Objective To identify differences in psychosocial, behavioural and clinical outcomes between patients with heart failure (HF) with and without stroke. Design and participantsA secondary analysis of 1023 patients with heart failure enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart failure (COACH). Setting Seventeen hospitals located across the NetherlandsOutcomes measures Depressive symptoms (Centre for Epidemiological Studies Depression Scale), quality of life (Minnesota Living with Heart Failure Questionnaire, Ladder of Life Scale), self-care (European Heart Failure Self-Care Behaviour Scale), adherence to HF management (modified version of the Heart Failure Compliance Questionnaire) and readmission for HF, cardiovascular- and all-cause hospitalizations at 18 months, and all-cause mortality at 18 months and 3 years.Results Compared to those without stroke, HF patients with a stroke (10.3%; n=105) had twice the likelihood of severe depressive symptoms (OR 2.83, 95% CI 1.27-6.28, p=0.011; OR 2.24, 95% CI 1.03-4.88, p=0.043) at 12 and 18 months, poorer disease-specific and generic quality of life (OR 2.80, 95% CI 1.61-4.84, p<0.001; OR 2.00, 95% CI 1.09-3.50, p=0.019) at 12 months, poorer self-care (OR 1.80, 95% CI 1.05-3.11, p=0.034; OR 2.87, 95% CI 1.61-5.11, p<0.0011) and HF management adherence (OR 0.39, 95% CI 0.18-0.81, p=0.012; OR 0.35, 95% CI 0.17-0.72, p=0.004) at 12 and 18 months, higher rates of hospitalizations and mortality at 18 months and higher all-cause mortality (HR 1.43, 95% CI 1.07-1.91, p=0.016) at 3 years. ConclusionsPatients with HF and stroke have worse psychosocial, behavioural and clinical outcomes, notably from 12 months, than those without stroke. To ameliorate these poor outcomes long-term, integrated disease management pathways are warranted.