survey_name survey_version question_name question_text mandatory? answer_type answer_text
3-Question Monthly Survey 1 weight What is your CURRENT weight (in pounds)? True integer |pounds
sob_level-1 In thinking about your breathing, and any difficulties you may have with your breathing, what level of difficulty best describes your breathing normally over the past month? True Select one I only get breathless with strenuous exercise
sob_level-2 I get short of breath when hurrying on level ground or walking up a slight hill
sob_level-3 On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace
sob_level-4 I stop for breath after walking about 100 yards or after a few minutes on level ground
sob_level-5 I am too breathless to leave the house or I am breathless when dressing
swelling_morning-1 Over the PAST 2 WEEKS, how many times did you have SWELLING in your feet, ankles or legs when you woke up in the morning? True Select one Every morning
swelling_morning-2 3 or more times a week, but not every day
swelling_morning-3 1-2 times a week
swelling_morning-4 Less than once a week
swelling_morning-5 Never over the past 2 weeks
2 weight What is your CURRENT weight (in pounds)? True integer |pounds
sob_level-1 In thinking about your breathing, and any difficulties you may have with your breathing, what level of difficulty best describes your breathing normally over the past month? True Select one I only get breathless with strenuous exercise
sob_level-2 I get short of breath when hurrying on level ground or walking up a slight hill
sob_level-3 On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace
sob_level-4 I stop for breath after walking about 100 yards or after a few minutes on level ground
sob_level-5 I am too breathless to leave the house or I am breathless when dressing
swelling_morning-1 Over the PAST 2 WEEKS, how many times did you have SWELLING in your feet, ankles or legs when you woke up in the morning? True Select one Every morning
swelling_morning-2 3 or more times a week, but not every day
swelling_morning-3 1-2 times a week
swelling_morning-4 Less than once a week
swelling_morning-5 Never over the past 2 weeks
6MWT Documentation Coordinator Form 1 6mwt_tech Who performed the 6MWT? True string String
6mwt_exclusion-equip Exclude the participant from the 6MWT if: True Select any Use of wheelchair
6mwt_exclusion-walk nability to walk because of musculoskeletal problems
6mwt_exclusion-hr Heart rate of less than 50 or more than 110 beats per minute at rest
6mwt_exclusion-bp Systolic blood pressure of >180 OR diastolic blood pressure of >110
6mwt_exclusion-pain Chest pain within the past four weeks
6mwt_exclusion-symptoms New or worsening symptoms of chest pain, shortening of breath, or fainting in the past 8 weeks
6mwt_exclusion-none None of the above (include)
6mwt_exclusion_bp-excl_systolic Is systolic or diastolic blood pressure the reason for exclusion? True Select one Systolic Blood Pressure
6mwt_exclusion_bp-excl_diastolic Diastolic Blood Pressure
6mwt_exclusion_bp-excl_bothbp Both Systolic AND Diastolic Blood Pressure
6mwt_exclusion_sbp Systolic blood pressure: True integer Integer
6mwt_exclusion_dbp Diastolic blood pressure: True integer Integer
6mwt_comp-comp 6MWT Results: True Select one Complete
6mwt_comp-incomp Incomplete
6mwt_comp-nd Not done
6mwt_comp_reason-equip Reason incomplete or not done: True Select any Equipment malfunction
6mwt_comp_reason-physically Participant physically unable to continue
6mwt_comp_reason-refused Participant refused
6mwt_comp_reason-oth Other
6mwt_comp_other What was the ‘other’ reason the 6MWT was incomplete or not done? True text Text
6mwt_suppl_o2-suppl_o2_yes Supplemental oxygen during the test? True Select one Yes
6mwt_suppl_o2-suppl_o2_no No
6mwt_suppl_o2_rate Rate of oxygen (L/min): True float Float
6mwt_suppl_o2_type Type of oxygen: True text Text
6mwt_base_hr Baseline Heart Rate True integer Integer
6mwt_base_spo2 Baseline SpO2 True integer |%
6mwt_base_borg_breath-0 Pre‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_base_borg_breath-1 1 – Very slight
6mwt_base_borg_breath-2 2 – Slight (light)
6mwt_base_borg_breath-3 3 – Moderate
6mwt_base_borg_breath-4 4 – Somewhat severe
6mwt_base_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_breath-5 5 – Severe (heavy)
6mwt_base_borg_breath-6 6 – Severe (heavy)
6mwt_base_borg_breath-7 7 – Very severe
6mwt_base_borg_breath-8 8 – Very severe
6mwt_base_borg_breath-9 9 – Very severe
6mwt_base_borg_breath-10 10 – very, very severe (maximal)
6mwt_base_borg_fatigue-0 Pre‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_base_borg_fatigue-1 1 – Very slight
6mwt_base_borg_fatigue-2 2 – Slight (light)
6mwt_base_borg_fatigue-3 3 – Moderate
6mwt_base_borg_fatigue-4 4 – Somewhat severe
6mwt_base_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_fatigue-5 5 – Severe (heavy)
6mwt_base_borg_fatigue-6 6 – Severe (heavy)
6mwt_base_borg_fatigue-7 7 – Very severe
6mwt_base_borg_fatigue-8 8 – Very severe
6mwt_base_borg_fatigue-9 9 – Very severe
6mwt_base_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_borg_admin-borg_self Borg questions: True Select one Self-administered
6mwt_borg_admin-borg_intvw Interviewer-administered
6mwt_borg_admin_name Name of interviewer who administered the Borg questions? True string String
6mwt_datetime_start What date and time did the 6MWT begin? True datetime Datetime
6mwt_datetime_end What date and time did the 6MWT end? True datetime Datetime
6mwt_stopped-yes Stopped or paused before 6 minutes? True Select one Yes
6mwt_stopped-no No
6mwt_stopped_reason Reason the test stopped or paused before 6 minutes: True text Text
6mwt_complete_laps Number of <u>complete</u> laps (x 40 meters): True integer Integer
6mwt_complete_markers Number of additional markers (1 marker = 2 meters): True integer Integer
6mwt_total_distance Total distance walked in 6 minutes: True float |meters
6mwt_post_hr Post-walk Heart Rate True integer Integer
6mwt_post_spo2 Post-walk SpO2 True integer |%
6mwt_post_borg_breath-0 Post‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_post_borg_breath-1 1 – Very slight
6mwt_post_borg_breath-2 2 – Slight (light)
6mwt_post_borg_breath-3 3 – Moderate
6mwt_post_borg_breath-4 4 – Somewhat severe
6mwt_post_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_breath-5 5 – Severe (heavy)
6mwt_post_borg_breath-6 6 – Severe (heavy)
6mwt_post_borg_breath-7 7 – Very severe
6mwt_post_borg_breath-8 8 – Very severe
6mwt_post_borg_breath-9 9 – Very severe
6mwt_post_borg_breath-10 10 – very, very severe (maximal)
6mwt_post_borg_fatigue-0 Post‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_post_borg_fatigue-1 1 – Very slight
6mwt_post_borg_fatigue-2 2 – Slight (light)
6mwt_post_borg_fatigue-3 3 – Moderate
6mwt_post_borg_fatigue-4 4 – Somewhat severe
6mwt_post_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_fatigue-5 5 – Severe (heavy)
6mwt_post_borg_fatigue-6 6 – Severe (heavy)
6mwt_post_borg_fatigue-7 7 – Very severe
6mwt_post_borg_fatigue-8 8 – Very severe
6mwt_post_borg_fatigue-9 9 – Very severe
6mwt_post_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_post_symptoms-post_pain_chest Other symptoms at the end of exercise: True Select any Chest pain
6mwt_post_symptoms-post_pain_calf Calf pain
6mwt_post_symptoms-post_dizziness Dizziness
6mwt_post_symptoms-post_pain_leg Leg pain
6mwt_post_symptoms-post_pain_hip Hip pain
6mwt_post_symptoms-oth Other
6mwt_post_symptoms-none None
6mwt_post_symptoms_other List other/additional symptoms experienced at the end of exercise: True text Text
2 6mwt_tech Who performed the 6MWT? True string String
6mwt_exclusion-equip Exclude the participant from the 6MWT if: True Select any Use of wheelchair
6mwt_exclusion-walk Inability to walk because of musculoskeletal problems
6mwt_exclusion-hr Heart rate of less than 50 or more than 110 beats per minute at rest
6mwt_exclusion-bp Systolic blood pressure of >180 OR diastolic blood pressure of >110
6mwt_exclusion-pain Chest pain within the past four weeks
6mwt_exclusion-symptoms New or worsening symptoms of chest pain, shortening of breath, or fainting in the past 8 weeks
6mwt_exclusion-none None of the above (include)
6mwt_exclusion_bp-excl_systolic Is systolic or diastolic blood pressure the reason for exclusion? True Select one Systolic Blood Pressure
6mwt_exclusion_bp-excl_diastolic Diastolic Blood Pressure
6mwt_exclusion_bp-excl_bothbp Both Systolic AND Diastolic Blood Pressure
6mwt_exclusion_sbp Systolic blood pressure: True integer Integer
6mwt_exclusion_dbp Diastolic blood pressure: True integer Integer
6mwt_comp-comp 6MWT Results: True Select one Complete
6mwt_comp-incomp Incomplete
6mwt_comp-nd Not done
6mwt_comp_reason-equip Reason incomplete or not done: True Select any Equipment malfunction
6mwt_comp_reason-physically Participant physically unable to continue
6mwt_comp_reason-refused Participant refused
6mwt_comp_reason-oth Other
6mwt_comp_other What was the ‘other’ reason the 6MWT was incomplete or not done? True text Text
6mwt_suppl_o2-suppl_o2_yes Supplemental oxygen during the test? True Select one Yes
6mwt_suppl_o2-suppl_o2_no No
6mwt_suppl_o2_rate Rate of oxygen (L/min): True float Float
6mwt_suppl_o2_type Type of oxygen: True text Text
6mwt_base_hr Baseline Heart Rate True integer Integer
6mwt_base_spo2 Baseline SpO2 True integer |%
6mwt_base_borg_breath-0 Pre‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_base_borg_breath-1 1 – Very slight
6mwt_base_borg_breath-2 2 – Slight (light)
6mwt_base_borg_breath-3 3 – Moderate
6mwt_base_borg_breath-4 4 – Somewhat severe
6mwt_base_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_breath-5 5 – Severe (heavy)
6mwt_base_borg_breath-6 6 – Severe (heavy)
6mwt_base_borg_breath-7 7 – Very severe
6mwt_base_borg_breath-8 8 – Very severe
6mwt_base_borg_breath-9 9 – Very severe
6mwt_base_borg_breath-10 10 – very, very severe (maximal)
6mwt_base_borg_fatigue-0 Pre‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_base_borg_fatigue-1 1 – Very slight
6mwt_base_borg_fatigue-2 2 – Slight (light)
6mwt_base_borg_fatigue-3 3 – Moderate
6mwt_base_borg_fatigue-4 4 – Somewhat severe
6mwt_base_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_fatigue-5 5 – Severe (heavy)
6mwt_base_borg_fatigue-6 6 – Severe (heavy)
6mwt_base_borg_fatigue-7 7 – Very severe
6mwt_base_borg_fatigue-8 8 – Very severe
6mwt_base_borg_fatigue-9 9 – Very severe
6mwt_base_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_borg_admin-borg_self Borg questions: True Select one Self-administered
6mwt_borg_admin-borg_intvw Interviewer-administered
6mwt_borg_admin_name Name of interviewer who administered the Borg questions? True string String
6mwt_datetime_start What date and time did the 6MWT begin? True datetime Datetime
6mwt_datetime_end What date and time did the 6MWT end? True datetime Datetime
6mwt_stopped-yes Stopped or paused before 6 minutes? True Select one Yes
6mwt_stopped-no No
6mwt_stopped_reason Reason the test stopped or paused before 6 minutes: True text Text
6mwt_complete_laps Number of <u>complete</u> laps (x 40 meters): True integer Integer
6mwt_complete_markers Number of additional markers (1 marker = 2 meters): True integer Integer
6mwt_total_distance Total distance walked in 6 minutes: True float |meters
6mwt_post_hr Post-walk Heart Rate True integer Integer
6mwt_post_spo2 Post-walk SpO2 True integer |%
6mwt_post_borg_breath-0 Post‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_post_borg_breath-1 1 – Very slight
6mwt_post_borg_breath-2 2 – Slight (light)
6mwt_post_borg_breath-3 3 – Moderate
6mwt_post_borg_breath-4 4 – Somewhat severe
6mwt_post_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_breath-5 5 – Severe (heavy)
6mwt_post_borg_breath-6 6 – Severe (heavy)
6mwt_post_borg_breath-7 7 – Very severe
6mwt_post_borg_breath-8 8 – Very severe
6mwt_post_borg_breath-9 9 – Very severe
6mwt_post_borg_breath-10 10 – very, very severe (maximal)
6mwt_post_borg_fatigue-0 Post‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_post_borg_fatigue-1 1 – Very slight
6mwt_post_borg_fatigue-2 2 – Slight (light)
6mwt_post_borg_fatigue-3 3 – Moderate
6mwt_post_borg_fatigue-4 4 – Somewhat severe
6mwt_post_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_fatigue-5 5 – Severe (heavy)
6mwt_post_borg_fatigue-6 6 – Severe (heavy)
6mwt_post_borg_fatigue-7 7 – Very severe
6mwt_post_borg_fatigue-8 8 – Very severe
6mwt_post_borg_fatigue-9 9 – Very severe
6mwt_post_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_post_symptoms-post_pain_chest Other symptoms at the end of exercise: True Select any Chest pain
6mwt_post_symptoms-post_pain_calf Calf pain
6mwt_post_symptoms-post_dizziness Dizziness
6mwt_post_symptoms-post_pain_leg Leg pain
6mwt_post_symptoms-post_pain_hip Hip pain
6mwt_post_symptoms-oth Other
6mwt_post_symptoms-none None
6mwt_post_symptoms_other List other/additional symptoms experienced at the end of exercise: True text Text
3 6mwt_tech Who performed the 6MWT? False string String
6mwt_exclusion-equip Exclude the participant from the 6MWT if: False Select any Use of wheelchair
6mwt_exclusion-walk nability to walk because of musculoskeletal problems
6mwt_exclusion-hr Heart rate of less than 50 or more than 110 beats per minute at rest
6mwt_exclusion-bp Systolic blood pressure of >180 OR diastolic blood pressure of >110
6mwt_exclusion-pain Chest pain within the past four weeks
6mwt_exclusion-symptoms New or worsening symptoms of chest pain, shortening of breath, or fainting in the past 8 weeks
6mwt_exclusion-none None of the above (include)
6mwt_exclusion_bp-excl_systolic Is systolic or diastolic blood pressure the reason for exclusion? False Select one Systolic Blood Pressure
6mwt_exclusion_bp-excl_diastolic Diastolic Blood Pressure
6mwt_exclusion_bp-excl_bothbp Both Systolic AND Diastolic Blood Pressure
6mwt_exclusion_sbp Systolic blood pressure: False integer Integer
6mwt_exclusion_dbp Diastolic blood pressure: False integer Integer
6mwt_comp-comp 6MWT Results: False Select one Complete
6mwt_comp-incomp Incomplete
6mwt_comp-nd Not done
6mwt_comp_reason-equip Reason incomplete or not done: False Select any Equipment malfunction
6mwt_comp_reason-physically Participant physically unable to continue
6mwt_comp_reason-refused Participant refused
6mwt_comp_reason-oth Other
6mwt_comp_other What was the ‘other’ reason the 6MWT was incomplete or not done? False text Text
6mwt_suppl_o2-suppl_o2_yes Supplemental oxygen during the test? False Select one Yes
6mwt_suppl_o2-suppl_o2_no No
6mwt_suppl_o2_rate Rate of oxygen (L/min): False float Float
6mwt_suppl_o2_type Type of oxygen: False text Text
6mwt_base_hr Baseline Heart Rate False integer Integer
6mwt_base_spo2 Baseline SpO2 False integer |%
6mwt_base_borg_breath-0 Pre‐test Borg Dyspnea Fatigue Scale: Shortness of Breath False Select one 0 – Nothing at all
6mwt_base_borg_breath-1 1 – Very slight
6mwt_base_borg_breath-2 2 – Slight (light)
6mwt_base_borg_breath-3 3 – Moderate
6mwt_base_borg_breath-4 4 – Somewhat severe
6mwt_base_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_breath-5 5 – Severe (heavy)
6mwt_base_borg_breath-6 6 – Severe (heavy)
6mwt_base_borg_breath-7 7 – Very severe
6mwt_base_borg_breath-8 8 – Very severe
6mwt_base_borg_breath-9 9 – Very severe
6mwt_base_borg_breath-10 10 – very, very severe (maximal)
6mwt_base_borg_fatigue-0 Pre‐test Borg Dyspnea Fatigue Scale: Fatigue False Select one 0 – Nothing at all
6mwt_base_borg_fatigue-1 1 – Very slight
6mwt_base_borg_fatigue-2 2 – Slight (light)
6mwt_base_borg_fatigue-3 3 – Moderate
6mwt_base_borg_fatigue-4 4 – Somewhat severe
6mwt_base_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_fatigue-5 5 – Severe (heavy)
6mwt_base_borg_fatigue-6 6 – Severe (heavy)
6mwt_base_borg_fatigue-7 7 – Very severe
6mwt_base_borg_fatigue-8 8 – Very severe
6mwt_base_borg_fatigue-9 9 – Very severe
6mwt_base_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_borg_admin-borg_self Borg questions: False Select one Self-administered
6mwt_borg_admin-borg_intvw Interviewer-administered
6mwt_borg_admin_name Name of interviewer who administered the Borg questions? False string String
6mwt_datetime_start What date and time did the 6MWT begin? False datetime Datetime
6mwt_datetime_end What date and time did the 6MWT end? False datetime Datetime
6mwt_stopped-yes Stopped or paused before 6 minutes? False Select one Yes
6mwt_stopped-no No
6mwt_stopped_reason Reason the test stopped or paused before 6 minutes: False text Text
6mwt_stopped_times How many times did the test pause before 6 minutes? False integer Integer
6mwt_stopped_seconds How much time was spent paused during the test? False integer |seconds
6mwt_total_distance Total distance walked in 6 minutes: False float |meters
6mwt_post_hr Post-walk Heart Rate False integer Integer
6mwt_post_spo2 Post-walk SpO2 False integer |%
6mwt_post_borg_breath-0 Post‐test Borg Dyspnea Fatigue Scale: Shortness of Breath False Select one 0 – Nothing at all
6mwt_post_borg_breath-1 1 – Very slight
6mwt_post_borg_breath-2 2 – Slight (light)
6mwt_post_borg_breath-3 3 – Moderate
6mwt_post_borg_breath-4 4 – Somewhat severe
6mwt_post_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_breath-5 5 – Severe (heavy)
6mwt_post_borg_breath-6 6 – Severe (heavy)
6mwt_post_borg_breath-7 7 – Very severe
6mwt_post_borg_breath-8 8 – Very severe
6mwt_post_borg_breath-9 9 – Very severe
6mwt_post_borg_breath-10 10 – very, very severe (maximal)
6mwt_post_borg_fatigue-0 Post‐test Borg Dyspnea Fatigue Scale: Fatigue False Select one 0 – Nothing at all
6mwt_post_borg_fatigue-1 1 – Very slight
6mwt_post_borg_fatigue-2 2 – Slight (light)
6mwt_post_borg_fatigue-3 3 – Moderate
6mwt_post_borg_fatigue-4 4 – Somewhat severe
6mwt_post_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_fatigue-5 5 – Severe (heavy)
6mwt_post_borg_fatigue-6 6 – Severe (heavy)
6mwt_post_borg_fatigue-7 7 – Very severe
6mwt_post_borg_fatigue-8 8 – Very severe
6mwt_post_borg_fatigue-9 9 – Very severe
6mwt_post_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_post_symptoms-post_pain_chest Other symptoms at the end of exercise: False Select any Chest pain
6mwt_post_symptoms-post_pain_calf Calf pain
6mwt_post_symptoms-post_dizziness Dizziness
6mwt_post_symptoms-post_pain_leg Leg pain
6mwt_post_symptoms-post_pain_hip Hip pain
6mwt_post_symptoms-oth Other
6mwt_post_symptoms-none None
6mwt_post_symptoms_other List other/additional symptoms experienced at the end of exercise: False text Text
4 6mwt_tech Who performed the 6MWT? True string String
6mwt_exclusion-equip Exclude the participant from the 6MWT if: True Select any Use of wheelchair
6mwt_exclusion-walk nability to walk because of musculoskeletal problems
6mwt_exclusion-hr Heart rate of less than 50 or more than 110 beats per minute at rest
6mwt_exclusion-bp Systolic blood pressure of >180 OR diastolic blood pressure of >110
6mwt_exclusion-pain Chest pain within the past four weeks
6mwt_exclusion-symptoms New or worsening symptoms of chest pain, shortening of breath, or fainting in the past 8 weeks
6mwt_exclusion-none None of the above (include)
6mwt_exclusion_bp-excl_systolic Is systolic or diastolic blood pressure the reason for exclusion? True Select one Systolic Blood Pressure
6mwt_exclusion_bp-excl_diastolic Diastolic Blood Pressure
6mwt_exclusion_bp-excl_bothbp Both Systolic AND Diastolic Blood Pressure
6mwt_exclusion_sbp Systolic blood pressure: True integer Integer
6mwt_exclusion_dbp Diastolic blood pressure: True integer Integer
6mwt_comp-comp 6MWT Results: True Select one Complete
6mwt_comp-incomp Incomplete
6mwt_comp-nd Not done
6mwt_comp_reason-equip Reason incomplete or not done: True Select any No space to perform the test
6mwt_comp_reason-physically Participant physically unable to continue
6mwt_comp_reason-refused Participant refused
6mwt_comp_reason-oth Other
6mwt_comp_other What was the ‘other’ reason the 6MWT was incomplete or not done? True text Text
6mwt_suppl_o2-suppl_o2_yes Supplemental oxygen during the test? True Select one Yes
6mwt_suppl_o2-suppl_o2_no No
6mwt_suppl_o2_rate Rate of oxygen (L/min): True float Float
6mwt_suppl_o2_type Type of oxygen: True text Text
6mwt_base_hr Baseline Heart Rate True integer Integer
6mwt_base_spo2 Baseline SpO2 True integer |%
6mwt_base_borg_breath-0 Pre‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_base_borg_breath-1 1 – Very slight
6mwt_base_borg_breath-2 2 – Slight (light)
6mwt_base_borg_breath-3 3 – Moderate
6mwt_base_borg_breath-4 4 – Somewhat severe
6mwt_base_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_breath-5 5 – Severe (heavy)
6mwt_base_borg_breath-6 6 – Severe (heavy)
6mwt_base_borg_breath-7 7 – Very severe
6mwt_base_borg_breath-8 8 – Very severe
6mwt_base_borg_breath-9 9 – Very severe
6mwt_base_borg_breath-10 10 – very, very severe (maximal)
6mwt_base_borg_fatigue-0 Pre‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_base_borg_fatigue-1 1 – Very slight
6mwt_base_borg_fatigue-2 2 – Slight (light)
6mwt_base_borg_fatigue-3 3 – Moderate
6mwt_base_borg_fatigue-4 4 – Somewhat severe
6mwt_base_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_fatigue-5 5 – Severe (heavy)
6mwt_base_borg_fatigue-6 6 – Severe (heavy)
6mwt_base_borg_fatigue-7 7 – Very severe
6mwt_base_borg_fatigue-8 8 – Very severe
6mwt_base_borg_fatigue-9 9 – Very severe
6mwt_base_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_borg_admin-borg_self Borg questions: True Select one Self-administered
6mwt_borg_admin-borg_intvw Interviewer-administered
6mwt_borg_admin_name Name of interviewer who administered the Borg questions? True string String
6mwt_datetime_start What date and time did the 6MWT begin? True datetime Datetime
6mwt_datetime_end What date and time did the 6MWT end? True datetime Datetime
6mwt_stopped-yes Stopped or paused before 6 minutes? True Select one Yes
6mwt_stopped-no No
6mwt_stopped_reason Reason the test stopped or paused before 6 minutes: True text Text
6mwt_stopped_times How many times did the test pause before 6 minutes? True integer Integer
6mwt_stopped_seconds How much time was spent paused during the test? True integer |seconds
6mwt_total_distance Total distance walked in 6 minutes: True float |meters
6mwt_post_hr Post-walk Heart Rate True integer Integer
6mwt_post_spo2 Post-walk SpO2 True integer |%
6mwt_post_borg_breath-0 Post‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_post_borg_breath-1 1 – Very slight
6mwt_post_borg_breath-2 2 – Slight (light)
6mwt_post_borg_breath-3 3 – Moderate
6mwt_post_borg_breath-4 4 – Somewhat severe
6mwt_post_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_breath-5 5 – Severe (heavy)
6mwt_post_borg_breath-6 6 – Severe (heavy)
6mwt_post_borg_breath-7 7 – Very severe
6mwt_post_borg_breath-8 8 – Very severe
6mwt_post_borg_breath-9 9 – Very severe
6mwt_post_borg_breath-10 10 – very, very severe (maximal)
6mwt_post_borg_fatigue-0 Post‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_post_borg_fatigue-1 1 – Very slight
6mwt_post_borg_fatigue-2 2 – Slight (light)
6mwt_post_borg_fatigue-3 3 – Moderate
6mwt_post_borg_fatigue-4 4 – Somewhat severe
6mwt_post_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_fatigue-5 5 – Severe (heavy)
6mwt_post_borg_fatigue-6 6 – Severe (heavy)
6mwt_post_borg_fatigue-7 7 – Very severe
6mwt_post_borg_fatigue-8 8 – Very severe
6mwt_post_borg_fatigue-9 9 – Very severe
6mwt_post_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_post_symptoms-post_pain_chest Other symptoms at the end of exercise: True Select any Chest pain
6mwt_post_symptoms-post_pain_calf Calf pain
6mwt_post_symptoms-post_dizziness Dizziness
6mwt_post_symptoms-post_pain_leg Leg pain
6mwt_post_symptoms-post_pain_hip Hip pain
6mwt_post_symptoms-oth Other
6mwt_post_symptoms-none None
6mwt_post_symptoms_other List other/additional symptoms experienced at the end of exercise: True text Text
5 6mwt_tech Who performed the 6MWT? True string String
6mwt_exclusion-equip Exclude the participant from the 6MWT if: True Select any Use of wheelchair
6mwt_exclusion-walk Inability to walk because of musculoskeletal problems
6mwt_exclusion-hr Heart rate of less than 50 or more than 110 beats per minute at rest
6mwt_exclusion-bp Systolic blood pressure of >180 OR diastolic blood pressure of >110
6mwt_exclusion-pain Chest pain within the past four weeks
6mwt_exclusion-symptoms New or worsening symptoms of chest pain, shortening of breath, or fainting in the past 8 weeks
6mwt_exclusion-none None of the above (include)
6mwt_exclusion_bp-excl_systolic Is systolic or diastolic blood pressure the reason for exclusion? True Select one Systolic Blood Pressure
6mwt_exclusion_bp-excl_diastolic Diastolic Blood Pressure
6mwt_exclusion_bp-excl_bothbp Both Systolic AND Diastolic Blood Pressure
6mwt_exclusion_sbp Systolic blood pressure: True integer Integer
6mwt_exclusion_dbp Diastolic blood pressure: True integer Integer
6mwt_comp-comp 6MWT Results: True Select one Complete
6mwt_comp-incomp Incomplete
6mwt_comp-nd Not done
6mwt_comp_reason-equip Reason incomplete or not done: True Select any No space to perform the test
6mwt_comp_reason-physically Participant physically unable to continue
6mwt_comp_reason-refused Participant refused
6mwt_comp_reason-oth Other
6mwt_comp_other What was the ‘other’ reason the 6MWT was incomplete or not done? True text Text
6mwt_suppl_o2-suppl_o2_yes Supplemental oxygen during the test? True Select one Yes
6mwt_suppl_o2-suppl_o2_no No
6mwt_suppl_o2_rate Rate of oxygen (L/min): True float Float
6mwt_suppl_o2_type Type of oxygen: True text Text
6mwt_base_hr Baseline Heart Rate True integer Integer
6mwt_base_spo2 Baseline SpO2 True integer |%
6mwt_base_borg_breath-0 Pre‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_base_borg_breath-1 1 – Very slight
6mwt_base_borg_breath-2 2 – Slight (light)
6mwt_base_borg_breath-3 3 – Moderate
6mwt_base_borg_breath-4 4 – Somewhat severe
6mwt_base_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_breath-5 5 – Severe (heavy)
6mwt_base_borg_breath-6 6 – Severe (heavy)
6mwt_base_borg_breath-7 7 – Very severe
6mwt_base_borg_breath-8 8 – Very severe
6mwt_base_borg_breath-9 9 – Very severe
6mwt_base_borg_breath-10 10 – very, very severe (maximal)
6mwt_base_borg_fatigue-0 Pre‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_base_borg_fatigue-1 1 – Very slight
6mwt_base_borg_fatigue-2 2 – Slight (light)
6mwt_base_borg_fatigue-3 3 – Moderate
6mwt_base_borg_fatigue-4 4 – Somewhat severe
6mwt_base_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_base_borg_fatigue-5 5 – Severe (heavy)
6mwt_base_borg_fatigue-6 6 – Severe (heavy)
6mwt_base_borg_fatigue-7 7 – Very severe
6mwt_base_borg_fatigue-8 8 – Very severe
6mwt_base_borg_fatigue-9 9 – Very severe
6mwt_base_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_borg_admin-borg_self Borg questions: True Select one Self-administered
6mwt_borg_admin-borg_intvw Interviewer-administered
6mwt_borg_admin_name Name of interviewer who administered the Borg questions? True string String
6mwt_datetime_start What date and time did the 6MWT begin? True datetime Datetime
6mwt_datetime_end What date and time did the 6MWT end? True datetime Datetime
6mwt_stopped-yes Stopped or paused before 6 minutes? True Select one Yes
6mwt_stopped-no No
6mwt_stopped_reason Reason the test stopped or paused before 6 minutes: True text Text
6mwt_stopped_times How many times did the test pause before 6 minutes? True integer Integer
6mwt_stopped_seconds How much time was spent paused during the test? True integer |seconds
6mwt_total_distance Total distance walked in 6 minutes: True float |meters
6mwt_post_hr Post-walk Heart Rate True integer Integer
6mwt_post_spo2 Post-walk SpO2 True integer |%
6mwt_post_borg_breath-0 Post‐test Borg Dyspnea Fatigue Scale: Shortness of Breath True Select one 0 – Nothing at all
6mwt_post_borg_breath-1 1 – Very slight
6mwt_post_borg_breath-2 2 – Slight (light)
6mwt_post_borg_breath-3 3 – Moderate
6mwt_post_borg_breath-4 4 – Somewhat severe
6mwt_post_borg_breath-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_breath-5 5 – Severe (heavy)
6mwt_post_borg_breath-6 6 – Severe (heavy)
6mwt_post_borg_breath-7 7 – Very severe
6mwt_post_borg_breath-8 8 – Very severe
6mwt_post_borg_breath-9 9 – Very severe
6mwt_post_borg_breath-10 10 – very, very severe (maximal)
6mwt_post_borg_fatigue-0 Post‐test Borg Dyspnea Fatigue Scale: Fatigue True Select one 0 – Nothing at all
6mwt_post_borg_fatigue-1 1 – Very slight
6mwt_post_borg_fatigue-2 2 – Slight (light)
6mwt_post_borg_fatigue-3 3 – Moderate
6mwt_post_borg_fatigue-4 4 – Somewhat severe
6mwt_post_borg_fatigue-0_5 0.5 – Very, very slight (just noticeable)
6mwt_post_borg_fatigue-5 5 – Severe (heavy)
6mwt_post_borg_fatigue-6 6 – Severe (heavy)
6mwt_post_borg_fatigue-7 7 – Very severe
6mwt_post_borg_fatigue-8 8 – Very severe
6mwt_post_borg_fatigue-9 9 – Very severe
6mwt_post_borg_fatigue-10 10 – very, very severe (maximal)
6mwt_post_symptoms-post_pain_chest Other symptoms at the end of exercise: True Select any Chest pain
6mwt_post_symptoms-post_pain_calf Calf pain
6mwt_post_symptoms-post_dizziness Dizziness
6mwt_post_symptoms-post_pain_leg Leg pain
6mwt_post_symptoms-post_pain_hip Hip pain
6mwt_post_symptoms-oth Other
6mwt_post_symptoms-none None
6mwt_post_symptoms_other List other/additional symptoms experienced at the end of exercise: True text Text
Adipose Tissue Biopsy Consent Coordinator Form 1 adipose_consent_ready-yes Is this participant ready and willing to sign the Adipose Tissue Biopsy Consent? True Select one Yes
Alivecor Kardia Coordinator Form 1 ready-yes Are you with the participant and ready to set up the participant’s Kardia account? True Select one Yes
Anthropometrics Documentation Coordinator Form 1 anthro_tech Who performed the anthropometry? True string String
anthro_assessment-erect Assessment of ability to stand: True Select one Can stand erectly on both feet
anthro_assessment-not_errect Can stand on both feet, but posture not erect
anthro_assessment-no Cannot stand on both feet
anthro_height Standing height (to the nearest 0.1 cm) True float |cm (1 decimal)
anthro_mod_ht-yes Was there a modification to the protocol when measuring participant’s height? True Select one Yes
anthro_mod_ht-no No
anthro_weight Weight (to the nearest 0.1 kg) True float |kg (1 decimal)
anthro_mod_wt-yes Was there a modification to the protocol when measuring participant’s weight? True Select one Yes
anthro_mod_wt-no No
anthro_waist Waist circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_hip Hip circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_mod_girth-yes Was there a modification to the protocol when measuring participant’s waist or hip circumference? True Select one Yes
anthro_mod_girth-no No
anthro_neck_1 Neck circumference (to the nearest 0.1 cm) measurement 1: True float |cm (1 decimal)
anthro_neck_2 Neck circumference (to the nearest 0.1 cm) measurement 2: True float |cm (1 decimal)
anthro_neck_3 Neck circumference (to the nearest 0.1 cm) measurement 3: True float |cm (1 decimal)
anthro_neck_avg Average of the 3 neck measurements: True float |cm (1 decimal)
anthro_mod_oth-yes Comments / modification to the protocol? True Select one Yes
anthro_mod_oth-no No
anthro_mod_comm Explanation of modifications or comments True text Text
2 anthro_tech Who performed the anthropometry? True string String
anthro_datetime What date and time were anthropometrics collected? False datetime Datetime
anthro_assessment-erect Assessment of ability to stand: True Select one Can stand erectly on both feet
anthro_assessment-not_errect Can stand on both feet, but posture not erect
anthro_assessment-no Cannot stand on both feet
anthro_height Standing height (to the nearest 0.1 cm) True float |cm (1 decimal)
anthro_mod_ht-yes Was there a modification to the protocol when measuring participant’s height? True Select one Yes
anthro_mod_ht-no No
anthro_weight Weight (to the nearest 0.1 kg) True float |kg (1 decimal)
anthro_mod_wt-yes Was there a modification to the protocol when measuring participant’s weight? True Select one Yes
anthro_mod_wt-no No
anthro_waist Waist circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_hip Hip circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_mod_girth-yes Was there a modification to the protocol when measuring participant’s waist or hip circumference? True Select one Yes
anthro_mod_girth-no No
anthro_neck_1 Neck circumference (to the nearest 0.1 cm) measurement 1: True float |cm (1 decimal)
anthro_neck_2 Neck circumference (to the nearest 0.1 cm) measurement 2: True float |cm (1 decimal)
anthro_neck_3 Neck circumference (to the nearest 0.1 cm) measurement 3: True float |cm (1 decimal)
anthro_neck_avg Average of the 3 neck measurements: True float |cm (1 decimal)
anthro_mod_oth-yes Comments / modification to the protocol? True Select one Yes
anthro_mod_oth-no No
anthro_mod_comm Explanation of modifications or comments True text Text
3 anthro_tech Who performed the anthropometry? False string String
anthro_datetime What date and time were anthropometrics collected? False datetime Datetime
anthro_assessment-erect Assessment of ability to stand: False Select one Can stand erectly on both feet
anthro_assessment-not_errect Can stand on both feet, but posture not erect
anthro_assessment-no Cannot stand on both feet
anthro_height Standing height (to the nearest 0.1 cm) False float |cm (1 decimal)
anthro_weight Weight (to the nearest 0.1 kg) False float |kg (1 decimal)
anthro_waist Waist circumference (to the nearest 0.1 cm): False float |cm (1 decimal)
anthro_hip Hip circumference (to the nearest 0.1 cm): False float |cm (1 decimal)
anthro_neck_1 Neck circumference (to the nearest 0.1 cm) measurement 1: False float |cm (1 decimal)
anthro_neck_2 Neck circumference (to the nearest 0.1 cm) measurement 2: False float |cm (1 decimal)
anthro_neck_3 Neck circumference (to the nearest 0.1 cm) measurement 3: False float |cm (1 decimal)
anthro_neck_avg Average of the 3 neck measurements: False float |cm (1 decimal)
anthro_mod_oth-yes Comments / modification to the protocol? False Select one Yes
anthro_mod_oth-no No
anthro_mod_comm Explanation of modifications or comments False text Text
4 anthro_tech Who performed the anthropometry? True string String
anthro_datetime What date and time were anthropometrics collected? True datetime Datetime
anthro_assessment-erect Assessment of ability to stand: True Select one Can stand erectly on both feet
anthro_assessment-not_errect Can stand on both feet, but posture not erect
anthro_assessment-no Cannot stand on both feet
anthro_height Standing height (to the nearest 0.1 cm) True float |cm (1 decimal)
anthro_weight Weight (to the nearest 0.1 kg) True float |kg (1 decimal)
anthro_waist Waist circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_hip Hip circumference (to the nearest 0.1 cm): True float |cm (1 decimal)
anthro_neck_1 Neck circumference (to the nearest 0.1 cm) measurement 1: True float |cm (1 decimal)
anthro_neck_2 Neck circumference (to the nearest 0.1 cm) measurement 2: True float |cm (1 decimal)
anthro_neck_3 Neck circumference (to the nearest 0.1 cm) measurement 3: True float |cm (1 decimal)
anthro_neck_avg Average of the 3 neck measurements: True float |cm (1 decimal)
anthro_mod_oth-yes Comments / modification to the protocol? True Select one Yes
anthro_mod_oth-no No
anthro_mod_comm Explanation of modifications or comments True text Text
Arterial Stiffness (Tonometry) Documentation Coordinator Form 1 tonometry_date What is the date and time of the tonometry recording? True datetime Datetime
tonometry_tech Who performed the tonometry recording? True string String
tonometry_echo-yes Are the tonometry reading and resting echo being done simultaneously? True Select one Yes
tonometry_echo-pastecho No, resting echo was already completed
tonometry_echo-futureecho No, resting echo will be done after tonometry recording
tonometry_echo_datetime When was the resting echo completed? True datetime Datetime
tonometry_fasting-yes Has it been 2 hours or more that the participant last ate and/or drank anything other than water, including anything with caffeine or nicotine? True Select one Yes
tonometry_fasting-no No
tonometry_comp-yes Was the tonometry recording completed? True Select one Yes
tonometry_comp-no No
tonometry_comp_reason-hwm If not completed, why was the tonometry recording incomplete or not done? True Select any Hardware malfunction (please contact core lab team at Penn)
tonometry_comp_reason-af Lack of supplies
tonometry_comp_reason-insf Insufficient time or room not available
tonometry_comp_reason-fasting Participant not fasted for at least 2 hours
tonometry_comp_reason-oth Other
tonometry_comp_other What was the ‘other’ reason the tonometry recording was incomplete or not done? True text Text
tonometry_bpid The participant's BP+ ID: True integer Integer
tonometry_bp BP+ blood pressure True integer Systolic|
tonometry_bp BP+ blood pressure True integer Diastolic|
tonometry_hr BP+ heart rate True integer |BPM
tonometry_carotid Sternal angle to carotid: True integer |centimeter
tonometry_femoral Sternal angle to femoral: True integer |centimeter
tonometry_radial Sternal angle to radial: True integer |centimeter
tonometry_length Sternal length: True integer |centimeter
tonometry_carotid_side-right On which side was the carotid tonometry performed? True Select one Right
tonometry_carotid_side-left Left
tonometry_femoral_side-right On which side was the femoral tonometry performed? True Select one Right
tonometry_femoral_side-left Left
tonometry_radial_side-right On which side was the radial tonometry performed? True Select one Right
tonometry_radial_side-left Left
tonometry_comment Any other comments about the tonometry recording: (please note if the participant has a pacemaker, arrhythmia, difficulty lying supine, or any other difficulties encountered when taking the tonometry recording) True text Text
tonometry_mod-yes Was there a modification to the protocol? True Select one Yes
tonometry_mod-no No
tonometry_mod_comment Explain the protocol modification. True text Text
2 tonometry_date What is the date and time of the tonometry recording? True datetime Datetime
tonometry_tech Who performed the tonometry recording? True string String
tonometry_echo-yes Are the tonometry reading and resting echo being done simultaneously? True Select one Yes
tonometry_echo-pastecho No, resting echo was already completed
tonometry_echo-futureecho No, resting echo will be done after tonometry recording
tonometry_echo_datetime When was the resting echo completed? True datetime Datetime
tonometry_fasting-yes Has it been 2 hours or more that the participant last ate and/or drank anything other than water, including anything with caffeine or nicotine? True Select one Yes
tonometry_fasting-no No
tonometry_comp-yes Was the tonometry recording completed? True Select one Yes
tonometry_comp-no No
tonometry_comp_reason-hwm If not completed, why was the tonometry recording incomplete or not done? True Select any Hardware malfunction (please contact core lab team at Penn)
tonometry_comp_reason-af Lack of supplies
tonometry_comp_reason-insf Insufficient time or room not available
tonometry_comp_reason-fasting Participant not fasted for at least 2 hours
tonometry_comp_reason-oth Other
tonometry_comp_other What was the ‘other’ reason the tonometry recording was incomplete or not done? True text Text
tonometry_bpid The participant's BP+ ID: True integer Integer
tonometry_bp BP+ blood pressure True integer Systolic|
tonometry_bp BP+ blood pressure True integer Diastolic|
tonometry_hr BP+ heart rate True integer |BPM
tonometry_carotid Sternal angle to carotid: True integer |centimeter
tonometry_femoral Sternal angle to femoral: True integer |centimeter
tonometry_radial Sternal angle to radial: True integer |centimeter
tonometry_length Sternal length: True integer |centimeter
tonometry_carotid_side-right On which side was the carotid tonometry performed? True Select one Right
tonometry_carotid_side-left Left
tonometry_femoral_side-right On which side was the femoral tonometry performed? True Select one Right
tonometry_femoral_side-left Left
tonometry_radial_side-right On which side was the radial tonometry performed? True Select one Right
tonometry_radial_side-left Left
tonometry_comment Any other comments about the tonometry recording: (please note if the participant has a pacemaker, arrhythmia, difficulty lying supine, or any other difficulties encountered when taking the tonometry recording) False text Text
tonometry_mod-yes Was there a modification to the protocol? True Select one Yes
tonometry_mod-no No
tonometry_mod_comment Explain the protocol modification. True text Text
Atrial Fibrillation Symptoms 1 af_often-1 How often, on average, does your irregular heart rhythm (Atrial Fibrillation) occur? True Select one Continuously
af_often-1 Continuously
af_often-2 More than twice a day
af_often-2 More than twice a day
af_often-3 Daily or almost daily
af_often-3 Daily or almost daily
af_often-4 4-5 times a week
af_often-4 4-5 times a week
af_often-5 2-3 times a week
af_often-5 2-3 times a week
af_often-6 About once a week
af_often-6 About once a week
af_often-7 About twice a month
af_often-7 About twice a month
af_often-8 About once a month
af_often-8 About once a month
af_often-9 About 2-4 times a year
af_often-9 About 2-4 times a year
af_often-10 About once a year
af_often-10 About once a year
af_often-11 Less than once a year
af_often-11 Less than once a year
af_often-12 I have NEVER had an irregular heart rhythm
af_often-12 I have NEVER had an irregular heart rhythm
how_long_irreg-1 How long, on average, do the episodes of the irregular heart rhythm last? True Select one Continuously
how_long_irreg-1 Continuously
how_long_irreg-2 Several days or more
how_long_irreg-2 Several days or more
how_long_irreg-3 All day
how_long_irreg-3 All day
how_long_irreg-4 Several hours, but less than a day
how_long_irreg-4 Several hours, but less than a day
how_long_irreg-5 About an hour
how_long_irreg-5 About an hour
how_long_irreg-6 30-45 minutes
how_long_irreg-6 30-45 minutes
how_long_irreg-7 Less than 30 minutes
how_long_irreg-7 Less than 30 minutes
how_long_irreg-8 A few minutes
how_long_irreg-8 A few minutes
how_long_irreg-9 Not applicable, I have never had an irregular heart rhythm
how_long_irreg-9 Not applicable, I have never had an irregular heart rhythm
how_severe_recent-1 How severe was your MOST RECENT episode of irregular heart rhythm? True Select one 1 - Not at all Severe
how_severe_recent-1 1 - Not at all Severe
how_severe_recent-2 2
how_severe_recent-2 2
how_severe_recent-3 3
how_severe_recent-3 3
how_severe_recent-4 4
how_severe_recent-4 4
how_severe_recent-5 5
how_severe_recent-5 5
how_severe_recent-6 6
how_severe_recent-6 6
how_severe_recent-7 7
how_severe_recent-7 7
how_severe_recent-8 8
how_severe_recent-8 8
how_severe_recent-9 9
how_severe_recent-9 9
how_severe_recent-10 10 - Extremely Severe
how_severe_recent-10 10 - Extremely Severe
er_times-1 How many times did you visit the emergency room within the past year because of an irregular heart rhythm (Atrial Fibrillation)? True Select one 0
er_times-2 1
er_times-3 2
er_times-4 3
er_times-5 4
er_times-6 5
er_times-7 More than 5 times
how_severe_first-1 How severe was your FIRST episode of irregular heart rhythm? True Select one 1 - Not at all Severe
how_severe_first-2 2
how_severe_first-3 3
how_severe_first-4 4
how_severe_first-5 5
how_severe_first-6 6
how_severe_first-7 7
how_severe_first-8 8
how_severe_first-9 9
how_severe_first-10 10 - Extremely Severe
er_times-1 How many times did you visit the emergency room within the past year because of an irregular heart rhythm (Atrial Fibrillation)? True Select one 0
er_times-2 1
er_times-3 2
er_times-4 3
er_times-5 4
er_times-6 5
er_times-7 More than 5 times
how_many_times Please specify how many times you have visited the emergency room within the past year because of an irregular heart rhythm (Atrial Fibrillation)? True integer
hosp_times-1 How many times were you hospitalized within the past year because of an irregular heart rhythm? True Select one 0
hosp_times-2 1
hosp_times-3 2
hosp_times-4 3
hosp_times-5 4
hosp_times-6 5
hosp_times-7 More than 5 times
how_many_times Please specify how many times you have visited the emergency room within the past year because of an irregular heart rhythm (Atrial Fibrillation)? True integer
hosp_how_many_times Please specify how many times you were hospitalized within the past year because of an irregular heart rhythm. True integer
hosp_times-1 How many times were you hospitalized within the past year because of an irregular heart rhythm? True Select one 0
hosp_times-2 1
hosp_times-3 2
hosp_times-4 3
hosp_times-5 4
hosp_times-6 5
hosp_times-7 More than 5 times
hosp_how_many_times Please specify how many times you were hospitalized within the past year because of an irregular heart rhythm. True integer
spec_times-1 How many times did you visit a specialist (cardiologist or electrophysiologist) within the past year because of an irregular heart rhythm? True Select one 0
spec_times-2 1
spec_times-3 2
spec_times-4 3
spec_times-5 4
spec_times-6 5
spec_times-7 More than 5 times
spec_how_many_times Please specify how many times you have visited your specialist within the past year because of an irregular heart rhythm. True integer
spec_times-1 How many times did you visit a specialist (cardiologist or electrophysiologist) within the past year because of an irregular heart rhythm? True Select one 0
spec_times-2 1
spec_times-3 2
spec_times-4 3
spec_times-5 4
spec_times-6 5
spec_times-7 More than 5 times
spec_how_many_times Please specify how many times you have visited your specialist within the past year because of an irregular heart rhythm. True integer
palpitations_how_often-1 Palpitations: True Select one I have not had this symptom in the past 4 weeks
palpitations_how_often-2 Very little
palpitations_how_often-3 A little
palpitations_how_often-4 A fair amount
palpitations_how_often-5 A lot
palpitations_how_often-6 A great deal
palpitations_how_often-1 I have not had this symptom in the past 4 weeks
palpitations_how_often-2 Very little
palpitations_how_often-3 A little
palpitations_how_often-4 A fair amount
palpitations_how_often-5 A lot
palpitations_how_often-6 A great deal
sob_how_often-1 Shortness of breath at rest: True Select one I have not had this symptom in the past 4 weeks
sob_how_often-2 Very little
sob_how_often-3 A little
sob_how_often-4 A fair amount
sob_how_often-5 A lot
sob_how_often-6 A great deal
sob_how_often-1 I have not had this symptom in the past 4 weeks
sob_how_often-2 Very little
sob_how_often-3 A little
sob_how_often-4 A fair amount
sob_how_often-5 A lot
sob_how_often-6 A great deal
sob_pa_how_often-1 Shortness of breath during physical activity: True Select one I have not had this symptom in the past 4 weeks
sob_pa_how_often-2 Very little
sob_pa_how_often-3 A little
sob_pa_how_often-4 A fair amount
sob_pa_how_often-5 A lot
sob_pa_how_often-6 A great deal
ex_int_how_often-1 Exercise intolerance (fatigue during mild physical activity): True Select one I have not had this symptom in the past 4 weeks
ex_int_how_often-2 Very little
ex_int_how_often-3 A little
ex_int_how_often-4 A fair amount
ex_int_how_often-5 A lot
ex_int_how_often-6 A great deal
sob_pa_how_often-1 Shortness of breath during physical activity: True Select one I have not had this symptom in the past 4 weeks
sob_pa_how_often-2 Very little
sob_pa_how_often-3 A little
sob_pa_how_often-4 A fair amount
sob_pa_how_often-5 A lot
sob_pa_how_often-6 A great deal
ex_int_how_often-1 Exercise intolerance (fatigue during mild physical activity): True Select one I have not had this symptom in the past 4 weeks
ex_int_how_often-2 Very little
ex_int_how_often-3 A little
ex_int_how_often-4 A fair amount
ex_int_how_often-5 A lot
ex_int_how_often-6 A great deal
fatigue_how_often-1 Fatigue at rest: True Select one I have not had this symptom in the past 4 weeks
fatigue_how_often-2 Very little
fatigue_how_often-3 A little
fatigue_how_often-4 A fair amount
fatigue_how_often-5 A lot
fatigue_how_often-6 A great deal
dizziness_how_often-1 Lightheadedness/dizziness: True Select one I have not had this symptom in the past 4 weeks
dizziness_how_often-2 Very little
dizziness_how_often-3 A little
dizziness_how_often-4 A fair amount
dizziness_how_often-5 A lot
dizziness_how_often-6 A great deal
fatigue_how_often-1 Fatigue at rest: True Select one I have not had this symptom in the past 4 weeks
fatigue_how_often-2 Very little
fatigue_how_often-3 A little
fatigue_how_often-4 A fair amount
fatigue_how_often-5 A lot
fatigue_how_often-6 A great deal
chest_pain_how_often-1 Chest pain or pressure: True Select one I have not had this symptom in the past 4 weeks
chest_pain_how_often-2 Very little
chest_pain_how_often-3 A little
chest_pain_how_often-4 A fair amount
chest_pain_how_often-5 A lot
chest_pain_how_often-6 A great deal
dizziness_how_often-1 Lightheadedness/dizziness: True Select one I have not had this symptom in the past 4 weeks
dizziness_how_often-2 Very little
dizziness_how_often-3 A little
dizziness_how_often-4 A fair amount
dizziness_how_often-5 A lot
dizziness_how_often-6 A great deal
chest_pain_how_often-1 Chest pain or pressure: True Select one I have not had this symptom in the past 4 weeks
chest_pain_how_often-2 Very little
chest_pain_how_often-3 A little
chest_pain_how_often-4 A fair amount
chest_pain_how_often-5 A lot
chest_pain_how_often-6 A great deal
Atrial Fibrillation Symptoms Update 1 palpitations_how_often-1 Palpitations: True Select one I have not had this symptom in the past 4 weeks
palpitations_how_often-2 Very little
palpitations_how_often-3 A little
palpitations_how_often-4 A fair amount
palpitations_how_often-5 A lot
palpitations_how_often-6 A great deal
sob_how_often-1 Shortness of breath at rest: True Select one I have not had this symptom in the past 4 weeks
sob_how_often-2 Very little
sob_how_often-3 A little
sob_how_often-4 A fair amount
sob_how_often-5 A lot
sob_how_often-6 A great deal
sob_pa_how_often-1 Shortness of breath during physical activity: True Select one I have not had this symptom in the past 4 weeks
sob_pa_how_often-2 Very little
sob_pa_how_often-3 A little
sob_pa_how_often-4 A fair amount
sob_pa_how_often-5 A lot
sob_pa_how_often-6 A great deal
ex_int_how_often-1 Exercise intolerance (fatigue during mild physical activity): True Select one I have not had this symptom in the past 4 weeks
ex_int_how_often-2 Very little
ex_int_how_often-3 A little
ex_int_how_often-4 A fair amount
ex_int_how_often-5 A lot
ex_int_how_often-6 A great deal
fatigue_how_often-1 Fatigue at rest: True Select one I have not had this symptom in the past 4 weeks
fatigue_how_often-2 Very little
fatigue_how_often-3 A little
fatigue_how_often-4 A fair amount
fatigue_how_often-5 A lot
fatigue_how_often-6 A great deal
dizziness_how_often-1 Lightheadedness/dizziness: True Select one I have not had this symptom in the past 4 weeks
dizziness_how_often-2 Very little
dizziness_how_often-3 A little
dizziness_how_often-4 A fair amount
dizziness_how_often-5 A lot
dizziness_how_often-6 A great deal
chest_pain_how_often-1 Chest pain or pressure: True Select one I have not had this symptom in the past 4 weeks
chest_pain_how_often-2 Very little
chest_pain_how_often-3 A little
chest_pain_how_often-4 A fair amount
chest_pain_how_often-5 A lot
chest_pain_how_often-6 A great deal
Auscultation Coordinator Form 1 ausc_tech Who performed the participant’s lung exam (full name)? True string String
ausc_datetime What date and time was the lung exam performed? True datetime Datetime
crackles-yes Did the participant present CRACKLES? True Select one Yes
crackles-no No
crackles-dk Unable to determine
wheezes-yes Did the participant present WHEEZES? True Select one Yes
wheezes-no No
wheezes-dk Unable to determine
2 ausc_tech Who performed the participant's lung exam (full name)? True string String
ausc_datetime What date and time was the lung exam performed? True datetime Datetime
crackles-yes Did the participant present CRACKLES? True Select one Yes
crackles-no No
crackles-dk Unable to determine
wheezes-yes Did the participant present WHEEZES? True Select one Yes
wheezes-no No
wheezes-dk Unable to determine
3 ausc_tech Who performed the participant's lung exam (full name)? True string String
ausc_datetime What date and time was the lung exam performed? True datetime Datetime
crackles-yes Did the participant present CRACKLES? True Select one Yes
crackles-no No
crackles-dk Unable to determine
wheezes-yes Did the participant present WHEEZES? True Select one Yes
wheezes-no No
wheezes-dk Unable to determine
4 ausc_tech Who performed the participant's lung exam (full name)? True string String
ausc_datetime What date and time was the lung exam performed? True datetime Datetime
crackles-yes Did the participant present CRACKLES? True Select one Yes
crackles-no No
crackles-dk Unable to determine
wheezes-yes Did the participant present WHEEZES? True Select one Yes
wheezes-no No
wheezes-dk Unable to determine
5 ausc_success-yes Was auscultation performed using the Eko Duo? True Select one Yes
ausc_success-no No
ausc_not_success-1 Why wasn’t auscultation performed? True Select one Auscultation was done with a conventional stethoscope
ausc_not_success-2 No clinician available
ausc_not_success-3 Not enough time
ausc_not_success-4 Other
ausc_not_sucess_oth Please explain why auscultation wasn’t performed. True string String
ausc_tech Who performed the auscultation (full name)? True string String
ausc_datetime What date and time was the auscultation performed? True datetime Datetime
Balance Tests Coordinator Form 1 sbs_stand-0 For the SIDE-BY-SIDE Stand test, did the participant complete the full 10-second stand? True Select one Not held for full 10-seconds
sbs_stand-na The participant did not attempt the test
sbs_stand-1 Yes
sbs_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
sbs_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
sbs_stand_why-2 Participant could not hold position unassisted
sbs_stand_why-3 Not attempted, you (the proctor) felt unsafe
sbs_stand_why-4 Not attempted, participant felt unsafe
sbs_stand_why-5 Participant unable to understand instructions
sbs_stand_why-6 Other (specify)
sbs_stand_why-7 Participant refused
sbs_stand_oth What was the other reason? True text Text
sts_stand-0 For the SEMI-TANDEM Stand test, did the participant complete the full 10-second stand? True Select one Not held for full 10-seconds
sts_stand-na The participant did not attempt the test
sts_stand-1 Yes
sts_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
sts_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
sts_stand_why-2 Participant could not hold position unassisted
sts_stand_why-3 Not attempted, you (the proctor) felt unsafe
sts_stand_why-4 Not attempted, participant felt unsafe
sts_stand_why-5 Participant unable to understand instructions
sts_stand_why-6 Other (specify)
sts_stand_why-7 Participant refused
sts_stand_oth What was the other reason? True text Text
tandem_stand-0 For the TANDEM Stand test, did the participant complete the full 10-second stand? True Select one No, held for less than 3 seconds
tandem_stand-na The participant did not attempt the test
tandem_stand-1 No, held for 3-9.99 seconds
tandem_stand-2 Yes
tandem_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
tandem_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
tandem_stand_why-2 Participant could not hold position unassisted
tandem_stand_why-3 Not attempted, you (the proctor) felt unsafe
tandem_stand_why-4 Not attempted, participant felt unsafe
tandem_stand_why-5 Participant unable to understand instructions
tandem_stand_why-6 Other (specify)
tandem_stand_why-7 Participant refused
tandem_stand_oth What was the other reason? True text Text
balance_mod-yes Was there a modification to the protocol? True Select one Yes
balance_mod-no No
balance_mod_comment Explain the protocol modification. True text Text
2 sbs_stand-0 For the SIDE-BY-SIDE Stand test, did the participant complete the full 10-second stand? True Select one Not held for full 10-seconds
sbs_stand-na The participant did not attempt the test
sbs_stand-1 Yes
sbs_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
sbs_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
sbs_stand_why-2 Participant could not hold position unassisted
sbs_stand_why-3 Not attempted, you (the proctor) felt unsafe
sbs_stand_why-4 Not attempted, participant felt unsafe
sbs_stand_why-5 Participant unable to understand instructions
sbs_stand_why-6 Other (specify)
sbs_stand_why-7 Participant refused
sbs_stand_oth What was the other reason? True text Text
sts_stand-0 For the SEMI-TANDEM Stand test, did the participant complete the full 10-second stand? True Select one Not held for full 10-seconds
sts_stand-na The participant did not attempt the test
sts_stand-1 Yes
sts_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
sts_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
sts_stand_why-2 Participant could not hold position unassisted
sts_stand_why-3 Not attempted, you (the proctor) felt unsafe
sts_stand_why-4 Not attempted, participant felt unsafe
sts_stand_why-5 Participant unable to understand instructions
sts_stand_why-6 Other (specify)
sts_stand_why-7 Participant refused
sts_stand_oth What was the other reason? True text Text
tandem_stand-0 For the TANDEM Stand test, did the participant complete the full 10-second stand? True Select one No, held for less than 3 seconds
tandem_stand-na The participant did not attempt the test
tandem_stand-1 No, held for 3-9.99 seconds
tandem_stand-2 Yes
tandem_stand_less Number of seconds held (if less than 10 seconds): True float |seconds
tandem_stand_why-1 Why did the participant not attempt or fail the test? Select all that apply. True Select any Tried but unable
tandem_stand_why-2 Participant could not hold position unassisted
tandem_stand_why-3 Not attempted, you (the proctor) felt unsafe
tandem_stand_why-4 Not attempted, participant felt unsafe
tandem_stand_why-5 Participant unable to understand instructions
tandem_stand_why-6 Other (specify)
tandem_stand_why-7 Participant refused
tandem_stand_oth What was the other reason? True text Text
balance_mod-yes Was there a modification to the protocol? True Select one Yes
balance_mod-no No
balance_mod_comment Explain the protocol modification. True text Text
Basic Demographics 1 sex-1 What sex were you assigned at birth? True Select one Male
sex-2 Female
sex-3 Prefer not to answer
gender-man What best describes your gender identity? CHECK ALL THAT APPLY. True Select any Man
gender-woman Woman
gender-non_binary Non-binary
gender-trans Transgender
gender-none None of these describe me, and I’d like to consider additional options
gender-no_ans Prefer not to answer
gender_additional-trans_man Are any of these a closer description of your gender identity? True Select any Trans man/Transgender Man/FTM
gender_additional-trans_woman Trans woman/Transgender Woman/MTF
gender_additional-gen_queer Genderqueer
gender_additional-gen_fluid Genderfluid
gender_additional-gen_var Gender variant
gender_additional-unsure Questioning or unsure of your gender identity
gender_additional-other None of these describe me, and I want to specify
gender_additional_other Please describe your gender identity. True string String
race-1 What is your racial background? CHECK ALL THAT APPLY. True Select any Black or African American
race-2 White
race-3 Asian (including South Asian and Asian Indian)
race-4 Native Hawaiian or Pacific Islander
race-5 American Indian or Alaska Native
race-6 Some other race
race-7 Don't know
asian-1 What is your Asian background? True Select one Chinese
asian-2 Filipino
asian-3 Asian Indian
asian-4 Japanese
asian-5 Korean
asian-6 Vietnamese
asian-7 Other Asian or Mix
pacisland-1 What is your Pacific Islander background? True Select one Native Hawaiian
pacisland-2 Samoan
pacisland-3 Guamanian or Chamorro
pacisland-4 Other Pacific Islander or Mix
ethnicity-1 Are you of Hispanic, Latino or Spanish origin or ancestry? True Select one No
ethnicity-2 Yes: Mexican, Mexican American or Chicano
ethnicity-3 Yes: Puerto Rican
ethnicity-4 Yes: Cuban
ethnicity-5 Yes: Other or Mixed Hispanic, Latino or Spanish origin
ethnicity-6 Don't know
ethnicity-7 Prefer not to answer
CMR Documentation Coordinator Form 1 cmr_date What is the date of the MRI? True date Date
mri_egfr What is the participant’s eGFR (in mL/min)? True float |mL/min
mri_creatinine What is the participant’s serum creatinine (in mg/dL)? True float |mg/dL
mri_complete-yes Was MRI performed? True Select one Yes
mri_complete-no No
mri_incomplete Why wasn’t the MRI performed? True answer Scanner malfunction
mri_incomplete Why wasn’t the MRI performed? True answer Participant refused
mri_incomplete Why wasn’t the MRI performed? True answer Participant claustrophobic
mri_incomplete Why wasn’t the MRI performed? True answer Participant is too ill
mri_incomplete Why wasn’t the MRI performed? True answer Participant is ineligible
mri_incomplete Why wasn’t the MRI performed? True answer Participant is physically unable
mri_incomplete Why wasn’t the MRI performed? True answer Other reason
mri_incomplete_other If 'other reason', explain why the MRI wasn't performed. True text Text
mri_gadolinium-yes Was gadolinium administered? True Select one Yes
mri_gadolinium-no No
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Scanner/pump malfunction
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Participant refused
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Participant claustrophobic
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Unable to obtain IV access
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Participant is ineligible
mri_no_gadolinium Why wasn’t the gadolinium administered? True answer Other reason
mri_gadolinium_other If 'other reason', explain why the gadolinium wasn't administered. True text Text
contrast_agent_cc Gadolinium total volume administered (cc): True float |cc
contrast_agent_rate Gadolinium rate of injection (in µg/kg/min): True float |µg/kg/min
contrast_agent_time Time gadolinium was administered administration (use 24-hour time): True float |hhmm
mri_tech Name of person performing MRI: True string String
mri_mod-yes Was there a modification to the protocol? True Select one Yes
mri_mod-no No
mri_mod_comment Explain the protocol modification. True text Text
2 cmr_date What is the date of the MRI? True date Date
mri_hematocrit What is the participant's hematocrit? True float |%
mri_creatinine What is the participant's serum creatinine (in mg/dL)? True float |mg/dL
mri_complete-yes Was MRI performed? True Select one Yes
mri_complete-no No
mri_incomplete-scanner Why wasn't the MRI performed? True Select one Scanner malfunction
mri_incomplete-no Participant refused
mri_incomplete-claustrophobia Participant claustrophobic
mri_incomplete-ill Participant is too ill
mri_incomplete-ineligible Participant is ineligible
mri_incomplete-unable Participant is physically unable
mri_incomplete-other Other reason
mri_incomplete_other If 'other reason', explain why the MRI wasn't performed. True text Text
mri_starttime Study start time: True time Time
mri_contrasttime Contrast injection time: True time Time
contrast_ml Contrast volume injected (mL): True float |mL
mri_lge LGE Imaging start time: True time Time
mri_hr Heart rate during AO Cine: True float |bpm
mri_systolicbp Systolic blood pressure during AO Cine: True float |mmHg
mri_diastolicbp Diastolic blood pressure during AO Cine: True float |mmHg
mri_rhythm-nsr Cardiac rhythm(s) at scan: True Select any Normal Sinus Rhythm
mri_rhythm-af Atrial Fibrillation (AF)
mri_rhythm-flutter Atrial Flutter
mri_rhythm-pvc Premature Ventricular Contractions (PVCs)
mri_rhythm-apc Atrial Premature Contractions (APCs)
mri_rhythm-oth Other
mri_rhythm_oth If 'other', what cardiac rhythm(s)? True text Text
mri_abnormalities-yes Did the CMR tech note any abnormalities? True Select one Yes
mri_abnormalities-no No
mri_alert-yes Was a cardiologist/MRI physician alerted? True Select one Yes
mri_alert-no No
mri_tech Name of CMR tech: True string String
mri_mod-yes Was there a modification to the protocol? True Select one Yes
mri_mod-no No
mri_mod_comment Explain the protocol modification. True text Text
3 cmr_date What is the date of the CMR? False date Date
mri_hematocrit What is the participant's hematocrit? False float |%
mri_creatinine What is the participant's serum creatinine (in mg/dL)? False float |mg/dL
mri_complete-yes Was MRI performed? False Select one Yes
mri_complete-no No
mri_incomplete-scanner Why wasn't the MRI performed? False Select one Scanner malfunction
mri_incomplete-no Participant refused
mri_incomplete-claustrophobia Participant claustrophobic
mri_incomplete-ill Participant is too ill
mri_incomplete-ineligible Participant is ineligible
mri_incomplete-unable Participant is physically unable
mri_incomplete-other Other reason
mri_incomplete_other If 'other reason', explain why the MRI wasn't performed. False text Text
mri_starttime Study start time: False time Time
mri_contrasttime Contrast injection time: False time Time
contrast_ml Contrast volume injected (mL): False float |mL
mri_lge LGE Imaging start time: False time Time
mri_t1 Post-contrast T1 start time False time Time
mri_hr Heart rate during AO Cine: False float |bpm
mri_systolicbp Systolic blood pressure during AO Cine: False float |mmHg
mri_diastolicbp Diastolic blood pressure during AO Cine: False float |mmHg
mri_rhythm-nsr Cardiac rhythm(s) at scan: False Select any Normal Sinus Rhythm
mri_rhythm-af Atrial Fibrillation (AF)
mri_rhythm-flutter Atrial Flutter
mri_rhythm-pvc Premature Ventricular Contractions (PVCs)
mri_rhythm-apc Atrial Premature Contractions (APCs)
mri_rhythm-oth Other
mri_rhythm_oth If 'other', what cardiac rhythm(s)? False text Text
mri_abnormalities-yes Did the CMR tech note any abnormalities? False Select one Yes
mri_abnormalities-no No
mri_alert-yes Was a cardiologist/MRI physician alerted? False Select one Yes
mri_alert-no No
mri_tech Name of CMR tech: False string String
mri_mod-yes Was there a modification to the protocol? False Select one Yes
mri_mod-no No
mri_mod_comment Explain the protocol modification. False text Text
4 cmr_date What is the date of the CMR? True date Date
mri_hematocrit What is the participant's hematocrit? True float |%
mri_creatinine What is the participant's serum creatinine (in mg/dL)? True float |mg/dL
mri_complete-yes Was MRI performed? True Select one Yes
mri_complete-no No
mri_incomplete-scanner Why wasn't the MRI performed? True Select one Scanner malfunction
mri_incomplete-no Participant refused
mri_incomplete-claustrophobia Participant claustrophobic
mri_incomplete-ill Participant is too ill
mri_incomplete-ineligible Participant is ineligible
mri_incomplete-unable Participant is physically unable
mri_incomplete-other Other reason
mri_incomplete_other If 'other reason', explain why the MRI wasn't performed. True text Text
mri_starttime Study start time: True time Time
mri_contrasttime Contrast injection time: True time Time
contrast_ml Contrast volume injected (mL): True float |mL
mri_lge LGE Imaging start time: True time Time
mri_t1 Post-contrast T1 start time True time Time
mri_hr Heart rate during AO Cine: True float |bpm
mri_systolicbp Systolic blood pressure during AO Cine: True float |mmHg
mri_diastolicbp Diastolic blood pressure during AO Cine: True float |mmHg
mri_rhythm-nsr Cardiac rhythm(s) at scan: True Select any Normal Sinus Rhythm
mri_rhythm-af Atrial Fibrillation (AF)
mri_rhythm-flutter Atrial Flutter
mri_rhythm-pvc Premature Ventricular Contractions (PVCs)
mri_rhythm-apc Atrial Premature Contractions (APCs)
mri_rhythm-oth Other
mri_rhythm_oth If 'other', what cardiac rhythm(s)? True text Text
mri_abnormalities-yes Did the CMR tech note any abnormalities? True Select one Yes
mri_abnormalities-no No
mri_alert-yes Was a cardiologist/MRI physician alerted? True Select one Yes
mri_alert-no No
mri_tech Name of CMR tech: True string String
mri_mod-yes Was there a modification to the protocol? True Select one Yes
mri_mod-no No
mri_mod_comment Explain the protocol modification. True text Text
CPAP Usage Survey 1 cpap_prescribed-1 When were you first prescribed a CPAP/BiPAP (or a pressure device)? True Select one Less than 1 month ago
cpap_prescribed-2 1 to 6 months ago
cpap_prescribed-3 6 to 12 months ago
cpap_prescribed-4 1 to 5 years ago
cpap_prescribed-5 More than 5 years ago
cpap_nights-1 In the past month, on average, how often have you used your CPAP/BiPAP? True Select one 7 nights per week
cpap_nights-2 5 to 6 nights per week
cpap_nights-3 3 to 4 nights per week
cpap_nights-4 1 to 2 nights per week
cpap_nights-5 I did not use my CPAP
cpap_hours-1 In the past month, when you used your CPAP/BiPAP, on average, how long did you use it each night? True Select one 7 hours or more
cpap_hours-2 6 hours
cpap_hours-3 5 hours
cpap_hours-4 4 hours
cpap_hours-5 3 hours
cpap_hours-6 2 hours
cpap_hours-7 1 hour
cpap_hours-8 Less than 1 hour
cpap_sleep-1 On a typical night in the past month, how many hours did you sleep? True Select one 7 hours or more
cpap_sleep-2 6 hours
cpap_sleep-3 5 hours
cpap_sleep-4 4 hours
cpap_sleep-5 3 hours
cpap_sleep-6 Less than 3 hours
cpap_use-1 How has your use of CPAP/BiPAP changed over time? True Select one About the same amount as my first month of treatment
cpap_use-2 Less than in my first month of treatment
cpap_use-3 More than in my first month of treatment
cpap_use-4 Use has gone up and down
Cardiac Exam Coordinator Form 1 cardiac_tech Who performed the participant's cardiac exam (full name)? True string String
cardiac_datetime What date and time was the cardiac exam performed? True datetime Datetime
jvp What was the participant's JVP (jugular venous pressure)? True float |cm
s3-yes Is an S3 present (using a conventional stethoscope)? True Select one Yes
s3-no No
s3-dk Unable to determine
s4-yes Is an S4 present (using a conventional stethoscope)? True Select one Yes
s4-no No
s4-dk Unable to determine
murmur-yes Was a heart MURMUR present (using a conventional stethoscope)? True Select one Yes
murmur-no No
murmur-dk Unable to determine
eko-yes Was the Eko Duo Digital Stethoscope used? True Select one Yes
eko-no No
eko_success-yes Was the Eko Duo Digital Stethoscope recording done successfully? True Select one Yes
eko_success-no No
eko_fail Why wasn’t the Eko Duo Digital Stethoscope recording successfully completed? True text Text
eko_upload-yes Did you download the Eko Duo Digital Stethoscope recording and upload it via the secure file transfer provided by the DTC? True Select one Yes
eko_upload-no No
2 cardiac_tech Who performed the participant's cardiac exam (full name)? False string String
cardiac_datetime What date and time was the cardiac exam performed? False datetime Datetime
nyha-1 What is the participant's observed NYHA class? False Select one I
nyha-2 II
nyha-3 III
nyha-4 IV
dyspnea-no Is paroxysmal nocturnal dyspnea present? False Select one Absent
dyspnea-yes Present
ascites-no Are ascites present? False Select one Absent
ascites-yes Present
orthopnea-no Does the participant have orthopnea? False Select one Absent
orthopnea-1pillow 1 pillow
orthopnea-2pillow 2 pillows
orthopnea-many More than 2 pillows
jvd-no What was the participant’s jugular venous distension? False Select one No jugular venous distension
jvd-low <6cm
jvd-med 6 to 10 cm
jvd-high >10 cm
reflux-no Does the participant have hepatojugular reflux? False Select one Absent
reflux-yes Present
edema-no Does the participant have edema? False Select one Absent
edema-trace Trace
edema-1 1+
edema-2 2+
edema-3 3+
edema_location-feet What is the edema location? False Select any Feet/ankles
edema_location-legs Lower legs or thighs
edema_location-sacrum Sacrum
rales-no Does the participant have rales, crackles, or crepitations? False Select one Absent
rales-low Rales < 1/3
rales-med Rales 1/3 to 2/3
rales-high Rales > 2/3
3 cardiac_tech Who performed the participant's cardiac exam (full name)? True string String
cardiac_datetime What date and time was the cardiac exam performed? True datetime Datetime
nyha-1 What is the participant's observed NYHA class? True Select one I
nyha-2 II
nyha-3 III
nyha-4 IV
dyspnea-no Is paroxysmal nocturnal dyspnea present? True Select one Absent
dyspnea-yes Present
ascites-no Are ascites present? True Select one Absent
ascites-yes Present
orthopnea-no Does the participant have orthopnea? True Select one Absent
orthopnea-1pillow 1 pillow
orthopnea-2pillow 2 pillows
orthopnea-many More than 2 pillows
jvd-no What was the participant’s jugular venous distension? True Select one No jugular venous distension
jvd-low <6cm
jvd-med 6 to 10 cm
jvd-high >10 cm
reflux-no Does the participant have hepatojugular reflux? True Select one Absent
reflux-yes Present
edema-no Does the participant have edema? True Select one Absent
edema-trace Trace
edema-1 1+
edema-2 2+
edema-3 3+
edema_location-feet What is the edema location? True Select any Feet/ankles
edema_location-legs Lower legs or thighs
edema_location-sacrum Sacrum
rales-no Does the participant have rales, crackles, or crepitations? True Select one Absent
rales-low Rales < 1/3
rales-med Rales 1/3 to 2/3
rales-high Rales > 2/3
Cardiopulmonary ECHO Coordinator Form 1 echo_sono Name of sonographer: True string Full Name:|
echo_date Date of ECHO: True date Date
echo_hr_0 Heart Rate (bpm): True float |bpm
echo_spo2_0 SP O2 (%): True float |%
echo_sbp_0 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_0 Manual Diastolic BP (mmHg): True float |mmHg
echo_rhythm-nsr EKG Heart Rhythm (approximate based upon echo leads) True Select one Normal Sinus Rhythm
echo_rhythm-af Atrial Fibrillation
echo_rhythm-oth Other
echo_pacemaker-yes Does the participant have an artificial cardiac pacemaker? True Select one Yes
echo_pacemaker-no No
echo_supp_o2-yes Should supplemental oxygen be used during echocardiogram? True Select one Yes
echo_supp_o2-no No
echo_supp_vol How many liters of oxygen should be used? True float |Liters
echo_bl_views-yes Were all required baseline echo views obtained? True Select one Yes
echo_bl_views-no No
echo_bl_views_rsn-refused If No, why were all required baseline echo views not obtained? True Select one Participant Refused
echo_bl_views_rsn-terminated ECHO terminated early
echo_bl_views_rsn-tech Technical problems
echo_bl_alert-yes Was an urgent alert suspected? True Select one Yes
echo_bl_alert-no No
echo_bl_alert_id-tamponade What was the urgent alert? True Select one Suspected tamponade
echo_bl_alert_id-aortic Aortic aneurysm or dissection
echo_bl_alert_id-abscess Abscess or obvious vegetation
echo_bl_alert_id-thrombus Thrombus or mass
echo_bl_alert_id-pseudoaneurysm Psuedoaneurysm
echo_bl_alert_id-arrhythmia Significant arrhythmia
echo_bl_alert_comm Comments to reviewer about urgent alert: True text Text
echo_bl_alert_nonurgent-yes Was a non-urgent alert suspected? True Select one Yes
echo_bl_alert_nonurgent-no No
echo_bl_alert_nonurgent_id-stenosis What was the non-urgent alert? True Select one Moderate or greater valvular stenosis
echo_bl_alert_nonurgent_id-ai_mr Moderate or greater AI or MR
echo_bl_alert_nonurgent_id-tr_pi Severe TR or PI
echo_bl_alert_nonurgent_id-lv_rv Severe LV or RV enlargement
echo_bl_alert_nonurgent_id-lvot Moderate or greater LVOT obstruction
echo_bl_alert_nonurgent_id-ph Significant pulmonary hypertension
echo_bl_alert_nonurgent_id-ef_wma Low EF or WMA
echo_bl_alert_nonurgent_id-pe Moderate or greater pericardial effusion
echo_bl_alert_nonurgent_id-afib New atrial fibrillation
echo_bl_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
echo_assess_alert-yes Were there any suspected alerts during the baseline echo assessment? True Select one Yes
echo_assess_alert-no No
echo_asess_events-yes Were there any cardiovascular events (MI, unstable angina, or HF exacerbation) or stable angina in the last 3 months? True Select one Yes
echo_asess_events-no No
echo_assess_bike-yes s the participant physically able to perform the bicycle exercise? True Select one Yes
echo_assess_bike-no No
echo_assess_o2-yes Is the participant’s O2 saturation > 88% at rest? (supplemental oxygen use allowed) True Select one Yes
echo_assess_o2-no No
echo_assess_cpet-yes Is the participant willing to do the CPET? True Select one Yes
echo_assess_cpet-no No
echo_hr_3 Heart Rate (bpm): True float |bpm
echo_spo2_3 SP O2 (%): True float |%
echo_sbp_3 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_3 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_3-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_3-no No
echo_supp_vol_3 How many liters of oxygen should be used? True float |Liters
echo_hr_6 Heart Rate (bpm): True float |bpm
echo_spo2_6 SP O2 (%): True float |%
echo_sbp_6 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_6 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_6-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_6-no No
echo_supp_vol_6 How many liters of oxygen should be used? True float |Liters
echo_hr_9 Heart Rate (bpm): True float |bpm
echo_spo2_9 SP O2 (%): True float |%
echo_sbp_9 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_9 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_9-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_9-no No
echo_supp_vol_9 How many liters of oxygen should be used? True float |Liters
echo_hr_12 Heart Rate (bpm): True float |bpm
echo_spo2_12 SP O2 (%): True float |%
echo_sbp_12 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_12 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_12-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_12-no No
echo_supp_vol_12 How many liters of oxygen should be used? True float |Liters
echo_hr_15 Heart Rate (bpm): True float |bpm
echo_spo2_15 SP O2 (%): True float |%
echo_sbp_15 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_15 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_15-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_15-no No
echo_supp_vol_15 How many liters of oxygen should be used? True float |Liters
echo_hr_18 Heart Rate (bpm): True float |bpm
echo_spo2_18 SP O2 (%): True float |%
echo_sbp_18 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_18 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_18-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_18-no No
echo_supp_vol_18 How many liters of oxygen should be used? True float |Liters
echo_hr_21 Heart Rate (bpm): True float |bpm
echo_spo2_21 SP O2 (%): True float |%
echo_sbp_21 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_21 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_21-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_21-no No
echo_supp_vol_21 How many liters of oxygen should be used? True float |Liters
echo_hr_24 Heart Rate (bpm): True float |bpm
echo_spo2_24 SP O2 (%): True float |%
echo_sbp_24 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_24 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_24-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_24-no No
echo_supp_vol_24 How many liters of oxygen should be used? True float |Liters
echo_hr_27 Heart Rate (bpm): True float |bpm
echo_spo2_27 SP O2 (%): True float |%
echo_sbp_27 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_27 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_27-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_27-no No
echo_supp_vol_27 How many liters of oxygen should be used? True float |Liters
echo_hr_peak Heart Rate (bpm): True float |bpm
echo_spo2_peak SP O2 (%): True float |%
echo_sbp_peak Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_peak Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_peak-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_peak-no No
echo_supp_vol_peak How many liters of oxygen should be used? True float |Liters
echo_exer_time Total exercise time (mm:ss) True string |mm:ss format
echo_hr_recover Heart Rate (bpm): True float |bpm
echo_spo2_recover SP O2 (%): True float |%
echo_sbp_recover Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_recover Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_recover-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_recover-no No
echo_supp_vol_recover How many liters of oxygen should be used? True float |Liters
echo_exer_views-yes Were all required exercise echo views obtained? True Select one Yes
echo_exer_views-no No
echo_exer_views_rsn-refused If No, why were all required exercise echo views not obtained? True Select one Participant Refused
echo_exer_views_rsn-terminated ECHO terminated early
echo_exer_views_rsn-tech Technical problems
echo_exer_alert_nonurgent-yes Was a new non-urgent alert suspected? (There are no urgent alerts for the exercise portion) True Select one Yes
echo_exer_alert_nonurgent-no No
echo_exer_alert_nonurgent_id-new_afib What generated the non-urgent alert? True Select one New atrial fibrillation during the exercise test
echo_exer_alert_nonurgent_id-new_wma New WMA with exercise
echo_exer_alert_nonurgent_id-rsvp RSVP >70mmHg during exercise
echo_exer_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
2 echo_sono Name of sonographer: True string Full Name:|
echo_date Date of ECHO: True date Date
echo_hr_0 Heart Rate (bpm): True float |bpm
echo_spo2_0 SP O2 (%): True float |%
echo_sbp_0 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_0 Manual Diastolic BP (mmHg): True float |mmHg
echo_rhythm-nsr EKG Heart Rhythm (approximate based upon echo leads) True Select one Normal Sinus Rhythm
echo_rhythm-af Atrial Fibrillation
echo_rhythm-oth Other
echo_pacemaker-yes Does the participant have an artificial cardiac pacemaker? True Select one Yes
echo_pacemaker-no No
echo_supp_o2-yes Should supplemental oxygen be used during echocardiogram? True Select one Yes
echo_supp_o2-no No
echo_supp_vol How many liters of oxygen should be used? True float |Liters
echo_bl_views-yes Were all required baseline echo views obtained? True Select one Yes
echo_bl_views-no No
echo_bl_views_rsn-refused If No, why were all required baseline echo views not obtained? True Select one Participant Refused
echo_bl_views_rsn-terminated ECHO terminated early
echo_bl_views_rsn-tech Technical problems
echo_bl_alert-yes Was an urgent alert suspected? True Select one Yes
echo_bl_alert-no No
echo_bl_alert_id-tamponade What was the urgent alert? True Select one Suspected tamponade
echo_bl_alert_id-aortic Aortic aneurysm or dissection
echo_bl_alert_id-abscess Abscess or obvious vegetation
echo_bl_alert_id-thrombus Thrombus or mass
echo_bl_alert_id-pseudoaneurysm Psuedoaneurysm
echo_bl_alert_id-arrhythmia Significant arrhythmia
echo_bl_alert_comm Comments to reviewer about urgent alert: True text Text
echo_bl_alert_nonurgent-yes Was a non-urgent alert suspected? True Select one Yes
echo_bl_alert_nonurgent-no No
echo_bl_alert_nonurgent_id-stenosis What was the non-urgent alert? True Select one Moderate or greater valvular stenosis
echo_bl_alert_nonurgent_id-ai_mr Moderate or greater AI or MR
echo_bl_alert_nonurgent_id-tr_pi Severe TR or PI
echo_bl_alert_nonurgent_id-lv_rv Severe LV or RV enlargement
echo_bl_alert_nonurgent_id-lvot Moderate or greater LVOT obstruction
echo_bl_alert_nonurgent_id-ph Significant pulmonary hypertension
echo_bl_alert_nonurgent_id-ef_wma Low EF or WMA
echo_bl_alert_nonurgent_id-pe Moderate or greater pericardial effusion
echo_bl_alert_nonurgent_id-afib New atrial fibrillation
echo_bl_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
echo_assess_alert-yes Were there any suspected alerts during the baseline echo assessment? True Select one Yes
echo_assess_alert-no No
echo_asess_events-yes Were there any cardiovascular events (MI, unstable angina, or HF exacerbation) or stable angina in the last 3 months? True Select one Yes
echo_asess_events-no No
echo_assess_bike-yes Was the participant physically able to perform the bicycle exercise? True Select one Yes
echo_assess_bike-no No
echo_assess_o2-yes Is the participant's O2 saturation > 88% at rest? (supplemental oxygen use allowed) True Select one Yes
echo_assess_o2-no No
echo_assess_cpet-yes Is the participant willing to do the CPET? True Select one Yes
echo_assess_cpet-no No
echo_hr_3 Heart Rate (bpm): True float |bpm
echo_spo2_3 SP O2 (%): True float |%
echo_sbp_3 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_3 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_3-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_3-no No
echo_supp_vol_3 How many liters of oxygen should be used? True float |Liters
echo_hr_6 Heart Rate (bpm): True float |bpm
echo_spo2_6 SP O2 (%): True float |%
echo_sbp_6 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_6 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_6-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_6-no No
echo_supp_vol_6 How many liters of oxygen should be used? True float |Liters
echo_hr_9 Heart Rate (bpm): True float |bpm
echo_spo2_9 SP O2 (%): True float |%
echo_sbp_9 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_9 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_9-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_9-no No
echo_supp_vol_9 How many liters of oxygen should be used? True float |Liters
echo_hr_12 Heart Rate (bpm): True float |bpm
echo_spo2_12 SP O2 (%): True float |%
echo_sbp_12 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_12 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_12-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_12-no No
echo_supp_vol_12 How many liters of oxygen should be used? True float |Liters
echo_hr_15 Heart Rate (bpm): True float |bpm
echo_spo2_15 SP O2 (%): True float |%
echo_sbp_15 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_15 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_15-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_15-no No
echo_supp_vol_15 How many liters of oxygen should be used? True float |Liters
echo_hr_18 Heart Rate (bpm): True float |bpm
echo_spo2_18 SP O2 (%): True float |%
echo_sbp_18 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_18 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_18-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_18-no No
echo_supp_vol_18 How many liters of oxygen should be used? True float |Liters
echo_hr_21 Heart Rate (bpm): True float |bpm
echo_spo2_21 SP O2 (%): True float |%
echo_sbp_21 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_21 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_21-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_21-no No
echo_supp_vol_21 How many liters of oxygen should be used? True float |Liters
echo_hr_24 Heart Rate (bpm): True float |bpm
echo_spo2_24 SP O2 (%): True float |%
echo_sbp_24 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_24 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_24-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_24-no No
echo_supp_vol_24 How many liters of oxygen should be used? True float |Liters
echo_hr_27 Heart Rate (bpm): True float |bpm
echo_spo2_27 SP O2 (%): True float |%
echo_sbp_27 Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_27 Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_27-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_27-no No
echo_supp_vol_27 How many liters of oxygen should be used? True float |Liters
echo_hr_peak Heart Rate (bpm): True float |bpm
echo_spo2_peak SP O2 (%): True float |%
echo_sbp_peak Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_peak Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_peak-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_peak-no No
echo_supp_vol_peak How many liters of oxygen should be used? True float |Liters
echo_exer_time Total exercise time (mm:ss) True string |mm:ss format
echo_hr_recover Heart Rate (bpm): True float |bpm
echo_spo2_recover SP O2 (%): True float |%
echo_sbp_recover Manual Systolic BP (mmHg): True float |mmHg
echo_dbp_recover Manual Diastolic BP (mmHg): True float |mmHg
echo_supp_o2_recover-yes Was supplemental oxygen used? True Select one Yes
echo_supp_o2_recover-no No
echo_supp_vol_recover How many liters of oxygen should be used? True float |Liters
echo_exer_views-yes Were all required exercise echo views obtained? True Select one Yes
echo_exer_views-no No
echo_exer_views_rsn-refused If No, why were all required exercise echo views not obtained? True Select one Participant Refused
echo_exer_views_rsn-terminated ECHO terminated early
echo_exer_views_rsn-tech Technical problems
echo_exer_alert_nonurgent-yes Was a new non-urgent alert suspected? (There are no urgent alerts for the exercise portion) True Select one Yes
echo_exer_alert_nonurgent-no No
echo_exer_alert_nonurgent_id-new_afib What generated the non-urgent alert? True Select one New atrial fibrillation during the exercise test
echo_exer_alert_nonurgent_id-new_wma New WMA with exercise
echo_exer_alert_nonurgent_id-rsvp RSVP >70mmHg during exercise
echo_exer_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
Cardiopulmonary Exercise Test (CPET) Coordinator Form 3 cpet_completion-1 Was the CPET completed? True Select one Yes
cpet_completion-2 No
cpet_not_completed-1 Why was the CPET not completed? True Select any Insufficient time
cpet_not_completed-2 Insufficient resources (e.g. staffing, room, equipment)
cpet_not_completed-3 Participant unable to do CPET
cpet_not_completed-4 Participant refused CPET
cpet_not_completed-5 Other
cpet_other Please explain why the CPET wasn’t completed. True text Text
cpet_ep Technician of record? True string Full Name:|
cpet_start What date and time was the CPET STARTED? True datetime Datetime
cpet_cessation Reason for cessation of exercise? True text Text
cpet_seat Seat height (cm): True float |cm
Cardiopulmonary Exercise Test (CPET) Coordinator Form PART 1 1 cpet_ep Who moderated the participant’s CPET? True string Full Name:|
cpet_start What date and time was the CPET STARTED? True datetime Datetime
cpet_cessation Reason for cessation of exercise? True text Text
cpet_seat Seat height (cm): True float |cm
cpet_pr_0 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_0 Heart Rate (bpm): True float |bpm
cpet_spo2_0 SP O2 (%): True float |%
cpet_sbp_0 Systolic BP (mmHg): True float |mmHg
cpet_dbp_0 Diastolic BP (mmHg): True float |mmHg
cpet_pr_4 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_4 Heart Rate (bpm): True float |bpm
cpet_spo2_4 SP O2 (%): True float |%
cpet_sbp_4 Systolic BP (mmHg): True float |mmHg
cpet_dbp_4 Diastolic BP (mmHg): True float |mmHg
cpet_pr_7 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_7 Heart Rate (bpm): True float |bpm
cpet_spo2_7 SP O2 (%): True float |%
cpet_sbp_7 Systolic BP (mmHg): True float |mmHg
cpet_dbp_7 Diastolic BP (mmHg): True float |mmHg
cpet_pr_8 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_8 Heart Rate (bpm): True float |bpm
cpet_spo2_8 SP O2 (%): True float |%
cpet_sbp_8 Systolic BP (mmHg): True float |mmHg
cpet_dbp_8 Diastolic BP (mmHg): True float |mmHg
cpet_pr_9 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_9 Heart Rate (bpm): True float |bpm
cpet_spo2_9 SP O2 (%): True float |%
cpet_sbp_9 Systolic BP (mmHg): True float |mmHg
cpet_dbp_9 Diastolic BP (mmHg): True float |mmHg
cpet_pr_10 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_10 Heart Rate (bpm): True float |bpm
cpet_spo2_10 SP O2 (%): True float |%
cpet_sbp_10 Systolic BP (mmHg): True float |mmHg
cpet_dbp_10 Diastolic BP (mmHg): True float |mmHg
cpet_pr_11 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_11 Heart Rate (bpm): True float |bpm
cpet_spo2_11 SP O2 (%): True float |%
cpet_sbp_11 Systolic BP (mmHg): True float |mmHg
cpet_dbp_11 Diastolic BP (mmHg): True float |mmHg
cpet_pr_12 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_12 Heart Rate (bpm): True float |bpm
cpet_spo2_12 SP O2 (%): True float |%
cpet_sbp_12 Systolic BP (mmHg): True float |mmHg
cpet_dbp_12 Diastolic BP (mmHg): True float |mmHg
cpet_pr_13 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_13 Heart Rate (bpm): True float |bpm
cpet_spo2_13 SP O2 (%): True float |%
cpet_sbp_13 Systolic BP (mmHg): True float |mmHg
cpet_dbp_13 Diastolic BP (mmHg): True float |mmHg
cpet_pr_14 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_14 Heart Rate (bpm): True float |bpm
cpet_spo2_14 SP O2 (%): True float |%
cpet_sbp_14 Systolic BP (mmHg): True float |mmHg
cpet_dbp_14 Diastolic BP (mmHg): True float |mmHg
cpet_pr_15 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_15 Heart Rate (bpm): True float |bpm
cpet_spo2_15 SP O2 (%): True float |%
cpet_sbp_15 Systolic BP (mmHg): True float |mmHg
cpet_dbp_15 Diastolic BP (mmHg): True float |mmHg
2 cpet_completion-1 Was the CPET completed? False Select one Yes
cpet_completion-2 No
cpet_not_completed-1 Why was the CPET not completed? False Select any Insufficient time
cpet_not_completed-2 Insufficient resources (e.g. staffing, room, equipment)
cpet_not_completed-3 Participant unable to do CPET
cpet_not_completed-4 Participant refused CPET
cpet_not_completed-5 Other
cpet_other Please explain why the CPET wasn’t completed. False text Text
cpet_ep Technician of record? False string Full Name:|
cpet_start What date and time was the CPET STARTED? False datetime Datetime
cpet_cessation Reason for cessation of exercise? False text Text
cpet_seat Seat height (cm): False float |cm
Cardiopulmonary Exercise Test (CPET) Coordinator Form PART 2 1 cpet_pr_16 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_16 Heart Rate (bpm): True float |bpm
cpet_spo2_16 SP O2 (%): True float |%
cpet_sbp_16 Systolic BP (mmHg): True float |mmHg
cpet_dbp_16 Diastolic BP (mmHg): True float |mmHg
cpet_pr_17 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_17 Heart Rate (bpm): True float |bpm
cpet_spo2_17 SP O2 (%): True float |%
cpet_sbp_17 Systolic BP (mmHg): True float |mmHg
cpet_dbp_17 Diastolic BP (mmHg): True float |mmHg
cpet_pr_18 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_18 Heart Rate (bpm): True float |bpm
cpet_spo2_18 SP O2 (%): True float |%
cpet_sbp_18 Systolic BP (mmHg): True float |mmHg
cpet_dbp_18 Diastolic BP (mmHg): True float |mmHg
cpet_pr_19 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_19 Heart Rate (bpm): True float |bpm
cpet_spo2_19 SP O2 (%): True float |%
cpet_sbp_19 Systolic BP (mmHg): True float |mmHg
cpet_dbp_19 Diastolic BP (mmHg): True float |mmHg
cpet_pr_20 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_20 Heart Rate (bpm): True float |bpm
cpet_spo2_20 SP O2 (%): True float |%
cpet_sbp_20 Systolic BP (mmHg): True float |mmHg
cpet_dbp_20 Diastolic BP (mmHg): True float |mmHg
cpet_pr_21 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_21 Heart Rate (bpm): True float |bpm
cpet_spo2_21 SP O2 (%): True float |%
cpet_sbp_21 Systolic BP (mmHg): True float |mmHg
cpet_dbp_21 Diastolic BP (mmHg): True float |mmHg
cpet_pr_22 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_22 Heart Rate (bpm): True float |bpm
cpet_spo2_22 SP O2 (%): True float |%
cpet_sbp_22 Systolic BP (mmHg): True float |mmHg
cpet_dbp_22 Diastolic BP (mmHg): True float |mmHg
cpet_pr_23 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_23 Heart Rate (bpm): True float |bpm
cpet_spo2_23 SP O2 (%): True float |%
cpet_sbp_23 Systolic BP (mmHg): True float |mmHg
cpet_dbp_23 Diastolic BP (mmHg): True float |mmHg
cpet_pr_24 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_24 Heart Rate (bpm): True float |bpm
cpet_spo2_24 SP O2 (%): True float |%
cpet_sbp_24 Systolic BP (mmHg): True float |mmHg
cpet_dbp_24 Diastolic BP (mmHg): True float |mmHg
cpet_pr_24plus Actual Pedal Rate (rpm): True float |rpm
cpet_hr_24plus Heart Rate (bpm): True float |bpm
cpet_spo2_24plus SP O2 (%): True float |%
cpet_sbp_24plus Systolic BP (mmHg): True float |mmHg
cpet_dbp_24plus Diastolic BP (mmHg): True float |mmHg
cpet_time_peak Elapsed Time (min) True float |min
cpet_wr_peak Work Rate (W): True float Float
cpet_pr_peak Actual Pedal Rate (rpm): True float |rpm
cpet_hr_peak Heart Rate (bpm): True float |bpm
cpet_spo2_peak SP O2 (%): True float |%
cpet_sbp_peak Systolic BP (mmHg): True float |mmHg
cpet_dbp_peak Diastolic BP (mmHg): True float |mmHg
cpet_pr_rec1 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_rec1 Heart Rate (bpm): True float |bpm
cpet_spo2_rec1 SP O2 (%): True float |%
cpet_sbp_rec1 Systolic BP (mmHg): True float |mmHg
cpet_dbp_rec1 Diastolic BP (mmHg): True float |mmHg
cpet_pr_rec2 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_rec2 Heart Rate (bpm): True float |bpm
cpet_spo2_rec2 SP O2 (%): True float |%
cpet_sbp_rec2 Systolic BP (mmHg): True float |mmHg
cpet_dbp_rec2 Diastolic BP (mmHg): True float |mmHg
cpet_pr_rec3 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_rec3 Heart Rate (bpm): True float |bpm
cpet_spo2_rec3 SP O2 (%): True float |%
cpet_sbp_rec3 Systolic BP (mmHg): True float |mmHg
cpet_dbp_rec3 Diastolic BP (mmHg): True float |mmHg
cpet_pr_rec4 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_rec4 Heart Rate (bpm): True float |bpm
cpet_spo2_rec4 SP O2 (%): True float |%
cpet_sbp_rec4 Systolic BP (mmHg): True float |mmHg
cpet_dbp_rec4 Diastolic BP (mmHg): True float |mmHg
cpet_pr_rec5 Actual Pedal Rate (rpm): True float |rpm
cpet_hr_rec5 Heart Rate (bpm): True float |bpm
cpet_spo2_rec5 SP O2 (%): True float |%
cpet_sbp_rec5 Systolic BP (mmHg): True float |mmHg
cpet_dbp_rec5 Diastolic BP (mmHg): True float |mmHg
Case Assignment Confirmation Coordinator Form 1 group-case Is this participant a case (has HFpEF) or control subject? True Select one Case- this person has a HFpEF diagnosis
group-control Control
2 group-case Is this participant a case (has HFpEF) or control subject? True Select one Case- this person has a HFpEF diagnosis
group-control Control
Chair Stand Tests Coordinator Form 1 chair_first-yes For the first CHAIR STAND TEST, was the participant able to safely stand? True Select one Yes, the participant stood WITHOUT using arms
chair_first-arms Yes, but the participant used arms to stand
chair_first-no No
chair_first_why-1 What was the reason the participant failed or did not attempt the test? Select all that apply True Select any Tried but unable
chair_first_why-2 Participant could not stand unassisted
chair_first_why-3 Not attempted, you (the proctor) felt unsafe
chair_first_why-4 Not attempted, participant felt unsafe
chair_first_why-5 Participant unable to understand instructions
chair_first_why-6 Other (specify)
chair_first_why-7 Participant refused
cahir_first_oth What was the other reason? True text Text
chair_five-yes For the REPEATED CHAIR STAND test, was the participant able to safely stand five times? True Select one Yes
chair_five-no No
chair_five_times Total time to complete five stands (in seconds): True float |seconds
chair_five_why-1 What was the reason the participant failed or did not attempt the test? Select all that apply True Select any Tried but unable
chair_five_why-2 Participant could not stand unassisted
chair_five_why-3 Not attempted, you (the proctor) felt unsafe
chair_five_why-4 Not attempted, participant felt unsafe
chair_five_why-5 Participant unable to understand instructions
chair_five_why-6 Other (specify)
chair_five_why-7 Participant refused
chair_five_oth What was the other reason? True text Text
chair_mod-yes Was there a modification to the protocol? True Select one Yes
chair_mod-no No
chair_mod_comment Explain the protocol modification. True text Text
Chest Discomfort Symptoms 1 dress_yourself-1 Dress yourself True Select one Extremely Limited
dress_yourself-2 Quite a bit Limited
dress_yourself-3 Moderately Limited
dress_yourself-4 Slightly Limited
dress_yourself-5 Not at all Limited
dress_yourself-6 Limited for other reasons or did not do the activity
walking_indoors-1 Walking indoors on level ground True Select one Extremely Limited
walking_indoors-2 Quite a bit Limited
walking_indoors-3 Moderately Limited
walking_indoors-4 Slightly Limited
walking_indoors-5 Not at all Limited
walking_indoors-6 Limited for other reasons or did not do the activity
showering-1 Showering True Select one Extremely Limited
showering-2 Quite a bit Limited
showering-3 Moderately Limited
showering-4 Slightly Limited
showering-5 Not at all Limited
showering-6 Limited for other reasons or did not do the activity
climbing-1 Climbing a hill or a flight of stairs without stopping True Select one Extremely Limited
climbing-2 Quite a bit Limited
climbing-3 Moderately Limited
climbing-4 Slightly Limited
climbing-5 Not at all Limited
climbing-6 Limited for other reasons or did not do the activity
gardening-1 Gardening, vacuuming, or carrying groceries True Select one Extremely Limited
gardening-2 Quite a bit Limited
gardening-3 Moderately Limited
gardening-4 Slightly Limited
gardening-5 Not at all Limited
gardening-6 Limited for other reasons or did not do the activity
walking-1 Walking more than a block at a brisk pace True Select one Extremely Limited
walking-2 Quite a bit Limited
walking-3 Moderately Limited
walking-4 Slightly Limited
walking-5 Not at all Limited
walking-6 Limited for other reasons or did not do the activity
running-1 Running or jogging True Select one Extremely Limited
running-2 Quite a bit Limited
running-3 Moderately Limited
running-4 Slightly Limited
running-5 Not at all Limited
running-6 Limited for other reasons or did not do the activity
lifting-1 Lifting or moving heavy objects (e.g., furniture, children) True Select one Extremely Limited
lifting-2 Quite a bit Limited
lifting-3 Moderately Limited
lifting-4 Slightly Limited
lifting-5 Not at all Limited
lifting-6 Limited for other reasons or did not do the activity
sports-1 Participating in strenuous sports (e.g., swimming, tennis) True Select one Extremely Limited
sports-2 Quite a bit Limited
sports-3 Moderately Limited
sports-4 Slightly Limited
sports-5 Not at all Limited
sports-6 Limited for other reasons or did not do the activity
wk_chest_pain_strenuous-1 Compared with 4 weeks ago, how often do you have CHEST PAIN, CHEST TIGHTNESS, or ANGINA when doing your MOST STRENUOUS activities? True Select one Much more often
wk_chest_pain_strenuous-2 Slightly more often
wk_chest_pain_strenuous-3 About the same
wk_chest_pain_strenuous-4 Slightly less often
wk_chest_pain_strenuous-5 Much less often
wk_chest_pain_strenuous-6 I have had no chest pain over the last 4 weeks
wk_ave_chest_pain-1 Over the past 4 weeks, on average, how many times have you had CHEST PAIN, CHEST TIGHTNESS, or ANGINA? True Select one 4 or more times per day
wk_ave_chest_pain-2 1-3 times per day
wk_ave_chest_pain-3 3 or more times per week but not every day
wk_ave_chest_pain-4 1-2 times per week
wk_ave_chest_pain-5 Less than once a week
wk_ave_chest_pain-6 None over the past 4 weeks
wk_nitro-1 Over the past 4 weeks, on average, how many times have you had to take nitroglycerin (nitroglycerin tablets or spray) for your CHEST PAIN, CHEST TIGHTNESS, or ANGINA? True Select one 4 or more times per day
wk_nitro-2 1-3 times per day
wk_nitro-3 3 or more times per week but not every day
wk_nitro-4 1-2 times per week
wk_nitro-5 Less than once a week
wk_nitro-6 None over the past 4 weeks
bothersome_pills-1 How bothersome is it for you to take your pills for CHEST PAIN, CHEST TIGHTNESS, or ANGINA as prescribed? True Select one Extremely bothersome
bothersome_pills-2 Quite a bit bothersome
bothersome_pills-3 Moderately bothersome
bothersome_pills-4 Slightly bothersome
bothersome_pills-5 Not bothersome at all
bothersome_pills-6 My doctor has not prescribed pills
treatment_satisfied-1 How satisfied are you that everything possible is being done to treat your CHEST PAIN, CHEST TIGHTNESS, or ANGINA? True Select one Not at all satisfied
treatment_satisfied-2 Mostly dissatisfied
treatment_satisfied-3 Somewhat satisfied
treatment_satisfied-4 Mostly satisfied
treatment_satisfied-5 Completely satisfied
treatment_satisfied-6 I am not receiving treatment for chest pain, chest tightness, or angina
explanations_satisfied-1 How satisfied are you with the explanations your doctor has given you about your CHEST PAIN, CHEST TIGHTNESS, or ANGINA? True Select one Not at all satisfied
explanations_satisfied-2 Mostly dissatisfied
explanations_satisfied-3 Somewhat satisfied
explanations_satisfied-4 Mostly satisfied
explanations_satisfied-5 Completely satisfied
explanations_satisfied-6 My doctor has not given me an explanation.
overall_satisfied-1 Overall, how satisfied are you with the current treatment of your CHEST PAIN, CHEST TIGHTNESS, or ANGINA? True Select one Not at all satisfied
overall_satisfied-2 Mostly dissatisfied
overall_satisfied-3 Somewhat satisfied
overall_satisfied-4 Mostly satisfied
overall_satisfied-5 Completely satisfied
overall_satisfied-6 I am not receiving treatment for chest pain, chest tightness, or angina
enjoyment_limit-1 Over the past 4 weeks, how much has your CHEST PAIN, CHEST TIGHTNESS, or ANGINA limited your enjoyment of life? True Select one It has extremely limited my enjoyment of life
enjoyment_limit-2 It has limited my enjoyment of life quite a bit
enjoyment_limit-3 It has moderately limited my enjoyment of life
enjoyment_limit-4 It has slightly limited my enjoyment of life
enjoyment_limit-5 It has not limited my enjoyment of life at all
rest_of_life-1 If you had to spend the rest of your life with your CHEST PAIN, CHEST TIGHTNESS, or ANGINA the way it is right now, how would you feel about this? True Select one Not at all satisfied
rest_of_life-2 Mostly dissatisfied
rest_of_life-3 Somewhat satisfied
rest_of_life-4 Mostly satisfied
rest_of_life-5 Completely satisfied
worry-1 How often do you think or worry that you may have a heart attack or die suddenly? True Select one I can't stop thinking or worrying about it
worry-2 I often think or worry about it
worry-3 I occasionally think or worry about it
worry-4 I rarely think or worry about it
worry-5 I never think or worry about it
Cognition Survey 1 thinking-1 In the past 7 days... True Select one Very Often (Several times a day)
thinking-2 Often (About once a day)
thinking-3 Sometimes (Two or three times)
thinking-4 Rarely (Once)
thinking-5 Never
brain-1 In the past 7 days... True Select one Very Often (Several times a day)
brain-2 Often (About once a day)
brain-3 Sometimes (Two or three times)
brain-4 Rarely (Once)
brain-5 Never
work_harder-1 In the past 7 days... True Select one Very Often (Several times a day)
work_harder-2 Often (About once a day)
work_harder-3 Sometimes (Two or three times)
work_harder-4 Rarely (Once)
work_harder-5 Never
shifting-1 In the past 7 days... True Select one Very Often (Several times a day)
shifting-2 Often (About once a day)
shifting-3 Sometimes (Two or three times)
shifting-4 Rarely (Once)
shifting-5 Never
concentrating-1 In the past 7 days... True Select one Very Often (Several times a day)
concentrating-2 Often (About once a day)
concentrating-3 Sometimes (Two or three times)
concentrating-4 Rarely (Once)
concentrating-5 Never
mistake-1 In the past 7 days... True Select one Very Often (Several times a day)
mistake-2 Often (About once a day)
mistake-3 Sometimes (Two or three times)
mistake-4 Rarely (Once)
mistake-5 Never
Computed Tomography (CT) Documentation Coordinator Form 1 ct_date What is the date and time of the CT scan? True datetime Datetime
ct_tech Who performed the CT scan? True string String
ct_hardware-no Does the participant have any hardware, e.g. implant, pacemaker, etc.? True Select any No
ct_hardware-hip Hip
ct_hardware-lumbar Lumbar spine
ct_hardware-chest Chest
ct_hardware-cardiac Cardiac
ct_raisearms-yes Is the participant able to raise their arms above their head? True Select one Yes
ct_raisearms-no No
ct_breath-yes Was the breath hold performed correctly? (Lungs should be largest at TLC and smallest at RV) True Select one Yes
ct_breath-no No
ct_breath_scan-tlc If not, which scan(s) is not correct? True Select any TLC
ct_breath_scan-frc FRC
ct_breath_scan-rv RV
ct_breath_scan_why-moved Why is the scan not correct? True Select any Participant moved
ct_breath_scan_why-breathing Breathing instructions not followed
ct_breath_scan_why-other Other
ct_breath_other If ‘other,’ what happened? True text Text
ct_table-no A Table Height of 175 should be used for the scan. Did the table height need to be adjusted to fit the participant in the scanner bore? True Select one No
ct_table-yes Yes
ct_table_height If different than 175, what table height was used? True integer Integer
ct_mod-yes Was there a modification to the protocol? True Select one Yes
ct_mod-no No
ct_mod_comment Explain the protocol modification. True text Text
2 ct_date What is the date and time of the CT scan? True datetime Datetime
ct_tech Who performed the CT scan? True string String
ct_hardware-no Does the participant have any hardware, e.g. implant, pacemaker, etc.? True Select any No
ct_hardware-hip Hip
ct_hardware-lumbar Lumbar spine
ct_hardware-chest Chest
ct_hardware-cardiac Cardiac
ct_raisearms-yes Is the participant able to raise their arms above their head? True Select one Yes
ct_raisearms-no No
ct_breath-yes Was the breath hold performed correctly? (Lungs should be largest at TLC and smallest at RV) True Select one Yes
ct_breath-no No
ct_breath_scan-tlc If not, which scan(s) is not correct? True Select any TLC
ct_breath_scan-frc FRC
ct_breath_scan-rv RV
ct_breath_scan_why-moved Why is the scan not correct? True Select any Participant moved
ct_breath_scan_why-breathing Breathing instructions not followed
ct_breath_scan_why-other Other
ct_breath_other If ‘other,’ what happened? True text Text
ct_table-yes A Table Height of 175cm should be used for the scan. Did the table height need to be adjusted to fit the participant in the scanner bore? True Select one Yes
ct_table-no No
ct_table_height If different than 175, what table height was used? True integer Integer
ct_mod-yes Was there a modification to the protocol? True Select one Yes
ct_mod-no No
ct_mod_comment Explain the protocol modification. True text Text
Concentration Survey 2 thinking-1 In the past 7 days... True Select one Very Often (Several times a day)
thinking-2 Often (About once a day)
thinking-3 Sometimes (Two or three times)
thinking-4 Rarely (Once)
thinking-5 Never
brain-1 In the past 7 days... True Select one Very Often (Several times a day)
brain-2 Often (About once a day)
brain-3 Sometimes (Two or three times)
brain-4 Rarely (Once)
brain-5 Never
work_harder-1 In the past 7 days... True Select one Very Often (Several times a day)
work_harder-2 Often (About once a day)
work_harder-3 Sometimes (Two or three times)
work_harder-4 Rarely (Once)
work_harder-5 Never
shifting-1 In the past 7 days... True Select one Very Often (Several times a day)
shifting-2 Often (About once a day)
shifting-3 Sometimes (Two or three times)
shifting-4 Rarely (Once)
shifting-5 Never
concentrating-1 In the past 7 days... True Select one Very Often (Several times a day)
concentrating-2 Often (About once a day)
concentrating-3 Sometimes (Two or three times)
concentrating-4 Rarely (Once)
concentrating-5 Never
mistake-1 In the past 7 days... True Select one Very Often (Several times a day)
mistake-2 Often (About once a day)
mistake-3 Sometimes (Two or three times)
mistake-4 Rarely (Once)
mistake-5 Never
3 thinking-1 In the past 7 days, my thinking has been slow. True Select one Very Often (Several times a day)
thinking-2 Often (About once a day)
thinking-3 Sometimes (Two or three times)
thinking-4 Rarely (Once)
thinking-5 Never
brain-1 In the past 7 days, it has seemed like my brain was not working as well as usual. True Select one Very Often (Several times a day)
brain-2 Often (About once a day)
brain-3 Sometimes (Two or three times)
brain-4 Rarely (Once)
brain-5 Never
work_harder-1 In the past 7 days, I have had to work harder than usual to keep track of what I was doing. True Select one Very Often (Several times a day)
work_harder-2 Often (About once a day)
work_harder-3 Sometimes (Two or three times)
work_harder-4 Rarely (Once)
work_harder-5 Never
shifting-1 In the past 7 days, I have had trouble shifting back and forth between different activities that require thinking. True Select one Very Often (Several times a day)
shifting-2 Often (About once a day)
shifting-3 Sometimes (Two or three times)
shifting-4 Rarely (Once)
shifting-5 Never
concentrating-1 In the past 7 days, I have had trouble concentrating. True Select one Very Often (Several times a day)
concentrating-2 Often (About once a day)
concentrating-3 Sometimes (Two or three times)
concentrating-4 Rarely (Once)
concentrating-5 Never
mistake-1 In the past 7 days, I have had to work really hard to pay attention or I would make a mistake. True Select one Very Often (Several times a day)
mistake-2 Often (About once a day)
mistake-3 Sometimes (Two or three times)
mistake-4 Rarely (Once)
mistake-5 Never
Deep Phenotyping Eligibility Coordinator Form 1 inclusion-age Which of the following INCLUSION criteria are met by this participant? True Select any Appropriate age
inclusion-none None of the above
exclusion-ckd Which of the following EXCLUSION criteria are met by this participant? True Select any Chronic kidney disease
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
2 inclusion-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion-hf Signs and symptoms of HF
inclusion-nyha NYHA functional class II-IV
inclusion-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
3 inclusion-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion-hf Signs and symptoms of HF
inclusion-nyha NYHA functional class II-IV
inclusion-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
4 inclusion-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion-hf Signs and symptoms of HF
inclusion-nyha NYHA functional class II-IV
inclusion-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
5 inclusion-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion-hf Signs and symptoms of HF
inclusion-nyha NYHA functional class II-IV
inclusion-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
6 case_control-hfpef Is the participant being enrolled as a HFpEF patient or a non-HFpEF comparator? True Select one HFpEF patient
case_control-comparator Non-HF-pEF patient
inclusion_hfpef-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_hfpef-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_hfpef-hf Signs and symptoms of HF
inclusion_hfpef-nyha NYHA functional class II-IV
inclusion_hfpef-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion_hfpef-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion_hfpef-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion_hfpef-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion_hfpef-none None of the above
inclusion_comparator-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_comparator-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_comparator-nohf No known prior diagnosis of HF or use of diuretics for fluid management
inclusion_comparator-elevatedbnp No known prior history of BNP ≥75 pg/ml or NTproBNP ≥225 pg/ml, if prior laboratory tests are available in the EHR
inclusion_comparator-currentntprobnp BNP <75 pg/ml or NTproBNP <225 pg/ml at the time of screening. Choice of BNP or NTproBNP is based on availability at each clinical center
inclusion_comparator-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation.)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
7 case_control-hfpef Is the participant being enrolled as a HFpEF patient or a non-HFpEF comparator? True Select one HFpEF patient
case_control-comparator Non-HF-pEF patient
inclusion_hfpef-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_hfpef-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_hfpef-hf Signs and symptoms of HF
inclusion_hfpef-nyha NYHA functional class II-IV
inclusion_hfpef-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion_hfpef-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion_hfpef-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion_hfpef-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion_hfpef-none None of the above
inclusion_comparator-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_comparator-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_comparator-nohf No known prior diagnosis of HF or use of diuretics for fluid management
inclusion_comparator-elevatedbnp No known prior history of BNP ≥75 pg/ml or NTproBNP ≥225 pg/ml, if prior laboratory tests are available in the EHR
inclusion_comparator-currentntprobnp BNP <75 pg/ml or NTproBNP <225 pg/ml at the time of screening. Choice of BNP or NTproBNP is based on availability at each clinical center
inclusion_comparator-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation.)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
8 case_control-hfpef Is the participant being enrolled as a HFpEF patient or a non-HFpEF comparator? True Select one HFpEF patient
case_control-comparator Non-HF-pEF patient
inclusion_hfpef-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_hfpef-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_hfpef-hf Signs and symptoms of HF
inclusion_hfpef-nyha NYHA functional class II-IV
inclusion_hfpef-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion_hfpef-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion_hfpef-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion_hfpef-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion_hfpef-none None of the above
inclusion_comparator-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_comparator-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_comparator-nohf No known prior diagnosis of HF or use of diuretics for fluid management
inclusion_comparator-elevatedbnp No known prior history of BNP ≥75 pg/ml or NTproBNP ≥225 pg/ml, if prior laboratory tests are available in the EHR
inclusion_comparator-currentntprobnp BNP <75 pg/ml or NTproBNP <225 pg/ml at the time of screening. Choice of BNP or NTproBNP is based on availability at each clinical center
inclusion_comparator-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation.)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
9 case_control-hfpef Is the participant being enrolled as a HFpEF patient or a non-HFpEF comparator? True Select one HFpEF patient
case_control-comparator Non-HF-pEF patient
inclusion_hfpef-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_hfpef-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_hfpef-hf Signs and symptoms of HF
inclusion_hfpef-nyha NYHA functional class II-IV
inclusion_hfpef-bnp Elevated BNP at baseline (≥75 pg/ml in sinus rhythm or ≥225 pg/ml in atrial fibrillation/flutter)
inclusion_hfpef-ntprobnp Elevated NTproBNP at baseline (≥225 pg/ml in sinus rhythm or ≥675 in atrial fibrillation/flutter)
inclusion_hfpef-hospitalization Prior HF hospitalization (primary reason for the hospitalization is HF with elevated natriuretic peptide levels, requiring IV diuresis for HF, or pulmonary edema or pulmonary vascular congestion on chest radiography)
inclusion_hfpef-pcwp Elevated pulmonary capillary wedge pressure (PCWP) at rest (≥15 mmHg) or during exercise (≥25 mmHg for supine exercise or PCWP/cardiac output ratio≥2 mmHg/L/min for upright exercise)
inclusion_hfpef-none None of the above
inclusion_comparator-age Which of the following INCLUSION criteria are met by this participant? True Select any Age 30 or over
inclusion_comparator-lvef Left ventricular ejection fraction ≥50% measured by echocardiography
inclusion_comparator-nohf No known prior diagnosis of HF or use of diuretics for fluid management
inclusion_comparator-elevatedbnp No known prior history of BNP ≥75 pg/ml or NTproBNP ≥225 pg/ml, if prior laboratory tests are available in the EHR
inclusion_comparator-currentntprobnp BNP <75 pg/ml or NTproBNP <225 pg/ml at the time of screening. Choice of BNP or NTproBNP is based on availability at each clinical center
inclusion_comparator-none None of the above
exclusion-life Which of the following EXCLUSION criteria are met by this participant? True Select any Life expectancy estimated to be < 1 year
exclusion-amyloid Primary cardiomyopathy (including amyloid, hypertrophic cardiomyopathy, cardiac sarcoidosis, hemochromatosis, or other infiltrative cardiomyopathies) or pulmonary arterial hypertension (WHO Group I, III, or IV pulmonary hypertension)
exclusion-lvef Any prior known left ventricular ejection fraction <40%, except if this occurred only in the setting of an acute tachycardia episode (e.g., acute atrial fibrillation)
exclusion-vhd Clinically significant valvular heart disease (Defined as: Moderate to greater aortic stenosis, pulmonic stenosis, or tricuspid stenosis; Any mitral stenosis; Moderate or greater aortic regurgitation; Greater than moderate mitral regurgitation.)
exclusion-plannedsurgery Any planned cardiac surgery or cardiac intervention in the next 3 months
exclusion-sob Alternative primary reason for symptoms of shortness of breath and exercise intolerance in HFpEF participants in the opinion of the enrolling investigator
exclusion-priorsurgery Cardiac surgery, acute coronary syndrome, percutaneous coronary intervention, stroke, transient ischemic attack, or carotid intervention in the preceding 6 months prior to enrollment
exclusion-cad Known symptomatic epicardial coronary artery disease that is not revascularized
exclusion-recenthospital Any non-elective hospitalization in the preceding 2 weeks
exclusion-transplant Prior history of solid organ transplantation
exclusion-infection Prior history of chronic infection (HIV, hepatitis C, hepatitis B, tuberculosis) unless treated and not clinically active in the opinion of the enrolling investigator
exclusion-circulation Prior history of mechanical circulatory support
exclusion-cirrhosis Prior history of non-cardiac cirrhosis
exclusion-dialysis Estimated GFR <20 ml/min/1.73m2 or currently on dialysis
exclusion-other Any condition that may preclude participation or adherence to the study protocol, in the opinion of the enrolling investigator
exclusion-consent Inability to provide written consent to the study
exclusion-acutehf Current acute decompensated heart failure
exclusion-pregnant Currently pregnant
exclusion-none None of the above
dpc_eligible-yes Is this participant eligible to be invited to the Deep Phenotyping cohort of the HeartShare Study? True Select one Yes
muscle_eligible-yes Is this participant eligible to provide skeletal muscle biopsy samples? True Select one Yes
muscle_eligible-no No
muscle_eligible-na N/A- Biopsy not performed at this site
adipose_eligible-yes Is this participant eligible to provide adipose tissue biopsy samples? True Select one Yes
adipose_eligible-no No
adipose_eligible-na N/A- Biopsy not performed at this site
ECG Documentation Coordinator Form 1 ecg_date What is the date and time of the ECG? True datetime Datetime
ecg_tech Who performed the ECG? True string String
ecg_fasting-yes Has it been 8 hours or more that the participant last ate and/or drank anything other than water, including candy and chewing gum? True Select one Yes
ecg_fasting-no No
ecg_comp-yes Was the ECG completed? True Select one Yes
ecg_comp-no No
ecg_comp_reason-hwm If not completed, why was the ECG incomplete or not done? True Select any Hardware malfunction (please contact core lab team at Wake Forest)
ecg_comp_reason-supplies Lack of supplies
ecg_comp_reason-insf Insufficient time or room not available
ecg_comp_reason-fasting Participant not fasted for at least 8 hours
ecg_comp_reason-oth Other
ecg_comp_other What was the ‘other’ reason the ECG was incomplete or not done? True text Text
ecg_nv NV Measurement: True float |inch
ecg_midchest Mid-chest Measurement: True float |inch
ecg_alert-yes Were any alert conditions noted during the ECG? True Select one Yes
ecg_alert-no No
ecg_alert_detail-hrlow Specify the alert conditions noted: True Select any Heart rate less than 40 beats per minute
ecg_alert_detail-hrhigh Heart rate more than 120 beats per minute
ecg_alert_detail-infarction Acute myocardial infarction/injury
ecg_alert_detail-ischemia Acute myocardial ischemia
ecg_alert_detail-tachykardia Ventricular tachycardia
ecg_alert_detail-block Complete atrioventricular block
ecg_alert_detail-afib Atrial fibrillation or flutter (Note: only new atrial fibrillation or flutter, defined as atrial fibrillation or flutter with no documentation of prior history of these conditions. You may ask the participant about their history of atrial fibrillation or flutter)
ecg_alert_detail-wpw Wolff-Parkinson-White Syndrome – Pre-excitation
ecg_alert_action-true Specify the action taken in response to the alert condition(s) noted above: True Select one Alert checked with a healthcare provider and confirmed to be true. Participant referred to ER/their physician.
ecg_alert_action-false Alert checked with a healthcare provider and determined not true. Participant reassured.
ecg_alert_action-notchecked Alert was not checked with a healthcare provider. Participant was referred to ER/their physician.
ecg_alert_action-noaction No action taken
ecg_alter_not_checked Why wasn’t the alert checked with a healthcare provider? Please explain True text Text
ecg_alter_no_action Why was no action taken in response to the alert condition(s)? Please explain True text Text
ecg_mod-yes Was there a modification to the protocol? True Select one Yes
ecg_mod-no No
ecg_mod_comment Explain the protocol modification. True text Text
2 ecg_date What is the date and time of the ECG? False datetime Datetime
ecg_tech Who performed the ECG? False string String
ecg_fasting-yes Has it been 8 hours or more that the participant last ate and/or drank anything other than water, including candy and chewing gum? False Select one Yes
ecg_fasting-no No
ecg_comp-yes Was the ECG completed? False Select one Yes
ecg_comp-no No
ecg_comp_reason-hwm If not completed, why was the ECG incomplete or not done? False Select any Hardware malfunction (please contact core lab team at Wake Forest)
ecg_comp_reason-af Lack of supplies
ecg_comp_reason-insf Insufficient time or room not available
ecg_comp_reason-fasting Participant not fasted for at least 8 hours
ecg_comp_reason-oth Other
ecg_comp_other What was the ‘other’ reason the ECG was incomplete or not done? False text Text
ecg_nv NV Measurement: False float |inch
ecg_midchest Mid-chest Measurement: False float |inch
ecg_alert-yes Were any alert conditions noted during the ECG? False Select one Yes
ecg_alert-no No
ecg_alert_detail-hrlow Specify the alert conditions noted: False Select any Heart rate less than 40 beats per minute
ecg_alert_detail-hrhigh Heart rate more than 120 beats per minute
ecg_alert_detail-infarction Acute myocardial infarction/injury
ecg_alert_detail-ischemia Acute myocardial ischemia
ecg_alert_detail-tachykardia Ventricular tachycardia
ecg_alert_detail-block Complete atrioventricular block
ecg_alert_detail-afib Atrial fibrillation or flutter (Note: only new atrial fibrillation or flutter, defined as atrial fibrillation or flutter with no documentation of prior history of these conditions. You may ask the participant about their history of atrial fibrillation or flutter)
ecg_alert_detail-wpw Wolff-Parkinson-White Syndrome – Pre-excitation
ecg_alert_action-true Specify the action taken in response to the alert condition(s) noted above: False Select one Alert checked with a healthcare provider and confirmed to be true. Participant referred to ER/their physician.
ecg_alert_action-false Alert checked with a healthcare provider and determined not true. Participant reassured.
ecg_alert_action-notchecked Alert was not checked with a healthcare provider. Participant was referred to ER/their physician.
ecg_alert_action-noaction No action taken
ecg_alter_not_checked Why wasn’t the alert checked with a healthcare provider? Please explain False text Text
ecg_alter_no_action Why was no action taken in response to the alert condition(s)? Please explain False text Text
ecg_mod-yes Was there a modification to the protocol? False Select one Yes
ecg_mod-no No
ecg_mod_comment Explain the protocol modification. False text Text
3 ecg_date What is the date and time of the ECG? True datetime Datetime
ecg_tech Who performed the ECG? True string String
ecg_fasting How long has it been since the participant last ate and/or drank anything other than water, including candy and chewing gum? True float |hours
ecg_comp-yes Was the ECG completed? True Select one Yes
ecg_comp-no No
ecg_comp_reason-hwm If not completed, why was the ECG incomplete or not done? True Select any Hardware malfunction (please contact core lab team at Wake Forest)
ecg_comp_reason-af Lack of supplies
ecg_comp_reason-insf Insufficient time or room not available
ecg_comp_reason-fasting Participant not fasted for at least 8 hours
ecg_comp_reason-oth Other
ecg_comp_other What was the ‘other’ reason the ECG was incomplete or not done? True text Text
ecg_nv NV Measurement: True float |inch
ecg_midchest Mid-chest Measurement: True float |inch
ecg_alert-yes Were any alert conditions noted during the ECG? True Select one Yes
ecg_alert-no No
ecg_alert_detail-hrlow Specify the alert conditions noted: True Select any Heart rate less than 40 beats per minute
ecg_alert_detail-hrhigh Heart rate more than 120 beats per minute
ecg_alert_detail-infarction Acute myocardial infarction/injury
ecg_alert_detail-ischemia Acute myocardial ischemia
ecg_alert_detail-tachykardia Ventricular tachycardia
ecg_alert_detail-block Complete atrioventricular block
ecg_alert_detail-afib Atrial fibrillation or flutter (Note: only new atrial fibrillation or flutter, defined as atrial fibrillation or flutter with no documentation of prior history of these conditions. You may ask the participant about their history of atrial fibrillation or flutter)
ecg_alert_detail-wpw Wolff-Parkinson-White Syndrome – Pre-excitation
ecg_alert_action-true Specify the action taken in response to the alert condition(s) noted above: True Select one Alert checked with a healthcare provider and confirmed to be true. Participant referred to ER/their physician.
ecg_alert_action-false Alert checked with a healthcare provider and determined not true. Participant reassured.
ecg_alert_action-notchecked Alert was not checked with a healthcare provider. Participant was referred to ER/their physician.
ecg_alert_action-noaction No action taken
ecg_alter_not_checked Why wasn’t the alert checked with a healthcare provider? Please explain True text Text
ecg_alter_no_action Why was no action taken in response to the alert condition(s)? Please explain True text Text
ecg_mod-yes Was there a modification to the protocol? True Select one Yes
ecg_mod-no No
ecg_mod_comment Explain the protocol modification. True text Text
4 ecg_date What is the date and time of the ECG? True datetime Datetime
ecg_tech Who performed the ECG? True string String
ecg_fasting How long has it been since the participant last ate and/or drank anything other than water, including candy and chewing gum? True float |hours
ecg_comp-yes Was the ECG completed? True Select one Yes
ecg_comp-no No
ecg_comp_reason-hwm If not completed, why was the ECG incomplete or not done? True Select any Hardware malfunction (please contact core lab team at Wake Forest)
ecg_comp_reason-af Lack of supplies
ecg_comp_reason-insf Insufficient time or room not available
ecg_comp_reason-fasting Participant not fasted for at least 8 hours
ecg_comp_reason-oth Other
ecg_comp_other What was the ‘other’ reason the ECG was incomplete or not done? True text Text
ecg_nv NV Measurement: True float |inch
ecg_midchest Mid-chest Measurement: True float |inch
ecg_alert-yes Were any alert conditions noted during the ECG? True Select one Yes
ecg_alert-no No
ecg_alert_detail-hrlow Specify the alert conditions noted: True Select any Heart rate less than 40 beats per minute
ecg_alert_detail-hrhigh Heart rate more than 120 beats per minute
ecg_alert_detail-infarction Acute myocardial infarction/injury
ecg_alert_detail-ischemia Acute myocardial ischemia
ecg_alert_detail-tachykardia Ventricular tachycardia
ecg_alert_detail-block Complete atrioventricular block
ecg_alert_detail-afib Atrial fibrillation or flutter (Note: only new atrial fibrillation or flutter, defined as atrial fibrillation or flutter with no documentation of prior history of these conditions. You may ask the participant about their history of atrial fibrillation or flutter)
ecg_alert_detail-wpw Wolff-Parkinson-White Syndrome – Pre-excitation
ecg_alert_action-true Specify the action taken in response to the alert condition(s) noted above: True Select one Alert checked with a healthcare provider and confirmed to be true. Participant referred to ER/their physician.
ecg_alert_action-false Alert checked with a healthcare provider and determined not true. Participant reassured.
ecg_alert_action-notchecked Alert was not checked with a healthcare provider. Participant was referred to ER/their physician.
ecg_alert_action-noaction No action taken
ecg_alter_not_checked Why wasn't the alert checked with a healthcare provider? Please explain False text Text
ecg_alter_no_action Why was no action taken in response to the alert condition(s)? Please explain True text Text
ecg_mod-yes Was there a modification to the protocol? True Select one Yes
ecg_mod-no No
ecg_mod_comment Explain the protocol modification. True text Text
ECHO Coordinator Form 3 echo_sono Name of sonographer: False string Full Name:|
echo_date Date of ECHO: False date Date
echo_rhythm-nsr EKG Heart Rhythm (approximate based upon echo leads) False Select one Normal Sinus Rhythm
echo_rhythm-af Atrial Fibrillation
echo_rhythm-oth Other
echo_pacemaker-yes Does the participant have an artificial cardiac pacemaker? False Select one Yes
echo_pacemaker-no No
echo_bl_views-yes Were all required baseline echo views obtained? False Select one Yes
echo_bl_views-no No
echo_bl_views_rsn-refused If No, why were all required baseline echo views not obtained? False Select one Participant Refused
echo_bl_views_rsn-terminated ECHO terminated early
echo_bl_views_rsn-tech Technical problems
echo_bl_views_comment Comments to reviewer about baseline echo views: False text Text
echo_bl_alert-yes Was an urgent alert suspected? False Select one Yes
echo_bl_alert-no No
echo_bl_alert_id-tamponade What was the urgent alert? False Select one Suspected tamponade
echo_bl_alert_id-aortic Aortic aneurysm or dissection
echo_bl_alert_id-abscess Abscess or obvious vegetation
echo_bl_alert_id-thrombus Thrombus or mass
echo_bl_alert_id-pseudoaneurysm Psuedoaneurysm
echo_bl_alert_id-arrhythmia Significant arrhythmia
echo_bl_alert_comm Comments to reviewer about urgent alert: False text Text
echo_bl_alert_nonurgent-yes Was a non-urgent alert suspected? False Select one Yes
echo_bl_alert_nonurgent-no No
echo_bl_alert_nonurgent_id-stenosis What was the non-urgent alert? False Select one Moderate or greater valvular stenosis
echo_bl_alert_nonurgent_id-ai_mr Moderate or greater AI or MR
echo_bl_alert_nonurgent_id-tr_pi Severe TR or PI
echo_bl_alert_nonurgent_id-lv_rv Severe LV or RV enlargement
echo_bl_alert_nonurgent_id-lvot Moderate or greater LVOT obstruction
echo_bl_alert_nonurgent_id-ph Significant pulmonary hypertension
echo_bl_alert_nonurgent_id-ef_wma Low EF or WMA
echo_bl_alert_nonurgent_id-pe Moderate or greater pericardial effusion
echo_bl_alert_nonurgent_id-afib New atrial fibrillation
echo_bl_alert_nonurgent_comm Comments to reviewer about non-urgent alert: False text Text
echo_exer_views-yes Were all required exercise echo views obtained? False Select one Yes
echo_exer_views-no No
echo_exer_views_rsn-refused If No, why were all required exercise echo views not obtained? False Select one Participant Refused
echo_exer_views_rsn-terminated ECHO terminated early
echo_exer_views_rsn-tech Technical problems
echo_exer_views_comment Comments to reviewer about exercise echo views: False text Text
echo_exer_alert_nonurgent-yes Was a new non-urgent alert suspected? (There are no urgent alerts for the exercise portion) False Select one Yes
echo_exer_alert_nonurgent-no No
echo_exer_alert_nonurgent_id-new_afib What generated the non-urgent alert? False Select one New atrial fibrillation during the exercise test
echo_exer_alert_nonurgent_id-new_wma New WMA with exercise
echo_exer_alert_nonurgent_id-rsvp RSVP >70mmHg during exercise
echo_exer_alert_nonurgent_comm Comments to reviewer about non-urgent alert: False text Text
4 echo_sono Name of sonographer: True string Full Name:|
echo_date Date of ECHO: True date Date
echo_rhythm-nsr EKG Heart Rhythm (approximate based upon echo leads) True Select one Normal Sinus Rhythm
echo_rhythm-af Atrial Fibrillation
echo_rhythm-oth Other
echo_pacemaker-yes Does the participant have an artificial cardiac pacemaker? True Select one Yes
echo_pacemaker-no No
echo_bl_views-yes Were all required baseline echo views obtained? True Select one Yes
echo_bl_views-no No
echo_bl_views_rsn-refused If No, why were all required baseline echo views not obtained? True Select one Participant Refused
echo_bl_views_rsn-terminated ECHO terminated early
echo_bl_views_rsn-tech Technical problems
echo_bl_views_comment Comments to reviewer about baseline echo views: True text Text
echo_bl_alert-yes Was an urgent alert suspected? True Select one Yes
echo_bl_alert-no No
echo_bl_alert_id-tamponade What was the urgent alert? True Select one Suspected tamponade
echo_bl_alert_id-aortic Aortic aneurysm or dissection
echo_bl_alert_id-abscess Abscess or obvious vegetation
echo_bl_alert_id-thrombus Thrombus or mass
echo_bl_alert_id-pseudoaneurysm Psuedoaneurysm
echo_bl_alert_id-arrhythmia Significant arrhythmia
echo_bl_alert_comm Comments to reviewer about urgent alert: True text Text
echo_bl_alert_nonurgent-yes Was a non-urgent alert suspected? True Select one Yes
echo_bl_alert_nonurgent-no No
echo_bl_alert_nonurgent_id-stenosis What was the non-urgent alert? True Select one Moderate or greater valvular stenosis
echo_bl_alert_nonurgent_id-ai_mr Moderate or greater AI or MR
echo_bl_alert_nonurgent_id-tr_pi Severe TR or PI
echo_bl_alert_nonurgent_id-lv_rv Severe LV or RV enlargement
echo_bl_alert_nonurgent_id-lvot Moderate or greater LVOT obstruction
echo_bl_alert_nonurgent_id-ph Significant pulmonary hypertension
echo_bl_alert_nonurgent_id-ef_wma Low EF or WMA
echo_bl_alert_nonurgent_id-pe Moderate or greater pericardial effusion
echo_bl_alert_nonurgent_id-afib New atrial fibrillation
echo_bl_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
echo_exer_views-yes Were all required exercise echo views obtained? True Select one Yes
echo_exer_views-no No
echo_exer_views_rsn-refused If No, why were all required exercise echo views not obtained? True Select one Participant Refused
echo_exer_views_rsn-terminated ECHO terminated early
echo_exer_views_rsn-tech Technical problems
echo_exer_views_comment Comments to reviewer about exercise echo views: True text Text
echo_exer_alert_nonurgent-yes Was a new non-urgent alert suspected? (There are no urgent alerts for the exercise portion) True Select one Yes
echo_exer_alert_nonurgent-no No
echo_exer_alert_nonurgent_id-new_afib What generated the non-urgent alert? True Select one New atrial fibrillation during the exercise test
echo_exer_alert_nonurgent_id-new_wma New WMA with exercise
echo_exer_alert_nonurgent_id-rsvp RSVP >70mmHg during exercise
echo_exer_alert_nonurgent_comm Comments to reviewer about non-urgent alert: True text Text
End of Visit Checklist Coordinator Form 1 bp-1 Was data from the Uscom BP+ uploaded to the DTC Northwestern SharePoint? True Select one Yes
bp-2 No
auscultation-1 Was data from the Eko Duo uploaded to the DTC Northwestern SharePoint? True Select one Yes
auscultation-2 No
bloods-1 Were the lab results entered into the REDCap form? True Select one Yes
bloods-2 No
tonometry-1 Was arterial tonometry data uploaded to the DTC Northwestern SharePoint? True Select one Yes
tonometry-2 No
cmr-1 Was CMR data uploaded to WebPAX? (Confirm with MRI staff if necessary). True Select one Yes
cmr-2 No
cpet-1 Was CPET data transferred using the Mass General Kiteworks Secure File Transfer Service? (Confirm with exercise physiologist if necessary). True Select one Yes
cpet-2 No
ct-1 Were CT images uploaded to the CT Core Lab Box? (Confirm with CT staff if necessary). True Select one Yes
ct-2 No
echo-1 Were echoes uploaded to WebPAX? (Confirm with sonographers if necessary). True Select one Yes
echo-2 No
ecg-1 Was ECG data uploaded to the DTC Northwestern SharePoint? True Select one Yes
ecg-2 No
pft-1 Was PFT data transferred using the Mass General Kiteworks Secure File Transfer Service? True Select one Yes
pft-2 No
data_missing If you answered 'No' to any question above, please explain why data was not uploaded or transferred. True text Text
Gait Speed Tests Coordinator Form 1 gait_length-3 What is the length of the walk test course? True Select one Three (3) meters
gait_length-4 Four (4) meters
gait1_comp-yes Was the participant able to complete the FIRST GAIT SPEED TEST? True Select one Yes
gait1_comp-no No
gait1_time For the FIRST GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait1_why-1 What was the reason for the participant not completing the FIRST GAIT SPEED test? Select all that apply True Select any Tried but unable
gait1_why-2 Participant could not walk unassisted
gait1_why-3 Not attempted, you (the proctor) felt unsafe
gait1_why-4 Not attempted, participant felt unsafe
gait1_why-5 Participant unable to understand instructions
gait1_why-6 Other (specify)
gait1_why-7 Participant refused
gait1_oth What was the other reason? True text Text
gait1_aid-none Were any aids used for the FIRST GAIT SPEED test? True Select any None
gait1_aid-cane Cane
gait1_aid-oth Other
gait1_comment Additional comments: True text Text
gait2_comp-yes Was the participant able to complete the SECOND GAIT SPEED TEST? True Select one Yes
gait2_comp-no No
gait2_time For the SECOND GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait2_why-1 What was the reason for the participant not completing the SECOND GAIT SPEED test? Select all that apply True Select any Tried but unable
gait2_why-2 Participant could not walk unassisted
gait2_why-3 Not attempted, you (the proctor) felt unsafe
gait2_why-4 Not attempted, participant felt unsafe
gait2_why-5 Participant unable to understand instructions
gait2_why-6 Other (specify)
gait2_why-7 Participant refused
gait2_oth What was the other reason? True text Text
gait2_aid-none Were any aids used for the SECOND GAIT SPEED test? True Select any None
gait2_aid-cane Cane
gait2_aid-oth Other
gait2_comment Additional comments: True text Text
gait_mod-yes Was there a modification to the protocol? True Select one Yes
gait_mod-no No
gait_mod_comment Explain the protocol modification. True text Text
2 gait_length-3 What is the length of the walk test course? True Select one Three (3) meters
gait_length-4 Four (4) meters
gait1_comp-yes Was the participant able to complete the FIRST GAIT SPEED TEST? True Select one Yes
gait1_comp-no No
gait1_time For the FIRST GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait1_why-1 What was the reason for the participant not completing the FIRST GAIT SPEED test? Select all that apply True Select any Tried but unable
gait1_why-2 Participant could not walk unassisted
gait1_why-3 Not attempted, you (the proctor) felt unsafe
gait1_why-4 Not attempted, participant felt unsafe
gait1_why-5 Participant unable to understand instructions
gait1_why-6 Other (specify)
gait1_why-7 Participant refused
gait1_oth What was the other reason? True text Text
gait1_aid-none Were any aids used for the FIRST GAIT SPEED test? True Select any None
gait1_aid-cane Cane
gait1_aid-oth Other
gait1_comment Additional comments: False text Text
gait2_comp-yes Was the participant able to complete the SECOND GAIT SPEED TEST? True Select one Yes
gait2_comp-no No
gait2_time For the SECOND GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait2_why-1 What was the reason for the participant not completing the SECOND GAIT SPEED test? Select all that apply True Select any Tried but unable
gait2_why-2 Participant could not walk unassisted
gait2_why-3 Not attempted, you (the proctor) felt unsafe
gait2_why-4 Not attempted, participant felt unsafe
gait2_why-5 Participant unable to understand instructions
gait2_why-6 Other (specify)
gait2_why-7 Participant refused
gait2_oth What was the other reason? True text Text
gait2_aid-none Were any aids used for the SECOND GAIT SPEED test? True Select any None
gait2_aid-cane Cane
gait2_aid-oth Other
gait2_comment Additional comments: False text Text
gait_mod-yes Was there a modification to the protocol? True Select one Yes
gait_mod-no No
gait_mod_comment Explain the protocol modification. True text Text
3 gait1_comp-yes Was the participant able to complete the FIRST GAIT SPEED TEST? True Select one Yes
gait1_comp-no No
gait1_time For the FIRST GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait1_why-1 What was the reason for the participant not completing the FIRST GAIT SPEED test? Select all that apply True Select any Tried but unable
gait1_why-2 Participant could not walk unassisted
gait1_why-3 Not attempted, you (the proctor) felt unsafe
gait1_why-4 Not attempted, participant felt unsafe
gait1_why-5 Participant unable to understand instructions
gait1_why-6 Other (specify)
gait1_why-7 Participant refused
gait1_oth What was the other reason? True text Text
gait1_aid-none Were any aids used for the FIRST GAIT SPEED test? True Select any None
gait1_aid-cane Cane
gait1_aid-oth Other
gait1_comment Additional comments: True text Text
gait2_comp-yes Was the participant able to complete the SECOND GAIT SPEED TEST? True Select one Yes
gait2_comp-no No
gait2_time For the SECOND GAIT SPEED test, how long did it take for the participant to complete the course? True float |seconds
gait2_why-1 What was the reason for the participant not completing the SECOND GAIT SPEED test? Select all that apply True Select any Tried but unable
gait2_why-2 Participant could not walk unassisted
gait2_why-3 Not attempted, you (the proctor) felt unsafe
gait2_why-4 Not attempted, participant felt unsafe
gait2_why-5 Participant unable to understand instructions
gait2_why-6 Other (specify)
gait2_why-7 Participant refused
gait2_oth What was the other reason? True text Text
gait2_aid-none Were any aids used for the SECOND GAIT SPEED test? True Select any None
gait2_aid-cane Cane
gait2_aid-oth Other
gait_mod-yes Was there a modification to the protocol? True Select one Yes
gait_mod-no No
gait_mod_comment Explain the protocol modification. True text Text
General Family History 1 fam_died-1 Has anyone in your immediate or extended biological (natural or blood-related) family died suddenly and unexpectedly NOT from an accident, or had a cardiac arrest? True Select one Yes
fam_died-2 No
fam_died-3 Don't know
af_aflutter-1 Atrial fibrillation or atrial flutter? True Select one Yes
af_aflutter-2 No
af_aflutter-3 Don't know
heart_attack-1 Coronary artery disease or a heart attack (myocardial infarction)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
hypertension-1 High blood pressure (hypertension)? True Select one Yes
hypertension-2 No
hypertension-3 Don't know
heart_failure-1 Heart failure or congestive heart failure (CHF)? True Select one Yes
heart_failure-2 No
heart_failure-3 Don't know
diabetes-1 Diabetes? True Select one Yes
diabetes-2 No
diabetes-3 Don't know
None Which figure best represents your biological MOTHER’S appearance during most of YOUR childhood? False Select one
None
None
None
None
None
None
None
None
None
None
None Which figure best represents your biological FATHER’S appearance during most of YOUR childhood? False Select one
None
None
None
None
None
None
None
None
None
None
2 fam_died-1 Has anyone in your immediate or extended biological (natural or blood-related) family died suddenly and unexpectedly NOT from an accident, or had a cardiac arrest? True Select one Yes
fam_died-2 No
fam_died-3 Don't know
heart_failure-1 Heart failure or congestive heart failure (CHF)? True Select one Yes
heart_failure-2 No
heart_failure-3 Don't know
af_aflutter-1 Atrial fibrillation or atrial flutter? True Select one Yes
af_aflutter-2 No
af_aflutter-3 Don't know
heart_attack-1 Coronary artery disease or a heart attack (myocardial infarction)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
hypertension-1 High blood pressure (hypertension)? True Select one Yes
hypertension-2 No
hypertension-3 Don't know
diabetes-1 Diabetes? True Select one Yes
diabetes-2 No
diabetes-3 Don't know
mother-dk Which figure best represents your biological MOTHER’S appearance during most of YOUR childhood? False Select one Don't Know
mother-pnts Prefer not to answer
mother-1 1
mother-2 2
mother-3 3
mother-4 4
mother-5 5
mother-6 6
mother-7 7
mother-8 8
mother-9 9
father-dk Which figure best represents your biological FATHER’S appearance during most of YOUR childhood? False Select one Don't Know
father-pnts Prefer not to answer
father-1 1
father-2 2
father-3 3
father-4 4
father-5 5
father-6 6
father-7 7
father-8 8
father-9 9
General Symptom Overview 1 sob_level-1 In thinking about your breathing, and any difficulties you may have with your breathing, what level of difficulty best describes your breathing normally over the past month? True Select one I only get breathless with strenuous exercise
sob_level-2 I get short of breath when hurrying on level ground or walking up a slight hill
sob_level-3 On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace
sob_level-4 I stop for breath after walking about 100 yards or after a few minutes on level ground
sob_level-5 I am too breathless to leave the house or I am breathless when dressing
palpitations-1 Do you have heart palpitations, fast heartbeats or racing heart rate (not due to normal exercise), irregular heartbeats, skipped beats, or any funny feelings of abnormal heartbeats? True Select one Yes
palpitations-2 No
palpitations-3 I Don't Know
palp_often-1 About how often do you experience palpitations (on average)? True Select one Three or more times daily
palp_often-2 Twice daily
palp_often-3 Daily or almost daily
palp_often-4 4-5 times a week
palp_often-5 2-3 times a week
palp_often-6 About 1 time a week
palp_often-7 About 2 times in a month
palp_often-8 About 1 time in a month
palp_often-9 2-4 times in a year
palp_often-10 Once a year
palp_often-11 Less than 1 time per year
palp_often-12 Once ever
palp_often-13 Don't know
palp_how_long-1 About how long do your palpitations last? True Select one Not Applicable
palp_how_long-2 A few seconds
palp_how_long-3 About 1-5 minutes
palp_how_long-4 About 5-10 minutes
palp_how_long-5 About 10-20 minutes
palp_how_long-6 About 20-30 minutes
palp_how_long-7 About 30-45 minutes
palp_how_long-8 About 45 minutes to one hour
palp_how_long-9 Longer than one hour
palp_how_long-10 I don't know
palp_cause-1 Has the likely cause of your palpitations been diagnosed by a doctor or other healthcare provider? True Select one Yes
palp_cause-2 No
palp_cause-3 I Don't Know
palp_dx-1 What was the diagnosis of your palpitations? True Select one Atrial fibrillation (AF, AFIB) or flutter
palp_dx-2 Extra or premature beats (PVCs or PACs)
palp_dx-3 Slow heart beats or pauses
palp_dx-4 Supraventricular tachycardia (SVT, fast heart rhythm originating in the top chambers not due to AFib)
palp_dx-5 Ventricular tachycardia (VT, fast heart rhythm originating in the bottom chambers)
palp_dx-6 Sinus tachycardia
palp_dx-7 Other
palp_dx-8 I don't know
syncope-1 Have you ever fainted or passed out (lost consciousness) or been told you have syncope (not due to seizures, low blood sugar or an accident or other trauma)? True Select one Yes
syncope-2 No
syncope-3 I Don't Know
syncope_more-1 Has this happened more than once? True Select one Yes
syncope_more-2 No
syncope_more-3 I Don't Know
syncope_cause-1 Has the likely cause of your fainting been diagnosed by a doctor or other healthcare provider? True Select one Yes
syncope_cause-2 No
syncope_cause-3 I Don't Know
syncope_dx-1 What was the diagnosis of your fainting? True Select one Cardiac arrest
syncope_dx-2 Fast heart rhythm (tachycardia)
syncope_dx-3 Slow heart rhythm/pauses (bradycardia)
syncope_dx-4 Dehydration
syncope_dx-5 Low blood pressure from medication
syncope_dx-6 Low blood sugar
syncope_dx-7 Vasovagal/benign syncope
syncope_dx-8 Other
syncope_dx-9 I don't know
syncope_tx-1 Did you receive any specific treatment for your fainting? True Select one Placement of a new pacemaker
syncope_tx-2 Placement of a new implantable defibrillator (ICD)
syncope_tx-3 Adjustment of an existing pacemaker or defibrillator
syncope_tx-4 Adjustment or addition of medications (change in dose/addition/removal of medication)
syncope_tx-5 Other
syncope_tx-6 None
syncope_tx-7 I don't know
chest_pain-1 Have you had any pain, discomfort, or pressure in your chest anytime over the past year? True Select one Yes
chest_pain-2 No
chest_loc-1 Please select the boxes corresponding to the locations on the chest (mark all the appropriate places). True Select any A
chest_loc-2 B
chest_loc-3 C
chest_loc-4 D
chest_loc-5 E
chest_loc-6 F
chest_loc-7 G
chest_loc-8 H
chest_loc-9 I
chest_loc-10 J
chest_loc-11 K
chest_loc-12 L
chest_loc-13 M
chest_loc-14 N
chest_loc-15 O
chest_loc-16 P
when_pain-1 What best describes when you get the chest pain or discomfort? True Select one Rest or minimal exertion (such as walking across the room)
when_pain-2 Exercise or exertion
when_pain-3 Other
when_pain-4 Both
other Please describe when you get chest pain or discomfort. True string
walk-1 When you walk at an ordinary pace on level ground does this produce the pain? True Select one Yes
walk-2 No
walk-3 Don't know
uphill-1 When you walk uphill or hurry does this produce the pain? True Select one Yes
uphill-2 No
uphill-3 Don't know
what_do-1 When you get any pain or discomfort in your chest upon walking, what do you do? True Select one Stop
what_do-2 Slow down
what_do-3 Continue at same pace
what_do-4 Not applicable
stand_still-1 Does the pain or discomfort in your chest go away if you stand still? True Select one Always
stand_still-2 Sometimes
stand_still-3 Never
how_long-1 How long does it take to go away? True Select one 10 minutes or less
how_long-2 More than 10 minutes
pain_often-1 About how often do you get chest pain or discomfort? True Select one Daily
pain_often-2 1-6 times per week
pain_often-3 1-3 times per month
pain_often-4 1-12 times per year
pain_often-5 Less than once a year
pain_often-6 Once
pain_often-7 Don't know
pain_short_breath-1 Is your chest pain/discomfort associated with shortness of breath? True Select one Yes
pain_short_breath-2 No
pain_short_breath-3 Don't know
pain_lighthead-1 Is your chest pain/discomfort associated with lightheadedness? True Select one Yes
pain_lighthead-2 No
pain_lighthead-3 Don't know
pain_stent_angiogram-1 Have you had a stress test or coronary angiogram to evaluate the chest pain? True Select one Yes
pain_stent_angiogram-2 No
pain_stent_angiogram-3 Don't know
pain_meds-1 Have you been prescribed medications that have improved the chest pain? True Select one Yes
pain_meds-2 No
pain_meds-3 Don't know
pain_er-1 Have you been to the emergency room or admitted because of chest pain and positive cardiac enzymes (heart attack)? True Select one Yes
pain_er-2 No
pain_er-3 Don't know
General Symptom Overview Update 1 sob_level-1 In thinking about your breathing, and any difficulties you may have with your breathing, what level of difficulty best describes your breathing normally over the past month? True Select one I only get breathless with strenuous exercise
sob_level-2 I get short of breath when hurrying on level ground or walking up a slight hill
sob_level-3 On level ground, I walk slower than people of the same age because of breathlessness or have to stop for breath when walking at my own pace
sob_level-4 I stop for breath after walking about 100 yards or after a few minutes on level ground
sob_level-5 I am too breathless to leave the house or I am breathless when dressing
palpitations-1 OVER THE PAST 3 MONTHS, have you developed new (not previously diagnosed) heart palpitations, fast heartbeats or racing heart rate (not due to normal exercise), irregular heartbeats, skipped beats, or any funny feelings of abnormal heartbeats? True Select one Yes
palpitations-2 No
palpitations-3 I Don't Know
palp_often-1 About how often do you experience palpitations (on average)? True Select one Three or more times daily
palp_often-2 Twice daily
palp_often-3 Daily or almost daily
palp_often-4 4-5 times a week
palp_often-5 2-3 times a week
palp_often-6 About 1 time a week
palp_often-7 About 2 times in a month
palp_often-8 About 1 time in a month
palp_often-9 2-4 times in a year
palp_often-10 Once a year
palp_often-11 Less than 1 time per year
palp_often-12 Once ever
palp_often-13 Don't know
palp_how_long-1 About how long do your palpitations last? True Select one Not Applicable
palp_how_long-2 A few seconds
palp_how_long-3 About 1-5 minutes
palp_how_long-4 About 5-10 minutes
palp_how_long-5 About 10-20 minutes
palp_how_long-6 About 20-30 minutes
palp_how_long-7 About 30-45 minutes
palp_how_long-8 About 45 minutes to one hour
palp_how_long-9 Longer than one hour
palp_how_long-10 I don't know
palp_cause-1 Has the likely cause of your palpitations been diagnosed by a doctor or other healthcare provider? True Select one Yes
palp_cause-2 No
palp_cause-3 I Don't Know
palp_dx-1 What was the diagnosis of your palpitations? True Select one Atrial fibrillation (AF, AFIB) or flutter
palp_dx-2 Extra or premature beats (PVCs or PACs)
palp_dx-3 Slow heart beats or pauses
palp_dx-4 Supraventricular tachycardia (SVT, fast heart rhythm originating in the top chambers not due to AFib)
palp_dx-5 Ventricular tachycardia (VT, fast heart rhythm originating in the bottom chambers)
palp_dx-6 Sinus tachycardia
palp_dx-7 Other
palp_dx-8 I don't know
syncope-1 OVER THE PAST 3 MONTHS, have you ever fainted or passed out (lost consciousness) or been told you have syncope (not due to seizures, low blood sugar or an accident or other trauma)? True Select one Yes
syncope-2 No
syncope-3 I Don't Know
syncope_more-1 Has this happened more than once (at any point in time)? True Select one Yes
syncope_more-2 No
syncope_more-3 I Don't Know
syncope_cause-1 Has the likely cause of your fainting been diagnosed by a doctor or other healthcare provider? True Select one Yes
syncope_cause-2 No
syncope_cause-3 I Don't Know
syncope_dx-1 What was the diagnosis of your fainting? True Select one Cardiac arrest
syncope_dx-2 Fast heart rhythm (tachycardia)
syncope_dx-3 Slow heart rhythm/pauses (bradycardia)
syncope_dx-4 Dehydration
syncope_dx-5 Low blood pressure from medication
syncope_dx-6 Low blood sugar
syncope_dx-7 Vasovagal/benign syncope
syncope_dx-8 Other
syncope_dx-9 I don't know
syncope_tx-1 Did you receive any specific treatment for your fainting? True Select one Placement of a new pacemaker
syncope_tx-2 Placement of a new implantable defibrillator (ICD)
syncope_tx-3 Adjustment of an existing pacemaker or defibrillator
syncope_tx-4 Adjustment or addition of medications (change in dose/addition/removal of medication)
syncope_tx-5 Other
syncope_tx-6 None
syncope_tx-7 I don't know
chest_pain-1 Have you had any pain, discomfort, or pressure in your chest anytime over the past year? True Select one Yes
chest_pain-2 No
chest_loc-1 Please select the boxes corresponding to the locations on the chest (mark all the appropriate places). True Select any A
chest_loc-2 B
chest_loc-3 C
chest_loc-4 D
chest_loc-5 E
chest_loc-6 F
chest_loc-7 G
chest_loc-8 H
chest_loc-9 I
chest_loc-10 J
chest_loc-11 K
chest_loc-12 L
chest_loc-13 M
chest_loc-14 N
chest_loc-15 O
chest_loc-16 P
when_pain-1 What best describes when you get the chest pain or discomfort? True Select one Rest or minimal exertion (such as walking across the room)
when_pain-2 Exercise or exertion
when_pain-3 Other
when_pain-4 Both
other Please describe when you get chest pain or discomfort. True string
walk-1 When you walk at an ordinary pace on level ground does this produce the pain? True Select one Yes
walk-2 No
walk-3 Don't know
uphill-1 When you walk uphill or hurry does this produce the pain? True Select one Yes
uphill-2 No
uphill-3 Don't know
what_do-1 When you get any pain or discomfort in your chest upon walking, what do you do? True Select one Stop
what_do-2 Slow down
what_do-3 Continue at same pace
what_do-4 Not applicable
stand_still-1 Does the pain or discomfort in your chest go away if you stand still? True Select one Always
stand_still-2 Sometimes
stand_still-3 Never
how_long-1 How long does it take to go away? True Select one 10 minutes or less
how_long-2 More than 10 minutes
pain_often-1 About how often do you get chest pain or discomfort? True Select one Daily
pain_often-2 1-6 times per week
pain_often-3 1-3 times per month
pain_often-4 1-12 times per year
pain_often-5 Less than once a year
pain_often-6 Once
pain_often-7 Don't know
pain_short_breath-1 Is your chest pain/discomfort associated with shortness of breath? True Select one Yes
pain_short_breath-2 No
pain_short_breath-3 Don't know
pain_lighthead-1 Is your chest pain/discomfort associated with lightheadedness? True Select one Yes
pain_lighthead-2 No
pain_lighthead-3 Don't know
pain_stent_angiogram-1 Have you had a stress test or coronary angiogram to evaluate the chest pain? True Select one Yes
pain_stent_angiogram-2 No
pain_stent_angiogram-3 Don't know
pain_meds-1 Have you been prescribed medications that have improved the chest pain? True Select one Yes
pain_meds-2 No
pain_meds-3 Don't know
pain_er-1 Have you been to the emergency room or admitted because of chest pain and positive cardiac enzymes (heart attack)? True Select one Yes
pain_er-2 No
pain_er-3 Don't know
H2FPEF Score Form 1 bmi_over_30-yes Does the participant have a BMI over 30 kg/m2? True Select one Yes (2 points)
bmi_over_30-no No (0 points)
meds-yes Is the participant on 2 or more antihypertensive medications? True Select one Yes (1 point)
meds-no No (0 points)
afib-yes Does the participant have paroxysmal or persistent atrial fibrillation? True Select one Yes (3 points)
afib-no No (0 points)
pulm_htn-yes Does the participant have pulmonary hypertension? True Select one Yes (1 point)
pulm_htn-no No (0 points)
over_60-yes Is the participant older than 60 years? True Select one Yes (1 point)
over_60-no No (0 points)
dopp_echo-yes Does the participant have a Doppler Echocardiographic E/e' > 9? True Select one Yes (1 point)
dopp_echo-no No (0 points)
h2fpef_score What is the participant’s H2FPEF score? True integer Integer
Heart Failure Symptoms 1 showering-1 Showering/Bathing True Select one Extremely Limited
showering-2 Quite a bit Limited
showering-3 Moderately Limited
showering-4 Slightly Limited
showering-5 Not at all Limited
showering-6 Limited for other reasons or did not do the activity
walking-1 Walking 1 block on level ground True Select one Extremely Limited
walking-2 Quite a bit Limited
walking-3 Moderately Limited
walking-4 Slightly Limited
walking-5 Not at all Limited
walking-6 Limited for other reasons or did not do the activity
hurrying-1 Hurrying or jogging (as if to catch a bus) True Select one Extremely Limited
hurrying-2 Quite a bit Limited
hurrying-3 Moderately Limited
hurrying-4 Slightly Limited
hurrying-5 Not at all Limited
hurrying-6 Limited for other reasons or did not do the activity
swelling_morning-1 Over the PAST 2 WEEKS, how many times did you have SWELLING in your feet, ankles or legs when you woke up in the morning? True Select one Every morning
swelling_morning-2 3 or more times a week, but not every day
swelling_morning-3 1-2 times a week
swelling_morning-4 Less than once a week
swelling_morning-5 Never over the past 2 weeks
fatigue-1 Over the PAST 2 WEEKS, on average, how many times has FATIGUE limited your ability to do what you want? True Select one All of the time
fatigue-2 Several times per day
fatigue-3 At least once a day
fatigue-4 3 or more times per week but not every day
fatigue-5 1-2 times per week
fatigue-6 Less than once a week
fatigue-7 Never over the past 2 weeks
short_breath-1 Over the PAST 2 WEEKS, on average, how many times has SHORTNESS OF BREATH limited your ability to do what you wanted? True Select one All of the time
short_breath-2 Several times per day
short_breath-3 At least once a day
short_breath-4 3 or more times per week but not every day
short_breath-5 1-2 times per week
short_breath-6 Less than once a week
short_breath-7 Never over the past 2 weeks
short_breath_sleep-1 Over the PAST 2 WEEKS, on average, how many times have you been forced to sleep sitting up in a chair or with at least 3 pillows to prop you up because of SHORTNESS OF BREATH? True Select one Every night
short_breath_sleep-2 3 or more times a week, but not every day
short_breath_sleep-3 1-2 times per week
short_breath_sleep-4 Less than once a week
short_breath_sleep-5 Never over the past 2 weeks
enjoy_life-1 Over the PAST 2 WEEKS, how much has your HEART FAILURE limited your enjoyment of life? True Select one It has extremely limited my enjoyment of life
enjoy_life-2 It has limited my enjoyment of life quite a bit
enjoy_life-3 It has moderately limited my enjoyment of life
enjoy_life-4 It has slightly limited my enjoyment of life
enjoy_life-5 It has not limited my enjoyment of life at all
rest_of_life-1 If you had to spend the rest of your life with your HEART FAILURE the way it is RIGHT NOW, how would you feel about this? True Select one Not at all satisfied
rest_of_life-2 Mostly dissatisfied
rest_of_life-3 Somewhat satisfied
rest_of_life-4 Mostly satisfied
rest_of_life-5 Completely satisfied
hobbies-1 Hobbies, recreational activities True Select one Severely limited
hobbies-2 Limited quite a bit
hobbies-3 Moderately limited
hobbies-4 Slightly limited
hobbies-5 Did not limit at all
hobbies-6 Does not apply or did not do for other reasons
working-1 Working or doing household chores True Select one Severely limited
working-2 Limited quite a bit
working-3 Moderately limited
working-4 Slightly limited
working-5 Did not limit at all
working-6 Does not apply or did not do for other reasons
visiting-1 Visiting family or friends out of your home True Select one Severely limited
visiting-2 Limited quite a bit
visiting-3 Moderately limited
visiting-4 Slightly limited
visiting-5 Did not limit at all
visiting-6 Does not apply or did not do for other reasons
HeartShare Mini-Cog Scoring Coordinator Form 1 word_recall-0 For the WORD RECALL test, how many words was the participant able to recall without cueing? True Select one 0 Words (0 points)
word_recall-1 1 Word (1 point)
word_recall-2 2 Words (2 points)
word_recall-3 3 Words (3 points)
clock-0 For the CLOCK DRAW test, was the participant able to draw a normal clock with the hands at the right position (11 and 2 for 11:10)? True Select one No, inable or refused to draw clock (0 points)
clock-2 Yes, normal clock with correct hand placement (2 points)
2 word_recall-0 For the WORD RECALL test, how many words was the participant able to recall without cueing? True Select one 0 Words (0 points)
word_recall-1 1 Word (1 point)
word_recall-2 2 Words (2 points)
word_recall-3 3 Words (3 points)
clock-0 For the CLOCK DRAW test, was the participant able to draw a normal clock with the hands at the right position (11 and 2 for 11:10)? True Select one No, inable or refused to draw clock (0 points)
clock-2 Yes, normal clock with correct hand placement (2 points)
3 mini_cog_tech Who proctored the Mini-Cog assessment? False string String
mini_cog_datetime What date and time was the Mini-Cog performed? False datetime Datetime
word_recall-0 For the WORD RECALL test, how many words was the participant able to recall without cueing? True Select one 0 Words (0 points)
word_recall-1 1 Word (1 point)
word_recall-2 2 Words (2 points)
word_recall-3 3 Words (3 points)
clock-0 For the CLOCK DRAW test, was the participant able to draw a normal clock with the hands at the right position (11 and 2 for 11:10)? True Select one No, inable or refused to draw clock (0 points)
clock-2 Yes, normal clock with correct hand placement (2 points)
4 mini_cog_tech Who proctored the Mini-Cog assessment? True string String
mini_cog_datetime What date and time was the Mini-Cog performed? True datetime Datetime
word_recall-0 For the WORD RECALL test, how many words was the participant able to recall without cueing? True Select one 0 Words (0 points)
word_recall-1 1 Word (1 point)
word_recall-2 2 Words (2 points)
word_recall-3 3 Words (3 points)
clock-0 For the CLOCK DRAW test, was the participant able to draw a normal clock with the hands at the right position (11 and 2 for 11:10)? True Select one No, inable or refused to draw clock (0 points)
clock-2 Yes, normal clock with correct hand placement (2 points)
HeartShare Study Eligibility Survey 1 hf-yes Have you ever been told by a healthcare provider that you have heart failure? True Select one Yes
hf-no No
hf-dk I don't know
transplant-yes Have you ever had an organ transplant? This could include liver, kidney, heart, bone marrow, etc. True Select one Yes
transplant-no No
transplant-dk I don't know
dialysis-yes Are you currently on dialysis? True Select one Yes
dialysis-no No
dialysis-dk I don't know
surveys-yes Are you able and willing to complete study surveys every month about your medical history and health status? True Select one Yes
surveys-no No
surveys-dk I don't know
2 hf-yes Have you ever been told by a healthcare provider that you have heart failure? True Select one Yes
hf-no No
hf-dk I don't know
transplant-yes Have you ever had an organ transplant? This could include liver, kidney, heart, bone marrow, etc. True Select one Yes
transplant-no No
transplant-dk I don't know
dialysis-yes Are you currently on dialysis? True Select one Yes
dialysis-no No
dialysis-dk I don't know
surveys-yes Are you able and willing to complete study surveys every month about your medical history and health status? True Select one Yes
surveys-no No
surveys-dk I don't know
3 hf-yes Have you ever been told by a healthcare provider that you have heart failure? True Select one Yes
hf-no No
hf-dk I don't know
transplant-yes Have you ever had an organ transplant? This could include liver, kidney, heart, bone marrow, etc. True Select one Yes
transplant-no No
transplant-dk I don't know
dialysis-yes Are you currently on dialysis? True Select one Yes
dialysis-no No
dialysis-dk I don't know
Hospitalization Survey 1 hosp_admitted-1 Have you visited the emergency room or been hospitalized in the last 3 months due to a heart related condition? True Select one Yes
hosp_admitted-2 No
hosp_admitdate When were you hospitalized? True date Date
hosp_dischargedate When did you leave the hospital? True date Date
hosp_hospname What is the name of the hospital you went to? True string String
hosp_city City: True string String
hosp_state-1 State: True Select one Alabama
hosp_state-2 Alaska
hosp_state-3 Arizona
hosp_state-4 Arkansas
hosp_state-5 California
hosp_state-6 Colorado
hosp_state-7 Connecticut
hosp_state-8 Delaware
hosp_state-9 District of Columbia
hosp_state-10 Florida
hosp_state-11 Georgia
hosp_state-12 Hawaii
hosp_state-13 Idaho
hosp_state-14 Illinois
hosp_state-15 Indiana
hosp_state-16 Iowa
hosp_state-17 Kansas
hosp_state-18 Kentucky
hosp_state-19 Louisiana
hosp_state-20 Maine
hosp_state-21 Maryland
hosp_state-22 Massachusetts
hosp_state-23 Michigan
hosp_state-24 Minnesota
hosp_state-25 Mississippi
hosp_state-26 Missouri
hosp_state-27 Montana
hosp_state-28 Nebraska
hosp_state-29 Nevada
hosp_state-30 New Hampshire
hosp_state-31 New Jersey
hosp_state-32 New Mexico
hosp_state-33 New York
hosp_state-34 North Carolina
hosp_state-35 North Dakota
hosp_state-36 Ohio
hosp_state-37 Oklahoma
hosp_state-38 Oregon
hosp_state-39 Pennsylvania
hosp_state-40 Rhode Island
hosp_state-41 South Carolina
hosp_state-42 South Dakota
hosp_state-43 Tennessee
hosp_state-44 Texas
hosp_state-45 Utah
hosp_state-46 Vermont
hosp_state-47 Virginia
hosp_state-48 Washington
hosp_state-49 West Virginia
hosp_state-50 Wisconsin
hosp_state-51 Wyoming
hosp_state-52 N/A- Outside of the U.S.
hosp_mainreason-1 Was the main reason for your hospitalization cardiac related (you can look at the papers you received at discharge from the hospital)? True Select one Yes
hosp_mainreason-2 No
hosp_mainreason-3 I don't know
hosp_mainreasonheart-1 What was the main reason for your hospitalization (you can look at the papers you received at discharge from the hospital)? True Select any Heart attack (Myocardial infarction)
hosp_mainreasonheart-2 Angina or Chest Pain
hosp_mainreasonheart-3 Heart Failure or Pulmonary Edema (fluid in the lungs)
hosp_mainreasonheart-4 Stroke or Transient Ischemic Attack (TIA)
hosp_mainreasonheart-5 Atrial Fibrillation (AFib, AF) or Atrial Flutter
hosp_mainreasonheart-6 Other arrhythmia (abnormal heart rhythm)
hosp_mainreasonheart-7 Cardioversion (electrical cardioversion)
hosp_mainreasonheart-8 Ablation
hosp_mainreasonheart-9 Other
hosp_mainreasonheart-10 I don't know
hosp_mainreasonheart_other Please describe what was your main reason for hospitalization. True string String
hosp_symptoms-1 Did you have any of these symptoms when you came to the hospital or during your hospitalization? True Select any Chest pain or discomfort
hosp_symptoms-2 Shortness of breath
hosp_symptoms-3 Palpitations or abnormal heart beat
hosp_symptoms-4 Dizziness or fainting
hosp_symptoms-5 A cardiac arrest or need for CPR
hosp_symptoms-6 Difficulty talking
hosp_symptoms-7 Weakness or numbness
hosp_symptoms-8 Other
hosp_symptoms-9 I don't know
hosp_symptoms_other Please describe any other symptoms you had when you came to the hospital. True string String
2 hosp_admitted-1 Have you visited the emergency room or been hospitalized in the last month due to a heart related condition? True Select one Yes
hosp_admitted-2 No
hosp_admitdate When were you hospitalized? True date Date
hosp_dischargedate When did you leave the hospital? True date Date
hosp_hospname What is the name of the hospital you went to? True string String
hosp_city City: True string String
hosp_state-1 State: True Select one Alabama
hosp_state-2 Alaska
hosp_state-3 Arizona
hosp_state-4 Arkansas
hosp_state-5 California
hosp_state-6 Colorado
hosp_state-7 Connecticut
hosp_state-8 Delaware
hosp_state-9 District of Columbia
hosp_state-10 Florida
hosp_state-11 Georgia
hosp_state-12 Hawaii
hosp_state-13 Idaho
hosp_state-14 Illinois
hosp_state-15 Indiana
hosp_state-16 Iowa
hosp_state-17 Kansas
hosp_state-18 Kentucky
hosp_state-19 Louisiana
hosp_state-20 Maine
hosp_state-21 Maryland
hosp_state-22 Massachusetts
hosp_state-23 Michigan
hosp_state-24 Minnesota
hosp_state-25 Mississippi
hosp_state-26 Missouri
hosp_state-27 Montana
hosp_state-28 Nebraska
hosp_state-29 Nevada
hosp_state-30 New Hampshire
hosp_state-31 New Jersey
hosp_state-32 New Mexico
hosp_state-33 New York
hosp_state-34 North Carolina
hosp_state-35 North Dakota
hosp_state-36 Ohio
hosp_state-37 Oklahoma
hosp_state-38 Oregon
hosp_state-39 Pennsylvania
hosp_state-40 Rhode Island
hosp_state-41 South Carolina
hosp_state-42 South Dakota
hosp_state-43 Tennessee
hosp_state-44 Texas
hosp_state-45 Utah
hosp_state-46 Vermont
hosp_state-47 Virginia
hosp_state-48 Washington
hosp_state-49 West Virginia
hosp_state-50 Wisconsin
hosp_state-51 Wyoming
hosp_state-52 N/A- Outside of the U.S.
hosp_mainreason-1 Was the main reason for your hospitalization cardiac related (you can look at the papers you received at discharge from the hospital)? True Select one Yes
hosp_mainreason-2 No
hosp_mainreason-3 I don't know
hosp_mainreasonheart-1 What was the main reason for your hospitalization (you can look at the papers you received at discharge from the hospital)? True Select any Heart attack (Myocardial infarction)
hosp_mainreasonheart-2 Angina or Chest Pain
hosp_mainreasonheart-3 Heart Failure or Pulmonary Edema (fluid in the lungs)
hosp_mainreasonheart-4 Stroke or Transient Ischemic Attack (TIA)
hosp_mainreasonheart-5 Atrial Fibrillation (AFib, AF) or Atrial Flutter
hosp_mainreasonheart-6 Other arrhythmia (abnormal heart rhythm)
hosp_mainreasonheart-7 Cardioversion (electrical cardioversion)
hosp_mainreasonheart-8 Ablation
hosp_mainreasonheart-9 Other
hosp_mainreasonheart-10 I don't know
hosp_mainreasonheart_other Please describe what was your main reason for hospitalization. True string String
hosp_symptoms-1 Did you have any of these symptoms when you came to the hospital or during your hospitalization? True Select any Chest pain or discomfort
hosp_symptoms-2 Shortness of breath
hosp_symptoms-3 Palpitations or abnormal heart beat
hosp_symptoms-4 Dizziness or fainting
hosp_symptoms-5 A cardiac arrest or need for CPR
hosp_symptoms-6 Difficulty talking
hosp_symptoms-7 Weakness or numbness
hosp_symptoms-8 Other
hosp_symptoms-9 I don't know
hosp_symptoms_other Please describe any other symptoms you had when you came to the hospital. True string String
Medical Conditions 0 diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
1 arrhythmia-1 Any arrhythmia other than Atrial Fibrillation? True Select one Yes
arrhythmia-2 No
arrhythmia-3 Don't know
cancer-1 Cancer (other than minor skin cancer)? True Select one Yes
cancer-2 No
cancer-3 Don't know
ckd-1 Chronic kidney (renal) disease or decreased kidney (renal) function or failure? True Select one Yes, but not on dialysis
ckd-2 Yes, and on dialysis
ckd-3 Yes, I’ve had a kidney transplant and my kidney function is now normal
ckd-4 No
ckd-5 Don't know
copd-1 Chronic lung disease (COPD, emphysema, chronic bronchitis, obstructive pulmonary disease)? True Select one Yes
copd-2 No
copd-3 Don't know
covid_year-1 In the past year, have you tested positive for COVID-19? True Select one Yes
covid_year-2 No
covid_year-3 Don't know
cancer_type-lung What type of cancer were you diagnosed with? (select all that apply) True Select any Lung
cancer_type-prostate Prostate
cancer_type-breast Breast
cancer_type-colorectal Colorectal
cancer_type-melanoma Melanoma
cancer_type-bone Bone
cancer_type-leu Leukemia (blood cancer)
cancer_type-renal Renal (kidney)
cancer_type-bladder Bladder
cancer_type-thyroid Thyroid
cancer_type-uterine Uterine
cancer_type-ovarian Ovarian
cancer_type-oral Throat and/or mouth
cancer_type-oth Other
cancer_type-dk I don’t know
cov_vax-1 In the past year, have you received a COVID-19 vaccine? True Select one Yes
cov_vax-2 No
cov_vax-3 Don't know
cancer_treat-surg Are you CURRENTLY undergoing any treatment or do you have any planned surgeries for your cancer diagnosis? (select all that apply) True Select any Surgery
cancer_treat-chemo Chemotherapy
cancer_treat-radia Radiation Therapy
cancer_treat-immuno Immunotherapy
cancer_treat-bmt Bone marrow transplant
cancer_treat-none None
cancer_treat-dk I don’t know
cov_vax_co-1 Which company’s COVID-19 vaccine did you receive? True Select one AstraZeneca
cov_vax_co-2 Janssen (Johnson & Johnson)
cov_vax_co-3 Moderna
cov_vax_co-4 Novavax
cov_vax_co-5 Pfizer
cov_vax_co-6 Other (Specify):
cov_vax_co-7 I don’t know
hbp-1 High blood pressure or hypertension? True Select one Yes
hbp-2 No
hbp-3 Don't know
high_chol-1 High cholesterol? True Select one Yes
high_chol-2 No
high_chol-3 Don't know
prediabetes-1 Prediabetes or ""early"" diabetes not requiring medications? True Select one Yes
prediabetes-2 No
prediabetes-3 Don't know
block_coronary-1 Coronary artery disease (blockages in your heart vessels)? True Select one Yes
block_coronary-2 No
block_coronary-3 Don't know
year_cd What year were you diagnosed with Coronary artery disease? True string String
why_cd-1 How do you know you have coronary artery disease? Check all that apply. True Select any My doctor told me
why_cd-2 My nurse told me
why_cd-3 Heart catheterization/Angiogram or CT scan showed blockages in the arteries of my heart
why_cd-4 Abnormal stress test
why_cd-5 Found on an ECG/EKG
why_cd-6 Self-Diagnosed
why_cd-7 Other
why_cd-8 Don’t know
why_cd_other Please specify why you think you have coronary artery disease. False string String
heart_attack-1 A myocardial infarction (also known as a heart attack)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
chf-1 Congestive heart failure (CHF, heart failure)? True Select one Yes
chf-2 No
chf-3 Don't know
stroke-1 Stroke or TIA (Transient Ischemic Attack or Mini-Stroke)? True Select one Yes
stroke-2 No
stroke-3 Don't know
afib-1 Atrial fibrillation (AFib, AF)? True Select one Yes
afib-2 No
afib-3 Don't know
afib_age At what age were you first diagnosed with Atrial Fibrillation? True integer
sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_prescription-1 If yes, have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-1 CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription-3 Other therapy
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-1 Yes
sleep_current-2 No
sleep_current-2 No
sleep_current-3 I Don't know
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-1 Yes
sleep_cpap-2 No
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
arthritis-1 Arthritis? (osteoarthritis or degenerative) True Select one Yes
arthritis-2 No
arthritis-3 Don't know
asthma-1 Asthma, to the point that you use inhalers daily or have been to the hospital for your asthma? True Select one Yes
asthma-2 No
asthma-3 Don't know
autoimmune-1 Autoimmune/rheumatologic disorder/connective tissue disease (rheumatoid arthritis, lupus, scleroderma, dermatomyositis, polymyositis, polymyalgia rheumatica, or other autoimmune disorders)? True Select one Yes
autoimmune-2 No
autoimmune-3 Don't know
cardiac-1 A cardiac arrest? True Select one Yes
cardiac-2 No
cardiac-3 Don't know
implant-1 Do you have an implanted device for your heart? If you have one, you were given a card, which has this information on it. True Select one No
implant-2 Pacemaker (not an ICD)
implant-3 ICD (Implantable Cardioverter-Defibrillator)
implant-4 Implanted Loop Recorder or rhythm monitor (e.g. Reveal, Confirm)
implant-5 Other
implant-6 I Don't Know
implant_pace-1 Kind of pacemaker: True Select one Regular (1 or 2 lead)
implant_pace-2 BiV or CRT
implant_pace-3 Don't know
implant_icd-1 Kind of ICD: True Select one Regular (1 or 2 lead)
implant_icd-2 BiV or CRT (2 leads in the ventricle to “resynchronize”)
implant_icd-3 Don't know
implant_other Please specify your other type of implanted device. True string
bypass-1 Have you ever had bypass surgery (coronary artery bypass surgery)? True Select one Yes
bypass-2 No
bypass-3 Don't know
how_many_heart_vessels-1 How many heart vessels (coronary arteries) were bypassed? e.g. ""triple bypass"" means 3 vessels bypassed True Select one 1
how_many_heart_vessels-2 2
how_many_heart_vessels-3 3
how_many_heart_vessels-4 4 or more
how_many_heart_vessels-5 Don't know
stent_year-1 Have you had a stent or angioplasty in your heart (coronary) arteries in the past year? True Select one Yes
stent_year-2 No
stent_year-3 Don't know
valve_rep-1 Have you ever had a valve replacement or repair? (either with open-heart surgery, minimally invasive surgery, or with a catheter) True Select one Yes
valve_rep-2 No
valve_rep-3 Don't know
2 sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_prescription-1 You previously indicated that you have been diagnosed with sleep apnea (obstructive sleep apnea, OSA). Have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_prescription-1 If yes, have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
3 sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_prescription-1 You previously indicated that you have been diagnosed with sleep apnea (obstructive sleep apnea, OSA). Have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription-4 None
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_prescription-1 Have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription-4 None
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
Medications Activity Handoff Coordinator Form 1 ready-yes Are you with the participant and ready to reconcile the participant’s medications list? True Select one Yes
name Enter the name of the person who will reconcile the participant’s medication list. True string String
Microbiome Coordinator Form 1 microbiome_completion-yes Did the study coordinator give the participant a microbiome sample collection kit and explain its use? True Select one Yes
microbiome_completion-no No
microbiome_tracking What is the tracking number on the microbiome kit given to the participant? True string String
microbiome_no-none What is the tracking number on the microbiome kit given to the participant? True Select one Lack of kits available to distribute
microbiome_no-insf Insufficient time
microbiome_no-refuse The participant refused the microbiome sample collection kit
microbiome_no-oth Other reason
microbiome_other If 'other reason', please explain why the study coordinator did not give the participant a microbiome sample collection kit. True text Text
MoCA Cognition Test Coordinator Form 1 moca_tech Who administered the MoCA? False string String
moca_datetime What date and time was the MoCA administered? False datetime Datetime
visuospatial Enter the number of points the participant scored on the visuospatial/executive test. False integer Integer
naming Enter the number of points the participant scored on the naming test. False integer Integer
memory Enter the number of points the participant scored on the memory test. False integer Integer
attention Enter the number of points the participant scored on the attention test. False integer Integer
language Enter the number of points the participant scored on the language test. False integer Integer
abstraction Enter the number of points the participant scored on the abstraction test. False integer Integer
recall Enter the number of points the participant scored on the delayed recall test. False integer Integer
orientation Enter the number of points the participant scored on the orientation test. False integer Integer
2 moca_tech Who administered the MoCA? True string String
moca_datetime What date and time was the MoCA administered? True datetime Datetime
visuospatial Enter the number of points the participant scored on the visuospatial/executive test. True integer Integer
naming Enter the number of points the participant scored on the naming test. True integer Integer
memory Enter the number of points the participant scored on the memory test. True integer Integer
attention Enter the number of points the participant scored on the attention test. True integer Integer
language Enter the number of points the participant scored on the language test. True integer Integer
abstraction Enter the number of points the participant scored on the abstraction test. True integer Integer
recall Enter the number of points the participant scored on the delayed recall test. True integer Integer
orientation Enter the number of points the participant scored on the orientation test. True integer Integer
Mood Survey 1 bothered-0 In the past week, I was bothered by things that usually don’t bother me. True Select one Rarely or none of the time (less than 1 day)
bothered-1 Some or a little of the time (1-2 days)
bothered-2 Occasionally or a moderate amount of time (3-4 days)
bothered-3 Most or all of the time (5-7 days)
focus-0 In the past week, I had trouble keeping my mind on what I was doing. True Select one Rarely or none of the time (less than 1 day)
focus-1 Some or a little of the time (1-2 days)
focus-2 Occasionally or a moderate amount of time (3-4 days)
focus-3 Most or all of the time (5-7 days)
depressed-0 In the past week, I felt depressed. True Select one Rarely or none of the time (less than 1 day)
depressed-1 Some or a little of the time (1-2 days)
depressed-2 Occasionally or a moderate amount of time (3-4 days)
depressed-3 Most or all of the time (5-7 days)
effort-0 In the past week, I felt that everything I did was an effort. True Select one Rarely or none of the time (less than 1 day)
effort-1 Some or a little of the time (1-2 days)
effort-2 Occasionally or a moderate amount of time (3-4 days)
effort-3 Most or all of the time (5-7 days)
hopeful_pos-0 In the past week, I felt hopeful about the future. True Select one Most or all of the time (5-7 days)
hopeful_pos-1 Occasionally or a moderate amount of time (3-4 days)
hopeful_pos-2 Some or a little of the time (1-2 days)
hopeful_pos-3 Rarely or none of the time (less than 1 day)
fearful-0 In the past week, I felt fearful. True Select one Rarely or none of the time (less than 1 day)
fearful-1 Some or a little of the time (1-2 days)
fearful-2 Occasionally or a moderate amount of time (3-4 days)
fearful-3 Most or all of the time (5-7 days)
sleep-0 In the past week, my sleep was restless. True Select one Rarely or none of the time (less than 1 day)
sleep-1 Some or a little of the time (1-2 days)
sleep-2 Occasionally or a moderate amount of time (3-4 days)
sleep-3 Most or all of the time (5-7 days)
happy_pos-0 In the past week, I was happy. True Select one Most or all of the time (5-7 days)
happy_pos-1 Occasionally or a moderate amount of time (3-4 days)
happy_pos-2 Some or a little of the time (1-2 days)
happy_pos-3 Rarely or none of the time (less than 1 day)
lonely-0 In the past week, I felt lonely. True Select one Rarely or none of the time (less than 1 day)
lonely-1 Some or a little of the time (1-2 days)
lonely-2 Occasionally or a moderate amount of time (3-4 days)
lonely-3 Most or all of the time (5-7 days)
going-0 In the past week, I could not get 'going'. True Select one Rarely or none of the time (less than 1 day)
going-1 Some or a little of the time (1-2 days)
going-2 Occasionally or a moderate amount of time (3-4 days)
going-3 Most or all of the time (5-7 days)
Palpitations Survey 1 palp_last-0 Do any of your palpitations last more than 1 minute of continuous symptoms? True Select one No
palp_last-1 Yes
palp_rate-1 How would you best characterize the speed (rate) of the palpitations? Check all that apply. False Select any Fast rate
palp_rate-2 Slow rate
palp_rate-3 Fast and slow together (irregular)
palp_rate-4 Normal rate
palp_rate-5 Not sure
palp_rhythm-1 How would you best characterize the rhythm of the palpitations? Sample sounds of different heart beat examples are below. Check all that apply. False Select any Regular rhythm
palp_rhythm-2 Irregular
palp_rhythm-3 Extra beat
palp_rhythm-4 Skipped beat
palp_rhythm-5 Not sure
palp_symptoms-1 What are the symptoms associated with these palpitations (can be only occasionally associated)? Check all that apply. False Select any Chest pain, pressure, and/or discomfort
palp_symptoms-2 Shortness of breath
palp_symptoms-3 Dizziness
palp_symptoms-4 Passing out
palp_symptoms-5 None
palp_symptoms-6 Not sure
exertion-1 Does this occur while resting (or minimal physical activity) or with physical activity or while emotionally upset? True Select one Resting or minimal physical activity (such as walking across the room)
exertion-2 Exercise or exertion, emotional upset or excitement
exertion-3 Other
exertion-4 Both
exertion_other Please specify when your palpitation symptoms occur. True string
seen_doctor-0 Have you seen a doctor or nurse about this (include being hospitalized or a visit to an emergency room for this)? True Select one No
seen_doctor-1 Yes
told_cause-0 Have you been told the cause by a doctor or nurse? True Select one No
told_cause-1 Yes
cause-1 What is the cause? Check all that apply. True Select any Atrial fibrillation (AF, AFib)
cause-2 Atrial flutter (flutter)
cause-3 Supraventricular tachycardia (SVT)
cause-4 Wolff Parkinson-White (WPW)
cause-5 AV Nodal Reentrant Tachycardia (AVNRT)
cause-6 Atrial tachycardia or PAT
cause-7 Ventricular tachycardia (VT)
cause-8 PACs or PVCs (premature beats)
cause-9 Bradycardia (slow heart rates)
cause-10 Other
cause-11 Still being evaluated by my doctor
cause-12 Don't know
cause_other Please specify the other cause of your palpitation symptoms. True string
hospital-1 Have you ever gone to the emergency room or hospital for this problem? True Select one Yes
hospital-2 No
hospital-3 Don't know
cardioversion-1 Have you ever gotten a shock to the chest or cardioversion? True Select one Yes
cardioversion-2 No
cardioversion-3 Don't know
long_term_treat-1 What long-term treatment have you received for these palpitations? Check all that apply. False Select any No treatment
long_term_treat-2 Medications
long_term_treat-3 Ablation
long_term_treat-4 Pacemaker
long_term_treat-5 Implantable Cardioverter-Defibrillator (ICD)
long_term_treat-6 Don't know
Physical Activity Survey 1 sanyha-1 Please check ONE box containing the description which best summarizes your ability to do physical activity OVER THE PAST 4 WEEKS, assuming you have not been hospitalized over that time period. True Select one I can perform all physical activity without getting short of breath or tired, or having palpitations.
sanyha-2 I get short of breath or tired, or have palpitations when performing more strenuous activites. For example, walking on steep inclines or walking up several flights of steps.
sanyha-3 I get short of breath or tired, or have palpitations when performing day to day activities. For example, walking on flat ground.
sanyha-4 I feel breathless at rest, and am mostly housebound. I am unable to carry out any physical activity without getting short of breath or tired, or having palpitations.
Physical Limitations Survey 1 fatigue-1 How much of the time during the past 4 weeks did you feel tired? True Select one 1 (All of the time)
fatigue-2 2 (Most of the time)
fatigue-3 3 (Some of the time)
fatigue-4 4 (A little of the time)
fatigue-5 5 (None of the time)
resistance-1 By yourself and not using aids, do you have any difficulty walking up 10 steps without resting? True Select one Yes
resistance-2 No
ambulation-1 By yourself and not using aids, do you have any difficulty walking a couple of blocks (e.g. several hundred yards)? True Select one Yes
ambulation-2 No
2 fatigue-1 How much of the time during the past 4 weeks did you feel tired? True Select one All of the time
fatigue-2 Most of the time
fatigue-3 Some of the time
fatigue-4 A little of the time
fatigue-5 None of the time
resistance-1 By yourself and not using aids, do you have any difficulty walking up 10 steps without resting? True Select one Yes
resistance-2 No
ambulation-1 By yourself and not using aids, do you have any difficulty walking a couple of blocks (e.g. several hundred yards)? True Select one Yes
ambulation-2 No
Pregnancy History Follow-Up 1 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you been pregnant within the past year? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
2 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you been pregnant within the past year? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
Pregnancy History Survey 1 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you ever been pregnant? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
num_preg-dk How many times have you been pregnant in your life? False Select one Don't know
num_preg-no_ans Prefer not to answer
num_preg-1 1
num_preg-2 2
num_preg-3 3
num_preg-4 4
num_preg-5 5
num_preg-6 6
num_preg-7 7
num_preg-8 8
num_preg-9 9
num_preg-10 10 or more
None If you have had a miscarriage, how many? False Select one
None
None
None
None
None
None
None
None
None
None
None
None
None How many live births have you had? False Select one
None
None
None
None
None
None
None
None
None
None
None
None
premature-yes Were any of your babies born 3 weeks early or sooner? False Select one Yes
premature-no No
premature-dk Don't know
premature-refused Prefer not to answer
gest_dia-yes During any of your pregnancies, were you told you had gestational diabetes or high blood sugar, or sugar in the urine? False Select one Yes
gest_dia-no No
gest_dia-dk Don't know
gest_dia-refused Prefer not to answer
preeclamp-yes During any of your pregnancies, did you have preeclampsia (toxemia, high blood pressure during and/or right after pregnancy also associated with protein in the urine) or eclampsia (preeclampsia AND seizures/convulsions)? False Select one Yes
preeclamp-no No
preeclamp-dk Don't know
preeclamp-refused Prefer not to answer
hbp-yes During any of your pregnancies, did you have high blood pressure (gestational hypertension, pregnancy-induced hypertension) not related to preeclampsia? False Select one Yes
hbp-no No
hbp-dk Don't know
hbp-refused Prefer not to answer
weigh_less-yes Have you ever given birth to a baby that weighed less than 5 pounds, 8 ounces (less than 2,500 grams)? False Select one Yes
weigh_less-no No
weigh_less-dk Don't know
weigh_less-refused Prefer not to answer
weigh_more-yes Have you ever given birth to a baby that weighed more than 9 pounds, 14 ounces (more than 4,500 grams)? False Select one Yes
weigh_more-no No
weigh_more-dk Don't know
weigh_more-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
2 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you ever been pregnant? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
num_preg-dk How many times have you been pregnant in your life? False Select one Don't know
num_preg-no_ans Prefer not to answer
num_preg-1 1
num_preg-2 2
num_preg-3 3
num_preg-4 4
num_preg-5 5
num_preg-6 6
num_preg-7 7
num_preg-8 8
num_preg-9 9
num_preg-10 10 or more
None If you have had a miscarriage, how many? False Select one
None
None
None
None
None
None
None
None
None
None
None
None
None How many live births have you had? False Select one
None
None
None
None
None
None
None
None
None
None
None
None
premature-yes Were any of your babies born 3 weeks early or sooner? False Select one Yes
premature-no No
premature-dk Don't know
premature-refused Prefer not to answer
gest_dia-yes During any of your pregnancies, were you told you had gestational diabetes or high blood sugar, or sugar in the urine? False Select one Yes
gest_dia-no No
gest_dia-dk Don't know
gest_dia-refused Prefer not to answer
preeclamp-yes During any of your pregnancies, did you have preeclampsia (toxemia, high blood pressure during and/or right after pregnancy also associated with protein in the urine) or eclampsia (preeclampsia AND seizures/convulsions)? False Select one Yes
preeclamp-no No
preeclamp-dk Don't know
preeclamp-refused Prefer not to answer
hbp-yes During any of your pregnancies, did you have high blood pressure (gestational hypertension, pregnancy-induced hypertension) not related to preeclampsia? False Select one Yes
hbp-no No
hbp-dk Don't know
hbp-refused Prefer not to answer
weigh_less-yes Have you ever given birth to a baby that weighed less than 5 pounds, 8 ounces (less than 2,500 grams)? False Select one Yes
weigh_less-no No
weigh_less-dk Don't know
weigh_less-refused Prefer not to answer
weigh_more-yes Have you ever given birth to a baby that weighed more than 9 pounds, 14 ounces (more than 4,500 grams)? False Select one Yes
weigh_more-no No
weigh_more-dk Don't know
weigh_more-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
3 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you ever been pregnant? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
num_preg-dk How many times have you been pregnant in your life? False Select one Don't know
num_preg-no_ans Prefer not to answer
num_preg-1 1
num_preg-2 2
num_preg-3 3
num_preg-4 4
num_preg-5 5
num_preg-6 6
num_preg-7 7
num_preg-8 8
num_preg-9 9
num_preg-10 10 or more
num_miscarriage-0 If you have had a miscarriage, how many? False Select one 0
num_miscarriage-dk Don't know
num_miscarriage-pnts Prefer not to answer
num_miscarriage-1 1
num_miscarriage-2 2
num_miscarriage-3 3
num_miscarriage-4 4
num_miscarriage-5 5
num_miscarriage-6 6
num_miscarriage-7 7
num_miscarriage-8 8
num_miscarriage-9 9
num_miscarriage-10 10 or more
num_kids-0 How many live births have you had? False Select one 0
num_kids-dk Don't know
num_kids-pnts Prefer not to answer
num_kids-1 1
num_kids-2 2
num_kids-3 3
num_kids-4 4
num_kids-5 5
num_kids-6 6
num_kids-7 7
num_kids-8 8
num_kids-9 9
num_kids-10 10 or more
premature-yes Were any of your babies born 3 weeks early or sooner? False Select one Yes
premature-no No
premature-dk Don't know
premature-refused Prefer not to answer
gest_dia-yes During any of your pregnancies, were you told you had gestational diabetes or high blood sugar, or sugar in the urine? False Select one Yes
gest_dia-no No
gest_dia-dk Don't know
gest_dia-refused Prefer not to answer
preeclamp-yes During any of your pregnancies, did you have preeclampsia (toxemia, high blood pressure during and/or right after pregnancy also associated with protein in the urine) or eclampsia (preeclampsia AND seizures/convulsions)? False Select one Yes
preeclamp-no No
preeclamp-dk Don't know
preeclamp-refused Prefer not to answer
hbp-yes During any of your pregnancies, did you have high blood pressure (gestational hypertension, pregnancy-induced hypertension) not related to preeclampsia? False Select one Yes
hbp-no No
hbp-dk Don't know
hbp-refused Prefer not to answer
weigh_less-yes Have you ever given birth to a baby that weighed less than 5 pounds, 8 ounces (less than 2,500 grams)? False Select one Yes
weigh_less-no No
weigh_less-dk Don't know
weigh_less-refused Prefer not to answer
weigh_more-yes Have you ever given birth to a baby that weighed more than 9 pounds, 14 ounces (more than 4,500 grams)? False Select one Yes
weigh_more-no No
weigh_more-dk Don't know
weigh_more-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
4 pregnancy-yes Are you currently pregnant? False Select one Yes
pregnancy-no No
pregnancy-dk Don't know
pregnancy-refused Prefer not to answer
pregnancy_ever-yes Have you ever been pregnant? False Select one Yes
pregnancy_ever-no No
pregnancy_ever-dk Don't know
pregnancy_ever-refused Prefer not to answer
num_preg-dk How many times have you been pregnant in your life? False Select one Don't know
num_preg-no_ans Prefer not to answer
num_preg-1 1
num_preg-2 2
num_preg-3 3
num_preg-4 4
num_preg-5 5
num_preg-6 6
num_preg-7 7
num_preg-8 8
num_preg-9 9
num_preg-10 10 or more
num_miscarriage-0 If you have had a miscarriage, how many? False Select one 0
num_miscarriage-dk Don't know
num_miscarriage-no_ans Prefer not to answer
num_miscarriage-1 1
num_miscarriage-2 2
num_miscarriage-3 3
num_miscarriage-4 4
num_miscarriage-5 5
num_miscarriage-6 6
num_miscarriage-7 7
num_miscarriage-8 8
num_miscarriage-9 9
num_miscarriage-10 10 or more
num_kids-0 How many live births have you had? False Select one 0
num_kids-dk Don't know
num_kids-no_ans Prefer not to answer
num_kids-1 1
num_kids-2 2
num_kids-3 3
num_kids-4 4
num_kids-5 5
num_kids-6 6
num_kids-7 7
num_kids-8 8
num_kids-9 9
num_kids-10 10 or more
premature-yes Were any of your babies born 3 weeks early or sooner? False Select one Yes
premature-no No
premature-dk Don't know
premature-refused Prefer not to answer
gest_dia-yes During any of your pregnancies, were you told you had gestational diabetes or high blood sugar, or sugar in the urine? False Select one Yes
gest_dia-no No
gest_dia-dk Don't know
gest_dia-refused Prefer not to answer
preeclamp-yes During any of your pregnancies, did you have preeclampsia (toxemia, high blood pressure during and/or right after pregnancy also associated with protein in the urine) or eclampsia (preeclampsia AND seizures/convulsions)? False Select one Yes
preeclamp-no No
preeclamp-dk Don't know
preeclamp-refused Prefer not to answer
hbp-yes During any of your pregnancies, did you have high blood pressure (gestational hypertension, pregnancy-induced hypertension) not related to preeclampsia? False Select one Yes
hbp-no No
hbp-dk Don't know
hbp-refused Prefer not to answer
weigh_less-yes Have you ever given birth to a baby that weighed less than 5 pounds, 8 ounces (less than 2,500 grams)? False Select one Yes
weigh_less-no No
weigh_less-dk Don't know
weigh_less-refused Prefer not to answer
weigh_more-yes Have you ever given birth to a baby that weighed more than 9 pounds, 14 ounces (more than 4,500 grams)? False Select one Yes
weigh_more-no No
weigh_more-dk Don't know
weigh_more-refused Prefer not to answer
menopause-yes Have you reached menopause (point at which you stopped having menstrual periods)? False Select one Yes
menopause-no No
menopause-dk Don't know
menopause-refused Prefer not to answer
meno_how-naturally How did your periods stop? False Select one Naturally
meno_how-surg_wo By surgery (hysterectomy WITHOUT ovaries removed)
meno_how-surg_with By surgery (hysterectomy AND both ovaries removed)
meno_how-dk Don't Know
meno_how-refused Prefer not to answer
meno_age Approximately, at what age did you reach menopause (point at which you stopped having menstrual periods)? False integer
hrt-yes Have you ever undergone Hormone Replacement Therapy (HRT) for menopause? False Select one Yes and I am currently undergoing HRT
hrt-stopped Yes, but I have stopped HRT
hrt-no No
hrt-dk Don't Know
hrt-refused Prefer not to answer
Pulmonary Function Test (PFT) Documentation Coordinator Form 1 pft_smoking-never What is the participant’s smoking history? (Including cigarettes, pipe smoking, vaping, e-cigarettes) True Select one Never smoked
pft_smoking-smoker Has smoked in the past or is currently a smoker
pft_smoking_years How many years has the participant been a smoker, or how many years did they smoke before quitting? True float |years
pft_smoking_amount On average, how many cigarettes does/did the participant smoke per day? (There are 20 cigarettes in a pack) True float Float
pft_date What is the date and time of the PFT? True datetime Datetime
pft_tech Who performed the PFT? True string String
pft_spiro-yes Was spirometry performed? True Select one Yes
pft_spiro-decline No, the participant declined
pft_spiro-noshow No, the participant could not be reached or did not show
pft_spiro-contra No, clinical contraindication
pft_spiro-staff No, staff not available
pft_spiro-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_spiro-oth Spirometry not done for some other reason
pft_spiro_other If ‘other,’ please explain why the spirometry was not performed. True text Text
pft_dlco-yes Was DLCO performed? True Select one Yes
pft_dlco-decline No, the participant declined
pft_dlco-noshow No, the participant could not be reached or did not show
pft_dlco-contra No, clinical contraindication
pft_dlco-staff No, staff not available
pft_dlco-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_dlco-oth DLCO not done for some other reason
pft_dlco_other If ‘other,’ please explain why the DLCO was not performed. True text Text
pft_acceptable-yes Was the patient’s spirometry performance acceptable? (see MOP for acceptability criteria) True Select one Yes
pft_acceptable-no No
pft_mod-yes Was there a modification to the protocol? True Select one Yes
pft_mod-no No
pft_mod_comment Explain the protocol modification. True text Text
2 pft_smoking-never What is the participant’s smoking history? (Including cigarettes, pipe smoking, vaping, e-cigarettes) False Select any Never smoked
pft_smoking-ciggarettes Has smoked in the past or is currently a smoker
pft_smoking-vaping Has used vape or e-cigarette products in the past or currently uses these products
pft_smoking_years How many years has the participant been a smoker, or how many years did they smoke before quitting? False float |years
pft_smoking_amount On average, how many cigarettes does/did the participant smoke per day? (There are 20 cigarettes in a pack) False float Float
pft_vaping Please describe the participant’s use of vape or e-cigarette products (for example, how frequently do they use these products). False text Text
pft_date What is the date and time of the PFT? True datetime Datetime
pft_tech Who performed the PFT? True string String
pft_spiro-yes Was spirometry performed? True Select one Yes
pft_spiro-decline No, the participant declined
pft_spiro-noshow No, the participant could not be reached or did not show
pft_spiro-contra No, clinical contraindication
pft_spiro-staff No, staff not available
pft_spiro-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_spiro-oth Spirometry not done for some other reason
pft_spiro_other If ‘other,’ please explain why the spirometry was not performed. True text Text
pft_dlco-yes Was DLCO performed? True Select one Yes
pft_dlco-decline No, the participant declined
pft_dlco-noshow No, the participant could not be reached or did not show
pft_dlco-contra No, clinical contraindication
pft_dlco-staff No, staff not available
pft_dlco-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_dlco-oth DLCO not done for some other reason
pft_dlco_other If ‘other,’ please explain why the DLCO was not performed. True text Text
pft_acceptable-yes Was the patient’s spirometry performance acceptable? (see MOP for acceptability criteria) True Select one Yes
pft_acceptable-no No
pft_mod-yes Was there a modification to the protocol? True Select one Yes
pft_mod-no No
pft_mod_comment Explain the protocol modification. True text Text
3 pft_smoking-never What is the participant’s smoking history? (Including cigarettes, pipe smoking, vaping, e-cigarettes) True Select any Never smoked
pft_smoking-ciggarettes Has smoked in the past or is currently a smoker
pft_smoking-vaping Has used vape or e-cigarette products in the past or currently uses these products
pft_smoking_years How many years has the participant been a smoker, or how many years did they smoke before quitting? True float |years
pft_smoking_amount On average, how many cigarettes does/did the participant smoke per day? (There are 20 cigarettes in a pack) True float Float
pft_vaping Please describe the participant’s use of vape or e-cigarette products (for example, how frequently do they use these products). True text Text
pft_date What is the date and time of the PFT? True datetime Datetime
pft_tech Who performed the PFT? True string String
pft_spiro-yes Was spirometry performed? True Select one Yes
pft_spiro-decline No, the participant declined
pft_spiro-noshow No, the participant could not be reached or did not show
pft_spiro-contra No, clinical contraindication
pft_spiro-staff No, staff not available
pft_spiro-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_spiro-oth Spirometry not done for some other reason
pft_spiro_other If ‘other,’ please explain why the spirometry was not performed. True text Text
pft_dlco-yes Was DLCO performed? True Select one Yes
pft_dlco-decline No, the participant declined
pft_dlco-noshow No, the participant could not be reached or did not show
pft_dlco-contra No, clinical contraindication
pft_dlco-staff No, staff not available
pft_dlco-insf No, insufficient resources (Scheduling, transportation, equipment, etc.)
pft_dlco-oth DLCO not done for some other reason
pft_dlco_other If ‘other,’ please explain why the DLCO was not performed. True text Text
pft_acceptable-yes Was the patient’s spirometry performance acceptable? (see MOP for acceptability criteria) True Select one Yes
pft_acceptable-no No
pft_mod-yes Was there a modification to the protocol? True Select one Yes
pft_mod-no No
pft_mod_comment Explain the protocol modification. True text Text
Recent Hospitalization Survey 1 admitted-1 Looks like you were near/at a hospital. Were you there for YOUR medical care? True Select one Yes
admitted-2 No
overnight-1 Did you stay at the hospital overnight? True Select one Yes
overnight-2 No
hosp_admitdate When were you admitted to the hospital? True date Date
dischargedate When did you leave the hospital? True date Date
hosp_hospname What is the name of the hospital you went to? True string |hospital name
hosp_city City: True string |city
hosp_state-1 State: True Select one Alabama
hosp_state-2 Alaska
hosp_state-3 Arizona
hosp_state-4 Arkansas
hosp_state-5 California
hosp_state-6 Colorado
hosp_state-7 Connecticut
hosp_state-8 Delaware
hosp_state-9 District of Columbia
hosp_state-10 Florida
hosp_state-11 Georgia
hosp_state-12 Hawaii
hosp_state-13 Idaho
hosp_state-14 Illinois
hosp_state-15 Indiana
hosp_state-16 Iowa
hosp_state-17 Kansas
hosp_state-18 Kentucky
hosp_state-19 Louisiana
hosp_state-20 Maine
hosp_state-21 Maryland
hosp_state-22 Massachusetts
hosp_state-23 Michigan
hosp_state-24 Minnesota
hosp_state-25 Mississippi
hosp_state-26 Missouri
hosp_state-27 Montana
hosp_state-28 Nebraska
hosp_state-29 Nevada
hosp_state-30 New Hampshire
hosp_state-31 New Jersey
hosp_state-32 New Mexico
hosp_state-33 New York
hosp_state-34 North Carolina
hosp_state-35 North Dakota
hosp_state-36 Ohio
hosp_state-37 Oklahoma
hosp_state-38 Oregon
hosp_state-39 Pennsylvania
hosp_state-40 Rhode Island
hosp_state-41 South Carolina
hosp_state-42 South Dakota
hosp_state-43 Tennessee
hosp_state-44 Texas
hosp_state-45 Utah
hosp_state-46 Vermont
hosp_state-47 Virginia
hosp_state-48 Washington
hosp_state-49 West Virginia
hosp_state-50 Wisconsin
hosp_state-51 Wyoming
hosp_mainreason-1 Was the main reason for your hospitalization cardiac related (you can look at the papers you received at discharge from the hospital)? True Select one Yes
hosp_mainreason-2 No
hosp_mainreason-3 I don't know
hosp_mainreasonheart-1 What was the main reason for your hospitalization (you can look at the papers you received at discharge from the hospital)? True Select any Heart Attack (Myocardial infarction)
hosp_mainreasonheart-2 Angina or chest pain
hosp_mainreasonheart-3 Heart Failure or Pulmonary Edema (fluid in the lungs)
hosp_mainreasonheart-4 Stroke or Transient Ischemic Attack (TIA)
hosp_mainreasonheart-5 Atrial Fibrillation (AFib, AF) or Atrial Flutter
hosp_mainreasonheart-6 Other arrhythmia (abnormal heart rhythm)
hosp_mainreasonheart-7 Cardioversion (electrical cardioversion)
hosp_mainreasonheart-8 Ablation
hosp_mainreasonheart-9 Other
hosp_mainreasonheart-10 I don't know
hosp_mainreasonheart_other Please describe what was your main reason for hospitalization. True text |Other main reason for hospitalization
hosp_symptoms-1 Did you have any of these symptoms when you came to the hospital or during your hospitalization? True Select any Chest pain or discomfort
hosp_symptoms-2 Shortness of breath
hosp_symptoms-3 Palpitations or abnormal heart beat
hosp_symptoms-4 Dizziness or fainting
hosp_symptoms-5 A cardiac arrest or need for CPR
hosp_symptoms-6 Difficulty talking
hosp_symptoms-7 Weakness or numbness
hosp_symptoms-8 Other
hosp_symptoms-9 I don't know
Skeletal Muscle Biopsy Consent Coordinator Form 1 muscle_consent_ready-yes Is this participant ready and willing to sign the Skeletal Muscle Biopsy Consent? True Select one Yes
Sleep Survey 1 sitting_reading-0 Sitting and reading True Select one Would never doze
sitting_reading-1 Slight chance of dozing
sitting_reading-2 Moderate chance of dozing
sitting_reading-3 High chance of dozing
watching_tv-0 Watching TV True Select one Would never doze
watching_tv-1 Slight chance of dozing
watching_tv-2 Moderate chance of dozing
watching_tv-3 High chance of dozing
sitting_public-0 Sitting, inactive in a public place (e.g., a theatre or a meeting) True Select one Would never doze
sitting_public-1 Slight chance of dozing
sitting_public-2 Moderate chance of dozing
sitting_public-3 High chance of dozing
car_passenger-0 As a passenger in a car for an hour without a break True Select one Would never doze
car_passenger-1 Slight chance of dozing
car_passenger-2 Moderate chance of dozing
car_passenger-3 High chance of dozing
lying_down-0 Lying down to rest in the afternoon when circumstances permit True Select one Would never doze
lying_down-1 Slight chance of dozing
lying_down-2 Moderate chance of dozing
lying_down-3 High chance of dozing
sitting_talking-0 Sitting and talking to someone True Select one Would never doze
sitting_talking-1 Slight chance of dozing
sitting_talking-2 Moderate chance of dozing
sitting_talking-3 High chance of dozing
sitting_after_lunch-0 Sitting quietly after a lunch without alcohol True Select one Would never doze
sitting_after_lunch-1 Slight chance of dozing
sitting_after_lunch-2 Moderate chance of dozing
sitting_after_lunch-3 High chance of dozing
car_traffic-0 In a car, while stopped for a few minutes in the traffic True Select one Would never doze
car_traffic-1 Slight chance of dozing
car_traffic-2 Moderate chance of dozing
car_traffic-3 High chance of dozing
Snoring Survey 1 snore-0 Do you SNORE LOUDLY (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)? True Select one No
snore-1 Yes
sleepiness_tired-0 Do you often feel TIRED, FATIGUED, or SLEEPY during the daytime (Such as falling asleep during driving or talking to someone)? True Select one No
sleepiness_tired-1 Yes
stop_breathing-0 Has anyone observed you STOP BREATHING or CHOKING/GASPING during your sleep? True Select one No
stop_breathing-1 Yes
hbp-0 Do you have or are you being treated for HIGH BLOOD PRESSURE? True Select one No
hbp-1 Yes
neck_size-0 Do you know your neck size? True Select one Yes
neck_size-1 I don't know
neck_size_ans What is your NECK SIZE? You can measure or use your shirt’s collar size. True float |inches
Substance Use Survey 1 tobacco-0 In the PAST 12 MONTHS, how often have you used any TOBACCO product (for example, cigarettes, e-cigarettes, cigars, pipes, or smokeless tobacco)? True Select one Never
tobacco-1 Less Than Monthly
tobacco-2 Monthly
tobacco-3 Weekly
tobacco-4 Daily or Almost Daily
drink-0 In the PAST 12 MONTHS, how often have you had 5 OR MORE DRINKS (men)/4 OR MORE DRINKS (women) containing ALCOHOL in one day? True Select one Never
drink-1 Less Than Monthly
drink-2 Monthly
drink-3 Weekly
drink-4 Daily or Almost Daily
illicit-0 In the PAST 12 MONTHS, how often have you used any DRUGS including marijuana, cocaine or crack, heroin, methamphetamine (crystal meth), hallucinogens, ecstasy/MDMA? True Select one Never
illicit-1 Less Than Monthly
illicit-2 Monthly
illicit-3 Weekly
illicit-4 Daily or Almost Daily
rx-0 In the PAST 12 MONTHS, how often have you used any PRESCRIPTION MEDICATIONS just for the feeling, more than prescribed or that were not prescribed for you? True Select one Never
rx-1 Less Than Monthly
rx-2 Monthly
rx-3 Weekly
rx-4 Daily or Almost Daily
tobacco2-yes In the PAST 3 MONTHS, did you smoke a CIGARETTE containing tobacco? True Select one Yes
tobacco2-no No
tobacco_ten-yes In the PAST 3 MONTHS, did you usually smoke more than 10 CIGARETTES each day? True Select one Yes
tobacco_ten-no No
tobacco_walk-yes In the PAST 3 MONTHS, did you usually smoke within 30 minutes after waking? True Select one Yes
tobacco_walk-no No
alcohol-yes In the PAST 3 MONTHS, did you have a DRINK CONTAINING ALCOHOL? True Select one Yes
alcohol-no No
alcohol_more-yes In the PAST 3 MONTHS, did you have 5 OR MORE DRINKS (men)/4 OR MORE DRINKS (women) containing ALCOHOL in a day? True Select one Yes
alcohol_more-no No
alcohol_stop-yes In the PAST 3 MONTHS, have you TRIED AND FAILED to control, cut down, or stop DRINKING? True Select one Yes
alcohol_stop-no No
alcohol_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your DRINKING? True Select one Yes
alcohol_concern-no No
marijuana-yes In the PAST 3 MONTHS, did you use MARIJUANA (hash, weed)? True Select one Yes
marijuana-no No
marijuana_urge-yes In the PAST 3 MONTHS, have you had a strong desire or urge to use MARIJUANA at least once a week or more often? True Select one Yes
marijuana_urge-no No
marijuana_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of MARIJUANA? True Select one Yes
marijuana_concern-no No
crack-yes In the PAST 3 MONTHS, did you use COCAINE, CRACK, or METHAMPHETAMINE (crystal meth)? True Select one Yes
crack-no No
crack_often-yes In the PAST 3 MONTHS, did you use COCAINE, CRACK, or METHAMPHETAMINE (crystal meth) at least once a week or more often? True Select one Yes
crack_often-no No
crack_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of COCAINE, CRACK, or METHAMPHETAMINE (crystal meth)? True Select one Yes
crack_concern-no No
heroin-yes In the PAST 3 MONTHS, did you use HEROIN? True Select one Yes
heroin-no No
heroin_stop-yes In the PAST 3 MONTHS, have you TRIED AND FAILED to control, cut down or stop using HEROIN? True Select one Yes
heroin_stop-no No
heroin_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of HEROIN? True Select one Yes
heroin_concern-no No
opiate-yes In the PAST 3 MONTHS, did you use a prescription OPIATE PAIN RELIEVER (for example, Percocet, Vicodin) not as prescribed or that was not prescribed for you? True Select one Yes
opiate-no No
opiate_stop-yes In the PAST 3 MONTHS, have you TRIED AND FAILED to control, cut down or stop using an OPIATE PAIN RELIEVER? True Select one Yes
opiate_stop-no No
opiate_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of an OPIATE PAIN RELIEVER? True Select one Yes
opiate_concern-no No
benzo-yes In the PAST 3 MONTHS, did you use a MEDICATION FOR ANXIETY OR SLEEP (for example, Xanax, Ativan, or Klonopin) not as prescribed or that was not prescribed for you? True Select one Yes
benzo-no No
benzo_urge-yes In the PAST 3 MONTHS, have you had a strong desire or urge to use MEDICATIONS FOR ANXIETY OR SLEEP at least once a week or more often? True Select one Yes
benzo_urge-no No
benzo_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of MEDICATION FOR ANXIETY OR SLEEP? True Select one Yes
benzo_concern-no No
stim-yes In the PAST 3 MONTHS, did you use a MEDICATION FOR ADHD (for example, Adderall, Ritalin) not as prescribed or that was not prescribed for you? True Select one Yes
stim-no No
stim_often-yes In the PAST 3 MONTHS, did you use a MEDICATION FOR ADHD (for example, Adderall, Ritalin) at least once a week or more often? True Select one Yes
stim_often-no No
stim_concern-yes In the PAST 3 MONTHS, has anyone expressed concern about your use of a MEDICATION FOR ADHD (for example, Adderall or Ritalin)? True Select one Yes
stim_concern-no No
illegal-yes In the PAST 3 MONTHS, did you use any other ILLEGAL or RECREATIONAL DRUG (for example, ecstasy/molly, GHB, poppers, LSD, mushrooms, special K, bath salts, synthetic marijuana ('spice'), whip-its, etc.)? True Select one Yes
illegal-no No
illegal_what In the PAST 3 MONTHS, what were the other drug(s) you used? True string
Syncope Questionnaire 1 how_old_know-0 Do you know about how old you were when these spells started? True Select one No
how_old_know-1 Yes
how_old_start About how old were you when these spells started? True integer
headaches-1 Do you have recurrent headaches? True Select one Yes
headaches-2 No
headaches-3 Don't know
lightheaded-1 Have you ever had lightheaded spells or fainted with prolonged sitting or standing? True Select one Yes
lightheaded-2 No
lightheaded-3 Don't know
sweaty-1 Do you feel sweaty or warm before fainting? True Select one Yes
sweaty-2 No
sweaty-3 Don't know
light_spells-1 Have you had any lightheaded spells? True Select one Yes
light_spells-2 No
light_spells-3 Don't know
light_spells_stress-1 Do you have lightheaded spells or faint with stress? True Select one Yes
light_spells_stress-2 No
light_spells_stress-3 Don't know
light_spells_pain-1 Do you have lightheaded spells or faint with pain or in a medical setting (e.g., giving blood, getting blood drawn)? True Select one Yes
light_spells_pain-2 No
light_spells_pain-3 Don't know
light_spells_dejavu-1 Do you have a feeling of having experienced a similar situation (deja vu) just before fainting? True Select one Yes
light_spells_dejavu-2 No
light_spells_dejavu-3 Don't know
cut_tongue-1 Have you awoken with a cut tongue after fainting? True Select one Yes
cut_tongue-2 No
cut_tongue-3 Don't know
remember-1 Do you remember anything about being unconscious? True Select one Yes
remember-2 No
remember-3 Don't know
tired-1 Do you get tired after fainting (tiredness lasting more than 1 minute)? True Select one Yes
tired-2 No
tired-3 Don't know
confusion-1 Have bystanders noticed confusion after you have fainted? True Select one Yes
confusion-2 No
confusion-3 Don't know
unresponsiveness-1 Have bystanders noticed unresponsiveness, unusual posturing, limb jerking or lack of memory when you have fainted? True Select one Yes
unresponsiveness-2 No
unresponsiveness-3 Don't know
head_turn-1 Have bystanders noticed your head turning when you have fainted? True Select one Yes
head_turn-2 No
head_turn-3 Don't know
turn_blue-1 Have bystanders noticed you turning blue during a fainting or lightheaded spell? True Select one Yes
turn_blue-2 No
turn_blue-3 Don't know
2 how_old_know-0 Do you know about how old you were when these spells started? True Select one No
how_old_know-1 Yes
how_old_start About how old were you when these spells started? True integer
headaches-1 Do you have recurrent headaches? True Select one Yes
headaches-2 No
headaches-3 Don't know
lightheaded-1 Have you ever had lightheaded spells or fainted with prolonged sitting or standing? True Select one Yes
lightheaded-2 No
lightheaded-3 Don't know
sweaty-1 Do you feel sweaty or warm before fainting? True Select one Yes
sweaty-2 No
sweaty-3 Don't know
light_spells-1 Have you had any lightheaded spells? True Select one Yes
light_spells-2 No
light_spells-3 Don't know
light_spells_stress-1 Do you have lightheaded spells or faint with stress? True Select one Yes
light_spells_stress-2 No
light_spells_stress-3 Don't know
light_spells_pain-1 Do you have lightheaded spells or faint with pain or in a medical setting (e.g., giving blood, getting blood drawn)? True Select one Yes
light_spells_pain-2 No
light_spells_pain-3 Don't know
light_spells_dejavu-1 Do you have a feeling of having experienced a similar situation (deja vu) just before fainting? True Select one Yes
light_spells_dejavu-2 No
light_spells_dejavu-3 Don't know
cut_tongue-1 Have you awoken with a cut tongue after fainting? True Select one Yes
cut_tongue-2 No
cut_tongue-3 Don't know
remember-1 Do you remember anything about being unconscious? True Select one Yes
remember-2 No
remember-3 Don't know
tired-1 Do you get tired after fainting (tiredness lasting more than 1 minute)? True Select one Yes
tired-2 No
tired-3 Don't know
confusion-1 Have bystanders noticed confusion after you have fainted? True Select one Yes
confusion-2 No
confusion-3 Don't know
unresponsiveness-1 Have bystanders noticed unresponsiveness, unusual posturing, limb jerking or lack of memory when you have fainted? True Select one Yes
unresponsiveness-2 No
unresponsiveness-3 Don't know
head_turn-1 Have bystanders noticed your head turning when you have fainted? True Select one Yes
head_turn-2 No
head_turn-3 Don't know
turn_blue-1 Have bystanders noticed you turning blue during a fainting or lightheaded spell? True Select one Yes
turn_blue-2 No
turn_blue-3 Don't know
Tissue Biopsy Coordinator Form 1 biopsies_starlims What is the StarLIMS kit number? True string String
biopsies_consent-adipose Which biopsies did the participant consent to? True Select any Adipose Tissue
biopsies_consent-muscle Skeletal Muscle
adipose_consent_date Date of Adipose Tissue consent: True date Date
muscle_consent_date Date of Skeletal Muscle consent: True date Date
biopsies_completion-adipose Which biopsies were performed? True Select any Adipose Tissue
biopsies_completion-muscle Skeletal Muscle
biopsies_date Date of biopsy collection: True date Date
biopsy_operator Name of biopsy operator: True string String
biopsy_processor Name of biopsy processor: True string String
biopsies_adipose-yes Was any tissue collected from the adipose biopsy? True Select one Yes
biopsies_adipose-no No
biopsies_adipose_total What was the total tissue weight of the adipose collected? True float |mg
biopsies_adipose_none-time If none, why was no adipose tissue collected? True Select one Shortened clinic visit
biopsies_adipose_none-resources Equipment, supply, or space problem
biopsies_adipose_none-ae Adverse event (follow up with AE/SAE form)
biopsies_adipose_none-oth Other
biopsies_adipose_other If 'other', please explain why no adipose tissue was collected. True text Text
biopsies_muscle-yes Was any tissue collected from the muscle biopsy? True Select one Yes
biopsies_muscle-no No
biopsies_muscle_total What was the total tissue weight of the muscle collected? True float |mg
biopsies_muscle_none-time If none, why was no muscle tissue collected? True Select one Shortened clinic visit
biopsies_muscle_none-resources Equipment, supply, or space problem
biopsies_muscle_none-ae Adverse event (follow up with AE/SAE form)
biopsies_muscle_none-oth Other
biopsies_muscle_other If 'other', please explain why no muscle tissue was collected. True text Text
2 biopsies_consent-adipose Which biopsies did the participant consent to? False Select any Adipose Tissue
biopsies_consent-muscle Skeletal Muscle
adipose_consent_date Date of Adipose Tissue consent: False date Date
muscle_consent_date Date of Skeletal Muscle consent: False date Date
biopsies_completion-adipose Which biopsies were performed? False Select any Adipose Tissue
biopsies_completion-muscle Skeletal Muscle
adipose_biopsy_starlims What is the StarLIMS kit number for the adipose biopsy? False string String
muscle_biopsy_starlims What is the StarLIMS kit number for the skeletal muscle biopsy? False string String
biopsies_date Date of biopsy collection: False date Date
biopsy_operator Name of biopsy operator: False string String
biopsy_processor Name of biopsy processor: False string String
biopsies_adipose-yes Was any tissue collected from the adipose biopsy? False Select one Yes
biopsies_adipose-no No
biopsies_adipose_total What was the total tissue weight of the adipose collected? False float |mg
biopsies_adipose_none-time If none, why was no adipose tissue collected? False Select one Shortened clinic visit
biopsies_adipose_none-resources Equipment, supply, or space problem
biopsies_adipose_none-ae Adverse event (follow up with AE/SAE form)
biopsies_adipose_none-oth Other
biopsies_adipose_other If 'other', please explain why no adipose tissue was collected. False text Text
biopsies_muscle-yes Was any tissue collected from the muscle biopsy? False Select one Yes
biopsies_muscle-no No
biopsies_muscle_total What was the total tissue weight of the muscle collected? False float |mg
biopsies_muscle_none-time If none, why was no muscle tissue collected? False Select one Shortened clinic visit
biopsies_muscle_none-resources Equipment, supply, or space problem
biopsies_muscle_none-ae Adverse event (follow up with AE/SAE form)
biopsies_muscle_none-oth Other
biopsies_muscle_other If 'other', please explain why no muscle tissue was collected. False text Text
3 biopsies_consent-adipose Which biopsies did the participant consent to? True Select any Adipose Tissue
biopsies_consent-muscle Skeletal Muscle
adipose_consent_date Date of Adipose Tissue consent: True date Date
muscle_consent_date Date of Skeletal Muscle consent: True date Date
biopsies_completion-adipose Which biopsies were performed? True Select any Adipose Tissue
biopsies_completion-muscle Skeletal Muscle
adipose_biopsy_starlims What is the StarLIMS kit number for the adipose biopsy? True string String
muscle_biopsy_starlims What is the StarLIMS kit number for the skeletal muscle biopsy? True string String
biopsies_date Date of biopsy collection: True date Date
biopsy_operator Name of biopsy operator: True string String
biopsy_processor Name of biopsy processor: True string String
biopsies_adipose-yes Was any tissue collected from the adipose biopsy? True Select one Yes
biopsies_adipose-no No
biopsies_adipose_total What was the total tissue weight of the adipose collected? True float |mg
biopsies_adipose_none-time If none, why was no adipose tissue collected? True Select one Shortened clinic visit
biopsies_adipose_none-resources Equipment, supply, or space problem
biopsies_adipose_none-ae Adverse event (follow up with AE/SAE form)
biopsies_adipose_none-oth Other
biopsies_adipose_other If 'other', please explain why no adipose tissue was collected. True text Text
biopsies_muscle-yes Was any tissue collected from the muscle biopsy? True Select one Yes
biopsies_muscle-no No
biopsies_muscle_total What was the total tissue weight of the muscle collected? True float |mg
biopsies_muscle_none-time If none, why was no muscle tissue collected? True Select one Shortened clinic visit
biopsies_muscle_none-resources Equipment, supply, or space problem
biopsies_muscle_none-ae Adverse event (follow up with AE/SAE form)
biopsies_muscle_none-oth Other
biopsies_muscle_other If 'other', please explain why no muscle tissue was collected. True text Text
Urine Sample Collection Coordinator Form 1 urine_research_staff Please enter the name of the research staff who observed or performed the URINE collection: True string String
urine_sample_success-1 Was the URINE sample collection successful? True Select one Yes
urine_sample_success-2 No
why_urine_samp_not_collec Why was the URINE collection not successful? True string String
urine_time At what date and time was the URINE sample collected? True datetime Datetime
urine_fast Approximately how long has this participant been fasting prior to the URINE sample collection? True float |hours
urine_volume What was the approximate volume of URINE collected? True integer |mL
urine_concern-1 Were there any concerns about the URINE sample collection? True Select one Yes
urine_concern-2 No
urine_concern_explain Please explain your concerns about the URINE sample collection. True string String
2 urine_research_staff Please enter the name of the research staff who observed or performed the URINE collection: True string String
urine_sample_success-1 Was the URINE sample collection successful? True Select one Yes
urine_sample_success-2 No
why_urine_samp_not_collec Why was the URINE collection not successful? True string String
urine_time At what date and time was the URINE sample collected? True datetime Datetime
urine_fast Approximately how long has this participant been fasting prior to the URINE sample collection? True float |hours
urine_volume What was the approximate volume of URINE collected? True integer |mL
urine_concern-1 Were there any concerns about the URINE sample collection? True Select one Yes
urine_concern-2 No
urine_concern_explain Please explain your concerns about the URINE sample collection. True string String
3 urine_research_staff Please enter the name of the research staff who observed or performed the URINE collection: True string String
urine_sample_success-1 Was the URINE sample collection successful? True Select one Yes
urine_sample_success-2 No
why_urine_samp_not_collec Why was the URINE collection not successful? True string String
urine_time At what date and time was the URINE sample collected? True datetime Datetime
urine_fast Approximately how long has this participant been fasting prior to the URINE sample collection? True float |hours
urine_volume What was the approximate volume of URINE collected? True integer |mL
urine_concern-1 Were there any concerns about the URINE sample collection? True Select one Yes
urine_concern-2 No
urine_concern_explain Please explain your concerns about the URINE sample collection. True string String
urine_pregnancy-yes Did the participant's pregnancy test come back positive? False Select one Yes- positive
urine_pregnancy-no No- negative
urine_pregnancy-na Not applicable
4 urine_sample_success-1 Was any urine collected? False Select one Yes
urine_sample_success-2 No
why_urine_samp_not_collec-1 Why was the URINE sample not taken? False Select one Participant unable to void
why_urine_samp_not_collec-2 Refused
why_urine_samp_not_collec-3 Other
why_urine_samp_not_collec_oth Please explain why the urine sample was not collected. False text Text
urine_time At what date and time was the URINE sample collected? False datetime Datetime
urine_fast How long has it been since the participant ate or drank anything other than water? False float |hours
urine_volume What was the approximate volume of URINE collected? False integer |mL
urine_pregnancy-yes Did the participant's pregnancy test come back positive? False Select one Yes- positive
urine_pregnancy-no No- negative
urine_pregnancy-na Not applicable
5 urine_sample_success-1 Was any urine collected? True Select one Yes
urine_sample_success-2 No
why_urine_samp_not_collec-1 Why was the URINE sample not taken? True Select one Participant unable to void
why_urine_samp_not_collec-2 Refused
why_urine_samp_not_collec-3 Other
why_urine_samp_not_collec_oth Please explain why the urine sample was not collected. True text Text
urine_time At what date and time was the URINE sample collected? True datetime Datetime
urine_fast How long has it been since the participant ate or drank anything other than water? True float |hours
urine_volume What was the approximate volume of URINE collected? True integer |mL
urine_pregnancy-yes Did the participant's pregnancy test come back positive? True Select one Yes- positive
urine_pregnancy-no No- negative
urine_pregnancy-na Not applicable
Venous Blood Sample Collection Coordinator Form 1 vb_research_staff Please enter the name of the research staff who observed or performed the VENOUS BLOOD collection: True string String
vb_sample_success-1 Was the VENOUS BLOOD sample collection successful? True Select one Yes
vb_sample_success-2 No
why_vb_samp_not_collec Why was the VENOUS BLOOD collection not successful? True string String
vb_time At what date and time was the VENOUS BLOOD sample collected? True datetime Datetime
vb_fast Approximately how long has this participant been fasting prior to the VENOUS BLOOD sample collection? True float |hours
vb_location-1 What was the location of the VENOUS BLOOD sample collection True Select one Left antecubital
vb_location-2 Right antecubital
vb_location-3 Left arm
vb_location-4 Right arm
vb_location-5 Left hand
vb_location-6 Right hand
vb_location-7 Other
vb_location_oth What was the other location? True string String
vb_type_tube-red Which blood collection tubes were used? (check all that apply) True Select any Red top tube (serum separator)
vb_type_tube-purple Purple top tube (EDTA)
vb_type_tube-tiger Green/red tiger top tube (heparin CPT)
vb_type_tube-paxgene PAXGene RNA tube
vb_type_tube-plasma 10mL tube for pooling plasma
vb_type_tube-cryo 10mL cryovial for Packed RBCs
vb_type_tube-oth Other
vb_type_tube_red How many RED top tubes were collected? True integer Integer
vb_type_tube_purple How many PURPLE top tubes were collected? True integer Integer
vb_type_tube_tiger How many GREEN/RED TIGER top tubes were collected? True integer Integer
vb_type_tube_paxgene How many PAXGene RNA tubes were collected? True integer Integer
vb_type_tube_plasma How many 10mL tubes for pooling plasma were collected? True integer Integer
vb_type_tube_cryo How many 10mL cryovial for Packed RBCs were collected? True integer Integer
vb_type_tube_oth What was the other tube type? True string String
vb_type_tube_oth What was the other tube type? True integer Number of tubes|
vb_volume What was the approximate volume of blood collected? True integer |mL
vb_concern-1 Were there any concerns about the VENOUS BLOOD sample collection? True Select one Yes
vb_concern-2 No
vb_concern_explain Please explain your concerns about the VENOUS BLOOD sample collection. True string String
2 vb_bleed_easily-1 Does the participant bleed or bruise easily? False Select one Yes
vb_bleed_easily-2 No
vb_bleed_easily-3 Don't know
vb_bleeding_disorder-1 Has the participant ever been told they have a disorder relating to blood clotting or coagulation? False Select one Yes
vb_bleeding_disorder-2 No
vb_bleeding_disorder-3 Don't know
vb_fainting-1 Has the participant ever experienced fainting spells while having blood drawn? False Select one Yes
vb_fainting-2 No
vb_fainting-3 Don't know
vb_fast How many hours has it been since the participant ate or drank anything other than water? False float |hours
vb_time At what date and time was the VENOUS BLOOD sample collected? False datetime Datetime
vb_time_start Time at the start of venipuncture: False time Time
vb_successful-1 Was any blood drawn? False Select one Yes
vb_successful-2 No, participant refused
vb_successful-3 No, hard to stick
vb_successful-4 No, other reason
why_vb_samp_not_collec Explain why blood was not drawn: False string String
vb_time_elapsed Elapsed time until tourniquet released: False integer |seconds
vb_time_end Time at end of venipuncture: False time Time
vb_quality-1 Quality of venipuncture: False Select one Traumatic
vb_quality-2 Clean
vb_quality_traumatic-1 Descirbe the traumatic venipuncture: False Select one Vein collapsed
vb_quality_traumatic-2 Hematoma
vb_quality_traumatic-3 Excessive duration of draw
vb_quality_traumatic-4 Multiple sticks
vb_quality_traumatic-5 Vein hard to get
vb_quality_traumatic-6 Leakage at venipuncture site
vb_serum-1 Was the 10mL Serum tube filled? False Select one Yes
vb_serum-2 No (less than half full)
vb_serum-3 Partially filled (at least half full)
vb_serum_partial Specify the volume filled: False integer |mL
vb_edta1-1 Was the first 10mL EDTA tube filled? False Select one Yes
vb_edta1-2 No (less than half full)
vb_edta1-3 Partially filled (at least half full)
vb_edta1_partial Specify the volume filled: False integer |mL
vb_edta2-1 Was the second 10mL EDTA tube filled? False Select one Yes
vb_edta2-2 No (less than half full)
vb_edta2-3 Partially filled (at least half full)
vb_edta2_partial Specify the volume filled: False integer |mL
vb_cpt1-1 Was the first 8mL CPT tube filled? False Select one Yes
vb_cpt1-2 No (less than half full)
vb_cpt1-3 Partially filled (at least half full)
vb_cpt1_partial Specify the volume filled: False integer |mL
vb_cpt2-1 Was the second 8mL CPT tube filled? False Select one Yes
vb_cpt2-2 No (less than half full)
vb_cpt2-3 Partially filled (at least half full)
vb_cpt2_partial Specify the volume filled: False integer |mL
vb_paxgene-1 Was the 2.5mL PAXGene tube filled? False Select one Yes
vb_paxgene-2 No (less than half full)
vb_paxgene-3 Partially filled (at least half full)
vb_paxgene_partial Specify the volume filled: False integer |mL
3 vb_bleed_easily-1 Does the participant bleed or bruise easily? True Select one Yes
vb_bleed_easily-2 No
vb_bleed_easily-3 Don't know
vb_bleeding_disorder-1 Has the participant ever been told they have a disorder relating to blood clotting or coagulation? True Select one Yes
vb_bleeding_disorder-2 No
vb_bleeding_disorder-3 Don't know
vb_fainting-1 Has the participant ever experienced fainting spells while having blood drawn? True Select one Yes
vb_fainting-2 No
vb_fainting-3 Don't know
vb_fast How many hours has it been since the participant ate or drank anything other than water? True float |hours
vb_time At what date and time was the VENOUS BLOOD sample collected? True datetime Datetime
vb_successful-1 Was any blood drawn? True Select one Yes
vb_successful-2 No, participant refused
vb_successful-3 No, hard to stick
vb_successful-4 No, other reason
vb_time_start Time at the start of venipuncture: True time Time
why_vb_samp_not_collec Explain why blood was not drawn: True string String
vb_time_elapsed Elapsed time until tourniquet released: True integer |seconds
vb_time_end Time at end of venipuncture: True time Time
vb_quality-1 Quality of venipuncture: True Select one Traumatic
vb_quality-2 Clean
vb_quality_traumatic-1 Descirbe the traumatic venipuncture: True Select one Vein collapsed
vb_quality_traumatic-2 Hematoma
vb_quality_traumatic-3 Excessive duration of draw
vb_quality_traumatic-4 Multiple sticks
vb_quality_traumatic-5 Vein hard to get
vb_quality_traumatic-6 Leakage at venipuncture site
vb_serum-1 Was the 10mL Serum tube filled? True Select one Yes
vb_serum-2 No (less than half full)
vb_serum-3 Partially filled (at least half full)
vb_serum_partial Specify the volume filled: True integer |mL
vb_edta1-1 Was the first 10mL EDTA tube filled? True Select one Yes
vb_edta1-2 No (less than half full)
vb_edta1-3 Partially filled (at least half full)
vb_edta1_partial Specify the volume filled: True integer |mL
vb_edta2-1 Was the second 10mL EDTA tube filled? True Select one Yes
vb_edta2-2 No (less than half full)
vb_edta2-3 Partially filled (at least half full)
vb_edta2_partial Specify the volume filled: True integer |mL
vb_cpt1-1 Was the first 8mL CPT tube filled? True Select one Yes
vb_cpt1-2 No (less than half full)
vb_cpt1-3 Partially filled (at least half full)
vb_cpt1_partial Specify the volume filled: True integer |mL
vb_cpt2-1 Was the second 8mL CPT tube filled? True Select one Yes
vb_cpt2-2 No (less than half full)
vb_cpt2-3 Partially filled (at least half full)
vb_cpt2_partial Specify the volume filled: True integer |mL
vb_paxgene-1 Was the 2.5mL PAXGene tube filled? True Select one Yes
vb_paxgene-2 No (less than half full)
vb_paxgene-3 Partially filled (at least half full)
vb_paxgene_partial Specify the volume filled: True integer |mL
4 vb_bleed_easily-1 Does the participant bleed or bruise easily? True Select one Yes
vb_bleed_easily-2 No
vb_bleed_easily-3 Don't know
vb_bleeding_disorder-1 Has the participant ever been told they have a disorder relating to blood clotting or coagulation? True Select one Yes
vb_bleeding_disorder-2 No
vb_bleeding_disorder-3 Don't know
vb_fainting-1 Has the participant ever experienced fainting spells while having blood drawn? True Select one Yes
vb_fainting-2 No
vb_fainting-3 Don't know
vb_fast How many hours has it been since the participant ate or drank anything other than water? True float |hours
vb_time At what date and time was the VENOUS BLOOD sample collected? True datetime Datetime
vb_successful-1 Was any blood drawn? True Select one Yes
vb_successful-2 No, participant refused
vb_successful-3 No, hard to stick
vb_successful-4 No, other reason
vb_time_start Time at the start of venipuncture: True time Time
why_vb_samp_not_collec Explain why blood was not drawn: True string String
vb_time_elapsed Elapsed time until tourniquet released: True integer |seconds
vb_time_end Time at end of venipuncture: True time Time
vb_quality-1 Quality of venipuncture: True Select one Traumatic
vb_quality-2 Clean
vb_quality_traumatic-1 Descirbe the traumatic venipuncture: True Select one Vein collapsed
vb_quality_traumatic-2 Hematoma
vb_quality_traumatic-3 Excessive duration of draw
vb_quality_traumatic-4 Multiple sticks
vb_quality_traumatic-5 Vein hard to get
vb_quality_traumatic-6 Leakage at venipuncture site
vb_serum-1 Was the 10mL Serum tube filled? True Select one Yes
vb_serum-2 No (less than half full)
vb_serum-3 Partially filled (at least half full)
vb_serum_partial Specify the volume filled: True integer |mL
vb_edta1-1 Was the first 10mL EDTA tube filled? True Select one Yes
vb_edta1-2 No (less than half full)
vb_edta1-3 Partially filled (at least half full)
vb_edta1_partial Specify the volume filled: True integer |mL
vb_edta2-1 Was the second 10mL EDTA tube filled? True Select one Yes
vb_edta2-2 No (less than half full)
vb_edta2-3 Partially filled (at least half full)
vb_edta2_partial Specify the volume filled: True integer |mL
vb_cpt1-1 Was the first 8mL CPT tube filled? True Select one Yes
vb_cpt1-2 No (less than half full)
vb_cpt1-3 Partially filled (at least half full)
vb_cpt1_partial Specify the volume filled: True integer |mL
vb_cpt2-1 Was the second 8mL CPT tube filled? True Select one Yes
vb_cpt2-2 No (less than half full)
vb_cpt2-3 Partially filled (at least half full)
vb_cpt2_partial Specify the volume filled: True integer |mL
vb_paxgene-1 Was the 2.5mL PAXGene tube filled? True Select one Yes
vb_paxgene-2 No (less than half full)
vb_paxgene-3 Partially filled (at least half full)
vb_paxgene_partial Specify the volume filled: True integer |mL
Vital Signs Coordinator Form 1 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_datetime What was the date and time of vital sign collection during the in-person visit? True datetime Datetime
systolic SYSTOLIC Blood Pressure True float |mmHg
diastolic DIASTOLIC Blood Pressure True float |mmHg
2 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_datetime What was the date and time of vital sign collection during the in-person visit? True datetime Datetime
systolic SYSTOLIC Blood Pressure True float |mmHg
diastolic DIASTOLIC Blood Pressure True float |mmHg
3 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_datetime What was the date and time of vital sign collection during the in-person visit? True datetime Datetime
systolic SYSTOLIC Blood Pressure True float |mmHg
diastolic DIASTOLIC Blood Pressure True float |mmHg
4 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_datetime What was the date and time of vital sign collection during the in-person visit? True datetime Datetime
systolic SYSTOLIC Blood Pressure True float |mmHg
diastolic DIASTOLIC Blood Pressure True float |mmHg
heart_rate What was the participant’s HEART RATE (in beats per minute)? True float |bpm
oxygen What was the participant’s RESTING O2 (%)? True float |%
5 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_datetime What was the date and time of vital sign collection during the in-person visit? True datetime Datetime
systolic SYSTOLIC Blood Pressure False float |mmHg
diastolic DIASTOLIC Blood Pressure False float |mmHg
heart_rate What was the participant’s HEART RATE (in beats per minute)? False float |bpm
oxygen What was the participant’s RESTING O2 (%)? False float |%
6 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_date What was the date of vital sign collection during the in-person visit? True date Date
bp_device-uscom Select the model of the blood pressure device used: True Select one Uscom BP+
bp_device-oth Other
bp_device_oth Enter details of the model used: True string String
bp_device_uscom_id Uscom BP+ ID Number True string String
cuff_place-upper_arm Cuff placement: True Select one Upper Arm
cuff_place-forearm Forearm
cuff_place_upper-small Cuff on upper arm True Select one Samll Adult (17-24cm)
cuff_place_upper-adult Adult (24-32cm)
cuff_place_upper-large Large Adult (32-42cm)
cuff_place_fore-adult Cuff on forearm True Select one Adult (24-32cm)
cuff_place_fore-large Large Adult (32-42cm)
arm_circ Arm circumference (to nearest 0.1cm) True float |cm
time_seat What time did the participant first get into seated position? True time Time
time_reading_1 What time was the first blood pressure reading taken? True time Time
systolic_1 First Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_1 First Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_1 First Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_1 First Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_1 First reading: Pulse (in beats per minute)? True float |bpm
ai_1 First reading: AI (%) True float |%
time_reading_2 What time was the second blood pressure reading taken? True time Time
systolic_2 Second Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_2 Second Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_2 Second Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_2 Second Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_2 Second reading: Pulse (in beats per minute)? True float |bpm
ai_2 Second reading: AI (%) True float |%
time_reading_3 What time was the third blood pressure reading taken? True time Time
systolic_3 Third Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_3 Third Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_3 Third Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_3 Third Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_3 Third reading: Pulse (in beats per minute)? True float |bpm
ai_3 Third reading: AI (%) True float |%
oxygen Pulse Oximetry (%)? True float |%
suppl_o2-yes Was the participant using supplemental oxygen? True Select one Yes
suppl_o2-no No
o2_flow_rate What is the flow rate? (Liters/min) True float |L/min
systolic_mean Mean of 2nd and 3rd recordings: SYSTOLIC Blood Pressure True float |mmHg
diastolic_mean Mean of 2nd and 3rd recordings: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_mean Mean of 2nd and 3rd recordings: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_mean Mean of 2nd and 3rd recordings: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_mean Mean of 2nd and 3rd recordings: Pulse (in beats per minute)? True float |bpm
comments Comments: True text Text
alert-yes Was the participant notified of an alert? True Select one Yes
alert-no No
alert_which-alert_bp_immediate What alert was the participant notified about? True Select any SBP > 210120mmHg OR DBP > 120mmHg
alert_which-alert_bp_week SBP = 180-210mmHg OR DBP 110-120mmHg
alert_which-alert_bp_months BP > 140/90mmHg
alert_which-alert_pulse Pulse > 130 bpm
alert_which-alert_spO2 spO2< 88%
7 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_date What was the date of vital sign collection during the in-person visit? True date Date
bp_device-uscom Select the model of the blood pressure device used: True Select one Uscom BP+
bp_device-oth Other
bp_device_oth Enter details of the model used: True string String
bp_device_uscom_id Uscom BP+ ID Number True string String
cuff_place-upper_arm Cuff placement: True Select one Upper Arm
cuff_place-forearm Forearm
cuff_place_upper-small Cuff on upper arm True Select one Samll Adult (17-24cm)
cuff_place_upper-adult Adult (24-32cm)
cuff_place_upper-large Large Adult (32-42cm)
cuff_place_fore-adult Cuff on forearm True Select one Adult (24-32cm)
cuff_place_fore-large Large Adult (32-42cm)
arm_circ Arm circumference (to nearest 0.1cm) True float |cm
time_seat What time did the participant first get into seated position? True time Time
time_reading_1 What time was the first blood pressure reading taken? True time Time
systolic_1 First Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_1 First Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_1 First Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_1 First Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_1 First reading: Pulse (in beats per minute)? True float |bpm
ai_1 First reading: AI (%) True float |%
time_reading_2 What time was the second blood pressure reading taken? True time Time
systolic_2 Second Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_2 Second Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_2 Second Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_2 Second Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_2 Second reading: Pulse (in beats per minute)? True float |bpm
ai_2 Second reading: AI (%) True float |%
time_reading_3 What time was the third blood pressure reading taken? True time Time
systolic_3 Third Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_3 Third Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_3 Third Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_3 Third Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_3 Third reading: Pulse (in beats per minute)? True float |bpm
ai_3 Third reading: AI (%) True float |%
oxygen Pulse Oximetry (%)? True float |%
suppl_o2-yes Was the participant using supplemental oxygen? True Select one Yes
suppl_o2-no No
o2_flow_rate What is the flow rate? (Liters/min) True float |L/min
systolic_mean Mean of 2nd and 3rd recordings: SYSTOLIC Blood Pressure True float |mmHg
diastolic_mean Mean of 2nd and 3rd recordings: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_mean Mean of 2nd and 3rd recordings: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_mean Mean of 2nd and 3rd recordings: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_mean Mean of 2nd and 3rd recordings: Pulse (in beats per minute)? True float |bpm
comments Comments: False text Text
alert-yes Was the participant notified of an alert? True Select one Yes
alert-no No
alert_which-alert_bp_immediate What alert was the participant notified about? True Select any SBP > 210120mmHg OR DBP > 120mmHg
alert_which-alert_bp_week SBP = 180-210mmHg OR DBP 110-120mmHg
alert_which-alert_bp_months BP > 140/90mmHg
alert_which-alert_pulse Pulse > 130 bpm
alert_which-alert_spO2 spO2< 88%
8 vitals_tech Who measured the participant’s vital signs (full name)? False string String
vitals_date What was the date of vital sign collection during the in-person visit? False date Date
bp_device-uscom Select the model of the blood pressure device used: False Select one Uscom BP+
bp_device-oth Other
bp_device_oth Enter details of the model used: False string String
bp_device_uscom_id Uscom BP+ ID Number False string String
cuff_place_upper-small Cuff on upper arm False Select one Samll Adult (17-24cm)
cuff_place_upper-adult Adult (24-32cm)
cuff_place_upper-large Large Adult (32-42cm)
arm_circ Arm circumference (to nearest 0.1cm) False float |cm
time_seat What time did the participant first get into seated position? False time Time
time_reading_1 What time was the first blood pressure reading taken? False time Time
systolic_1 First Reading: SYSTOLIC Blood Pressure False float |mmHg
diastolic_1 First Reading: DIASTOLIC Blood Pressure False float |mmHg
cent_systolic_1 First Reading: Central SYSTOLIC Blood Pressure False float |mmHg
cent_diastolic_1 First Reading: Central DIASTOLIC Blood Pressure False float |mmHg
heart_rate_1 First reading: Pulse (in beats per minute)? False float |bpm
ai_1 First reading: AI (%) False float |%
time_reading_2 What time was the second blood pressure reading taken? False time Time
systolic_2 Second Reading: SYSTOLIC Blood Pressure False float |mmHg
diastolic_2 Second Reading: DIASTOLIC Blood Pressure False float |mmHg
cent_systolic_2 Second Reading: Central SYSTOLIC Blood Pressure False float |mmHg
cent_diastolic_2 Second Reading: Central DIASTOLIC Blood Pressure False float |mmHg
heart_rate_2 Second reading: Pulse (in beats per minute)? False float |bpm
ai_2 Second reading: AI (%) False float |%
time_reading_3 What time was the third blood pressure reading taken? False time Time
systolic_3 Third Reading: SYSTOLIC Blood Pressure False float |mmHg
diastolic_3 Third Reading: DIASTOLIC Blood Pressure False float |mmHg
cent_systolic_3 Third Reading: Central SYSTOLIC Blood Pressure False float |mmHg
cent_diastolic_3 Third Reading: Central DIASTOLIC Blood Pressure False float |mmHg
heart_rate_3 Third reading: Pulse (in beats per minute)? False float |bpm
ai_3 Third reading: AI (%) False float |%
oxygen Pulse Oximetry (%)? False float |%
suppl_o2-yes Was the participant using supplemental oxygen? False Select one Yes
suppl_o2-no No
o2_flow_rate What is the flow rate? (Liters/min) False float |L/min
systolic_mean Mean of 2nd and 3rd recordings: SYSTOLIC Blood Pressure False float |mmHg
diastolic_mean Mean of 2nd and 3rd recordings: DIASTOLIC Blood Pressure False float |mmHg
cent_systolic_mean Mean of 2nd and 3rd recordings: Central SYSTOLIC Blood Pressure False float |mmHg
cent_diastolic_mean Mean of 2nd and 3rd recordings: Central DIASTOLIC Blood Pressure False float |mmHg
heart_rate_mean Mean of 2nd and 3rd recordings: Pulse (in beats per minute)? False float |bpm
comments Comments: False text Text
alert-yes Was the participant notified of an alert? False Select one Yes
alert-no No
alert_which-alert_bp_immediate What alert was the participant notified about? False Select any SBP > 210120mmHg OR DBP > 120mmHg
alert_which-alert_bp_week SBP = 180-210mmHg OR DBP 110-120mmHg
alert_which-alert_bp_months BP > 140/90mmHg
alert_which-alert_pulse Pulse > 130 bpm
alert_which-alert_spO2 spO2< 88%
9 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_date What was the date of vital sign collection during the in-person visit? True date Date
bp_device-uscom Select the model of the blood pressure device used: True Select one Uscom BP+
bp_device-oth Other
bp_device_oth Enter details of the model used: True string String
bp_device_uscom_id Uscom BP+ ID Number True string String
cuff_place_upper-small Cuff on upper arm True Select one Samll Adult (17-24cm)
cuff_place_upper-adult Adult (24-32cm)
cuff_place_upper-large Large Adult (32-42cm)
arm_circ Arm circumference (to nearest 0.1cm) True float |cm
time_seat What time did the participant first get into seated position? True time Time
time_reading_1 What time was the first blood pressure reading taken? True time Time
systolic_1 First Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_1 First Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_1 First Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_1 First Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_1 First reading: Pulse (in beats per minute)? True float |bpm
ai_1 First reading: AI (%) True float |%
time_reading_2 What time was the second blood pressure reading taken? True time Time
systolic_2 Second Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_2 Second Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_2 Second Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_2 Second Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_2 Second reading: Pulse (in beats per minute)? True float |bpm
ai_2 Second reading: AI (%) True float |%
time_reading_3 What time was the third blood pressure reading taken? True time Time
systolic_3 Third Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_3 Third Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_3 Third Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_3 Third Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_3 Third reading: Pulse (in beats per minute)? True float |bpm
ai_3 Third reading: AI (%) True float |%
oxygen Pulse Oximetry (%)? True float |%
suppl_o2-yes Was the participant using supplemental oxygen? True Select one Yes
suppl_o2-no No
o2_flow_rate What is the flow rate? (Liters/min) True float |L/min
systolic_mean Mean of 2nd and 3rd recordings: SYSTOLIC Blood Pressure True float |mmHg
diastolic_mean Mean of 2nd and 3rd recordings: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_mean Mean of 2nd and 3rd recordings: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_mean Mean of 2nd and 3rd recordings: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_mean Mean of 2nd and 3rd recordings: Pulse (in beats per minute)? True float |bpm
comments Comments: True text Text
alert-yes Was the participant notified of an alert? True Select one Yes
alert-no No
alert_which-alert_bp_immediate What alert was the participant notified about? True Select any SBP > 210120mmHg OR DBP > 120mmHg
alert_which-alert_bp_week SBP = 180-210mmHg OR DBP 110-120mmHg
alert_which-alert_bp_months BP > 140/90mmHg
alert_which-alert_pulse Pulse > 130 bpm
alert_which-alert_spO2 spO2< 88%
10 vitals_tech Who measured the participant’s vital signs (full name)? True string String
vitals_date What was the date of vital sign collection during the in-person visit? True date Date
bp_device-uscom Select the model of the blood pressure device used: True Select one Uscom BP+
bp_device-oth Other
bp_device_oth Enter details of the model used: True string String
bp_device_uscom_id Uscom BP+ ID Number True string String
cuff_place_upper-small Cuff on upper arm True Select one Samll Adult (17-24cm)
cuff_place_upper-adult Adult (24-32cm)
cuff_place_upper-large Large Adult (32-42cm)
arm_circ Arm circumference (to nearest 0.1cm) True float |cm
time_seat What time did the participant first get into seated position? True time Time
time_reading_1 What time was the first blood pressure reading taken? True time Time
systolic_1 First Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_1 First Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_1 First Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_1 First Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_1 First reading: Pulse (in beats per minute)? True float |bpm
ai_1 First reading: AI (%) True float |%
time_reading_2 What time was the second blood pressure reading taken? True time Time
systolic_2 Second Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_2 Second Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_2 Second Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_2 Second Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_2 Second reading: Pulse (in beats per minute)? True float |bpm
ai_2 Second reading: AI (%) True float |%
time_reading_3 What time was the third blood pressure reading taken? True time Time
systolic_3 Third Reading: SYSTOLIC Blood Pressure True float |mmHg
diastolic_3 Third Reading: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_3 Third Reading: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_3 Third Reading: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_3 Third reading: Pulse (in beats per minute)? True float |bpm
ai_3 Third reading: AI (%) True float |%
oxygen Pulse Oximetry (%)? True float |%
suppl_o2-yes Was the participant using supplemental oxygen? True Select one Yes
suppl_o2-no No
o2_flow_rate What is the flow rate? (Liters/min) True float |L/min
systolic_mean Mean of 2nd and 3rd recordings: SYSTOLIC Blood Pressure True float |mmHg
diastolic_mean Mean of 2nd and 3rd recordings: DIASTOLIC Blood Pressure True float |mmHg
cent_systolic_mean Mean of 2nd and 3rd recordings: Central SYSTOLIC Blood Pressure True float |mmHg
cent_diastolic_mean Mean of 2nd and 3rd recordings: Central DIASTOLIC Blood Pressure True float |mmHg
heart_rate_mean Mean of 2nd and 3rd recordings: Pulse (in beats per minute)? True float |bpm
comments Comments: False text Text
alert-yes Was the participant notified of an alert? True Select one Yes
alert-no No
alert_which-alert_bp_immediate What alert was the participant notified about? True Select any SBP > 210mmHg OR DBP > 120mmHg
alert_which-alert_bp_week SBP = 180-210mmHg OR DBP 110-120mmHg
alert_which-alert_bp_months BP > 140/90mmHg
alert_which-alert_pulse Pulse > 130 bpm
alert_which-alert_spO2 spO2< 88%
Your Current Weight 1 weight What is your CURRENT weight (in pounds)? True integer |pounds
2 weight What is your CURRENT weight (in pounds)? True integer |pounds
Your Demographics 3 sex-1 What sex were you assigned at birth? True Select one Male
sex-2 Female
sex-3 Prefer not to answer
gender-man What best describes your gender identity? CHECK ALL THAT APPLY. True Select any Man
gender-woman Woman
gender-non_binary Non-binary
gender-trans Transgender
gender-none None of these describe me, and I’d like to consider additional options
gender-no_ans Prefer not to answer
gender_additional-trans_man Are any of these a closer description of your gender identity? True Select any Trans man/Transgender Man/FTM
gender_additional-trans_woman Trans woman/Transgender Woman/MTF
gender_additional-gen_queer Genderqueer
gender_additional-gen_fluid Genderfluid
gender_additional-gen_var Gender variant
gender_additional-unsure Questioning or unsure of your gender identity
gender_additional-other None of these describe me, and I want to specify
gender_additional_other Please describe your gender identity. True string String
race-1 What is your racial background? CHECK ALL THAT APPLY. True Select any Black or African American
race-2 White
race-3 Asian (including South Asian and Asian Indian)
race-4 Native Hawaiian or Pacific Islander
race-5 American Indian or Alaska Native
race-6 Some other race
race-7 Don't know
asian-1 What is your Asian background? True Select one Chinese
asian-2 Filipino
asian-3 Asian Indian
asian-4 Japanese
asian-5 Korean
asian-6 Vietnamese
asian-7 Other Asian or Mix
pacisland-1 What is your Pacific Islander background? True Select one Native Hawaiian
pacisland-2 Samoan
pacisland-3 Guamanian or Chamorro
pacisland-4 Other Pacific Islander or Mix
ethnicity-1 Are you of Hispanic, Latino or Spanish origin or ancestry? True Select one No
ethnicity-2 Yes: Mexican, Mexican American or Chicano
ethnicity-3 Yes: Puerto Rican
ethnicity-4 Yes: Cuban
ethnicity-5 Yes: Other or Mixed Hispanic, Latino or Spanish origin
ethnicity-6 Don't know
ethnicity-7 Prefer not to answer
Your Height and Weight 1 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 What was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 What was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 What was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
2 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 What was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 What was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 What was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
3 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 What was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 What was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 What was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
4 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 What was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 What was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 What was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
5 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 What was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 What was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 What was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
6 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
None Which figure best represents YOUR CURRENT body appearance? False Select one
None
None
None
None
None
None
None
None
None
None
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 About what was your weight at AGE 18 (in pounds)? True integer |pounds
None Which figure best represents YOUR body appearance AT AGE 18? False Select one
None
None
None
None
None
None
None
None
None
None
weight_30 About what was your weight at AGE 30 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 30? False Select one
None
None
None
None
None
None
None
None
None
None
None
weight_50 About what was your weight at AGE 50 (in pounds)? False integer |pounds
None Which figure best represents YOUR body appearance AT AGE 50? False Select one
None
None
None
None
None
None
None
None
None
None
None
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
7 height What is your height (in feet and inches)? True integer |feet
height What is your height (in feet and inches)? True integer |inches
weight What is your CURRENT weight (in pounds)? True integer |pounds
image_current-dk Which figure best represents YOUR CURRENT body appearance? False Select one Don't Know
image_current-pnts Prefer not to answer
image_current-1 1
image_current-2 2
image_current-3 3
image_current-4 4
image_current-5 5
image_current-6 6
image_current-7 7
image_current-8 8
image_current-9 9
weight_year What was YOUR weight one year ago (in pounds)? True integer |pounds
weight_high What was YOUR HIGHEST weight within the past year (in pounds)? True integer |pounds
weight_low What was YOUR LOWEST weight within the past year (in pounds)? True integer |pounds
weight_int-gain Have you INTENTIONALLY tried to gain or lose weight in the past year? True Select one I have tried to gain weight
weight_int-lose I have tried to lose weight
weight_int-no I have NOT tried to gain or lose weight in the past year
weight_int-ns Not sure
weight_int-no_ans Prefer not to answer
weight_18 About what was your weight at AGE 18 (in pounds)? True integer |pounds
image_18-dk Which figure best represents YOUR body appearance AT AGE 18? False Select one Don't Know
image_18-pnts Prefer not to answer
image_18-1 1
image_18-2 2
image_18-3 3
image_18-4 4
image_18-5 5
image_18-6 6
image_18-7 7
image_18-8 8
image_18-9 9
weight_30 About what was your weight at AGE 30 (in pounds)? False integer |pounds
image_30-dk Which figure best represents YOUR body appearance AT AGE 30? False Select one Don't Know
image_30-na N/A- I am younger than 30
image_30-pnts Prefer not to answer
image_30-1 1
image_30-2 2
image_30-3 3
image_30-4 4
image_30-5 5
image_30-6 6
image_30-7 7
image_30-8 8
image_30-9 9
weight_50 About what was your weight at AGE 50 (in pounds)? False integer |pounds
image_50-dk Which figure best represents YOUR body appearance AT AGE 50? False Select one Don't Know
image_50-na N/A- I am younger than 50
image_50-pnts Prefer not to answer
image_50-1 1
image_50-2 2
image_50-3 3
image_50-4 4
image_50-5 5
image_50-6 6
image_50-7 7
image_50-8 8
image_50-9 9
health_literacy-extremely How confident are you filling out medical forms by yourself? True Select one Extremely
health_literacy-quite Quite a bit
health_literacy-somewhat Somewhat
health_literacy-little A little bit
health_literacy-not_at_all Not at all
Your Medical Conditions 1 hbp-1 High blood pressure or hypertension? True Select one Yes
hbp-2 No
hbp-3 Don't know
high_chol-1 High cholesterol? True Select one Yes
high_chol-2 No
high_chol-3 Don't know
prediabetes-1 Prediabetes or ""early"" diabetes not requiring medications? True Select one Yes
prediabetes-2 No
prediabetes-3 Don't know
diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
block_coronary-1 Coronary artery disease (blockages in your heart vessels)? True Select one Yes
block_coronary-2 No
block_coronary-3 Don't know
year_cd What year were you diagnosed with Coronary artery disease? True string String
why_cd-1 How do you know you have coronary artery disease? Check all that apply. True Select any My doctor told me
why_cd-2 My nurse told me
why_cd-3 Heart catheterization/Angiogram or CT scan showed blockages in the arteries of my heart
why_cd-4 Abnormal stress test
why_cd-5 Found on an ECG/EKG
why_cd-6 Self-Diagnosed
why_cd-7 Other
why_cd-8 Don’t know
why_cd_other Please specify why you think you have coronary artery disease. False string String
heart_attack-1 A myocardial infarction (also known as a heart attack)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
chf-1 Congestive heart failure (CHF, heart failure)? True Select one Yes
chf-2 No
chf-3 Don't know
stroke-1 Stroke or TIA (Transient Ischemic Attack or Mini-Stroke)? True Select one Yes
stroke-2 No
stroke-3 Don't know
cancer_type-lung What type of cancer were you diagnosed with? (select all that apply) True Select any Lung
cancer_type-prostate Prostate
cancer_type-breast Breast
cancer_type-colorectal Colorectal
cancer_type-melanoma Melanoma
cancer_type-bone Bone
cancer_type-leu Leukemia (blood cancer)
cancer_type-renal Renal (kidney)
cancer_type-bladder Bladder
cancer_type-thyroid Thyroid
cancer_type-uterine Uterine
cancer_type-ovarian Ovarian
cancer_type-oral Throat and/or mouth
cancer_type-oth Other
cancer_type-dk I don’t know
afib-1 Atrial fibrillation (AFib, AF)? True Select one Yes
afib-2 No
afib-3 Don't know
cancer_treat-surg Are you CURRENTLY undergoing any treatment or do you have any planned surgeries for your cancer diagnosis? (select all that apply) True Select any Surgery
cancer_treat-chemo Chemotherapy
cancer_treat-radia Radiation Therapy
cancer_treat-immuno Immunotherapy
cancer_treat-bmt Bone marrow transplant
cancer_treat-none None
cancer_treat-dk I don’t know
afib_age At what age were you first diagnosed with Atrial Fibrillation? True integer
arrhythmia-1 Other arrhythmia? True Select one Yes
arrhythmia-2 No
arrhythmia-3 Don't know
cancer-1 Cancer (other than minor skin cancer)? True Select one Yes
cancer-2 No
cancer-3 Don't know
sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_prescription-1 If yes, have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
ckd-1 Chronic kidney (renal) disease or decreased kidney (renal) function or failure? True Select one Yes, but not on dialysis
ckd-2 Yes, and on dialysis
ckd-3 Yes, I’ve had a kidney transplant and my kidney function is now normal
ckd-4 No
ckd-5 Don't know
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
copd-1 Chronic lung disease (COPD, emphysema, chronic bronchitis, obstructive pulmonary disease)? True Select one Yes
copd-2 No
copd-3 Don't know
arthritis-1 Arthritis? (osteoarthritis or degenerative) True Select one Yes
arthritis-2 No
arthritis-3 Don't know
asthma-1 Asthma, to the point that you use inhalers daily or have been to the hospital for your asthma? True Select one Yes
asthma-2 No
asthma-3 Don't know
autoimmune-1 Autoimmune/rheumatologic disorder/connective tissue disease (rheumatoid arthritis, lupus, scleroderma, dermatomyositis, polymyositis, polymyalgia rheumatica, or other autoimmune disorders)? True Select one Yes
autoimmune-2 No
autoimmune-3 Don't know
cardiac-1 A cardiac arrest? True Select one Yes
cardiac-2 No
cardiac-3 Don't know
implant-1 Do you have an implanted device for your heart? If you have one, you were given a card, which has this information on it. True Select one No
implant-2 Pacemaker (not an ICD)
implant-3 ICD (Implantable Cardioverter-Defibrillator)
implant-4 Implanted Loop Recorder or rhythm monitor (e.g. Reveal, Confirm)
implant-5 Other
implant-6 I Don't Know
implant_pace-1 Kind of pacemaker: True Select one Regular (1 or 2 lead)
implant_pace-2 BiV or CRT
implant_pace-3 Don't know
implant_icd-1 Kind of ICD: True Select one Regular (1 or 2 lead)
implant_icd-2 BiV or CRT (2 leads in the ventricle to “resynchronize”)
implant_icd-3 Don't know
implant_other Please specify your other type of implanted device. True string
bypass-1 Have you ever had bypass surgery (coronary artery bypass surgery)? True Select one Yes
bypass-2 No
bypass-3 Don't know
covid Have you ever tested positive for COVID-19? True answer Yes
covid Have you ever tested positive for COVID-19? True answer No
covid Have you ever tested positive for COVID-19? True answer Don't know
how_many_heart_vessels-1 How many heart vessels (coronary arteries) were bypassed? e.g. ""triple bypass"" means 3 vessels bypassed True Select one 1
how_many_heart_vessels-2 2
how_many_heart_vessels-3 3
how_many_heart_vessels-4 4 or more
how_many_heart_vessels-5 Don't know
covid_num How many times were you infected with COVID-19? True answer Once
covid_num How many times were you infected with COVID-19? True answer Twice
covid_num How many times were you infected with COVID-19? True answer Three times
covid_num How many times were you infected with COVID-19? True answer Four times
covid_num How many times were you infected with COVID-19? True answer Five or more times
covid_num How many times were you infected with COVID-19? True answer Don't know
stent-1 Have you ever had a stent or angioplasty in your heart (coronary) arteries? True Select one Yes
stent-2 No
stent-3 Don't know
covid_date What was the date of your MOST RECENT COVID-19 infection? True date
stent_proc How many separate procedures (where you received either an angioplasty or stent) have you undergone? True integer
covid_vax-1 Have you ever received a COVID-19 (SARS-CoV-2) vaccine? False Select one Yes
covid_vax-2 No
covid_vax-3 Don't know
when_recent_stent Please specify the date of your most recent heart (coronary) stent or angioplasty? True date
covid_vax_doses-1 How many vaccine doses have you received? False Select one 1 dose
covid_vax_doses-2 2 doses
covid_vax_doses-3 3 doses
covid_vax_doses-4 4 doses
covid_vax_doses-5 5 or more doses
covid_vax_doses-6 Other
covid_vax_doses-7 I don't know
valve_rep-1 Have you ever had a valve replacement or repair? (either with open-heart surgery, minimally invasive surgery, or with a catheter) True Select one Yes
valve_rep-2 No
valve_rep-3 Don't know
covid_vax1-1 Which company’s COVID-19 vaccine did you receive as your FIRST dose? False Select one AstraZeneca
covid_vax1-2 Janssen (Johnson & Johnson)
covid_vax1-3 Moderna
covid_vax1-4 Novavax
covid_vax1-5 Pfizer
covid_vax1-6 Other (Specify):
covid_vax1-7 I don’t know
covid_vax2-1 Which company’s COVID-19 vaccine did you receive as your SECOND dose? False Select one AstraZeneca
covid_vax2-2 Janssen (Johnson & Johnson)
covid_vax2-3 Moderna
covid_vax2-4 Novavax
covid_vax2-5 Pfizer
covid_vax2-6 Other (Specify):
covid_vax2-7 I don’t know
covid_vax3-1 Which company’s COVID-19 vaccine did you receive as your THIRD dose? False Select one AstraZeneca
covid_vax3-2 Janssen (Johnson & Johnson)
covid_vax3-3 Moderna
covid_vax3-4 Novavax
covid_vax3-5 Pfizer
covid_vax3-6 Other (Specify):
covid_vax3-7 I don’t know
covid_vax4-1 Which company’s COVID-19 vaccine did you receive as your FOURTH dose? False Select one AstraZeneca
covid_vax4-2 Janssen (Johnson & Johnson)
covid_vax4-3 Moderna
covid_vax4-4 Novavax
covid_vax4-5 Pfizer
covid_vax4-6 Other (Specify):
covid_vax4-7 I don’t know
covid_vax5-1 Which company’s COVID-19 vaccine did you receive as your FIFTH dose? False Select one AstraZeneca
covid_vax5-2 Janssen (Johnson & Johnson)
covid_vax5-3 Moderna
covid_vax5-4 Novavax
covid_vax5-5 Pfizer
covid_vax5-6 Other (Specify):
covid_vax5-7 I don’t know
2 hbp-1 High blood pressure or hypertension? True Select one Yes
hbp-2 No
hbp-3 Don't know
high_chol-1 High cholesterol? True Select one Yes
high_chol-2 No
high_chol-3 Don't know
prediabetes-1 Prediabetes or ""early"" diabetes not requiring medications? True Select one Yes
prediabetes-2 No
prediabetes-3 Don't know
diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
block_coronary-1 Coronary artery disease (blockages in your heart vessels)? True Select one Yes
block_coronary-2 No
block_coronary-3 Don't know
year_cd What year were you diagnosed with Coronary artery disease? True string String
why_cd-1 How do you know you have coronary artery disease? Check all that apply. True Select any My doctor told me
why_cd-2 My nurse told me
why_cd-3 Heart catheterization/Angiogram or CT scan showed blockages in the arteries of my heart
why_cd-4 Abnormal stress test
why_cd-5 Found on an ECG/EKG
why_cd-6 Self-Diagnosed
why_cd-7 Other
why_cd-8 Don’t know
why_cd_other Please specify why you think you have coronary artery disease. False string String
heart_attack-1 A myocardial infarction (also known as a heart attack)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
chf-1 Congestive heart failure (CHF, heart failure)? True Select one Yes
chf-2 No
chf-3 Don't know
stroke-1 Stroke or TIA (Transient Ischemic Attack or Mini-Stroke)? True Select one Yes
stroke-2 No
stroke-3 Don't know
afib-1 Atrial fibrillation (AFib, AF)? True Select one Yes
afib-2 No
afib-3 Don't know
afib_age At what age were you first diagnosed with Atrial Fibrillation? True integer
arrhythmia-1 Other arrhythmia? True Select one Yes
arrhythmia-2 No
arrhythmia-3 Don't know
cancer-1 Cancer (other than minor skin cancer)? True Select one Yes
cancer-2 No
cancer-3 Don't know
cancer_type-lung What type of cancer were you diagnosed with? (select all that apply) True Select any Lung
cancer_type-prostate Prostate
cancer_type-breast Breast
cancer_type-colorectal Colorectal
cancer_type-melanoma Melanoma
cancer_type-bone Bone
cancer_type-leu Leukemia (blood cancer)
cancer_type-renal Renal (kidney)
cancer_type-bladder Bladder
cancer_type-thyroid Thyroid
cancer_type-uterine Uterine
cancer_type-ovarian Ovarian
cancer_type-oral Throat and/or mouth
cancer_type-oth Other
cancer_type-dk I don’t know
cancer_treat-surg Are you CURRENTLY undergoing any treatment or do you have any planned surgeries for your cancer diagnosis? (select all that apply) True Select any Surgery
cancer_treat-chemo Chemotherapy
cancer_treat-radia Radiation Therapy
cancer_treat-immuno Immunotherapy
cancer_treat-bmt Bone marrow transplant
cancer_treat-none None
cancer_treat-dk I don’t know
sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_prescription-1 If yes, have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
copd-1 Chronic lung disease (COPD, emphysema, chronic bronchitis, obstructive pulmonary disease)? True Select one Yes
copd-2 No
copd-3 Don't know
asthma-1 Asthma, to the point that you use inhalers daily or have been to the hospital for your asthma? True Select one Yes
asthma-2 No
asthma-3 Don't know
arthritis-1 Arthritis? (osteoarthritis or degenerative) True Select one Yes
arthritis-2 No
arthritis-3 Don't know
autoimmune-1 Autoimmune/rheumatologic disorder/connective tissue disease (rheumatoid arthritis, lupus, scleroderma, dermatomyositis, polymyositis, polymyalgia rheumatica, or other autoimmune disorders)? True Select one Yes
autoimmune-2 No
autoimmune-3 Don't know
ckd-1 Chronic kidney (renal) disease or decreased kidney (renal) function or failure? True Select one Yes, but not on dialysis
ckd-2 Yes, and on dialysis
ckd-3 Yes, I’ve had a kidney transplant and my kidney function is now normal
ckd-4 No
ckd-5 Don't know
cardiac-1 A cardiac arrest? True Select one Yes
cardiac-2 No
cardiac-3 Don't know
implant-1 Do you have an implanted device for your heart? If you have one, you were given a card, which has this information on it. True Select one No
implant-2 Pacemaker (not an ICD)
implant-3 ICD (Implantable Cardioverter-Defibrillator)
implant-4 Implanted Loop Recorder or rhythm monitor (e.g. Reveal, Confirm)
implant-5 Other
implant-6 I Don't Know
implant_pace-1 Kind of pacemaker: True Select one Regular (1 or 2 lead)
implant_pace-2 BiV or CRT
implant_pace-3 Don't know
implant_icd-1 Kind of ICD: True Select one Regular (1 or 2 lead)
implant_icd-2 BiV or CRT (2 leads in the ventricle to “resynchronize”)
implant_icd-3 Don't know
implant_other Please specify your other type of implanted device. True string
bypass-1 Have you ever had bypass surgery (coronary artery bypass surgery)? True Select one Yes
bypass-2 No
bypass-3 Don't know
how_many_heart_vessels-1 How many heart vessels (coronary arteries) were bypassed? e.g. ""triple bypass"" means 3 vessels bypassed True Select one 1
how_many_heart_vessels-2 2
how_many_heart_vessels-3 3
how_many_heart_vessels-4 4 or more
how_many_heart_vessels-5 Don't know
stent-1 Have you ever had a stent or angioplasty in your heart (coronary) arteries? True Select one Yes
stent-2 No
stent-3 Don't know
stent_proc How many separate procedures (where you received either an angioplasty or stent) have you undergone? True integer
when_recent_stent Please specify the date of your most recent heart (coronary) stent or angioplasty? True date
valve_rep-1 Have you ever had a valve replacement or repair? (either with open-heart surgery, minimally invasive surgery, or with a catheter) True Select one Yes
valve_rep-2 No
valve_rep-3 Don't know
covid-1 Have you ever tested positive for COVID-19? True Select one Yes
covid-2 No
covid-3 Don't know
covid_num-1 How many times were you infected with COVID-19? True Select one Once
covid_num-2 Twice
covid_num-3 Three times
covid_num-4 Four times
covid_num-5 Five or more times
covid_num-6 Don't know
covid_date What was the date of your MOST RECENT COVID-19 infection? True date
covid_vax-1 Have you ever received a COVID-19 (SARS-CoV-2) vaccine? False Select one Yes
covid_vax-2 No
covid_vax-3 Don't know
covid_vax_doses-1 How many vaccine doses have you received? False Select one 1 dose
covid_vax_doses-2 2 doses
covid_vax_doses-3 3 doses
covid_vax_doses-4 4 doses
covid_vax_doses-5 5 or more doses
covid_vax_doses-6 Other
covid_vax_doses-7 I don't know
covid_vax1-1 Which company’s COVID-19 vaccine did you receive as your FIRST dose? False Select one AstraZeneca
covid_vax1-2 Janssen (Johnson & Johnson)
covid_vax1-3 Moderna
covid_vax1-4 Novavax
covid_vax1-5 Pfizer
covid_vax1-6 Other (Specify):
covid_vax1-7 I don’t know
covid_vax2-1 Which company’s COVID-19 vaccine did you receive as your SECOND dose? False Select one AstraZeneca
covid_vax2-2 Janssen (Johnson & Johnson)
covid_vax2-3 Moderna
covid_vax2-4 Novavax
covid_vax2-5 Pfizer
covid_vax2-6 Other (Specify):
covid_vax2-7 I don’t know
covid_vax3-1 Which company’s COVID-19 vaccine did you receive as your THIRD dose? False Select one AstraZeneca
covid_vax3-2 Janssen (Johnson & Johnson)
covid_vax3-3 Moderna
covid_vax3-4 Novavax
covid_vax3-5 Pfizer
covid_vax3-6 Other (Specify):
covid_vax3-7 I don’t know
covid_vax4-1 Which company’s COVID-19 vaccine did you receive as your FOURTH dose? False Select one AstraZeneca
covid_vax4-2 Janssen (Johnson & Johnson)
covid_vax4-3 Moderna
covid_vax4-4 Novavax
covid_vax4-5 Pfizer
covid_vax4-6 Other (Specify):
covid_vax4-7 I don’t know
covid_vax5-1 Which company’s COVID-19 vaccine did you receive as your FIFTH dose? False Select one AstraZeneca
covid_vax5-2 Janssen (Johnson & Johnson)
covid_vax5-3 Moderna
covid_vax5-4 Novavax
covid_vax5-5 Pfizer
covid_vax5-6 Other (Specify):
covid_vax5-7 I don’t know
3 hbp-1 High blood pressure or hypertension? True Select one Yes
hbp-2 No
hbp-3 Don't know
high_chol-1 High cholesterol? True Select one Yes
high_chol-2 No
high_chol-3 Don't know
prediabetes-1 Prediabetes or ""early"" diabetes not requiring medications? True Select one Yes
prediabetes-2 No
prediabetes-3 Don't know
diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
block_coronary-1 Coronary artery disease (blockages in your heart vessels)? True Select one Yes
block_coronary-2 No
block_coronary-3 Don't know
year_cd What year were you diagnosed with Coronary artery disease? True string String
why_cd-1 How do you know you have coronary artery disease? Check all that apply. True Select any My doctor told me
why_cd-2 My nurse told me
why_cd-3 Heart catheterization/Angiogram or CT scan showed blockages in the arteries of my heart
why_cd-4 Abnormal stress test
why_cd-5 Found on an ECG/EKG
why_cd-6 Self-Diagnosed
why_cd-7 Other
why_cd-8 Don’t know
why_cd_other Please specify why you think you have coronary artery disease. False string String
heart_attack-1 A myocardial infarction (also known as a heart attack)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
chf-1 Congestive heart failure (CHF, heart failure)? True Select one Yes
chf-2 No
chf-3 Don't know
stroke-1 Stroke or TIA (Transient Ischemic Attack or Mini-Stroke)? True Select one Yes
stroke-2 No
stroke-3 Don't know
afib-1 Atrial fibrillation (AFib, AF)? True Select one Yes
afib-2 No
afib-3 Don't know
afib_age At what age were you first diagnosed with Atrial Fibrillation? True integer
arrhythmia-1 Other arrhythmia? True Select one Yes
arrhythmia-2 No
arrhythmia-3 Don't know
cancer-1 Cancer (other than minor skin cancer)? True Select one Yes
cancer-2 No
cancer-3 Don't know
cancer_type-lung What type of cancer were you diagnosed with? (select all that apply) True Select any Lung
cancer_type-prostate Prostate
cancer_type-breast Breast
cancer_type-colorectal Colorectal
cancer_type-melanoma Melanoma
cancer_type-bone Bone
cancer_type-leu Leukemia (blood cancer)
cancer_type-renal Renal (kidney)
cancer_type-bladder Bladder
cancer_type-thyroid Thyroid
cancer_type-uterine Uterine
cancer_type-ovarian Ovarian
cancer_type-oral Throat and/or mouth
cancer_type-oth Other
cancer_type-dk I don’t know
cancer_treat-surg Are you CURRENTLY undergoing any treatment or do you have any planned surgeries for your cancer diagnosis? (select all that apply) True Select any Surgery
cancer_treat-chemo Chemotherapy
cancer_treat-radia Radiation Therapy
cancer_treat-immuno Immunotherapy
cancer_treat-bmt Bone marrow transplant
cancer_treat-none None
cancer_treat-dk I don’t know
sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_prescription-1 If yes, have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
copd-1 Chronic lung disease (COPD, emphysema, chronic bronchitis, obstructive pulmonary disease)? True Select one Yes
copd-2 No
copd-3 Don't know
asthma-1 Asthma, to the point that you use inhalers daily or have been to the hospital for your asthma? True Select one Yes
asthma-2 No
asthma-3 Don't know
arthritis-1 Arthritis? (osteoarthritis or degenerative) True Select one Yes
arthritis-2 No
arthritis-3 Don't know
autoimmune-1 Autoimmune/rheumatologic disorder/connective tissue disease (rheumatoid arthritis, lupus, scleroderma, dermatomyositis, polymyositis, polymyalgia rheumatica, or other autoimmune disorders)? True Select one Yes
autoimmune-2 No
autoimmune-3 Don't know
ckd-1 Chronic kidney (renal) disease or decreased kidney (renal) function or failure? True Select one Yes, but not on dialysis
ckd-2 Yes, and on dialysis
ckd-3 Yes, I’ve had a kidney transplant and my kidney function is now normal
ckd-4 No
ckd-5 Don't know
cardiac-1 A cardiac arrest? True Select one Yes
cardiac-2 No
cardiac-3 Don't know
implant-1 Do you have an implanted device for your heart? If you have one, you were given a card, which has this information on it. True Select one No
implant-2 Pacemaker (not an ICD)
implant-3 ICD (Implantable Cardioverter-Defibrillator)
implant-4 Implanted Loop Recorder or rhythm monitor (e.g. Reveal, Confirm)
implant-5 Other
implant-6 I Don't Know
implant_pace-1 Kind of pacemaker: True Select one Regular (1 or 2 lead)
implant_pace-2 BiV or CRT
implant_pace-3 Don't know
implant_icd-1 Kind of ICD: True Select one Regular (1 or 2 lead)
implant_icd-2 BiV or CRT (2 leads in the ventricle to “resynchronize”)
implant_icd-3 Don't know
implant_other Please specify your other type of implanted device. True string
bypass-1 Have you ever had bypass surgery (coronary artery bypass surgery)? True Select one Yes
bypass-2 No
bypass-3 Don't know
how_many_heart_vessels-1 How many heart vessels (coronary arteries) were bypassed? e.g. ""triple bypass"" means 3 vessels bypassed True Select one 1
how_many_heart_vessels-2 2
how_many_heart_vessels-3 3
how_many_heart_vessels-4 4 or more
how_many_heart_vessels-5 Don't know
stent-1 Have you ever had a stent or angioplasty in your heart (coronary) arteries? True Select one Yes
stent-2 No
stent-3 Don't know
stent_proc How many separate procedures (where you received either an angioplasty or stent) have you undergone? True integer
when_recent_stent Please specify the date of your most recent heart (coronary) stent or angioplasty? True date
valve_rep-1 Have you ever had a valve replacement or repair? (either with open-heart surgery, minimally invasive surgery, or with a catheter) True Select one Yes
valve_rep-2 No
valve_rep-3 Don't know
covid-1 Have you ever tested positive for COVID-19? True Select one Yes
covid-2 No
covid-3 Don't know
covid_num-1 How many times were you infected with COVID-19? True Select one Once
covid_num-2 Twice
covid_num-3 Three times
covid_num-4 Four times
covid_num-5 Five or more times
covid_num-6 Don't know
covid_date What was the date of your MOST RECENT COVID-19 infection? True date
covid_vax-1 Have you ever received a COVID-19 (SARS-CoV-2) vaccine? False Select one Yes
covid_vax-2 No
covid_vax-3 Don't know
covid_vax_doses-1 How many vaccine doses have you received? False Select one 1 dose
covid_vax_doses-2 2 doses
covid_vax_doses-3 3 doses
covid_vax_doses-4 4 doses
covid_vax_doses-5 5 or more doses
covid_vax_doses-6 Other
covid_vax_doses-7 I don't know
covid_vax1-1 Which company’s COVID-19 vaccine did you receive as your FIRST dose? False Select one AstraZeneca
covid_vax1-2 Janssen (Johnson & Johnson)
covid_vax1-3 Moderna
covid_vax1-4 Novavax
covid_vax1-5 Pfizer
covid_vax1-6 Other (Specify):
covid_vax1-7 I don’t know
covid_vax2-1 Which company’s COVID-19 vaccine did you receive as your SECOND dose? False Select one AstraZeneca
covid_vax2-2 Janssen (Johnson & Johnson)
covid_vax2-3 Moderna
covid_vax2-4 Novavax
covid_vax2-5 Pfizer
covid_vax2-6 Other (Specify):
covid_vax2-7 I don’t know
covid_vax3-1 Which company’s COVID-19 vaccine did you receive as your THIRD dose? False Select one AstraZeneca
covid_vax3-2 Janssen (Johnson & Johnson)
covid_vax3-3 Moderna
covid_vax3-4 Novavax
covid_vax3-5 Pfizer
covid_vax3-6 Other (Specify):
covid_vax3-7 I don’t know
covid_vax4-1 Which company’s COVID-19 vaccine did you receive as your FOURTH dose? False Select one AstraZeneca
covid_vax4-2 Janssen (Johnson & Johnson)
covid_vax4-3 Moderna
covid_vax4-4 Novavax
covid_vax4-5 Pfizer
covid_vax4-6 Other (Specify):
covid_vax4-7 I don’t know
covid_vax5-1 Which company’s COVID-19 vaccine did you receive as your FIFTH dose? False Select one AstraZeneca
covid_vax5-2 Janssen (Johnson & Johnson)
covid_vax5-3 Moderna
covid_vax5-4 Novavax
covid_vax5-5 Pfizer
covid_vax5-6 Other (Specify):
covid_vax5-7 I don’t know
4 hbp-1 High blood pressure or hypertension? True Select one Yes
hbp-2 No
hbp-3 Don't know
high_chol-1 High cholesterol? True Select one Yes
high_chol-2 No
high_chol-3 Don't know
prediabetes-1 Prediabetes or ""early"" diabetes not requiring medications? True Select one Yes
prediabetes-2 No
prediabetes-3 Don't know
diabetes-1 Diabetes (requiring medications)? Do not include prediabetes. True Select one Yes
diabetes-2 No
diabetes-3 Don't know
block_coronary-1 Coronary artery disease (blockages in your heart vessels)? True Select one Yes
block_coronary-2 No
block_coronary-3 Don't know
year_cd What year were you diagnosed with Coronary artery disease? True string String
why_cd-1 How do you know you have coronary artery disease? Check all that apply. True Select any My doctor told me
why_cd-2 My nurse told me
why_cd-3 Heart catheterization/Angiogram or CT scan showed blockages in the arteries of my heart
why_cd-4 Abnormal stress test
why_cd-5 Found on an ECG/EKG
why_cd-6 Self-Diagnosed
why_cd-7 Other
why_cd-8 Don’t know
why_cd_other Please specify why you think you have coronary artery disease. False string String
heart_attack-1 A myocardial infarction (also known as a heart attack)? True Select one Yes
heart_attack-2 No
heart_attack-3 Don't know
chf-1 Congestive heart failure (CHF, heart failure)? True Select one Yes
chf-2 No
chf-3 Don't know
stroke-1 Stroke or TIA (Transient Ischemic Attack or Mini-Stroke)? True Select one Yes
stroke-2 No
stroke-3 Don't know
afib-1 Atrial fibrillation (AFib, AF)? True Select one Yes
afib-2 No
afib-3 Don't know
afib_age At what age were you first diagnosed with Atrial Fibrillation? True integer
arrhythmia-1 Other arrhythmia? True Select one Yes
arrhythmia-2 No
arrhythmia-3 Don't know
cancer-1 Cancer (other than minor skin cancer)? True Select one Yes
cancer-2 No
cancer-3 Don't know
cancer_type-lung What type of cancer were you diagnosed with? (select all that apply) True Select any Lung
cancer_type-prostate Prostate
cancer_type-breast Breast
cancer_type-colorectal Colorectal
cancer_type-melanoma Melanoma
cancer_type-bone Bone
cancer_type-leu Leukemia (blood cancer)
cancer_type-renal Renal (kidney)
cancer_type-bladder Bladder
cancer_type-thyroid Thyroid
cancer_type-uterine Uterine
cancer_type-ovarian Ovarian
cancer_type-oral Throat and/or mouth
cancer_type-oth Other
cancer_type-dk I don’t know
cancer_treat-surg Are you CURRENTLY undergoing any treatment or do you have any planned surgeries for your cancer diagnosis? (select all that apply) True Select any Surgery
cancer_treat-chemo Chemotherapy
cancer_treat-radia Radiation Therapy
cancer_treat-immuno Immunotherapy
cancer_treat-bmt Bone marrow transplant
cancer_treat-none None
cancer_treat-dk I don’t know
sleep_apnea-1 Sleep apnea (obstructive sleep apnea, OSA)? True Select one Yes
sleep_apnea-2 No
sleep_apnea-3 Don't know
sleep_diagnosis-1 If yes, how were you diagnosed? True Select one A sleep study
sleep_diagnosis-2 Told by a doctor or nurse because I snore
sleep_diagnosis-3 Told by a doctor or nurse for another reason
sleep_diagnosis-4 Other
sleep_diagnosis-5 Don't know/refuse to say
sleep_diagnosis_other How were you diagnosed with sleep apnea? True string
sleep_prescription-1 Have you been prescribed any of the following for your sleep apnea? True Select one CPAP/BiPAP
sleep_prescription-2 Mouth/jaw prosthetic device
sleep_prescription-3 Other therapy
sleep_prescription-4 None
sleep_prescription_other What therapy have you been prescribed for sleep apnea? True string
sleep_current-1 Do you still have sleep apnea? True Select one Yes
sleep_current-2 No
sleep_current-3 I Don't know
sleep_cpap-1 Do you use a CPAP/BiPAP machine when sleeping? True Select one Yes
sleep_cpap-2 No
sleep_cpap-3 I Don't know
sleep_cpap_nights_per_week How many nights per week do you use your CPAP/BiPAP? False integer
copd-1 Chronic lung disease (COPD, emphysema, chronic bronchitis, obstructive pulmonary disease)? True Select one Yes
copd-2 No
copd-3 Don't know
asthma-1 Asthma, to the point that you use inhalers daily or have been to the hospital for your asthma? True Select one Yes
asthma-2 No
asthma-3 Don't know
arthritis-1 Arthritis? (osteoarthritis or degenerative) True Select one Yes
arthritis-2 No
arthritis-3 Don't know
autoimmune-1 Autoimmune/rheumatologic disorder/connective tissue disease (rheumatoid arthritis, lupus, scleroderma, dermatomyositis, polymyositis, polymyalgia rheumatica, or other autoimmune disorders)? True Select one Yes
autoimmune-2 No
autoimmune-3 Don't know
ckd-1 Chronic kidney (renal) disease or decreased kidney (renal) function or failure? True Select one Yes, but not on dialysis
ckd-2 Yes, and on dialysis
ckd-3 Yes, I’ve had a kidney transplant and my kidney function is now normal
ckd-4 No
ckd-5 Don't know
cardiac-1 A cardiac arrest? True Select one Yes
cardiac-2 No
cardiac-3 Don't know
implant-1 Do you have an implanted device for your heart? If you have one, you were given a card, which has this information on it. True Select one No
implant-2 Pacemaker (not an ICD)
implant-3 ICD (Implantable Cardioverter-Defibrillator)
implant-4 Implanted Loop Recorder or rhythm monitor (e.g. Reveal, Confirm)
implant-5 Other
implant-6 I Don't Know
implant_pace-1 Kind of pacemaker: True Select one Regular (1 or 2 lead)
implant_pace-2 BiV or CRT
implant_pace-3 Don't know
implant_icd-1 Kind of ICD: True Select one Regular (1 or 2 lead)
implant_icd-2 BiV or CRT (2 leads in the ventricle to “resynchronize”)
implant_icd-3 Don't know
implant_other Please specify your other type of implanted device. True string
bypass-1 Have you ever had bypass surgery (coronary artery bypass surgery)? True Select one Yes
bypass-2 No
bypass-3 Don't know
how_many_heart_vessels-1 How many heart vessels (coronary arteries) were bypassed? e.g. ""triple bypass"" means 3 vessels bypassed True Select one 1
how_many_heart_vessels-2 2
how_many_heart_vessels-3 3
how_many_heart_vessels-4 4 or more
how_many_heart_vessels-5 Don't know
stent-1 Have you ever had a stent or angioplasty in your heart (coronary) arteries? True Select one Yes
stent-2 No
stent-3 Don't know
stent_proc How many separate procedures (where you received either an angioplasty or stent) have you undergone? True integer
when_recent_stent Please specify the date of your most recent heart (coronary) stent or angioplasty? True date
valve_rep-1 Have you ever had a valve replacement or repair? (either with open-heart surgery, minimally invasive surgery, or with a catheter) True Select one Yes
valve_rep-2 No
valve_rep-3 Don't know
covid-1 Have you ever tested positive for COVID-19? True Select one Yes
covid-2 No
covid-3 Don't know
covid_num-1 How many times were you infected with COVID-19? True Select one Once
covid_num-2 Twice
covid_num-3 Three times
covid_num-4 Four times
covid_num-5 Five or more times
covid_num-6 Don't know
covid_date What was the date of your MOST RECENT COVID-19 infection? True date
covid_vax-1 Have you ever received a COVID-19 (SARS-CoV-2) vaccine? False Select one Yes
covid_vax-2 No
covid_vax-3 Don't know
covid_vax_doses-1 How many vaccine doses have you received? False Select one 1 dose
covid_vax_doses-2 2 doses
covid_vax_doses-3 3 doses
covid_vax_doses-4 4 doses
covid_vax_doses-5 5 or more doses
covid_vax_doses-6 Other
covid_vax_doses-7 I don't know
covid_vax1-1 Which company’s COVID-19 vaccine did you receive as your FIRST dose? False Select one AstraZeneca
covid_vax1-2 Janssen (Johnson & Johnson)
covid_vax1-3 Moderna
covid_vax1-4 Novavax
covid_vax1-5 Pfizer
covid_vax1-6 Other (Specify):
covid_vax1-7 I don’t know
covid_vax2-1 Which company’s COVID-19 vaccine did you receive as your SECOND dose? False Select one AstraZeneca
covid_vax2-2 Janssen (Johnson & Johnson)
covid_vax2-3 Moderna
covid_vax2-4 Novavax
covid_vax2-5 Pfizer
covid_vax2-6 Other (Specify):
covid_vax2-7 I don’t know
covid_vax3-1 Which company’s COVID-19 vaccine did you receive as your THIRD dose? False Select one AstraZeneca
covid_vax3-2 Janssen (Johnson & Johnson)
covid_vax3-3 Moderna
covid_vax3-4 Novavax
covid_vax3-5 Pfizer
covid_vax3-6 Other (Specify):
covid_vax3-7 I don’t know
covid_vax4-1 Which company’s COVID-19 vaccine did you receive as your FOURTH dose? False Select one AstraZeneca
covid_vax4-2 Janssen (Johnson & Johnson)
covid_vax4-3 Moderna
covid_vax4-4 Novavax
covid_vax4-5 Pfizer
covid_vax4-6 Other (Specify):
covid_vax4-7 I don’t know
covid_vax5-1 Which company’s COVID-19 vaccine did you receive as your FIFTH dose? False Select one AstraZeneca
covid_vax5-2 Janssen (Johnson & Johnson)
covid_vax5-3 Moderna
covid_vax5-4 Novavax
covid_vax5-5 Pfizer
covid_vax5-6 Other (Specify):
covid_vax5-7 I don’t know
Your Social Demographics 1 education-none What is the <i>highest</i> level of education you completed? True Select one No formal schooling
education-some Some school, but did not graduate high school
education-hs High school diploma or equivalency (e.g., GED)
education-associate Associate degree (e.g., junior college)
education-some_col Some college, but did not graduate college
education-bach Bachelor's degree
education-master Master's degree
education-phd Doctorate (PhD)
education-doc Professional doctorate (MD, JD, DDS, etc.)
education-oth Other
education-dk Don't know
education-pnts Prefer not to state
education_oth Please specify your other level of education. True string String
daily_act-full What best describes your current main daily activities and/or responsibilities? True Select one Working full-time
daily_act-part Working part-time
daily_act-unemp Unemployed, laid off, or looking for work
daily_act-school In school (full- or part-time student)
daily_act-home Stay-at-home parent or keeping household
daily_act-retired Retired
daily_act-disabled Disabled
daily_act-oth Other (specify)
daily_act-pnts Prefer not to state
education_hs-1 Please choose the highest level of education you have completed. False Select one Never attended/Kindergarten only
education_hs-2 1st grade
education_hs-3 2nd grade
education_hs-4 3rd grade
education_hs-5 4th grade
education_hs-6 5th grade
education_hs-7 6th grade
education_hs-8 7th grade
education_hs-9 8th grade
education_hs-10 9th grade
education_hs-11 10th grade
education_hs-12 11th grade
education_hs-13 12th grade, no diploma
daily_oth Please specify what you do: True string String
unemployed-yes In the past year, have you been unemployed <u>and looking for work</u> for more than 2 months? True Select one Yes
unemployed-no No
unemployed-pnts Prefer not to state
income-1 Last year, what was your total household income from all sources, before taxes? True Select one Less than $10,000
income-2 $10,000 to under $20,000
income-3 $20,000 to under $30,000
income-4 $30,000 to under $40,000
income-5 $40,000 to under $50,000
income-6 $50,000 to under $75,000
income-7 $75,000 to under $100,000
income-8 $100,000 to under $150,000
income-9 More than $150,000
income-10 Don't know
income-11 Prefer not to state
marital_status-married What is your current marital status? False Select one Married
marital_status-partner Living with domestic partner (or other marriage-like relationship)
marital_status-widow Widowed
marital_status-divorce Divorced
marital_status-sep Separated
marital_status-never Never Married
marital_status-oth Other
marital_status-pnts Prefer not to state
marital_status_other Please specify your other marital status. True string String