Patient-rated changes in fatigue over a 12-month period predict poor outcome in chronic heart failure

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.

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 = 0.02) and cognitive-affective depressive symptoms (P = 0.03) at baseline, and not having a biventricular pacemaker shortly after baseline (P = 0.02), whereas an increase in general fatigue was only predicted by cognitive-affective depressive symptoms (P = 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 two-fold increased risk of events beyond 12-months of follow-up (hazard ratio = 1.78; 95% confidence interval 1.18-2.68, P = 0.006), while controlling for standard cardiac risk factors.

Baseline clinical and psychosocial factors predicted changes in fatigue. Increased exertion fatigue independently predicted an increased risk of cardiac re-admission or death.