The hidden patient in heart failure: psychological distress and gender-based differences in caregiver quality of life: a cross-sectional study

Background Informal caregivers of patients with heart failure frequently assume demanding roles that include prolonged caregiving hours, complex medication management, symptom monitoring, and coordination of medical care. HF management relies heavily on informal caregivers, a role that may lead to significant physical and emotional exhaustion. Purpose To examine the association between anxiety, depression, and Quality of Life (QoL) in HF caregivers, exploring gender differences and the role of objective caregiving workload. Method We designed a cross-sectional study, 78 caregivers were evaluated. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the Generalized Anxiety Disorder-7 (GAD-7), and quality of life was measured with the WHOQOL-BREF across physical, psychological, social, and environmental domains (0–100 scale). Objective caregiving burden was quantified by time and complexity of care. Non-parametric tests and Spearman correlations were used for analysis. Results Clinically significant depressive (PHQ-9≥10) and anxiety (GAD-7≥10) symptoms were highly prevalent, affecting 24.4% and 25.6% of caregivers, respectively, with a pronounced burden in women (p =0.027). Spearman analysis revealed that depressive symptoms were the most potent drivers of diminished QoL across all domains (ρ range:−0.32 to−0.58, all p <0.01), showing the strongest inverse correlation with the psychological domain. Anxiety significantly impacted psychological (p<0.001) physical (p>0.020) and environmental QoL (p=0.003) it spared the social domain. Remarkably, objective caregiving burden (hours and tasks) failed to show any significant association with QoL. In multivariable regression models adjusted for age, sex, and workload, depressive symptoms emerged as the sole independent predictor of both psychological (β=−1.40,p=0.002;model R²=0.31) and physical QoL (β=−1.31, p<0.001;model R²=0.22). Conclusions Emotional distress, notably depressive symptomatology, outweighs objective workload as the primary determinant of caregiver quality of life in heart failure. These findings shift the therapeutic focus from logistical support to mandatory psychological screening and gender-sensitive resilience interventions, essential for sustaining the home-based caregiving unit within comprehensive heart failure programs.