Aims Patients with heart failure often have under-recognized symptoms, depression, anxiety, and poorer spiritual well-being ('QoL domains'). Ideally all patients should have heart failure-specific health status and quality of life (QoL) domains routinely evaluated; however, lack of time and resources are limiting in most clinical settings. Therefore, we aimed to evaluate whether heart failure-specific health status was associated with QoL domains and to identify a score warranting further evaluation of QoL domain deficits. Methods and results Participants (N = 314) enrolled in the Collaborative Care to Alleviate Symptoms and Adjust to Illness trial completed measures of heart failure-specific health status [Kansas City Cardiomyopathy Questionnaire, KCCQ (score 0-100, 0 = worst health status)], additional symptoms (Memorial Symptom Assessment Scale), depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), and spiritual well-being (Facit-Sp) at baseline. Mean [+ or -] standard deviation (SD) KCCQ score was 46.9[+ or -]19.3, mean age was 65.5 [+ or -] 11.4, and 79% were male. Prevalence of QoL domain deficits ranged from 11% (nausea) to 47% (depression). Sensitivity/specificity of KCCQ for each QoL domain ranged from 20-40%/80-96% for KCCQ[less than or equal to]25, 61-84%/48-62% for KCCQ[less than or equal to]50, 84-97%/26-40% for KCCQ [less than or equal to]60, and 96-100%/8-13% for KCCQ[less than or equal to]75. Patients with KCCQ[less than or equal to] 60 had mean [+ or -] SD 4.5[+ or -]2.5 QoL domain deficits (maximum 12), vs. 1.6[+ or -]1.6 for KCCQ 60 (P Conclusion KCCQ[less than or equal to]60 had good sensitivity for each QoL domain deficit and for patients with at least one QoL domain deficit. Screening for QoL domain deficits should target patients with lower KCCQ scores based on a clinic's KCCQ score distribution and clinical resources for addressing QoL domain deficits. Keywords Health status * Kansas City Cardiomyopathy Questionnaire * Heart failure * Symptoms * Depression * Anxiety * Spiritual-well being