Abstract
BackgroundFatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF). This study sought to evaluate the prevalence, predictors, and prognostic value of clinically documented fatigue in newly diagnosed HF patients from the community.MethodsThis retrospective cohort study consisted of 12,285 newly diagnosed HF patients receiving health care services through the Geisinger Health System, with passive data collection through electronic medical records (EMR). Incident HF, fatigue, and other study variables were derived from coded data within EMRs. A collection of 87 candidate predictors were evaluated to ascertain the strongest independent predictors of fatigue using logistic regression. Patients were followed for all-cause mortality for an average of 4.8 years. The associations between fatigue and 6-month, 12-month, and overall mortality were evaluated via Cox proportional hazards regression models.ResultsClinically documented fatigue was found in 4827 (39%) newly diagnosed HF patients. Depression demonstrated the strongest association with fatigue. Fatigue was often part of a symptom cluster, as other HF symptoms including dyspnea, chest pain, edema, syncope, and palpitations were significant predictors of fatigue. Volume depletion, lower body mass index, and abnormal weight loss were also strong predictors of fatigue. Fatigue was not significantly associated with either 6-month (HR = 1.12, p = 0.16) or overall mortality (HR = 1.00, p = 0.89) in adjusted models.ConclusionsFatigue is a commonly documented symptom among newly diagnosed HF patients, and its origins may lie in both psychologic and physiologic factors. Though fatigue did provide a prognostic signal in the short-term, this was largely explained by physiologic confounders. Proper therapeutic remediation of fatigue in HF relies on identifying underlying factors.
Highlights
Fatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF)
Documented symptoms near, or prior to, the HF diagnosis date were highly prevalent with 62% having documented dyspnea, 53% chest pain, 43% edema, and 31% syncope
The extensive electronic medical records (EMR) data repository of the Geisinger Health System was utilized to provide a detailed perspective on the prevalence, predictors, and prognostic value of clinically documented fatigue in a large HF population receiving primary care and other health care services through a single health care system
Summary
Fatigue is a common and distressing but poorly understood symptom among patients with heart failure (HF). Heart failure (HF) is often a highly symptomatic condition, with shortness of breath, fatigue, chest pain, edema, and syncope being the most commonly reported symptoms [1,2,3,4,5,6,7]. These symptoms impair quality of life, drive the need for HF-related hospitalizations, inhibit individuals’ ability to function physically and perform activities of daily living, and in many cases signal a poor prognosis in the HF condition [1, 8]. Whether fatigue signals a hastened mortality independent of other clinical factors remains unresolved
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