Distinct trajectories of fatigue in chronic heart failure and their association with prognosis

Otto R. F. Smith, Nina Kupper, Peter de Jonge, Johan Denollet*

*Corresponding author for this work

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20 Citations (Scopus)
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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.

Original languageEnglish
Pages (from-to)841-848
Number of pages8
JournalEuropean Journal of Heart Failure
Volume12
Issue number8
DOIs
Publication statusPublished - Aug-2010

Keywords

  • Chronic heart failure
  • Fatigue
  • Mortality
  • Latent class mixture modelling
  • DEPRESSIVE SYMPTOMS
  • MYOCARDIAL-INFARCTION
  • VITAL EXHAUSTION
  • DISEASE
  • PREDICTORS
  • LIFE
  • INTERVENTION
  • INFLAMMATION
  • HEALTH
  • PERIOD

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