The total congestive heart failure sample was characterised by significantly reduced scores in all aspects of quality of life compared with a healthy reference group (fig 1; table 2). As illustrated in fig 2A, there was a gradual decline in SF-36 scores compared with the normal population (reference group)from NYHA class I to class III. With in NYHA class I,the most significant decreases were observed in the scales which primarily refer to somatic well being and functioning. In higher NYHA classes,significant decreases in the scales measuring emotional well being and functioning were also found (fig 2A). Patients in NYHA class III had roughly one third of the scores of the healthy population in the following short form scales: physical functioning, role functioning physical, bodily pain,general health,vitality,and role functioning emotional. NYHA class III patients reached a minimum mean SF-36 score in physical role functioning of only 10.7%, compared with 96.9% in the healthy population (fig 2A, table 2).