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

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

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

20 Citaten (Scopus)
239 Downloads (Pure)


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.

Originele taal-2English
Pagina's (van-tot)841-848
Aantal pagina's8
TijdschriftEuropean Journal of Heart Failure
Nummer van het tijdschrift8
StatusPublished - aug-2010

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