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Distinct trajectories of fatigue in chronic heart failure and their association with prognosis
Author(s) -
Smith Otto R.F.,
Kupper Nina,
Jonge Peter,
Denollet Johan
Publication year - 2010
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfq075
Subject(s) - medicine , heart failure , exertion , confidence interval , chronic fatigue , cardiology , hazard ratio , proportional hazards model , clinical endpoint , chronic fatigue syndrome , randomized controlled trial
Aims To identify distinct trajectories of fatigue over a 12‐month period and to examine their impact on mortality in chronic heart failure (CHF). Methods and results Consecutive CHF patients ( n = 310) were assessed at baseline and at 2‐ and 12‐month follow‐up for symptoms of exertion and general fatigue. Latent growth mixture modelling was used to examine the course of fatigue over time. The endpoint was mortality following the 12‐month assessment of fatigue. Over the initial 12‐month follow‐up, six distinct trajectories for exertion fatigue and four distinct trajectories for general fatigue were identified. Beyond the 12‐month follow‐up (mean follow‐up period, 693 days), 50 patients (17%) had died. After controlling for standard risk factors and disease severity, both severe exertion fatigue [hazards ratio (HR) = 2.59, 95% confidence interval (CI): 1.09–6.16, P = 0.03] and severe general fatigue (HR = 3.20, 95% CI: 1.62–6.31, P = 0.001) trajectories predicted an increased mortality rate (29 vs. 19% and 28 vs. 14%, respectively). The low exertion fatigue trajectory was associated with a decreased mortality risk (3 vs. 19%, HR = 0.12, 95% CI: 0.02–0.93, P = 0.04). Conclusion Fatigue trajectories varied across CHF patients and had a differential effect on mortality. Persistent severe fatigue was a predictor of poor prognosis. These results may help identify distinct groups of CHF patients with potentially differential risks of adverse health outcomes.