Patterns of fatigue in elderly heart failure patients measured by a quality of life scale (Minnesota living with heart failure)

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 75 years) of a 5 year heart failure programme (HFP). Methods: Patients (n=200 at baseline) participated in a 6 month 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 5 year follow-up time point provided information on their experience of fatigue. Results: At baseline and 5 years, 45% patients rated fatigue within the two highest categories of severity, whereas 10% reported no symptoms on assessment. Over 5 years, 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 (pb0.05) in the proportion of patients with reduced haemoglobin level and severe fatigue at 5 years. Fatigue scores correlated significantly (pb0.01) with QoL and physical measures. Conclusions: Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.