The Contribution of Vascular Risk Factors in Prevalence of Fatigue Four Years Following Stroke: Results from a Population-Based Study

Abstract

Fatigue is a debilitating symptom after stroke, which may persist for many years. Survivors of stroke commonly have comorbid medical conditions such as hypertension and diabetes mellitus that may produce fatigue by themselves. The contribution of vascular and other risk factors on long-term poststroke fatigue (PSF) has not been sufficiently investigated at a population-based level. Adults (N = 256) with stroke, who consented into the Auckland Regional Stroke Outcomes Study (ARCOS-IV), completed assessments including the Fatigue Severity Scale (FFS) at 4 years poststroke. A mean score greater than 4 was indicative of fatigue. A multiple regression model identified baseline associations (reported as adjusted odds ratio [AOR] with 95% confidence intervals [CI]) with long-term fatigue. Fatigue was present in 141 stroke survivors (55%) 4 years after stroke, with a mean FSS score of 5.2 ± 1.3. Having hypertension (AOR = 2.05, 95% CI: 1.05-3.99, P < .05), diabetes mellitus (AOR = 2.15, 95% CI: 1.09-4.25, P < .05), and arrhythmia (AOR = 3.01, 95% CI: 1.46-6.20, P < .01) at the time of stroke were associated with increased PSF at 4 years. Nonvascular risk factors including female sex (AOR = 1.99, 95% CI: 1.06-03.70, P < .05) and depression (AOR = 1.18, 95% CI: 1.01-1.39, P < .05) were related to PSF. PSF was prevalent in the majority of survivors, with comorbid vascular factors significantly contributing to persistent fatigue. The implications of these findings are important as potentially modifiable factors can be targeted and treated from acute onset. Additional research examining PSF predictors in other populations and trialing targeted interventions to control predictors of PSF are warranted.