FAILURE
is a registered trademark of the Regents of the University of Minnesota
数据收集和评分说明Instructions for Data Collection and Scoring:
应在被调查者进行其他评定之前完成本表,否则有可能影响调查
你应当告诉被调查者,在你做出医疗评定之前,你希望得到他或她的意见