Dyspnoea versus fatigue: Additional prognostic information from symptoms in chronic heart failure?

Abstract

Background: In non-heart failure populations, dyspnoea reported by the patient as the reason for stopping an exercise test is associated with a worse prognosis than fatigue. Patients with chronic heart failure (CHF) have exercise limitation due to breathlessness or fatigue, but it is unclear whether one symptom confers an adverse prognosis over the other. Methods: Consecutive CHF patients underwent exercise testing with metabolic gas exchange. Upon stopping exercise the dominant symptom reported by the patients was recorded. Survival analyses were performed to establish predictors of mortality and relationships between symptoms and objective measures of exercise capacity. Results: Data were analysed on 271 patients (219 men), mean age 67 (10) years, mean left ventricular ejection fraction 32 (8)%, and median follow-up 59 months (interquartile range 38). There were no differences in exercise variables, sex, NYHA class, body mass index and medical therapy between fatigued and dyspnoeic patients. At the censor date 92 (34%) patients had died. Deceased patients had a lower peak oxygen consumption (17.2 (4.6) versus 20.3 (5.6); p = 0.0028). Although NYHA class was related to death at 36 months (χ 2 value = 7.3, p = 0.026), reason for stopping was not (χ 2 value = 0.57, p = 0.45). Conclusion: Unlike in non-heart failure populations, dyspnoea as the reason for stopping an exercise test in CHF subjects is not associated with increased mortality. CHF patients should be assessed for treatments such as cardiac resynchronisation therapy by the degree of exercise intolerance, not the nature of their symptoms.

Oscillatory Breathing and Exercise Gas Exchange Abnormalities Prognosticate Early Mortality and Morbidity in Heart Failure

“…Comparing prognosis using other measurements. Although some investigators have reported that dyspnea rather than fatigue as the symptom terminating exercise indicates a worse prognosis in CHF (28 -30), other reports and this study do not confirm this (31,32). We found by t test that higher body weight, lower New York Heart Association functional classification, and higher left ventricular ejection fraction significantly improved survival (Table 1).…”

Metformin: an old but still the best treatment for type 2 diabetes

“…DM and hyperglycemia are strongly implicated as a cause for the progression from asymptomatic left ventricular dysfunction to symptomatic HF, increased hospitalizations for HF, and an overall increased mortality risk in patients with chronic HF [78]. Despite all its benefits, metformin is contraindicated in patients with heart failure due to the potential risk of developing lactic acidosis, a rare but potentially fatal metabolic condition resulting from severe tissue hypoperfusion [79].…”

Exercise performance, haemodynamics, and respiratory pattern do not identify heart failure patients who end exercise with dyspnoea from those with fatigue

“…The percent of HF patients referring dyspnoea as the cause of exercise limitation varies among studies 6, 9, 23. In the present study, we observed that the first cause for self‐ending a maximal effort referred by patients with chronic HF is fatigue (78% of cases), and dyspnoea was reported in 22% of cases.…”