Author ContributionsPC, AC and JR were involved in the analysis and interpretation of data, drafting of the manuscript and final approval of the manuscript. RP, SC, SP and HU were involved in the conception and design, analysis and interpretation of data, critical revision of manuscript and final approval. Word Count: 2767 (excl abstract, tables and references)A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPTAbstract Background: Heart failure (HF) is a major healthcare problem contributing significantly to hospital admission

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Various studies have investigated and reported on the association between physical and psychiatric conditions [1,2]. Recently, research focussing on the link between cardiovascular disease and psychiatric conditions has been on the rise [3]. Carter et al. [3] found that one in four psychiatric patients also suffered from a cardiovascular co-morbidity. Whether these links are causative, or not, there is a need to quantify this data to provide the evidence on which better targeted, holistic care-pathways can be based.It is well known that depression and anxiety are significant and commonly reported factors in heart failure [4] and it has been shown that patients with non-ischaemic heart failure, such as hypertrophic cardiomyopathy (HCM) [5,6] and dilated cardiomyopathy (DCM) [7] experience emotional stress, anxiety and in some cases depression and other psychiatric co-morbidities. This often attributed the fear of associated risk of sudden death and potential genetic risk to their own children [5,8]. In addition, recent studies [9] have shown an increasing trend in patients with psychiatric comorbidities alongside DCM, and have called for a lower threshold to both assess and detect these co-morbidities as they often go under-detected and under-diagnosed in hospital [10].In light of this and the increasing evidence of association between psychiatric conditions and cardiovascular disease, we investigated the prevalence of psychiatric co-morbidities and tendencies in patients with dilated cardiomyopathy (DCM) over a 14 year period. We do not believe any study has looked into DCM and the possible links to psychiatric conditions and tendencies over such a long period to date.We compiled an entirely anonymous database of adult patients diagnosed with dilated cardiomyopathy across seven hospitals in the North of England, UK during the period 01/01/2000 to 31/03/2013. We analysed the data for prevalence of firstly psychiatric co-morbidities such as; anxiety disorder, obsessive compulsive disorder, schizophrenia, schizoaffective disorder, bipolar disease, depression and dementia and secondly substance abuse and suicidal intent. We traced our patients with the ACALM (Algorithm for Co-morbidities, Associations, length of stay and Mortality) study protocol, which uses ICD-10 (International Classification of Disease, Version 10) and OPCS-4 (Office of population Censuses and Surveys Classification of Interventions and Procedures) procedure codes to correctly allocate patients for statistical analysis using SPSS Version 20.0. The prevalence data was assembled into five groups to aid analysis of trends over time. This methodology has been described by our group and others previously [1][2][3]9,[11][12][13][14][15][16][17][18][19][20][21][22][23].Between the years 2000 and 2013, 929,552 patients were admitted, 710 of which (0.08%) were labelled with a diagnosis of dilated cardiomyopathy. The majority of the population were made up of male patients (69%) and the mean age was 54.9 years ± 13.9 years (S.D.). The population consisted o...