Fatigue: The Misunderstood Symptom of Heart and Lung Disease

Abstract

Fatigue is a common symptom experienced by patients with chronic heart and lung failure that can lead to adverse health outcomes, such as frailty. To better understand the nature of fatigue in heart and lung failure, a meta-synthesis of qualitative studies was conducted to explore patients' experiences of fatigue while living with heart failure (HF) or chronic obstructive pulmonary disease (COPD). Understanding the nature and impact of fatigue in these chronic conditions can guide the evaluation and management of fatigue and inform future development of therapeutic interventions to decrease fatigue and improve quality of life. Three databases (Embase, PubMed, CINAHL) were searched for qualitative studies published in the last ten years that describe fatigue in patients with HF or COPD. Studies with descriptions of fatigue, either as the primary focus or as a component to a symptom profile, were synthesized, integrated, and interpreted. 13 studies describing the experience of fatigue in HF and COPD across 444 participants were identified and included in the analysis. Across studies, fatigue was described as an all-consuming experience of lethargy, lack of energy, and physical weakness that was refractory to rest and worsened over time. Fatigue was deeply disruptive to daily life, impacting both physical and social activities, and leading to a loss of independence and isolation. This disruption had significant physical and psychological consequences, which further emerged in two sub-themes; co-occurrence of symptoms (e.g. sleep disturbances, anxiety and depression, reduced appetite, and impaired cognition), and feeling that the extent of their suffering and capabilities were either under recognized or misunderstood by both loved ones and clinicians. Findings highlight the pervasive experiences of fatigue in chronic heart failure and COPD. Fatigue deeply impacts physical, psychological, and social domains and decreases quality of life. Fatigue is commonly under recognized or misunderstood by family, friends, and clinicians. Assessment and management of fatigue needs to be incorporated in routine clinical care of patients with heart and lung failure. Themes of commonly occurring co-symptoms highlight key physical and psychological elements that mediate or exacerbate fatigue, and may serve as targets in future interventional studies.