| Content Provider |
World Health Organization (WHO)-Global Index Medicus |
| Author |
Perez-Moreno, Ana Cristina Jhund, Pardeep S. Macdonald, Michael R. Petrie, Mark C. Cleland, John G. F. Böhm, Michael Van Veldhuisen, Dirk J. Gullestad, Lars Wikstrand, John Kjekshus, John Lewsey, James D. McMurray, John J. V. |
| Description |
Country affiliation: United kingdom Author Affiliation: Perez-Moreno AC ( BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.); Jhund PS ( BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.); Macdonald MR ( BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.); Petrie MC ( BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland.); Cleland JG ( Imperial College, London, United Kingdom.); Böhm M ( Universitätsklinikum des Saarlandes, Homburg/Saar Germany.); van Veldhuisen DJ ( University Hospital Groningen, Groningen, the Netherlands.); Gullestad L ( Department of Cardiology, Oslo University Hospital, Rikshospitalet, and K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway.); Wikstrand J ( Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.); Kjekshus J ( Department of Cardiology, Oslo University Hospital, Rikshospitalet, and K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway.); Lewsey JD ( Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.); McMurray JJ ( BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland. Electronic address: john.mcmurray@glasgow.ac.uk.) |
| Abstract |
OBJECTIVES: The purpose of this study was to examine the relationship between fatigue and clinical outcomes, using dyspnea as a comparator, in patients with left ventricular ejection fraction (LVEF) ≤35% enrolled in the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) study. BACKGROUND: Although fatigue is a common symptom in heart failure (HF), little is known about its association with prognosis. METHODS: At baseline in CORONA, fatigue 'during the past few days' was measured using a 5-point exertion scale (0 = none, 1 = heavy exertion, 2 = moderate exertion, 3 = slight exertion, 4 = rest); a 4-point scale was used for dyspnea (1 to 4 as for fatigue). Patients were grouped into 3 categories: a fatigue score 0 to 1 (n = 535), fatigue score 2 (n = 1,632), and fatigue score 3 to 4 (n = 1,663); and a dyspnea score of 1 (n = 292), dyspnea score of 2 (n = 1,695), and dyspnea score of 3 to 4 (n = 1,843). The association between fatigue and dyspnea and the composite outcome of cardiovascular (CV) death or HF hospital stay and each component separately was examined using Kaplan-Meier analysis and Cox proportional-hazard models. We also examined all-cause mortality. RESULTS: In univariate analyses, symptom severity was associated with a higher risk of CV death or HF hospital stay (fatigue: group 3, 49% [n = 810], vs. group 1, 30% [n = 160]; dyspnea: group 3, 50% [n = 918], vs. group 1, 28% [n = 82]) and all-cause mortality (fatigue: group 3, 38% [n = 623], vs. group 1, 24% [n = 130]; dyspnea: group 3, 38% [n = 697], vs. group 1, 23% [n = 66], log-rank p < 0.0001 for all). After adjusting for other prognostic variables, including LVEF, New York Heart Association class, and N-terminal pro-B-type natriuretic peptide level, worse fatigue remained associated with higher risk of HF hospital stay but not mortality (worse dyspnea remained associated with a higher risk of both). An increase in fatigue (or dyspnea) between baseline and 6 months was also associated with worse outcomes. CONCLUSIONS: In HF, greater fatigue is associated with worse clinical outcomes. Closer attention should be paid to this symptom in clinical practice, with more done to standardize its measurement and understand its origins, with a view to improving treatment. |
| File Format |
HTM / HTML |
| ISSN |
22131779 |
| e-ISSN |
22131787 |
| Journal |
JACC: Heart Failure |
| Issue Number |
2 |
| Volume Number |
2 |
| Language |
English |
| Publisher |
Elsevier |
| Publisher Date |
2014-04-01 |
| Publisher Place |
United States |
| Access Restriction |
Open |
| Subject Keyword |
Discipline Cardiology Fatigue Etiology Fluorobenzenes Therapeutic Use Heart Failure Drug Therapy Hydroxymethylglutaryl-coa Reductase Inhibitors Pyrimidines Sulfonamides Dyspnea Physiopathology Complications Hospitalization Rosuvastatin Calcium Stroke Volume Physiology Multicenter Study Randomized Controlled Trial |
| Content Type |
Text |
| Resource Type |
Article |
| Subject |
Cardiology and Cardiovascular Medicine |
