Abstract Body (Do not enter title and authors here): Introduction: As therapies for heart failure (HF) continue to improve, patients (pts) with HF are living longer with more comorbidities. Improvement in quality of life (QOL) is increasingly recognized as a goal of HF therapy but reflects other medical and non-medical conditions.

Research Question: From questionnaires assigned to pts for completion before HF clinic, we sought to determine how often and by whom HF is reported is as the major limitation to their QOL.

Methods: Demographic data, diagnosis codes (Dx), medications, labs, and QOL questions including the Kansas City Cardiomyopathy questionnaire (KCCQ) were extracted from electronic health records. An additional question included 4 choices for what most limits pt’s QOL: HF; HF and other medical Dx equally; other medical Dx; or non-medical problems. Characteristics were compared between pts grouped by reported cause of QOL limitation using non-parametric Kruskal-Wallis tests for continuous variables and Chi-squared tests for categorical variables.

Results: Between 2019-2023, 2,809 unique pts in an academic HF clinic entered QOL responses before visits. QOL was reported as limited primarily by HF in 955 pts (34%), who reported HF severity by furosemide doses, BNP, and KCCQ, that were similar to the 890 pts (32%) reporting QOL limited equally by HF and other medical Dx. The pts limited by HF equal to other medical Dx and those limited by other Dx greater than HF (605, 21%) had more comorbidities by Charlson scores than those limited by HF alone. QOL was limited by non-medical problems in 13% of pts with the lowest HF severity. Pts reporting limitations from other medical Dx were older, but differences by sex and race were not significant. (Table) QOL limitation dominated by HF was more common with HFrEF Dx than HFpEF Dx (42% vs 28%, p<0.001). (Table)

Conclusions: HF is reported as the dominant QOL limitation by only one third of HF clinic outpatients and more often limiting for HFrEF than for HFpEF. HF appears similarly severe in pts describing QOL as most limited by HF alone and those limited equally by HF and other Dx, the two groups in whom design and testing of HF therapies to improve QOL will likely have the greatest impact.