Fatigue, Inflammation, and Projected Mortality in Heart Failure

Abstract

Background Fatigue is a prominent and poorly understood symptom of heart failure with reduced ejection fraction (HFrEF). The purpose of this study was to determine whether fatigue correlated with immune biomarkers and prognosis. Methods/Results In patients with HFrEF (N = 59) and healthy controls (N = 25), we prospectively measured fatigue (Profile of Mood States), depressive symptoms (Patient Health Questionnaire-8), sleep quality (Pittsburgh Sleep Quality Index), and immune biomarkers (plasma C-reactive protein [CRP], tumor necrosis factor-α [TNFα], and interleukins [IL-6 and IL-10]). Seattle Heart Failure Model (SHFM) mortality risk scores were determined. Patients with HFrEF had significantly greater fatigue and depressive symptoms and poorer sleep quality compared to control subjects. When controlling for depressive symptoms, however, fatigue did not differ significantly between patients with HFrEF and controls. Patients with HFrEF had significantly lower levels of IL-10 compared to controls. Cytokines did not correlate significantly with fatigue, but fatigue was significantly associated with higher SHFM scores. Conclusions Depressive symptoms were an important covariate of fatigue in patients with HFrEF. Our study findings were the first to show a positive association between fatigue and the SHFM score, indicating that fatigue was associated with poorer prognosis.

Feasibility and Efficacy of a Self-Management Intervention for Insomnia in Stable Heart Failure

“…35 The score range is from 0-28. Score levels indicate no (0-7), mild clinical insomnia (8)(9)(10)(11)(12)(13)(14), moderate (15)(16)(17)(18)(19)(20)(21), and severe clinical (22)(23)(24)(25)(26)(27)(28) insomnia. We used the continuous, as well as categorical scores, depending on the analyses.…”

“…6 It is distressing and associated with symptoms, such as fatigue, nocturnal dyspnea, depression, anxiety, pain, and excessive daytime sleepiness, poor quality of life, and decrements in functional performance. 3,5,[7][8][9][10][11][12][13] Health care providers frequently attribute sleep disturbance, including insomnia symptoms, to the pathophysiology (e.g., fl uid congestion) and symptoms of HF itself (e.g., nocturnal dyspnea, nocturia) or to sleep disordered breathing that occurs in about half the population.14 However, sleep disordered breathing does not consistently explain insomnia, self-reported sleep quality, or fatigue; and insomnia was closely associated with daytime symptoms (fatigue, sleepiness, and depression) and both self-reported and objectively measured functional performance among patients with stable HF who received evidence based disease management. …”

Nursing Diagnoses of hospitalized patients with heart failure: a longitudinal study

“…Fatigue is considered a phenomenon of physical, cognitive, and emotional causes, and it reduces the quality of life (24) . Tiredness, feeling exhausted, decreased functional capacity and difficulty to obtain energy are inherent characteristics of fatigue (25) . However, the attempt to include causes or related factors to try to meet everything that fatigue means can bring forth difficulties in evaluating it.…”

“…Fatigue is one of the most prevalent complaints in patients with HF and it has already been associated to dyspnea, a decline in physical and emotional health, depression, insomnia, reduced ejection fraction and worsening of functional class, being more present in women and betablockers users (25) . Thus, we question whether the definition of the symptom "fatigue" presented in the studies is the same definition for nursing diagnosis, and if the defining characteristics are enough for the symptoms in hospitalized patients with HF.…”

Caring needs in patient-partner dyads affected by heart failure: An evaluation of the long-term effects of a dyadic psycho-educational intervention

“…Specific HF signs are elevated jugular venous pressure, third heart sound, and cardiac murmur [1,27]. Fatigue is highly prevalent in patients with HF and has been associated with depressive symptoms, decreased exercise capacity, and dyspnoea [27,28]. Heart failure leads to different levels of symptom severity, described by the NYHA-class, Figure 1.…”