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Published on: February 26, 2013
Factors Associated With Fatigue in Persons With Atrial Fibrillation in the Atherosclerosis Risk in Communities (ARIC)
Kathryn A Wood1, Aniqa B Alam2, Lin Yee Chen3
1Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
Insights
Biomarkers for cardiac injury, like NT-proBNP and hs-TnT, are linked to fatigue in atrial fibrillation (AF) patients. These findings suggest cardiac overload or injury, not inflammation, may drive AF-related fatigue.
Area of Science:
- Cardiology
- Biomarkers
- Patient-reported outcomes
Background:
- Atrial fibrillation (AF) affects millions, with fatigue being a common yet poorly understood symptom.
- Existing research on chronic fatigue in conditions like cancer and HIV implicates inflammation, but AF-fatigue mechanisms remain unclear.
- This study sought to identify biomarkers and correlates of fatigue in individuals with AF.
Purpose of the Study:
- To investigate the association between cardiac injury biomarkers and fatigue in atrial fibrillation patients.
- To explore the relationship between these biomarkers, depressive symptoms, and physical functioning in the AF population.
Main Methods:
- Utilized data from 446 participants with AF from the ARIC study (visit 5, 2011-2013).
- Employed multiple linear regression to assess associations between hs-TnT, NT-proBNP, hsCRP levels and fatigue, depressive symptoms, and physical function scores.
- Transformed biomarker data using natural-log transformation for analysis.
Main Results:
- Elevated NT-proBNP levels were associated with increased AF-fatigue, depressive symptoms, and reduced physical function.
- Higher hs-TnT levels correlated with greater AF-fatigue and diminished physical function.
- No significant association was observed between hsCRP levels and AF-fatigue.
Conclusions:
- Increased cardiac injury biomarkers (NT-proBNP, hs-TnT) are linked to fatigue in AF patients.
- Depressive symptoms and decreased physical function are also associated with AF-fatigue.
- Findings suggest cardiac overload or myocardial injury pathways, rather than inflammation, are more pertinent to AF-fatigue.
Background:
Atrial fibrillation (AF) is a common cardiac arrhythmia affecting over 6 million people in the U.S. Fatigue is a frequent symptom of AF, yet no underlying biological mechanisms have been identified in AF-related fatigue as in other chronic conditions such as cancer or HIV fatigue (inflammation, tissue injury). We aimed to identify biomarkers and correlates of AF-fatigue in ARIC participants.
Methods:
Participants with AF from ARIC visit 5 (2011-2013) were included in the study. Multiple linear regression was used to estimate the association of high sensitivity troponin (hs-TnT), N-terminal fragment B-type natriuretic peptide (NT-proBNP) and high sensitivity C-reactive protein (hsCRP) levels with self-reported fatigue (SF-12 and PROMIS Fatigue Scale), depressive symptoms (Center for Epidemiological Studies Depression survey), and physical functioning (Short Physical Performance Battery) scores. All biomarkers underwent natural-log transformation.
Results:
There were 446 participants (mean age: 78 y ± 5; 44% women). In adjusted analyses, NT-proBNP was associated with AF-fatigue (β: 0.11, 95% CI: 0.03, 0.19), increased depressive symptoms (β: 0.44, 95% CI: 0.19, 0.70), and decreased physical function (β: -0.48, 95% CI: -0.72, -0.23). Hs-TnT was also associated with elevated AF-fatigue (β: 0.24, 95% CI: 0.09, 0.39) along with decreased physical function (β: -1.19, 95% CI: -1.64, -0.75). No significant associations were found with hsCRP and fatigue.
Conclusion:
Increased levels of cardiac injury biomarkers, depressive symptoms, and decreased physical function were associated with AF-fatigue. Inflammation was not associated with AF-fatigue; other physiological pathways, such as cardiac overload or myocardial injury may be more relevant in AF-fatigue.
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