Since there are conflicting reports about the patch (mainly because some people that are having problems on certain platforms,aren't posting solely under those platform forums,confuses others)
I do play on the xbox 360.English version (northeast, USA...Haven't downloaded patch 1.3 nor 1.4,because game was working fine.(well....good enough)
Do I need to download it in order to play the new DLC'S? If so is it better to start all over again (have six play throughs with multiple endings each), and if so do you really need to erase all passed downloads,pre-order packs,caches,saves and reload them? Thanks....G

So much for G-staff, and Jason saying they are continually monitoring the forum posts.....how about an answer?

they dont monitor anything they just get on here whenever they feel like it and only answer questions when they want to dog on someone.

I think you need the 1.4 patch for Honest Hearts. I think the next patch will be for Old World Blues and Lonesome Road. Supposedly the next patch (1.5?) will have bug fixes. The 1.4 was for stability, optimization and weapons balance. I found 1.4 helped, especially in areas like New Vegas, The Hoover Dam that were really choppy and laggy pre- 1.4 patch.

Yeah,,they claimed the did monitor.Anyways, called tech support because I didn't want to download this new patch if it was going to screw up my previous saves.They just said to clear cache before downloading patch.I did,have no real problems.Loaded my old saves.But restarted a new game and has frozen three times on me.Now if I load the continue file, a nightkin appears where I am with a rebar club And says "time to die",reload and he doesn't appear second time.