Chronic fatigue after myocardial infarction: what of rest and recuperation?

Abstract

Fatigue is a symptom associated with living with chronic conditions. Chronic fatigue and depression, alone or together, are also associated with having had a myocardial infarction (MI). The paper by Alsén et al. (2008) in this issue of Journal of Advanced Nursing describes their study of chronic fatigue in people who have experienced MI. They used grounded theory methods and identified a central theme of living with incomprehensible fatigue along with categories, which refer to its consequences. They set their study and findings in the context of research literature where fatigue has been defined as having a number of constructs such as general fatigue, mental fatigue, reduced motivation and reduced activity. Fatigue also forms part of an adaptive continuum with tiredness and exhaustion as beginning and end points, with each state being an adaptive response to stressors. This is an important study that contributes to our understanding of the psychological and physical impacts of life events and illness on people’s health and wellbeing. Alsén et al. conclude with the contention that identifying stressors and coping strategies following MI could prevent the aggravation of fatigue and that failure to detect tiredness, fatigue and exhaustion by health professionals can lead to incorrect interventions. This paper prompted my thinking about the underlying causes of fatigue and in this case, post-MI, it could also have physiological bases because of illness, raised cardiac enzymes, damaged heart muscle, altered electrical and neural transmissions and a threatened immune system. As Alsén et al. identify, chronic fatigue could be a consequence of MI or a precursor as a result of life stressors and coping responses. What then of the role of rest and recuperation? In order for people and their bodies to heal and recover, time is required for adequate rest and recuperation. In these days of emphasis on efficiency in health services people are expected to recover quickly and to return to being as active as possible. The health service focus is on avoiding hospitalization and delayed discharges, shortened lengths of stay and rapid throughput of patients for cost efficiencies and the prevention of iatrogenic events, such as hospital acquired infections or consequences of immobility. The focus of care is on function with rehabilitation returning people to the resumption of independence, activities of daily living and productivity. Convalescence does not feature in current care processes or pathways, particularly in Western cultures. The days of ‘lying-in’ and ‘1 week’s bed rest as the doctor ordered’ have long gone. In the United Kingdom even respite care is no longer a feature of health care but has been deemed social care. We could take heed of Eastern cultures, in particular the teachings of Buddhism and the importance of ‘being’ and appreciating the positive aspects of each moment lived. In this modern day 24/7 culture, with instant messaging (texts or emails), news transmission and work it is a challenge for people to rest, relax and reflect. In order to prevent chronic fatigue or promote recovery, adequate rest and recuperation in conjunction with individuals’ needs and expressed preferences should be what health professionals recommend.