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 <0.0005). Conclusions: Although anxiety did not predict HRQoL, independent associations between depression and HRQoL and depression and anxiety indicate that clinicians should routinely assess the emotional health of HF patients and incorporate psychological components into interventions to improve their HRQoL. Currently, evidence suggests that during consultation both clinicians and patients focus more on physical symptoms of their conditions than emotional symptoms and well-being across a range of LTCs.