Abstract : The diagnosis of heart failure is associated with many comorbid psychological distress factors such as depression, anxiety, and hostility that significantly affect patients’ health outcomes and prognosis. This study aims to investigate if the combined effect of comorbid psychological distress factors is a predictors of the cardiac emergency visits, re-hospitalization, and mortality and among adult heart failure patients. A sample of 419 of patients with heart failure were recruited. Data collected in relation to Depression, anxiety, and hostility. Event-free survival was defined as the time to the first event. Cox proportional hazards hierarchal regressions were constructed to determine the predictors of free survival in heart failure patients. The analysis showed that in first block, comorbidity and New York Heart Association class were the only significant variables, while in the second block, none of the variables was significant except depression, comorbidity and New York Heart Association. In the final model, the interaction between depression, anxiety, and hostility was not significant. The combined effect of depression, anxiety, and hostility were not significant predictor of free survival among patients with heart failure. Nevertheless, depression was the only factor that predicts free survival among patients with heart failure.