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Background—Assessment of dyspnea, fatigue and physical disability is fundamental to the monitoring of patients with heart failure (HF). A plethora of patient-reported measures exist, but most are too burdensome or imprecise to be useful in clinical practice. New techniques used for computer adaptive tests (CAT) may be able to address these problems. The purpose of this study was to build a CAT for patients with HF. Methods and Results—Item banks of 74 queries (‘items’) were developed to assess selfreported physical disability, fatigue and dyspnea. All queries were administered to 658 adults with HF to build three item banks. The resulting HF-CAT was administered to 100 ancillary HF-patients (NYHA I 11%, II 53%, III&IV 36%). In addition, the physical function and vitality domains of the SF-36 questionnaire, an established shortness-of-breath-scale (SOB), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ) were applied. The HFCAT assessment took 3:09 1:52 minutes to complete and score. All HF-CAT scales demonstrated good construct validity through high correlations with the corresponding SF-36 physical function (r=-.87), vitality (r=-.85) scales, and the SOB scale (r=.84). Simulation studies showed a more precise measurement of all HF-CAT scales over a larger range than comparable static tools. HF-CAT scales identified significant differences between patients classified by the NYHA symptom criteria, similar to the MLHFQ. Conclusions—A new CAT for HF patients was built using modern psychometric methods. Initial results demonstrate its potential to increase the feasibility, and precision of patient selfassessments of symptoms of HF with minimized respondent burden. Clinical Trial Registration—URL: http://www.projectreporter.nih.gov. Unique identifier: 1R43HL083622-01.