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Pavlovic N, Ndumele CE, Saylor MA, Szanton SL, Lee CS, Shah AM, Chang PP, Florido R, Matsushita K, Himmelfarb C, Leoutsakos JM. Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010115. [PMID: 38240158 PMCID: PMC10922158 DOI: 10.1161/circoutcomes.123.010115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/31/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. METHODS We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. RESULTS Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. CONCLUSIONS We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.
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Affiliation(s)
| | | | | | - Sarah L. Szanton
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | | | - Kunihiro Matsushita
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cheryl Himmelfarb
- Johns Hopkins School of Nursing, Baltimore, MD
- Johns Hopkins School of Medicine, Baltimore, MD
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jeannie Marie Leoutsakos
- Johns Hopkins School of Medicine, Baltimore, MD
- Boston College Connell School of Nursing, Boston, MA
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Fatigue in Persons With Heart Failure: A Systematic Literature Review and Meta-Synthesis Using the Biopsychosocial Model of Health. J Card Fail 2022; 28:283-315. [PMID: 34329719 PMCID: PMC8795245 DOI: 10.1016/j.cardfail.2021.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/27/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fatigue is a common and distressing symptom of heart failure (HF) and has important implications for patient-reported and clinical outcomes. Despite being a common and bothersome symptom, fatigue has been understudied in HF. We sought to synthesize existing literature on fatigue in HF through a systematic literature review guided by the biopsychosocial model of health. METHODS AND RESULTS A systematic search of the literature was performed on March 18, 2020, using Pubmed, Embase, and CINAHL. Full-text, primary research articles, written in English, in which fatigue was a primary symptom of interest in adults with a diagnosis of HF, were included. The search yielded 1138 articles; 33 articles that met inclusion criteria were selected for extraction and synthesis. Biological and psychological factors associated with fatigue were New York Heart Association functional class, hemoglobin level, history of stroke, and depression. However, there are limited HF-specific factors linked to fatigue. Social factors related to fatigue included social roles, relationship strain, and loneliness and isolation. Few nonpharmacologic interventions have been tested by show some promise for alleviating fatigue in HF. Studies show conflicting evidence related to the prognostic implications of fatigue. CONCLUSIONS Important biological correlates of fatigue were identified; however, psychological and social variables were limited to qualitative description. There is need for expanded models to better understand the complex physiologic nature of fatigue in HF. Additionally, more research is needed to (1) define the relationships between fatigue and both psychological and social factors, (2) better describe the prognostic implications of fatigue, and (3) develop more therapeutic approaches to alleviate fatigue with the goal of improving overall quality of life.
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Wallström S, Ali L, Ekman I, Swedberg K, Fors A. Effects of a person-centred telephone support on fatigue in people with chronic heart failure: Subgroup analysis of a randomised controlled trial. Eur J Cardiovasc Nurs 2019; 19:393-400. [PMID: 31782661 DOI: 10.1177/1474515119891599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Fatigue is a prevalent symptom that is associated with various conditions. In patients with chronic heart failure (CHF), fatigue is one of the most commonly reported and distressing symptoms and it is associated with disease progression. Person-centred care (PCC) is a fruitful approach to increase the patient's ability to handle their illness. AIM The aim of this study was to evaluate the effects of PCC in the form of structured telephone support on self-reported fatigue in patients with CHF. METHOD This study reports a subgroup analysis of a secondary outcome measure from the Care4Ourselves randomised intervention. Patients (n=77) that were at least 50 years old who had been hospitalized due to worsening CHF received either usual care (n=38) or usual care and PCC in the form of structured telephone support (n=39). Participants in the intervention group created a health plan in partnership with a registered nurse. The plan was followed up and evaluated by telephone. Self-reported fatigue was assessed using the Multidimensional Fatigue Inventory 20 (MFI-20) at baseline and at 6 months. Linear regression was used to analyse the change in MFI-20 score between the groups. RESULTS The intervention group improved significantly from baseline to the 6-month follow-up compared with the control group regarding the 'reduced motivation' dimension of the MFI-20 (Δ -1.41 versus 0.38, p=0.046). CONCLUSION PCC in the form of structured telephone support shows promise in supporting patients with CHF in their rehabilitation, improve health-related quality of life and reduce adverse events. TRIAL REGISTRATION ISRCTN.com ISRCTN55562827.
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Affiliation(s)
- Sara Wallström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lilas Ali
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College, London, UK
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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Ma C. Rehospitalisation rates and associated factors within 6 months after hospital discharge for patients with chronic heart failure: A longitudinal observational study. J Clin Nurs 2019; 28:2526-2536. [DOI: 10.1111/jocn.14830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/21/2019] [Accepted: 02/09/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Chunhua Ma
- School of Nursing; Guangzhou Medical University; Guangzhou China
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Tsai MF, Tsay SL, Moser D, Huang TY, Tsai FC. Examining symptom trajectories that predict worse outcomes in post-CABG patients. Eur J Cardiovasc Nurs 2018; 18:204-214. [PMID: 30379108 PMCID: PMC6399732 DOI: 10.1177/1474515118809906] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Coronary artery bypass grafting is one of the most common interventional revascularisation procedures used to treat coronary artery disease worldwide. With a wide variability in postoperative cardiac symptoms, identification of symptom trajectories during the 3-month postoperative recovery period may improve clinicians' abilities to support symptom recovery. AIMS To identify distinct trajectories of cardiac symptoms seen over time in a cohort of patients during the 3-month post-coronary artery bypass grafting period, and determine clinical characteristics associated with different symptom trajectories postoperatively. METHODS A prospective trial used the cardiac symptom survey to determine patient symptoms at baseline prior to surgery, and at 1 week, 6 weeks and 3 months following coronary artery bypass grafting. A latent class growth model and multivariate logistic regression analyses were used. RESULTS Data were obtained from patients ( N=198) undergoing coronary artery bypass grafting in six medical centres of Taiwan, through patient medical records and interviews. Based on their frequency, trajectories were explored for the six most common postoperative symptoms including angina, dyspnoea, fatigue, depression, sleep problems and anxiety. We identified two to three distinct classes of trajectories for each symptom. Age, longer intensive care unit stay, fewer vessels bypassed, off-pump coronary artery bypass grafting, smoking history and lack of regular exercise were associated with worse symptom outcome trends over time. CONCLUSIONS Using this unique trajectories-based research method, we are able to achieve a better understanding of symptom recovery patterns over time among coronary artery bypass grafting patients. Recognising risk factors and potential recovery patterns prior to surgery may allow healthcare providers to deliver targeted discharge planning and individualised care after coronary artery bypass grafting.
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Affiliation(s)
- Ming-Fen Tsai
- 1 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | | | - Debra Moser
- 3 University of Kentucky, College of Nursing, USA
| | - Tsuey-Yuan Huang
- 4 Chang Gung University of Science and Technology, College of Nursing, Taiwan
| | - Feng-Chun Tsai
- 5 Chang Gung Memorial Hospital, Division of Cardiovascular Surgery, Taiwan
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Schjoedt I, Sommer I, Bjerrum MB. Experiences and management of fatigue in everyday life among adult patients living with heart failure. ACTA ACUST UNITED AC 2016; 14:68-115. [DOI: 10.11124/jbisrir-2016-2441] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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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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Lainscak M, Blue L, Clark AL, Dahlström U, Dickstein K, Ekman I, McDonagh T, McMurray JJ, Ryder M, Stewart S, Strömberg A, Jaarsma T. Self-care management of heart failure: practical recommendations from the Patient Care Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2014; 13:115-26. [DOI: 10.1093/eurjhf/hfq219] [Citation(s) in RCA: 278] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mitja Lainscak
- Division of Cardiology; University Clinic of Respiratory and Allergic Diseases Golnik; Golnik 36 SI-4204 Golnik Slovenia
- Applied Cachexia Research, Department of Cardiology; Charité, Campus Virchow-Klinikum; Berlin Germany
| | | | | | - Ulf Dahlström
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences; Linkoping University; Linkoping Sweden
| | - Kenneth Dickstein
- Stavanger University Hospital; Stavanger Norway
- Institute of Internal Medicine; University of Bergen; Bergen Norway
| | - Inger Ekman
- Institute of Health and Care Sciences; The Sahlgrenska Academy at Gothenburg University; Gothenburg Sweden
| | | | | | - Mary Ryder
- Heart Failure Unit; St Vincent's Healthcare Group; Dublin Ireland
| | - Simon Stewart
- Preventative Health; Baker IDI, Heart and Diabetes Institute; Melbourne Australia
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Division of Nursing, Faculty of Health Sciences; Linkoping University; Linkoping Sweden
| | - Tiny Jaarsma
- ISV, Department of Social and Welfare Studies, Faculty of Health Sciences; Linkoping University; Linkoping Sweden
- Department of Cardiology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
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Schjoedt I, Sommer I, Bjerrum M. Adult patients living with heart failure: Experiences and management of fatigue in everyday life - a systematic review protocol of qualitative evidence. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/01938924-201311040-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Fink AM, Gonzalez RC, Lisowski T, Pini M, Fantuzzi G, Levy WC, Piano MR. Fatigue, inflammation, and projected mortality in heart failure. J Card Fail 2013; 18:711-6. [PMID: 22939040 DOI: 10.1016/j.cardfail.2012.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/28/2012] [Accepted: 07/11/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Fatigue is a prominent and poorly understood symptom of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to determine whether fatigue correlated with immune biomarkers and prognosis. METHODS/RESULTS In patients with HFrEF (N = 59) and healthy controls (N = 25), we prospectively measured fatigue (Profile of Mood States), depressive symptoms (Patient Health Questionnaire-8), sleep quality (Pittsburgh Sleep Quality Index), and immune biomarkers (plasma C-reactive protein [CRP], tumor necrosis factor-α [TNFα], and interleukins [IL-6 and IL-10]). Seattle Heart Failure Model (SHFM) mortality risk scores were determined. Patients with HFrEF had significantly greater fatigue and depressive symptoms and poorer sleep quality compared to control subjects. When controlling for depressive symptoms, however, fatigue did not differ significantly between patients with HFrEF and controls. Patients with HFrEF had significantly lower levels of IL-10 compared to controls. Cytokines did not correlate significantly with fatigue, but fatigue was significantly associated with higher SHFM scores. CONCLUSIONS Depressive symptoms were an important covariate of fatigue in patients with HFrEF. Our study findings were the first to show a positive association between fatigue and the SHFM score, indicating that fatigue was associated with poorer prognosis.
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Affiliation(s)
- Anne M Fink
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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The experience of fatigue as a distressing symptom of heart failure. Heart Lung 2012; 41:484-91. [DOI: 10.1016/j.hrtlng.2012.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 04/08/2012] [Accepted: 04/10/2012] [Indexed: 11/22/2022]
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Somatic depression predicts mortality in chronic heart failure: can this be explained by covarying symptoms of fatigue? Psychosom Med 2012; 74:459-63. [PMID: 22511727 DOI: 10.1097/psy.0b013e31824ef2f4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Somatic symptoms of depression predict mortality in chronic heart failure (CHF), but symptoms of fatigue that are common to both conditions may confound this association. We therefore examined the contribution of fatigue to the association between somatic depression and increased risk of mortality in patients with CHF. METHODS At baseline, 380 consecutive patients with CHF were assessed for symptoms of depression, exertion fatigue, and general fatigue. Demographic and clinical data were obtained from the patients' medical records or the treating cardiologist. The primary end point was mortality after a median follow-up of 2.3 years (range = 0.15-4.76 years). RESULTS At follow-up, 63 patients (16.6%) had died. Exertion fatigue (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.01-1.06, p = .003), not general fatigue, was associated with an increased risk of mortality in CHF. Multivariate Cox regression analysis revealed that somatic symptoms of depression (HR = 1.41, 95% CI = 1.05-1.88, p = .02) were independently associated with increased mortality risk and that this association could not be explained by exertion fatigue (HR = 1.02, 95% CI = 0.97-1.05, p = .31). CONCLUSIONS The adverse effect of somatic depression on prognosis in CHF was not confounded by exertion fatigue. Behavioral interventions should focus not only on fatigue but also on other somatic manifestations of depression in patients with CHF.
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Osthus A, Aarstad A, Olofsson J, Aarstad H. Health-Related Quality of Life Scores in long-term head and neck cancer survivors predict subsequent survival: a prospective cohort study. Clin Otolaryngol 2011; 36:361-8. [DOI: 10.1111/j.1749-4486.2011.02342.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Patterns of fatigue in elderly heart failure patients measured by a quality of life scale (Minnesota living with heart failure). Eur J Cardiovasc Nurs 2011; 11:439-44. [DOI: 10.1016/j.ejcnurse.2011.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Smith ORF, Kupper N, de Jonge P, Denollet J. Distinct trajectories of fatigue in chronic heart failure and their association with prognosis. Eur J Heart Fail 2010; 12:841-8. [PMID: 20495205 PMCID: PMC2913047 DOI: 10.1093/eurjhf/hfq075] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS To identify distinct trajectories of fatigue over a 12-month period and to examine their impact on mortality in chronic heart failure (CHF). METHODS AND RESULTS Consecutive CHF patients (n = 310) were assessed at baseline and at 2- and 12-month follow-up for symptoms of exertion and general fatigue. Latent growth mixture modelling was used to examine the course of fatigue over time. The endpoint was mortality following the 12-month assessment of fatigue. Over the initial 12-month follow-up, six distinct trajectories for exertion fatigue and four distinct trajectories for general fatigue were identified. Beyond the 12-month follow-up (mean follow-up period, 693 days), 50 patients (17%) had died. After controlling for standard risk factors and disease severity, both severe exertion fatigue [hazards ratio (HR) = 2.59, 95% confidence interval (CI): 1.09-6.16, P = 0.03] and severe general fatigue (HR = 3.20, 95% CI: 1.62-6.31, P = 0.001) trajectories predicted an increased mortality rate (29 vs. 19% and 28 vs. 14%, respectively). The low exertion fatigue trajectory was associated with a decreased mortality risk (3 vs. 19%, HR = 0.12, 95% CI: 0.02-0.93, P = 0.04). CONCLUSION Fatigue trajectories varied across CHF patients and had a differential effect on mortality. Persistent severe fatigue was a predictor of poor prognosis. These results may help identify distinct groups of CHF patients with potentially differential risks of adverse health outcomes.
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Affiliation(s)
- Otto R F Smith
- Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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