Abstract
Introduction Fatigue is one of the most common and distressing symptoms of heart failure (HF). It consists of two types: general and exertional. Although it’s common, little is known about whether and which type of fatigue is associated with patient reported and clinical outcomes. We conducted a secondary data analysis of the Atherosclerosis Risk in Communities (ARIC) study to determine if fatigue type predicts key patient reported and clinical outcomes in persons with HF. Methods This analysis included 1,068 individuals with a diagnosis of prevalent HF at visit 5 (2011-2013) of the ARIC study with available survey data on general and exertional fatigue. Four fatigue subtypes were identified previously through latent class analysis on general and exertional fatigue survey items in this sample. These fatigue subtypes are: 1) High general & exertional, 2) High general & low exertional, 3) Moderate general & exertional, and 4) Low/No fatigue (reference category). To assess the relationship between fatigue subtype and outcomes, we used latent class regression, regressing HF hospitalization, quality of life (QOL, SF-12 scale) and mortality on fatigue subtype, adjusting for covariates (demographics, clinical comorbidities, and medications). Results Our sample was 54% female and 38% Black, with a mean age of 77 ± 5.5. Those with the high general & exertional fatigue subtype had 2.2 times higher likelihood of HF hospitalization than those with the low/no fatigue subtype (OR = 2.2; 95%CI = 1.2, 4.1). Those with the high general & exertional fatigue subtype had significantly poorer mean physical (50.3 v 64.6, p<0.001) and mental (49.3 v 58.0, p<0.001) QOL than those with the low/no fatigue subtype. Those with the moderate general & exertional fatigue subtype also had significantly poorer physical QOL than the low/no fatigue subtype (61.9 v 64.6, p<0.001). There were no significant differences in mortality between fatigue subtypes. Conclusions Fatigue subtype in persons with HF is associated with HF admissions and quality of life. It will be important to elucidate the pathways underlying the development of fatigue and to determine whether targeting fatigue can improve clinical outcomes.
Published Version
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