Fatigue and self-care in patients with chronic heart failure.

Abstract

Fatigue is a debilitating and highly prevalent symptom in patients with chronic heart failure (HF) possibly complicating HF self-care behaviour which is crucial for maintaining health. The purpose of this study was to examine whether general and exertion fatigue are distinctively associated with self-care in patients with chronic HF. In total, 545 outpatients with chronic HF (mean age=66.2 years; 75% male) completed measures of general fatigue (i.e. a sustained sense of exhaustion including mental efforts), exertion fatigue (i.e. fatigue directly related to physical activity), sleep problems, mood symptoms and HF self-care behaviour at baseline, 12-, and 18-month follow-up. Linear mixed modelling results showed that general and exertion fatigue were significantly associated with poor HF self-care (estimate=0.10, p=0.004; estimate=0.06, p=0.01, respectively) and poor consulting behaviour (estimate=0.05, p=0.04; estimate=0.04, p=0.007, respectively) over time, independent of sleep and mood problems, and other clinical covariates. Exertion fatigue was associated with supplementary determinants. This is the first prospective study demonstrating that general and exertion fatigue were both associated with poor HF self-care, which could not be explained by sleep problems or mood symptoms, and was independent of clinical indicators of disease severity. Treatment of fatigue problems may improve HF self-care skills and ultimately quality of life and cardiovascular outcomes. Further research is needed to examine this potential causal relationship.