Abstract 18355: Predictors of Fatigue in Heart Failure

Abstract

Introduction Although fatigue is regarded as a prototypical symptom of heart failure (HF), little is known about its prevalence, severity and predictors. We examined which baseline characteristics predicted fatigue at baseline in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Methods CORONA enrolled 5011 patients aged ≥ 60 years with symptomatic (NYHA class II-IV), ischemic, systolic (LVEF ≤ 40%) heart failure. Fatigue “during the past few days” was measured using a five point scale: 0 none, 1 on heavy exertion, 2 moderate exertion, 3 slight exertion, 4 at rest. For the purposes of analysis, patients were grouped into 3 categories: fatigue score 0-1 (n= 588), 2 (n=1,898) and 3-4 (n= 2,525). The 3 category fatigue outcome was analyzed using ordered logistic regression, checking covariates for linearity and the proportional odds assumption. Only baseline variables that were significant (P< 0.05) predictors of fatigue in univariate analyses were included in the multivariable models. Results Fatigue was reported by 96% of patients with half scoring 4 or 5 out of a possible score of 5. The baseline variables which were independent predictors of fatigue are shown in the table. NYHA class was the strongest predictor. Both atrial fibrillation/flutter and higher heart rate were predictors. Lower serum creatine kinase (CK) levels were associated with more fatigue. Adding drug therapy made little difference to the models although some treatments were additional predictors of fatigue (e.g. diuretics) whereas others (e.g. beta-blockers) were not. Notable by their absence as predictors were LVEF, blood pressure, body mass index, diabetes, renal dysfunction and NT proBNP. Discussion Fatigue was an almost universal symptom and was pronounced in many patients. Fatigue was associated with NYHA class but not measures of cardiac function (LVEF, NT proBNP). Interestingly, fatigue was associated with lower CK, probably indicative of lower muscle mass.