Article

Fatigue is a prevalent and severe symptom associated with uncertainty and sense of coherence in patients with chronic heart failure.

Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Box 457, S-405 30 Göteborg, Sweden.
European Journal of Cardiovascular Nursing (Impact Factor: 1.83). 07/2007; 6(2):99-104. DOI: 10.1016/j.ejcnurse.2006.05.004
Source: PubMed

ABSTRACT Fatigue is a common symptom in patients with chronic heart failure (CHF) and has a major impact on their daily life activities. The purpose of this study was to examine the prevalence and severity of fatigue, conceptualized as a multiple dimensional symptom, and to determine the influence of sense of coherence and uncertainty on the fatigue experience in patients with CHF.
Ninety-three consecutive patients, hospitalized with a diagnosis of CHF, completed the Multidimensional Fatigue Inventory Scale (MFI-20), Cardiovascular Population Scale (CPS), and Sense of Coherence Scale (SOC) and were classified according to the New York Heart Association (NYHA) functional classification criteria. Associations between selected variables were explored with multiple regression analysis.
The patients reported high prevalence and severity in the physical dimensions of fatigue. Uncertainty was associated positively with tiredness and reduced functional status. High age predicted reduced motivation and the ability to concentrate were affected by low SOC.
Fatigue is a prevalent and distressing experience in patients with CHF, where a variety of factors influence different dimensions of the fatigue experience. Recognising this, symptom management must be directed towards comprehensive assessment and a broad approach in interventions aimed at alleviating fatigue.

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    ABSTRACT: BACKGROUND: Progression of fatigue in elderly heart failure patients is not well documented. AIM: To report on patterns and severity of fatigue in surviving patients (n=112, mean age 75years) of a 5year heart failure programme (HFP). METHODS: Patients (n=200 at baseline) participated in a 6month trial of cardiac rehabilitation (CR versus standard care) followed by the same prescribed maintenance programme (Phase IV and/or independent exercise). Fatigue was rated by the MLHF questionnaire and compared to quality of life (QoL), physical and clinical measures. Patterns of fatigue are described in the whole sample. Data analysis is undertaken on sub-groups based on baseline randomisation, aetiology, gender, co-morbidity and survival. Heart failure patients (n=29) newly diagnosed at the 5year follow-up time point provided information on their experience of fatigue. RESULTS: At baseline and 5years, 45% patients rated fatigue within the two highest categories of severity, whereas 10% reported no symptoms on assessment. Over 5years, the fatigue patterns in the sample were unsustained improvement commensurate with the HFP (37%), an adverse pattern from baseline (37%), maintained improvement (18%) or no overall change (8%). Fatigue was higher in patients with joint problems and responded to the intervention. There was a significant increase (p<0.05) in the proportion of patients with reduced haemoglobin level and severe fatigue at 5years. Fatigue scores correlated significantly (p<0.01) with QoL and physical measures. CONCLUSIONS: Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.
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