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Doedee F, van den Houdt S, Widdershoven J, Kupper N. Chronic stress exposure in men and women, and implications for the course of fatigue after percutaneous coronary intervention; the THORESCI study. Gen Hosp Psychiatry 2021; 72:45-52. [PMID: 34280618 DOI: 10.1016/j.genhosppsych.2021.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Fatigue is a prevalent symptom in patients with coronary heart disease (CHD). Individual differences in chronic stress may affect the experience and persistence of fatigue, and this may vary between the sexes. Therefore, we studied the effect of chronic stress on the course of fatigue over a 2-year period after percutaneous coronary intervention (PCI), and examined the moderating effects of sex. METHODS 1682 patients (78% men, age = 67.1 ± 10.6) were recruited and filled out multiple self-report questionnaires at baseline, one, 12, and 24 months post-PCI, including questions on demographics, fatigue (HCS). Multiple chronic stressors were assessed at baseline: work stress (ERI16), marital stress (MMQ-6), early life events (Life Events Questionnaire) and social stress. Latent class factor analysis (LatentGOLD) was used to construct a comprehensive chronic stress index. Linear mixed modeling examined the predictive quality of predictors and covariates. RESULTS Fatigue was found to substantially decrease over the first month post-PCI, then stabilized at a moderate level. Chronic stress impacted both the level and course of fatigue by increasing its level and delaying recovery. Overall and across time, women reported more fatigue than men. The level and course effects of chronic stress and sex were independent of demographic, health behavioral, and medical covariates. CONCLUSIONS Individual differences in chronic stress impact both the level and course of fatigue post-PCI, with women being affected most. Future research could further explain the mechanisms underlying the observed relationships. Developing and testing interventions focusing on exercise and stress-reduction could be used to alleviate fatigue.
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Affiliation(s)
- Fleur Doedee
- Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Sophie van den Houdt
- Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands
| | - Jos Widdershoven
- Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands; Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Nina Kupper
- Department of Medical & Clinical Psychology, Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
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Maass SWMC, Brandenbarg D, Boerman LM, Verhaak PFM, de Bock GH, Berendsen AJ. Fatigue among Long-Term Breast Cancer Survivors: A Controlled Cross-Sectional Study. Cancers (Basel) 2021; 13:cancers13061301. [PMID: 33803966 PMCID: PMC8001130 DOI: 10.3390/cancers13061301] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 01/22/2023] Open
Abstract
Simple Summary The number of long-term breast cancer survivors is increasing. Earlier research showed that many breast cancer survivors suffer from fatigue during and shortly after treatment. Fatigue is distressing and can severely impact quality of life. In this research, we assessed whether the prevalence of fatigue is also elevated long after breast cancer treatment. We showed that even ten years after diagnosis, one in four breast cancer survivors experience fatigue. This is more than women of the same age without a history of cancer. In addition, we found that fatigue among long-term breast cancer survivors was associated with symptoms of depression and anxiety. Abstract Background: Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, long-term prevalence of fatigue, among breast cancer survivors, needs further investigation. Aim: To compare fatigue experienced by long-term breast cancer survivors with that in a reference population and to evaluate the determinants of that fatigue. Design and Setting: A cross-sectional cohort study of 350 breast cancer survivors ≥5 years after diagnosis and a reference population of 350 women matched by age and general practitioner. Method: Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and for cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors. Results: Breast cancer survivors (median 10 years after diagnosis), more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4–2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1–40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6–11.4]). Conclusion: One in four breast cancer survivors experience multidimensional fatigue and fatigue occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.
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Affiliation(s)
- Saskia W. M. C. Maass
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
- Correspondence: ; Tel.: +31-50-3616151; Fax: +31-50-3610739
| | - Daan Brandenbarg
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
| | - Liselotte M. Boerman
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
| | - Peter F. M. Verhaak
- NIVEL, Netherlands Institute of Health Services Research, 3513 CR Utrecht, The Netherlands;
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands;
| | - Annette J. Berendsen
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; (D.B.); (L.M.B.); (A.J.B.)
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Elfimova EM, Mikhailova OO, Khachatryan NT, Litvin AY, Сhazova IE. [Clinical profile of patients with obstructive sleep apnea syndrome in a cardiology hospital]. TERAPEVT ARKH 2020; 92:9-16. [PMID: 32598692 DOI: 10.26442/00403660.2020.04.000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Indexed: 11/22/2022]
Abstract
RELEVANCE Obstructive sleep apnea syndrome (OSAS) is an important medical and social problem due to its high prevalence and impact on quality of life. The relationship between OSAS and cardiovascular pathology has been proven by many studies, which confirms the necessity for early diagnosis of OSAS and its treatment for the prevention of fatal and non-fatal events. AIM to study epidemiological and clinical profile of the patients referred by a cardiologist to a specialized sleep laboratory to verify the diagnosis of OSAS. MATERIALS AND METHODS Object of study 527 patients aged 56.912.5 years who were hospitalized to the Myasnikov Clinical Cardiology Research Institute from 20162018 and had OSAS risk factors. Initially, complaints, medical history, anthropometric data were collected. As a screening survey, questionnaires were conducted using questionnaire scales. Verification of the diagnosis of OSAS and determination of the severity was carried out by cardiorespiratory or respiratory monitoring. Subsequently, 4 groups were formed depending on the presence and severity of OSAS. RESULTS The prevalence of OSAS among patients in a cardiology hospital referred to a verification study was 88.6%. A comparative analysis of the groups revealed a progressive increase in the values of anthropometric indicators with increasing severity of OSAS. No differences were found between the groups by gender and daytime sleepiness on the Karolinska Sleepiness Scale. The average score on the Epworth sleepiness scale was statistically significantly lower only in the group of patients without OSAS when compared with the group with a severe degree of OSAS, and is comparable with the scores in the groups of mild and moderate degrees of OSAS. In a multivariate model of logistic regression, independent predictors of OSAS were identified as: age over 45 years, indications of loud intermittent snoring, frequent nightly urination, overweight or obesity. According to the results of assessing the incidence of various cardiovascular diseases in patients referred to the sleep laboratory, no significant differences were detected. At the same time, a significant difference was found in the frequency of obesity in patients with severe OSAS compared with other groups, as well as the frequency of type 2 diabetes mellitus or impaired glucose tolerance when compared with groups without OSAS, and with mild OSAS. In one-factor logistic regression models, it was found that the likelihood of having a severe degree of OSAS increases with increasing both comorbidity and age. CONCLUSIONS High prevalence of OSAS in patients of a cardiological hospital, referred to a sleep laboratory for verification study, was confirmed. Considering the data that early diagnosis and treatment of OSAS can affect the course of both nosologies, the quality of life and prognosis of these patients, it is advisable to routinely screen and verify the diagnosis of OSAS in patients with cardiovascular diseases.
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Affiliation(s)
| | | | | | - A Y Litvin
- National Medical Research Center for Cardiology.,Pirogov Russian National Research Medical University
| | - I E Сhazova
- National Medical Research Center for Cardiology
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Gholami M, Najafizadeh H, Teimouri H, Ardalan A, Pooria A, Tarrahi MJ. The combined effect of vitamin C and omega-3 polyunsaturated fatty acids on fatigue following coronary artery bypass graft surgery: a triple-blind clinical trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2019; 16:/j/jcim.ahead-of-print/jcim-2018-0113/jcim-2018-0113.xml. [PMID: 31433781 DOI: 10.1515/jcim-2018-0113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 12/24/2018] [Indexed: 11/15/2022]
Abstract
Background Fatigue is a common compliant among patients who undergo coronary artery bypass graft (CABG) surgery. This may affect patients' function in all aspects. A few studies have already assessed the influence of complementary therapies on minimizing fatigue. This study aimed to investigate the combined effect of vitamin C and omega-3 polyunsaturated fatty acids (n-3 PUFA) on fatigue following CABG surgery. Methods In this randomized, triple-blind placebo-controlled trial, 160 patients who already underwent CABG surgery were randomly assigned into an experimental or a control groups. Each group consisted of 80 patients. The experimental group was given both n-3 PUFA and vitamin C the day before surgery. They also received the same supplements in the first 5 days of operation. The control group received only placebo. Subjects in both groups responded to Multidimensional Fatigue Inventory (MFI-20) scale in the beginning, and at the end of the intervention as well as on the fifth day of the operation. Chi-square test and independent t-test were used for data analysis. Results The mean fatigue score in experimental and control groups came up to 62.01 ± 4.06 and 67.92 ± 4.95 (p<0.0001), respectively, which was greater than that of the values we had before intervention. The mean difference of fatigue score was 3.97 ± 3.49 and 9.56 ± 6.41 (p<0.0001) prior and following the intervention, correspondingly. Conclusion Combination of vitamin C and n-3 PUFA effectively reduces post-operative fatigue among patients who undergo CABG surgery.
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Affiliation(s)
- Mohammad Gholami
- School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hassan Najafizadeh
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hassan Teimouri
- Department of Cardiac Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arash Ardalan
- 563 hampshire Rd, Apt 273 Westlake Village, CA 91361, USA
| | - Ali Pooria
- Department of Cardiac Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Javad Tarrahi
- Department of Epidemiology and Biostatistics, School of Health, Isfahan university of Medical Sciences, Isfahan, Iran
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Nagy A, Szabados E, Simon A, Mezey B, Sándor B, Tiringer I, Tóth K, Bencsik K, Csathó Á. Association of Exercise Capacity with Physical Functionality and Various Aspects of Fatigue in Patients with Coronary Artery Disease. Behav Med 2018; 44:28-35. [PMID: 27223330 DOI: 10.1080/08964289.2016.1189395] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to examine associations between exercise capacity-indexed as the metabolic equivalent of the task-and various aspects of subjective fatigue, physical functionality, and depression in patients with coronary artery disease. A cross-sectional design was used. Patients with stable coronary artery disease (N = 240) underwent an exercise stress test and completed self-report assessments of depression, subjective physical limitations, vital exhaustion, and the impact of fatigue on physical, social, and cognitive functions. Associations between exercise capacity and these self-report variables were assessed using bivariate correlations and a series of multivariate regressions. Exercise capacity was negatively associated with vital exhaustion, physical limitations, and impact of fatigue on physical and social functioning but not on cognitive functioning. There was a marginal association between exercise capacity and depression. The associations between exercise capacity and fatigue remained significant even after controlling for effects of age, body mass index, gender, education, and comorbid diabetes mellitus. The main conclusion of the study is that in patients with coronary artery disease, exercise capacity has the strongest predictability for physical fatigue, but, importantly, it also independently predicts the feeling of loss of energy and malaise.
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Corrà U, Agostoni PG, Anker SD, Coats AJS, Crespo Leiro MG, de Boer RA, Harjola VP, Hill L, Lainscak M, Lund LH, Metra M, Ponikowski P, Riley J, Seferović PM, Piepoli MF. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 20:3-15. [PMID: 28925073 DOI: 10.1002/ejhf.979] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/25/2017] [Accepted: 08/01/2017] [Indexed: 12/20/2022] Open
Abstract
Traditionally, the main indication for cardiopulmonary exercise testing (CPET) in heart failure (HF) was for the selection of candidates to heart transplantation: CPET was mainly performed in middle-aged male patients with HF and reduced left ventricular ejection fraction. Today, CPET is used in broader patients' populations, including women, elderly, patients with co-morbidities, those with preserved ejection fraction, or left ventricular assistance device recipients, i.e. individuals with different responses to incremental exercise and markedly different prognosis. Moreover, the diagnostic and prognostic utility of symptom-limited CPET parameters derived from submaximal tests is more and more considered, since many patients are unable to achieve maximal aerobic power. Repeated tests are also being used for risk stratification and evaluation of intervention, so that these data are now available. Finally, patients, physicians and healthcare decision makers are increasingly considering how treatments might impact morbidity and quality of life rather than focusing more exclusively on hard endpoints (such as mortality) as was often the case in the past. Innovative prognostic flowcharts, with CPET at their core, that help optimize risk stratification and the selection of management options in HF patients, have been developed.
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Affiliation(s)
- Ugo Corrà
- Cardiology Division, Istituti Clinici Scientifici Maugeri, Centro Medico di Riabilitazione di Veruno, Veruno, Novara, Italy
| | - Pier Giuseppe Agostoni
- Cardiology Center of Monzino, IRCCS, Milan, Italy; and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Berlin; Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | | | - Maria G Crespo Leiro
- Heart Failure and Heart Transplant Unit, Complejo Hospitalario Universitario A Coruña (CHUAC), CIBERCV, La Coruña, Spain
| | | | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana; and Center for Heart Failure, General Hospital Murska Sobota, Slovenia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet; and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Jillian Riley
- National Heart and Lung Institute, Imperial College, London, UK
| | - Petar M Seferović
- Internal Medicine, University of Belgrade School of Medicine, Belgrade, Serbia
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy
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Kessing D, Denollet J, Widdershoven J, Kupper N. Fatigue and self-care in patients with chronic heart failure. Eur J Cardiovasc Nurs 2015; 15:337-44. [DOI: 10.1177/1474515115575834] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/11/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Dionne Kessing
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Johan Denollet
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
| | - Jos Widdershoven
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
- Department of Cardiology, Elisabeth-TweeSteden Hospital, the Netherlands
| | - Nina Kupper
- Department of Medical and Clinical Psychology, Tilburg University, the Netherlands
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How item banks and their application can influence measurement practice in rehabilitation medicine: a PROMIS fatigue item bank example. Arch Phys Med Rehabil 2011; 92:S20-7. [PMID: 21958919 DOI: 10.1016/j.apmr.2010.08.033] [Citation(s) in RCA: 234] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 07/15/2010] [Accepted: 08/10/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To illustrate how measurement practices can be advanced by using as an example the fatigue item bank (FIB) and its applications (short forms and computerized adaptive testing [CAT]) that were developed through the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. DESIGN Psychometric analysis of data collected by an Internet survey company using item response theory-related techniques. SETTING A U.S. general population representative sample collected through the Internet. PARTICIPANTS Respondents used for dimensionality evaluation of the PROMIS FIB (N=603) and item calibrations (N=14,931). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Fatigue items (112) developed by the PROMIS fatigue domain working group, 13-item Functional Assessment of Chronic Illness Therapy-Fatigue, and 4-item Medical Outcomes Study 36-Item Short Form Health Survey Vitality scale. RESULTS The PROMIS FIB version 1, which consists of 95 items, showed acceptable psychometric properties. CAT showed consistently better precision than short forms. However, all 3 short forms showed good precision for most participants in that more than 95% of the sample could be measured precisely with reliability greater than 0.9. CONCLUSIONS Measurement practice can be advanced by using a psychometrically sound measurement tool and its applications. This example shows that CAT and short forms derived from the PROMIS FIB can reliably estimate fatigue reported by the U.S. general population. Evaluation in clinical populations is warranted before the item bank can be used for clinical trials.
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