Fatigue in older adults with stable heart failure

Contemporary Nurse, 2019

Aims: To explore the experience of fatigue and living with fatigue in persons with advanced heart failure. Design: Single-setting, qualitative interview study. Methods: In-depth in-person interviews were conducted with participants from November 2012 to June 2013. Participant responses to open-ended questions were analysed using thematic content analysis. Inclusion criteria were: 18 years and older, diagnosis of New York Heart Association class III-IV heart failure with reduced ejection fraction by a consultant cardiologist, and able to participate in conversational-style interviews in their own language. Major exclusion criteria was cognitive deficit identified by Abbreviated Mental Test Score. Twenty-three adults participated in the study. Results: Participants (age 72.5 ± 9.5 years, 10/23 female, 17/23 New York Heart Association class III, and 6/23 class IV) identified experiencing fatigue almost daily with over 14/23 reporting it as their worst symptom or combined worst symptom with breathlessness. 9/23 identified fatigue as their second-worst symptom. Three key themes were identified: fatigue as a physical barrier, psychological response to fatigue, and living with fatigue as a part of daily life. The three themes however combine to influence a patients well-being and we suggest need to be acknowledged when planning self-care management. Conclusion: As heart failure progresses fatigue influences patients' daily life and may negatively affect self-care abilities however patients strive to adapt to these limitations. Understanding the patient experience of fatigue and living with fatigue is important to optimize health management strategies. Impact:  What problem did the study address? How fatigue is experienced by patients with heart failure as their condition progresses. This is currently unknown  What were the main findings? 14/23 patients reported fatigue as their worse symptom Patients reported feeling fatigue every day Fatigue affects physical and psychological health in patients with advanced heart failure  Where and on whom will the research have impact? This research will add to the evidence pertaining to patients experience of fatigue in advanced heart failure. The pattern of fatigue presented could inform patient centred care, including selfcare management strategies for patients in this stage of disease progression. Routine monitoring of fatigue must include assessing patient perceptions which may lead to timely recognition of progression and appropriate action taken to improve patient outcomes.

European Journal of Heart Failure, 2007

Objective: To examine the role of clinical and psychological characteristics as predictors of fatigue in CHF. Background: Little is known about predictors of fatigue in CHF. Next to heart failure characteristics, depressive symptoms and typeD personality may explain individual differences in fatigue. Methods: At baseline, 136 CHF outpatients (age ≤ 80 years) completed a questionnaire to assess depressive symptoms, typeD personality and cardiac symptoms. At one-year follow-up, they completed the Dutch Exertion Fatigue Scale and the Fatigue Assessment Scale to assess symptoms of fatigue. Medical information was obtained from the patients' medical records. Results: Exertion fatigue and general fatigue were identified as different manifestations of fatigue. We found that exertion fatigue at 12-month follow-up was predicted by decreased exercise capacity (β = −.35; p b .001), dyspnoea (β = 24; p = .002), hypertension (β = .16; p = .03), and depressive symptoms (β = .16; p = .05). In contrast, general fatigue at 12-month follow-up was predicted by dyspnoea (β = .24; p = .003), depressive symptoms (β = .27; p b .001), typeD personality (β = 17; p = .03), and sleep problems (β = .20; p = .01). Together, these variables explained 32% and 37% of the variance, respectively. Conclusion: The present study showed that fatigue was related to both clinical and psychological characteristics. The use of this knowledge may lead to a better understanding and treatment of the clinical manifestations of fatigue in CHF.

Journal of Cardiovascular Nursing, 2019

Background: Fatigue and depression based on self-report and diagnosis are prevalent in patients with heart failure and adversely affect high rates of hospitalization and emergency department visits, which can impact use of medical services. The relationships of fatigue and depression to use of medical services in patients with preserved and reduced left ventricular ejection fraction (LVEF) may differ. Purpose: We examined the associations of diagnoses of fatigue and depression with use of medical services in patients with preserved and reduced LVEF, controlling for covariates. Methods: Data were collected on fatigue, depression, covariates, and use of medical services. Patients (N = 582) were divided into 2 groups based on LVEF (<40%, reduced LVEF; ≥40%, preserved LVEF). Multiple linear regression analyses were used to analyze the data. Results: A diagnosis of fatigue was a significant factor associated with more use of medical services in the total sample (β = .18, P < .001, R 2 = 54%) and patients with reduced LVEF (β = .13, P = .008, R 2 = 54%) and also preserved LVEF (β = .21, P < .001, R 2 = 54%), controlling for all covariates, but a diagnosis of depression was not. Conclusions: This study demonstrates the important roles of a diagnosis of fatigue in use of medical services. Thus, fatigue needs to be assessed, diagnosed, and managed effectively.

2009

Little is known about the factors that are associated with changes in fatigue in chronic heart failure (CHF). Moreover, it is unclear whether these changes have prognostic impact. The aim of this study was to examine these issues. Methods and results Three hundred and eighty-seven CHF patients were assessed twice (at baseline and at 12-month follow-up) for exertion and general fatigue. Regression models were developed to assess whether baseline characteristics predicted changes in fatigue and to assess the effect of changes in fatigue on cardiac events occurring beyond 12-months of follow-up. An increase in exertion fatigue over a 12-month period was predicted by higher left ventricular ejection fraction (P ¼ 0.02) and cognitive-affective depressive symptoms (P ¼ 0.03) at baseline, and not having a biventricular pacemaker shortly after baseline (P ¼ 0.02), whereas an increase in general fatigue was only predicted by cognitiveaffective depressive symptoms (P ¼ 0.002). One hundred and forty-three patients (37%) experienced an event (readmitted, 117; death, 26). An increase in exertion fatigue was associated with a near twofold increased risk of events beyond 12-months of follow-up (hazard ratio ¼ 1.78; 95% confidence interval 1.18-2.68, P ¼ 0.006), while controlling for standard cardiac risk factors. Conclusion Baseline clinical and psychosocial factors predicted changes in fatigue. Increased exertion fatigue independently predicted an increased risk of cardiac re-admission or death.

Research in Nursing & Health, 2006

Self-care management of symptoms for persons with heart failure (HF) may only be successful when their representations regarding their symptoms are accurate and linked to appropriate behavioral strategies. The purpose of this secondary data analysis (N ¼ 169 women with HF) was to describe representations of one HF-related symptom, fatigue, and examine whether representations were related to physical health status, health care utilization, and psychological well-being and whether they differed by age. Overall, women agreed that fatigue was chronic, caused by HF, and had serious consequences. Midlife women reported more emotional distress and severe consequences from fatigue than older women. Higher levels of emotional distress due to fatigue from HF were associated with higher levels of health care utilization. ß

Revista Latino-Americana de Enfermagem, 2009

This is a literature review report to describe characteristics (frequency, intensity and correlates) of fatigue in cases of heart failure. MedLine and LILACS were the examined databases. Out of 89 articles identified, 27 were selected for data extraction. Fatigue frequency ranged from 69% to 88% and fatigue intensities are incomparable due to differences in measurement scales. Quality of life, illness progression, physical activity, social and demographic variables, comorbidity, treatment and who assessed the fatigue were variables studied in relation to fatigue. The diversity of fatigue assessment methods causes difficulties to integrate results on fatigue frequency, characteristics and related factors. No study was found on fatigue characteristics in samples of Brazilian heart failure patients.

European Journal of Cardiovascular Nursing, 2007

Introduction: Fatigue is a common symptom in patients with chronic heart failure (CHF) and has a major impact on their daily life activities. The purpose of this study was to examine the prevalence and severity of fatigue, conceptualized as a multiple dimensional symptom, and to determine the influence of sense of coherence and uncertainty on the fatigue experience in patients with CHF. Methods: Ninety-three consecutive patients, hospitalized with a diagnosis of CHF, completed the Multidimensional Fatigue Inventory Scale (MFI-20), Cardiovascular Population Scale (CPS), and Sense of Coherence Scale (SOC) and were classified according to the New York Heart Association (NYHA) functional classification criteria. Associations between selected variables were explored with multiple regression analysis. Results: The patients reported high prevalence and severity in the physical dimensions of fatigue. Uncertainty was associated positively with tiredness and reduced functional status. High age predicted reduced motivation and the ability to concentrate were affected by low SOC. Conclusion: Fatigue is a prevalent and distressing experience in patients with CHF, where a variety of factors influence different dimensions of the fatigue experience. Recognising this, symptom management must be directed towards comprehensive assessment and a broad approach in interventions aimed at alleviating fatigue.

2006

Objectives. Congestive heart failure (CHF) is a pervasive cardiac syndrome with an elevated prevalence in the older population. High level of psychological distress has been reported in this patient group, resulting in more hospital readmissions, poorer quality of life, and increased mortality. Yet, little is known about its relating factors. This study identified the significant demographic, clinical, and psychosocial factors relating to psychological distress in CHF patients.

The Journal for Nurse Practitioners, 2020

Heart failure is a chronic condition that negatively impacts sleep, fatigue, and quality of life. The purpose of this study was to explore sleep, fatigue, and quality of life among patients with heart failure. There were significant differences between the study variables, and these were moderately correlated. Together, sleep quality and fatigue predicted 40% of the variance in the physical and mental components of quality of life. The findings of this study support the use of sleep and fatigue assessments in patients with heart failure.

Journal of Psychosomatic Research, 2009

Objective: The aim of this study was to examine the components of vital exhaustion (VE) in chronic heart failure (CHF) patients and to examine whether psychological symptom profiles based on these components are differently associated with health status and cardiac rehospitalization. Methods: Consecutive CHF patients (N=381) were assessed for VE at baseline using the Maastricht Questionnaire and assessed for health status at 6month follow-up using the Minnesota Living with Heart Failure Questionnaire. Information on cardiac rehospitalization was obtained from the patients' medical records. Results: Principal component analysis revealed four essential features of VE: fatigue, cognitive-affective depressive symptoms, sleep difficulties, and lack of concentration. Latent class cluster analysis using these components identified three subgroups with different symptom profiles: a subgroup without VE, a first vitally exhausted subgroup (VE1; fatigue and lack of concentration, but with a relative absence of cognitive-affective depressive symptoms and sleep difficulties), and a second more severe, vitally exhausted subgroup (VE2; elevated levels of all components). Both vitally exhausted subgroups were more likely to have impaired health status (VE1: β=.36, Pb.001; VE2: β=.71, Pb.001). VE2 was also associated with an increased risk of cardiac rehospitalization at 6-month follow-up (odds ratio=2.98; 95% confidence interval=1.01-8.83; P=.049). Conclusions: VE in CHF comprised four components (fatigue, cognitive-affective depressive symptoms, sleep difficulties, and lack of concentration) from which three different symptom profiles were derived. Subgroups with symptoms of VE were associated with adverse clinical outcome in CHF. In clinical practice, these results may help identify distinct groups of patients with potentially differential risks of adverse health outcomes.