Cardiometabolic Risk Initial Screening Questionnaire

Guidance for Cardiology and Diabetes Evaluation

This tool helps adults identify symptoms or risk factors that warrant medical evaluation and guides them to the appropriate health service.

It does not provide a diagnosis and does not replace an examination by a healthcare professional.

Purpose and Use

This questionnaire is intended for the initial screening of adults. The responses lead to a recommended care pathway: emergency assistance, cardiac evaluation, testing for diabetes, or preventive assessment by a general practitioner or internal medicine physician.

Instructions for Completion

  • Answer based on what is happening now or what has happened recently, as specified in each question.
  • Select one response in each row. If you are unsure, select Do not know.
  • Do not use the total number of positive responses as a diagnosis.
  • If an emergency symptom is present, stop completing the questionnaire and seek immediate assistance.

Completion Details

Participant code  __________________________________________________________

Date  __________________________________________________________

Age  __________________________________________________________

Optional sex or gender  __________________________________________________________

Completed by  □ participant    □ healthcare professional    □ other

Important Limitation

The absence of symptoms does not exclude cardiovascular disease or diabetes. FINDRISC and SCORE2 must be used in their original forms, in the appropriate age groups, and by a person who understands their limitations. This questionnaire does not create a new validated numerical score.

Love & Check Yourself

Love & Check Yourself

We focus on offering updated information and raising awareness of diabetes and CVDs in easily comprehensible, non-verbal ways / animated videos, offering ways of self-monitoring one’s health status, emphasizing the importance of screening programs.

Cardiometabolic Risk Initial Screening Questionnaire

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Section A Emergency Warning Signs

Complete this section first. If you answer Yes to any question and the symptom is occurring now, call 112 or go immediately to an Emergency Department.

A1 - Do you currently have pain, pressure, heaviness, or tightness in your chest??? *
A2 - Does the chest pain spread to your arm, back, neck, or jaw, or is it accompanied by cold sweating or nausea? *
A3 - Do you have severe or sudden shortness of breath? *
A4 - Have you fainted, or do you feel that you may faint, together with chest pain or marked palpitations? *
A5 - Have you suddenly developed drooping on one side of the face, weakness in one arm, or difficulty speaking? *
A6 - Do you have intense thirst and very frequent urination together with vomiting, abdominal pain, deep rapid breathing, drowsiness, or confusion? *

Section B Symptoms Requiring Cardiac Evaluation 

Consider the past four weeks unless the question states otherwise. 

B1 - Do you experience pressure, heaviness, or discomfort in your chest when walking quickly, climbing stairs, or exercising? *
B2 - Do you become more short of breath than you did previously during everyday activities? *
B3 - Do you experience recurrent forceful or irregular heartbeats that last longer than a few minutes? *
B4 - Are the palpitations accompanied by dizziness, shortness of breath, chest pain, or a feeling that you may faint? *
B5 - Have you fainted during exercise or immediately afterward? *
B6 - Have you developed new swelling in your legs, or do you need more pillows because you have difficulty breathing when lying down? *
B7 - Has your ability to walk or exercise decreased noticeably without a clear reason? *
B8 - Have you been diagnosed with heart disease, an arrhythmia, or heart failure? *

Section C Symptoms Requiring Diabetes Testing 

Consider whether the following symptoms appeared recently or have become more pronounced. 

C1 - Are you noticeably thirstier than usual? *
C2 - Do you urinate more frequently, especially during the night? *
C3 - Have you lost weight without trying? *
C4 - Do you experience persistent tiredness or weakness without an obvious cause? *
C5 - Do you experience blurred vision that recurs or persists? *
C6 - Do you have wounds that heal slowly or recurrent infections? *
C7 - Do you have numbness, burning, or a wound on your feet that is not improving? *
C8 - Have you previously been told that you had high blood glucose, prediabetes, or gestational diabetes? *

Section D Cardiometabolic Risk Factors

The following information helps a healthcare professional decide whether preventive assessment is needed. These items are not scored automatically in this tool. 

D1 - Do you currently smoke, or did you stop smoking recently? *
D2 - Have you been told that you have high blood pressure, or do you take medicine for it? *
D3 - Have you been told that you have high cholesterol or triglycerides? *
D4 - Do you have excess body weight or an increased waist circumference? *
D5 - Are you physically active for less than about 30 minutes on most days? *
D6 - Do you eat vegetables, fruit, or other fibre-rich foods less than daily? *
D7 - Does a parent, brother, or sister have diabetes mellitus? *
D8 - Has a close relative developed cardiovascular disease at a relatively young age? *
D9 - Do you have chronic kidney disease, sleep apnoea, or another chronic condition that affects cardiovascular risk? *
D10 - Has it been more than two years since your last blood pressure, glucose, and lipid assessment? *
Completed by *

References

American Diabetes Association Professional Practice Committee. (2026). 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes 2026. Diabetes Care, 49(Supplement 1), S27–S49. https://doi.org/10.2337/dc26-S002

Byrne, R. A., Rossello, X., Coughlan, J. J., et al. (2023). 2023 ESC Guidelines for the management of acute coronary syndromes. European Heart Journal, 44(38), 3720–3826. https://doi.org/10.1093/eurheartj/ehad191

European Commission. (n.d.). Single European emergency number 112. https://europa.eu/youreurope/citizens/travel/security-and-emergencies/emergency/index_en.htm

Lindström, J., & Tuomilehto, J. (2003). The diabetes risk score: A practical tool to predict type 2 diabetes risk. Diabetes Care, 26(3), 725–731. https://doi.org/10.2337/diacare.26.3.725

Marx, N., Federici, M., Schütt, K., et al. (2023). 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. European Heart Journal, 44(39), 4043–4140. https://doi.org/10.1093/eurheartj/ehad192

National Institute for Health and Care Excellence. (2010). Recent onset chest pain of suspected cardiac origin: Assessment and diagnosis (Clinical Guideline CG95). https://www.nice.org.uk/guidance/cg95

SCORE2 Working Group and ESC Cardiovascular Risk Collaboration. (2021). SCORE2 risk prediction algorithms: New models to estimate 10 year risk of cardiovascular disease in Europe. European Heart Journal, 42(25), 2439–2454. https://doi.org/10.1093/eurheartj/ehab309

Visseren, F. L. J., Mach, F., Smulders, Y. M., et al. (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 42(34), 3227–3337. https://doi.org/10.1093/eurheartj/ehab484

World Health Organization. (2020). HEARTS technical package for cardiovascular disease management in primary health care: Risk based CVD management. World Health Organization. https://www.who.int/publications/i/item/9789240001367

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