Did any physician or nurse practitioner recently prescribe different medications for you or change the dose of your medications?
Do you take any over-the-counter medications or herbal supplements?
Do you sleep in bed or in a chair?
Activity
How far can you walk?
Can you dress, bathe, prepare food, and climb stairs without stopping to rest?
What activities could you do recently but not now because of worsened symptoms?
Have you decreased your activity level?
Other
Do you have difficulty remembering information or do you have feelings of confusion?
Have you had other health problems that may make your heart failure worse?