Depressive Symptoms Drive Fatigue Following Congestion in Heart Failure

Abstract

Background Physical and depressive symptoms in heart failure (HF) are drivers of quality of life and healthcare use. Intrathoracic impedance, an objective measure of pulmonary congestion in HF, has been associated with both physical and psychological symptoms. Little is known, however, about how intrathoracic impedance (Optivol® Index), and physical and psychological symptoms are inter-related. Objective To understand the mechanisms by which an objective measure of congestion is related to physical or depressive symptoms. Methods Adults with symptomatic HF and an Optivol device had congestion data (Optivol Index>60Ω threshold) collected over 180 days prior to completing surveys of physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early and Subtle Symptoms subscales) and depressive symptoms (9-item Patient Health Questionnaire). Symptoms associated with congestion were identified based on Pearson correlation (p value Results Participants (n=49) were mostly male (61%), on average 62 years old, with mainly non-ischemic (80%), NYHA Class III/IV HF (63%). Fatigue (r= 0.29) and depressive symptoms (r= 0.51) were the only symptoms correlated with congestion (p value Conclusion Optivol-detected congestion events in the previous 6 months were associated with more depressive symptoms and fatigue. Depression mediated the effects of fatigue from congestion events. Reducing congestion in HF may mitigate depression and reduce fatigue. In addition, this study highlights the importance of addressing depressive symptoms in patients with HF.