Another limitation might be the cross sectional design of
the study. However, the main thrust of our study was the correlation
between quality of life and somatic indices assessed at
a particular point in time. Nevertheless, it would be highly
desirable to document longitudinal changes in quality of life
in patients with congestive heart failure, along with objective
indicators of disease severity, to separate disease specific from
non-specific changes in quality of life and to study cause–
effect relations, especially in the domain of emotional impairment.