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* 1. Are you...

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* 2. Are you...

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* 3. How old are you? (Select one option)

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* 4. Where do you live?

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* 6. Anxiety - On a scale of 0(No anxiety) to 10(high anxiety level), how do you rate your anxiety level about

0 Heart failure 10
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i We adjusted the number you entered based on the slider’s scale.

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* 7. Anxiety - On a scale of 0(No anxiety) to 10(high anxiety level), how do you rate your anxiety level about

0 COVID-19 10
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i We adjusted the number you entered based on the slider’s scale.

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* 8. Specifically related to the management of your heart failure, how many appointments were scheduled in the 12 weeks (since the outbreak of the COVID-19 pandemic)?

0 Quantity of appointments for your heart failure 10
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i We adjusted the number you entered based on the slider’s scale.

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* 9. Please select which of the following appointments /procedures, if any, were scheduled in the last 12 weeks (since the outbreak of the COVID-19 pandemic) Tick all that apply

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* 10. Have any of your scheduled heart failure appointments, investigations/operations been affected by the ongoing COVID-19 pandemic?

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* 11. What impact has the ongoing COVID-19 pandemic had on your hospital heart failure team appointment(s) select all that apply

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* 12. What impact has the ongoing COVID-19 pandemic had on your community heart failure team appointment(s) select all that apply

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* 13. Did you have a cardiac investigation/ procedure during the pandemic? (select all that apply)

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* 14. Did you have a cardiac investigation/ procedure cancelled with no postponement. (select all that apply)

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* 15. Did you have a cardiac investigation/ procedure postponed (select all that apply)

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* 16. What impact has the ongoing COVID-19 pandemic had on your heart failure counselling. (select all that apply)

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* 17. Has the prescription /monitoring of your heart failure medication been affected by the ongoing COVID-19 pandemic?

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* 18. Do you feel you can access your heart failure services promptly if your symptoms worsen?

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* 19. If you were offered a hospital outpatient consultation during the COVID-19 pandemic, how willing would you be to attend the hospital ? select one option

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* 20. Which of these service changes or new models of care would you like to see established/continue in your area? select all that apply

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* 21. Is there anything else you would like to tell us about your experiences through the COVID19 pandemic relating to your heart failure care and treatments?

0 of 21 answered
 

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