1. For how long have you been diagnosed with heart failure?

2. Etiology of heart failure

Hypertension: 1

Congenital heart disease: 2

Valve disease:3

Ischemic heart disease:4

Cardiomyopathy:6

other: specify

3. What is the current clinical stage according to the NYHA?

4. Type of heart failure depending on the cavity

Left heart failure: 1

Right heart failure: 2

Global heart failure :3

5. Number of hospitalization for heart failure during the last 12 months

6. What medications are you currently taking?