BACKGROUND: Little is known regarding the effects of index angiograms on health-related quality of life related to angiographic outcome, that is, positive or negative for coronary heart disease (CHD). METHODS: A longitudinal, comparative design was used. Ninety-three patients underwent initial angiography and completed questionnaires (Cardiac-Quality of Life Index, Short Form-36 mental and physical, and Cardiac Attitudes Index) before, 1 week and 1 year after angiography. Data were evaluated with linear regression and analysis of variance. RESULTS: Fifty-five patients were CHD positive (age 65.3 +/- 10.7 years, 49% were female), and 38 patients were CHD negative (age 59.5 +/- 12 years, 53% were female). Compared with CHD-positive patients over 1 year, CHD-negative patients reported lower scores on the Cardiac-Quality of Life Index (P < .008), Short Form-36 mental and physical measures (P = .004), and Cardiac Attitudes Index (P = .05). CONCLUSION: CHD-negative patients experienced lower health-related quality of life and lower perceived control than CHD-positive patients. After an index angiogram, a negative finding may not be sufficient to relieve negative emotions. Cite this article: Eastwood, J.-A., Doering, L. V., Dracup, K., Evangelista, L., & Hays, R. D. (2011, MARCH/APRIL). Health-related quality of life: The impact of diagnostic angiography. Heart 84 Lung, 40(2), 147-155. doi:10.1016/j.hrtlng.2010.05.056.