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Background: We know little about how intrathoracic impedance, an objective marker of thoracic congestion, is associated with patient-reported outcomes in heart failure (HF). Objective: Quantify relationships between device-detected congestion and patient-reported outcomes over the course of 3 months among adults with HF. Methods: In a cohort of adults with HF, multivariate generalized linear modeling was used to quantify the relationship between thoracic congestion (Optivol® Index exceeding 60 Ω threshold) with health-related quality of life (HRQOL, 12-item Kansas City Cardiomyopathy Questionnaire), physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early and Subtle Symptoms subscales), and psychological symptoms (9-item Patient Health Questionnaire; 6-item Patient-Reported Outcomes Measurement Information System Anxiety Scale). Results: The mean age of the sample (n=49) was 62 years old, 39% were women, and 63% had NYHA class III/IV HF. Compared with patients who did not have device-detected congestion, patients who experienced threshold crossings in the previous 90 days reported 130% worse dyspnea (95% confidence interval (CI) = 10.2%-437% worse; p=0.017), 40% worse early and subtle symptoms (CI = 3.4%-89.7% worse; p=0.029), 106% worse depressive symptoms (CI=19.1%-257% worse; p=0.003), and 40% worse anxiety (CI = 3.7%-89.1% worse; p=0.028). Having a threshold crossing in the previous 90 days also was associated with a clinically meaningful decrease in HRQOL (β= -16.16±6.32; p=0.010). Conclusions: Intrathoracic congestion, as measured with the Optivol Index, can provide additional information regarding patient experiences in living with HF. [ABSTRACT FROM AUTHOR]