Emotional symptoms determine patient reported health related quality of life to the same extent as physical symptoms in patients with a diagnosis of heart failure.

Purpose: Common mental health problems, including anxiety are co-morbid in an estimated 30% of individuals with one or more long term conditions (LTCs). Research conducted with individuals with a diagnosis of heart failure (HF) indicates that depression and anxiety are highly prevalent and that depression has a detrimental effect on a range of health outcomes, including the important patient-reported outcome of health-related quality of life (HRQoL). However, the impact of anxiety on HRQoL has been relatively under-researched in this patient group compared with depression. Methods: In this study the relative contribution of anxiety, as measured using the Hospital Anxiety and Depression Scale (HADS) to reported HRQoL, measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) was examined. A comprehensive range of variables were assessed (n = 13) using appropriate and valid measurement tools. A cross-sectional, self-administered, postal returned questionnaire survey design was adopted. Patients were recruited from two large teaching hospitals in the north of the United Kingdom. Results: 158 patients were recruited to the study (response rate 63%). Patients had a mean age 70.7yrs (10.5), were 68% male, 94% White British, 61% NYHA II, with a mean of 14 reported physical symptoms. Clinical levels of anxiety and depression (>8) were identified in the sample; 29% were anxious and 34% were depressed. In multiple regression analysis depression, perceived social support and physical symptom burden accounted for a 53% of the variance in anxiety symptoms (F12, 126 = 14, p < 0.0005). Anxiety symptoms did not account for a significant proportion of unique variance in HRQoL scores. Higher levels of physical symptom burden, depression and an increased number of physical co-morbidities predominantly account for 69% of the variance in HRQoL (F13,125 = p