CHARACTERI STI CS OF FATI GUE I N HEART FAI LURE PATI ENTS: A LI TERATURE REVI EW
Andr ea Fini1 Diná de Alm eida Lopes Mont eir o da Cr uz2
Fin i A, Cr u z DALM. Ch ar act er ist ics of f at ig u e in h ear t f ailu r e p at ien t s: a lit er at u r e r ev iew . Rev Lat in o- am Enfer m agem 2009 j ulho- agost o; 17 ( 4 ) : 557 - 6 5.
This is a lit er at ur e r ev iew r epor t t o descr ibe char act er ist ics ( fr equency , int ensit y and cor r elat es) of fat igue in cases of heart failure. MedLine and LI LACS were t he exam ined dat abases. Out of 89 art icles ident ified, 27 were
select ed for dat a ext ract ion. Fat igue frequency ranged from 69% t o 88% and fat igue int ensit ies are incom parable d u e t o dif f er en ces in m easu r em en t scales. Qu alit y of lif e, illn ess pr ogr ession , ph y sical act iv it y , social an d dem ographic variables, com orbidit y, t reat m ent and w ho assessed t he fat igue w ere variables st udied in relat ion t o fat igue. The diversit y of fat igue assessm ent m et hods causes difficult ies t o int egrat e result s on fat igue frequency,
char act er ist ics and r elat ed fact or s. No st udy w as found on fat igue char act er ist ics in sam ples of Br azilian hear t failur e pat ient s.
DESCRI PTORS: fat igue; hear t failur e; r ev iew lit er at ur e; nur sing diagnosis
CARACTERÍ STI CAS DE LA FATI GA DE PACI ENTES CON I NSUFI CI ENCI A CARDÍ ACA:
REVI SI ÓN DE LI TERATURA
Est e es un r elat o de r evisión de lit er at ur a con el obj et ivo de descr ibir car act er íst icas ( fr ecuencia, int ensidad y f act or es cor r elacion ados) de la f at iga en la in su f icien cia car díaca. Las bases est u diadas f u er on MEDLI NE y LI LACS. De las 89 referencias encont radas, fueron seleccionadas 27 para ext racción de los dat os. La frecuencia de la f at iga v ar ió de 6 9 a 8 8 % y las in t en sidades n o se pu eden com par ar , y a qu e las escalas de m edida
present an diferent es variaciones. Fueron est udiadas asociaciones de la fat iga con calidad de vida, evolución de la enfer m edad, act iv idad física, v ar iables sociales y dem ogr áficas, enfer m edades concom it ant es, t r at am ient o y con el evaluador. La diversidad de los m ét odos de evaluación de la fat iga im pone dificult ades a la int egración de los r esult ados sobr e su fr ecuencia, car act er íst icas y fact or es a ella r elacionados. No se encont r ó est udios
que descr ibiesen la fat iga, en m uest r as de br asileños, con insuficiencia car díaca.
DESCRI PTORES: fat iga; insuficiencia car diaca; lit er at ur a de r ev isión; diagnóst ico de enfer m er ía
CARACTERÍ STI CAS DA FADI GA DE PACI ENTES COM I NSUFI CI ÊNCI A CARDÍ ACA:
REVI SÃO DE LI TERATURA
Est e é um r elat o de r ev isão de lit er at ur a com o obj et iv o de descr ev er car act er íst icas ( fr equência, int ensidade
e fat ores correlat os) da fadiga na insuficiência cardíaca. As bases est udadas foram MEDLI NE e LI LACS. Das 89 r efer ências lev ant adas, for am selecionadas 27 par a ex t r ação dos dados. A fr equência de fadiga v ar iou de 69 a 8 8 % e as in t en sid ad es são in com p ar áv eis, p ois as escalas d e m ed id a ap r esen t am d if er en t es v ar iações. For am est udadas associações da fadiga com qualidade de vida, evolução da doença, at ividade física, var iáveis
sociais e dem ogr áficas, com or bidades, t r at am ent o e com o avaliador . A diver sidade dos m ét odos de avaliação de fadiga im põe dificuldades à int egr ação dos r esult ados sobr e sua fr equência, car act er íst icas e fat or es a ela relacionados. Não se encont rou est udos que descrevessem a fadiga, em am ost ras de brasileiros, com insuficiência car d íaca.
DESCRI TORES: fadiga; insuficiência car díaca; lit er at ur a de r ev isão; diagnóst ico de enfer m agem
Escola de Enferm agem da Universidade de São Paulo, Brazil: 1RN, Mast er’s st udent , e- m ail: andreafini@uol.com .br; 2RN, Full Professor, e- m ail: m t m llt @usp.br.
I NTRODUCTI ON
C
a r d i o v a s c u l a r d i s e a s e s a r e t h e m a i nc a u s e o f m o r b i d i t y a n d m o r t a l i t y , w i t h h e a r t
f a i l u r e a s t h e m o s t c o m m o n c a u s e o f
h o s p i t a l i z a t i o n s a n d m o r b i d i t y - m o r t a l i t y i n t h e
e l d e r l y p o p u l a t i o n( 1 ). S e v e r a l p a t h o l o g i c a l
co n d i t i o n s p r eced e h ea r t f a i l u r e, su ch a s a r t er i a l
h y p e r t e n s i o n , d y s l i p i d e m i a s a n d m y o c a r d i a l
i n f a r c t i o n , w h i c h a r e n o t c o n t r o l l e d f r o m a n
e p i d e m i o l o g i c a l v i e w p o i n t a n d , t h e r e f o r e , c a n
ex p l a i n t h e i n cr ea sed i n ci d en ce o f h ea r t f a i l u r e( 2 ).
I n c i d e n c e l e v e l s h a v e i n c r e a s e d i n B r a z i l a n d
a r o u n d t h e w o r l d , w i t h a n e st i m a t e d 6 . 4 m i l l i o n
Br a zi l i a n s su f f e r i n g f r o m t h i s d i se a se( 2 ).
S y m p t o m s o f h e a r t f a i l u r e p a t i e n t s
i n c l u d e d y s p n e a a n d f a t i g u e , m a i n l y w h i l e
e x e r c i s i n g , p a r o x y s m a l n o c t u r n a l d y s p n e a ,
o r t h o p n e a , l o w e r l i m b e d e m a a n d n o c t u r n a l
co u g h . Th e se sy m p t o m s, e sp e ci a l l y f a t i g u e a n d
d y s p n e a , e n t a i l f u n c t i o n a l l i m i t a t i o n s t h a t c a n
a f f e c t p a t i e n t s ’ p s y c h o l o g i c a l a n d s o c i a l
co n d i t i o n s, i m p a i r i n g t h ei r q u a l i t y o f l i f e. Besi d es
t h e d i s e a s e i t s e l f t h a t c a u s e s t h e a b o v e
m e n t i o n e d l i m i t a t i o n s , m e d i c a t i o n t h e r a p y
i n c l u d e s t h e u s e o f b e t a b l o c k e r s , w h i c h c a n
i n cr ea se t h e r i sk o f h y p o t en si o n , b r a d y ca r d i a a n d
d i z z i n e s s , c o n t r i b u t i n g t o t h e p a t i e n t s ’
l i m i t a t i o n s( 3 ).
H e a r t f a i l u r e p a t i e n t s a r e i n a “ ch r o n i c”
c o n d i t i o n , l i v i n g w i t h a d i s e a s e t h a t c a n n o t b e
c u r e d , b e i n g o b l i g e d t o u n d e r g o c o n t i n u o u s
t r e a t m e n t , s u b m i t t i n g t h e m s e l v e s t o c o l l a t e r a l
e f f e c t s o f m e d i c a t i o n s , u n a b l e t o a v o i d t h e
w o r s e n i n g o f t h e i r d i s e a s e a n d t o f u l l y e s c a p e
f r o m t h e sy m p t o m s t h a t w i l l ch a n g e t h ei r q u a l i t y
o f l i f e . N o n - p h a r m a c o l o g i c a l m e a s u r e s c a n
i m p r o v e t r e a t m e n t a d h e r e n ce a n d m i t i g a t e q u i t e
f r e q u e n t co n d i t i o n s.
Fa t i g u e i s a f r e q u e n t m a n i f e s t a t i o n i n
h ea r t f a i l u r e, a s w el l a s d y sp n ea a n d o r t h o p n ea ,
a n d i s si g n i f i ca n t l y r e l a t e d w i t h t h e u n f a v o r a b l e
ev o l u t i o n o f t h e d i sea se( 4 ). Th i s p a p er r ep o r t s o n
a l i t e r a t u r e r e v i e w o n f a t i g u e i n ca se s o f h e a r t
f a i l u r e .
Fa t i g u e h a s b e e n i n cl u d e d a s a v a r i a b l e
i n d i f f e r e n t s t u d i e s , p r o b a b l y d u e t o i t s h i g h
p r e v a l e n ce i n d i f f e r e n t p o p u l a t i o n s a n d a l so d u e
t o i t s i m p a ct o n q u a l i t y o f l i f e( 5 ).
N o w a d a y s , f a t i g u e i s a c c e p t e d a s a
su b j e ct i v e a n d m u l t i ca u sa l p h e n o m e n o n , w h o se
o r i g i n a n d ex p r essi o n i n v o l v es p h y si ca l , co g n i t i v e
a n d e m o t i o n a l a s p e c t s a n d i t s i d e n t i f i c a t i o n
d e p e n d s o n se l f - r e p o r t i n g( 5 ).
Th e a n a l y si s o f t h e f a t i g u e co n ce p t a n d
i t s cl i n i ca l e v i d e n ce( 5 - 6 ) i n d i ca t e s t h a t f a t i g u e i s
t h e e x p r e s s i o n o f d i f f e r e n t s e n s a t i o n s p a t i e n t s
m e n t i o n , su ch a s t i r e d n e ss a n d l a ck o f e n e r g y.
Fa t i g u e i s a n u r si n g d i a g n o si s i n cl u d ed i n
t h e t a x o n o m y o f t h e N o r t h A m e r i c a n N u r s i n g
D i a g n o s i s A s s o c i a t i o n I n t e r n a t i o n a l ( N A N D A
-I ) . -I t w a s i n t r o d u ced i n 1 9 8 8 a n d d ef i n ed a s “ a n
o v er w h el m i n g su st a i n ed sen se o f ex h a u st i o n a n d
d ecr ea sed ca p a ci t y f o r p h y si ca l a n d m en t a l w o r k
a t u su a l l ev el ”( 7 ).
C o n s i d e r i n g i t s s u b j e c t i v e n a t u r e ,
e r r o n e o u s i n t e r p r e t a t i o n s a r e p o s s i b l e f o r t h e
f a t i g u e d i a g n o s i s . D i f f i c u l t i e s t o d i s t i n g u i s h
b e t w e e n a c t i v i t y i n t o l e r a n c e a n d f a t i g u e a r e
e s p e c i a l l y i m p o r t a n t i n c a r e d e l i v e r y t o h e a r t
f a i l u r e p a t i e n t s .
N u r s i n g c a n h e l p t o c o n t r o l f a t i g u e
t h r o u g h i n t e r v e n t i o n s a i m e d a t i m p r o v i n g
p a t i e n t s ’ r e s i s t a n c e c a p a c i t y, i n c l u d i n g : h e a l t h
a s s e s s m e n t , n u t r i t i o n c o n t r o l , p r e s c r i b e d
a c t i v i t y / e x e r c i s e , p r e s c r i b e d d i e t , s e t t i n g o f
m u t u a l g o a l s, r i sk i d e n t i f i ca t i o n , sl e e p i n cr e a se ,
e x e r c i s e p r o m o t i o n( 8 ).
H e a r t f a i l u r e p a t i e n t s e x p r e ss co u n t l e s s
r e s p o n s e s t o t h e i r p r i m a r y c o n d i t i o n , w h i c h
i n t e r f e r e i n t h e b i o l o g i ca l , so ci a l , p sy ch o l o g i ca l ,
m e n t a l a n d s p i r i t u a l s p h e r e . Th i s e x p l a i n s t h e
n e e d t o d e s c r i b e f a t i g u e a s o n e o f t h e m o s t
f r eq u en t sy m p t o m s i n t h i s p o p u l a t i o n , w i t h a v i ew
t o t h e p r o p o s a l o f i n t e r v e n t i o n s i n a d i r e c t e d ,
OBJECTI VE
T h i s r e v i e w a i m e d t o d e s c r i b e
c h a r a c t e r i s t i c s o f f a t i g u e ( f r e q u e n c y, i n t e n s i t y
a n d co r r el a t ed f a ct o r s) i n ca ses o f h ea r t f a i l u r e.
METHOD
T h i s i n t e g r a t i v e l i t e r a t u r e r e v i e w w a s
g u i d e d b y t h e q u e s t i o n : w h a t a r e t h e
ch a r a ct e r i st i cs a n d co r r e l a t e d f a ct o r s o f f a t i g u e
i n h e a r t f a i l u r e p a t i e n t s?
T h e r e v i e w i n c l u d e d p u b l i c a t i o n s o n
q u a n t i t a t i v e a n d q u a l i t a t i v e r e s e a r c h t h a t
c o n t a i n e d f a t i g u e a s t h e p r i m a r y o r s e c o n d a r y
v a r i a b l es, w i t h sa m p l es i n cl u d i n g a d u l t s o r el d er l y
p e o p l e d i a g n o se d w i t h h e a r t f a i l u r e d u e t o a n y
ca u se, i n a n y f u n ct i o n a l cl a ss, ei t h er h o sp i t a l i zed
o r u n d e r o u t p a t i e n t o r h o m e t r e a t m e n t , w i t h
f a t i g u e a sse sse d b y a n y m e t h o d .
S e a r c h s t r a t e g i e s a i m e d t o l o c a t e
r e s e a r c h p u b l i s h e d i n En g l i s h , Po r t u g u e s e o r
Sp a n i sh , i n t h e d a t a b a se s MED LI NE ( f r o m 1 9 6 6
t i l l D ecem b er 2 0 0 7 ) a n d LI LACS ( u n t i l D ecem b er
2 0 0 7 ) . Th e d e s c r i p t o r s u s e d f o r t h e s e a r c h i n
M E D L I N E w e r e f a t i g u e a n d h e a r t f a i l u r e ,
co n g est i v e. Ti t l es a n d a b st r a ct s, w h en a v a i l a b l e,
w e r e o b t a i n e d t h r o u g h t h e a b o v e d e s c r i b e d
s t r a t e g y a n d a s s e s s e d f o r r e l e v a n c e o f t h e
co n t en t s t o t h e g u i d i n g q u est i o n a n d w h et h er t h ey
p r e se n t e d e m p i r i ca l ( q u a n t i t a t i v e o r q u a l i t a t i v e )
r e s e a r c h r e p o r t s o r r e v i e w s .
Th e i d en t i f i ed st u d i es w er e d i st r i b u t ed i n
a q u a n t i t a t i v e a n d a q u a l i t a t i v e g r o u p . I n t h e
q u a n t i t a t i v e g r o u p , r esu l t s w er e ex t r a ct ed o n t h e
f a t i g u e a s s e s s m e n t m e t h o d , f r e q u e n c y, f a t i g u e
i n t e n s i t y a n d v a r i a b l e s c o r r e l a t e d w i t h f a t i g u e .
I n t h e q u a l i t a t i v e g r o u p , t h e m e s w e r e e x t r a ct e d
t h a t e x p r e s s e d t h e e x p e r i e n c e o f f a t i g u e a n d
r e l a t e d p h e n o m e n a .
RESULTS
Ei g h t y - e i g h t r e f e r e n c e s w e r e o b t a i n e d
f r o m MED LI NE a n d 1 f r o m LI LACS. Th e r e a d i n g
o f t h e t i t l e s a n d , w h e n p r e s e n t , t h e a b s t r a c t s
sh o w e d t h a t 3 6 r e f e r e n ce s f r o m MED LI NE a n d 1
f r o m L I L A C S w e r e r e l e v a n t f o r t h e g u i d i n g
q u e st i o n a n d t h e i r f u l l t e x t s w e r e se a r ch e d . Th e
r e m a i n i n g r e f e r e n ce s co u l d n o t b e u se d b e ca u se
t h e y e i t h e r w e r e n o r e se a r ch r e p o r t s o r d i d n o t
i n c l u d e f a t i g u e a s a s t u d y v a r i a b l e o r
p h en o m en o n . Th e 3 7 f u l l t ex t s o f t h e r ef er en ces
f o u n d i n t h e d a t a b a se s w e r e a sse sse d i n t e r m s
o f r e l e v a n c e f o r t h i s r e v i e w . Tw e n t y - s e v e n
r e f e r e n c e s w e r e m a i n t a i n e d .
I n t h is g r ou p of 2 7 p u b licat ion s, 2 6 ( 9 6 . 3 % )
w e r e q u a n t i t a t i v e a n d 1 ( 3 . 7 % ) q u a l i t a t i v e . Tw o
( 7 . 4 % ) p u b l i cat i o n s w er e i d en t i f i ed u n t i l 1 9 9 0 , 7
( 2 5 . 9 % ) b et w een 1 9 9 1 an d 2 0 0 0 an d 1 8 ( 6 6 . 7 % )
b et w een 2 0 0 1 a n d 2 0 0 7 . No r esea r ch w a s f o u n d
t h at descr ibed f at igu e in sam ples of Br azilian h ear t
f ai l u r e p at i en t s.
Th e q u alit at iv e st u d y aim ed t o u n d er st an d
t h e f a t i g u e e x p e r i e n ce a n d i t s co n se q u e n ce s f o r
d a i l y l i f e a n d t o i d e n t i f y a s p e c t s t h a t m i t i g a t e
f at igu e in h ear t f ailu r e pat ien t s( 9 ). Th e m et h od u sed
w a s Gr o u n d e d Th e o r y, a n d t h e sa m p l e co n si st e d
o f 1 5 o u t p a t i e n t s t r e a t e d f o r h e a r t f a i l u r e , w h o
p a r t i ci p a t e d i n i n t e r v i e w s. I t w a s o b se r v e d t h a t
f a t i g u e i s a c i r c u l a r p r o c e s s i n w h i c h t h e
c o n s e q u e n c e s e n h a n c e t h e f a t i g u e e x p e r i e n c e
i t sel f. Act i v i t i es t o r est o r e f a t i g u e i n cl u d ed b ei n g
u n w i l l i n g l y a t t e n t i v e , s o c i a l l y i n t e r a c t i v e a n d
m e n t a l l y a b s o r b e d( 9 ). Ta b l e 1 s u m m a r i z e s t h e
Table 1 – Descript ion of quant it at ive st udies on fat igue in heart h failure pat ient s, São Paulo - 2007
Con t in u e. . . r
a e
Y Objective Method Fatigueassessmentmethod Mainresults
7 0 0
2 (10) Examinefaitgueprevalenceandintensity
f o e s n e s f o e c n e u lf n i e h t e n i m r e t e d d n a e u g it a f e h t n o y t n i a t r e c n u d n a e c n e r e h o c s t n e it a p e r u li a f t r a e h n i e c n e i r e p x e s t n e it a p d e z il a t i p s o h 3 9 -l a n o i s n e m i d it l u M : s e l a c s 3 f o e s u -r a l u c s a v o i d r a C , y r o t n e v n I e u g it a F f o e s n e S d n a e l a c S s n o it a l u p o P e l a c S e c n e r e h o C r a e n il d n a n o it a l e r r o c s ' n o s r a e P -n o i s s e r g e r e u g it a F l a n o i s n e m i d it l u M -y r o t n e v n I e c n e l a v e r p e u g it a f h g i h d e t r o p e r s t n e it a P l a c i s y h p e h t n i y t i s n e t n i e u g it a f h g i h d n a e h t f o s s a l c l a n o it c n u f e h T . n o i s n e m i d e s n e s d n a ) F H C ( e r u li a f t r a e h e v it s e g n o c e c n a i r a v f o % 1 3 d e n i a l p x e e c n e r e h o c f o . e u g it a f l a r e n e g n i 7 0 0
2 (11) Comparefaitgueandquailtyofilfe
d e m r if n o c a h t i w s t n e it a p n e e w t e b s t n e it a p , ) F H ( e r u li a f t r a e h f o s i s o n g a i d e h t t u o h t i w t u b , F H f o s m o t p m y s h t i w l o r t n o c a d n a ) C I N ( s i s o n g a i d d e m r if n o c p u o r g F H t u o h t i w s t n e it a p 9 5 , s t n e it a p F H 9 4 -s r e e t n u l o v 0 4 f o p u o r g l o r t n o c a d n a l a n o i s n e m i d it l u M : s e l a c s 2 f o e s u -e l a c S s n o i s i v o r P l a i c o S , y r o t n e v n I e u g it a F e f il f o y t il a u q r o f 6 3 -F S d n a c it s i g o l d n a s i s y l a n a e t a i r a v i n u -n o i s s e r g e r e u g it a F l a n o i s n e m i d it l u M -y r o t n e v n I s e r o c s n a e m r e h g i h d e n i a t b o s t n e it a p F H s e l a c s b u s 6 3 -F S t s o m d n a e u g it a f r o f p u o r g l o r t n o c e h t n a h t 7 0 0
2 (12) Examinetheroleofcilnicaland
s a s c it s i r e t c a r a h c l a c i g o l o h c y s p f o s e s a c n i e u g it a f f o s r o t c a f e v it c i d e r p F H s t n e it a p t u o 6 3 1 -n o i s s e r p e d s s e s s a o t s t n e m u r t s n i f o e s u -d n a s t c e p s a y t il a n o s r e p , s m o t p m y s e u g it a f s e d i s e b , s m o t p m y s c a i d r a c s e l a c s t n e m s s e s s a r e t f a r e h t o n a d n a t n e m s s e s s a l a it i n i e n o -p u -w o ll o f f o s h t n o m 2 1 f o s e r u s a e m n e e w t e b s t s e t n o it a i c o s s a -e u g it a f l a it i n i g n i r u d d e n i a t b o s e l b a i r a v 2 1 r e t f a e u g it a f n o it r e x e d n a t n e m s s e s s a e h t y d u t s o t s e s y l a n a n o i s s e r g e R . s h t n o m e u g it a f n o it r e x e d n a e u g it a f f o n o it c i d e r p e u g it a F n o it r e x E h c t u D e h T -) S F E D ( e l a c S e l a c S t n e m s e s A e u g it a F e h T -) S A F ( -w o ll o f f o s h t n o m 2 1 r e t f a e u g it a f n o it r e x E , y t i c a p a c e s i c r e x e y b d e t c i d e r p s a w p u n o i s s e r p e d d n a n o i s n e t r e p y h , a e n p s y d d e t c i d e r p s a w e u g it a f l a r e n e G . s m o t p m y s -D , s m o t p m y s n o i s s e r p e d , a e n p s y d y b s m e l b o r p p e e l s d n a y t il a n o s r e p e p y t 6 0 0
2 (13) AssesstheSwedishversionoftheMLHF
o t t i e s u d n a F H h t i w e l p o e p y l r e d l e n i s i h t n i F H f o t c a p m i e h t e b i r c s e d e f il y li a d s ' n o it a l u p o p ) s r a e y 9 9 -5 6 ( s t n e it a p 7 5 3 -y d u t s l a n o it c e s -s s o r c -F L H M f o n o it a c il p p a -i h c f o e s u d n a s c it s it a t s e v it p i r c s e d -t s e t e r a u q s t r a e H g n i v i L a t o s e n n i M f o e s U -h t i w , e r i a n n o it s e u q ) F H L M ( e r u li a F e u g it a f t u o b a s n o it s e u q l a c i s y h p e h t n i s m e l b o r p n o m m o c t s o M d n a e u g it a f y ll a i c e p s e e r e w n o i s n e m i d y tl u c if f i d g n i h t a e r b 6 0 0
2 (14) Describefactorsandintervenitonsthat
. s t n e it a p F H f o e f il f o y t il a u q e h t e c n e u lf n i w e i v e r e r u t a r e t il -s e l c it r a 8 5 -s e s a b a t a d n i h c r a e s d e z i m e t s y s -d e b i r c s e d t o
N Faitguecaneasliyberelatedwith a d e r e d i s n o c e b o s l a n a c d n a a i n m o s n i n o i s s e r p e d f o m o t p m y s 6 0 0
2 (15) Analyzethecorrelaitonbetweendyspnea
e u g it a f g n i d u l c n i , s m o t p m y s r e h t o d n a s t n e it a p t u o 6 7 -e r i a n n o it s e u q t r o p e r -fl e s -n o it a l e r r o c s ' n o s r a e P -f o e e r g e d : e l a c s m e t i -e e r h T d n a e u g it a f f o y t i s n e t n i , e u g it a f e u g it a f h t i w d e t a i c o s s a h s i u g n a s t s e t n o i s s e r g e r d n a n o it a l e r r o C h t i w d e t a l e r y lt n a c if i n g i s s a w a e n p s y D h tl a e h l a r e n e g d n a e u g it a f , n o i s s e r p e d s m o t p m y s e e r h t e h T . n o it p e c r e p e c n a i r a v a e n p s y d f o % 8 3 d e n i a l p x e 6 0 0
2 (16) Assessdifferencesbetweenpaitentswith
d n a y t e i x n a f o s m r e t n i F H t u o h t i w d n a n o it a i c o s s a e h t y f i r e v -; n o i s s e r p e d l a c i s y h p d n a n o i s s e r p e d , y t e i x n a n e e w t e b y f i r e v -; e u g it a f g n i d u l c n i , F H f o s m o t p m y s F H d n a s m o t p m y s l a c i s y h p t n e t x e t a h w o t n o i s s e r p e d d n a y t e i x n a n i a l p x e F H h t i w s t n e it a p 1 6 -F H t u o h t i w s t n e it a p 7 5 -s e r i a n n o it s e u q t r o p e r -fl e s 3 -n o i s s e r g e r l a c i h c r a r e i h d n a n o it a l e r r o c -f o t n e m s e s A l a n o i s n e m i d it l u M -) S F A M ( e l a c S e u g it a F f o s m r e t n i d n u o f e r e w s e c n e r e f f i d o N n e e w t e b n o i s s e r p e d d n a y t e i x n a r o f d e s u p u o r g e h t d n a s t n e it a p t u o n o s i r a p m o c a e n p s y d d n a e u g it a f , s r e d r o s i d p e e l S s t n e it a p F H n i r e h g i h y lt n a c if i n g i s e r e w . p u o r g l o r t n o c e h t h t i w d e r a p m o c n e h w d n u o f e r e w s n o it a l e r r o c e t a r e d o M y t e i x n a , s r e d r o s i d p e e l s , e u g it a f n e e w t e b F H f o y lt n e d n e p e d n i , n o i s s e r p e d d n a 6 0 0
2 (17) VerifytowhatextentHFsymptoms
e f il f o y t il a u q o t e t u b i r t n o c V I d n a II I ,I I -F H s t n e it a p 6 0 9 1 -s i s y l a n a a t a d y r a d n o c e s -s i s y l a n a e t a i r a v it l u M -t r a e H g n i v i L a t o s e n n i M f o e s U -h t i w e r i a n n o it s e u q e r u li a F e u g it a f t u o b a s n o it s e u q n i e c n a i r a v f o % 8 3 s n i a l p x e e u g it a F s e r o c s F L H M 5 0 0
2 (4) Assesstheimportanceofsefl-reported
f o s r o t c a f e v it c i d e r p s a y t i s n e t n i m o t p m y s F H f o s e s a c n i s e s n o p s e r s t n e it a p 9 2 0 3 -y d u t s r e t n e c it l u m -s i s y l a n a e t a i r a v it l u m d n a i n u -s s e s s a o t e l a c s t n i o p -e v if f o e s U -d n a a e n p s y d e k il s m o t p m y s e r e w s m e t i e l a c s e h T . e u g it a f t a s r i a t s g n i b m il c , c it a m o t p m y s a l a m r o n t a g n i k l a w , m h t y h r l a m r o n g n i k l a w , e c a f r u s l e v e l a n o m h t y h r t s e r t a d n a e c a f r u s l e v e l a n o w o l s e r e w e u g it a f d n a a e n p o h t r o , a e n p s y D d e s a e r c n i f o s r o t c i d e r p t n a c if i n g i s y t il a t r o m d n a n o it a z il a t i p s o h 4 0 0
2 (18) Examinedifferencesinquailtyofilfe
n o d e s a b s p u o r g t n e it a p F H r u o f n e e w t e b n o it a l e r e h t s s e s s a d n a r e d n e g d n a e g a n i s e g n a h c d n a r e d n e g , e g a n e e w t e b h t n o m -x i s a g n i r u d e f il f o y t il a u q d e t r o p e r d o i r e p s t n e it a p 5 6 1 -Q H C d n a F H L M f o e s u -.l a v r e t n i k e e w -6 2 h t i w s e r u s a e m 2 -c i n o r h C ( Q H C d n a F H L M f o e s U -h t i w ) e r i a n n o it s e u Q e r u li a F t r a e H e u g it a f t u o b a s n o it s e u q d e y a l p s i d s r a e y 5 6 n a h t r e g n u o y n e m o W e u g it a f n i t n e m e v o r p m i e s n e t n i e r o m a r e d l o r o s r a e y 5 6 d e g a n e m o w n a h t 4 0 0
2 (3) Quanitfypotenitallyseriousrisksof
y b d e s u a c s t c e f f e r a l u c s a v o i d r a c e s r e v d a h t i w s t n e it a p F H n i y p a r e h t r e k c o l b a t e b n o it c n u f s y d c il o t s y s w e i v e r e r u t a r e t il -s e l c it r a 8 4 1 -s e s a b a t a d n i h c r a e s d e z i m e t s y s -d e b i r c s e d t o
N Betablockertherapywasassociatedwith s s e n i z z i d , n o i s n e t o p y h r o f s k s i r d e s a e r c n i t n a c if i n g i s o n e li h w , a i d r a c y d a r b d n a e u g it a f n e e w t e b d n u o f s a w n o it a i c o s s a y p a r e h t s i h t f o e s u e h t d n a 4 0 0
2 (19) Idenitfythecorrelaitonbetween
s t n e it a p y l r e d l e n i s r o s s e r t s l a c i g o l o h c y s p e r u li a f t r a e h h t i w ) s r a e y 0 6 > e g a ( s t n e it a p 7 2 2 -y d u t s l a n o it c e s -s s o r c -e l p it l u m h t i w s i s y l a n a l a c it s it a t s -n o i s s e r g e r e u g it a f d n a a e n p s y d f o e s u -f o n o i s r e v e s e n i h C m o r f s e l a c s e r u li a F t r a e H c i n o r h C ) Q H C ( e r i a n n o it s e u Q w o l d e v i e c r e p d n a e u g it a f f o s l e v e l h g i H d e if it n e d i e r e w t r o p p u s l a n o it o m e 3 0 0
2 (20) Describe"tolerabiilty"tobetablockers
s t n e it a p F H g n o m a s t n e it a p 8 6 2 -s t c e f f e l a r e t a ll o c f o g n i r o t i n o m -s t r o p e r t n e it a
P Thestudyevidencedweightgain,faitgue, t s o m e h t s a a e n p s y d d n a s s e n i z z i d s t c e f f e l a r e t a ll o c n o m m o c t s o m e h t e r e w n o i s n e t o p y h d n a e u g it a F a t e b g n i s u p o t s o t s n o s a e r n o m m o c s r e k c o l b 3 0 0
2 (21) DescribethesymptomsofHFpaitentsin
Table 1 – Cont inuat ion...
r a e
Y Objective Method Fatigueassessmentmethod Mainresults
2 0 0
2 (22) Comparefaitguedescripitonsduring
h t i w s t n e it a p F H y l r e d l e h t i w s w e i v r e t n i t n e it a p t u o l a c i n il c a t a a t a d t r o p e r g n i s r u n c i n il c s d r o c e r g n i s r u n 6 5 / s t n e it a p 8 5 1 -y d u t s e v it p i r c s e d -w e i v r e t n I e u g it a F f o n o it a c il p p a -. ) S I F ( e l u d e h c S w e i v r e t n I e u g it a F f o e s u -n o s n o it s e u q h t i w ) S I F ( e l u d e h c S n o t c a p m i , s n o it a s n e s l a c i s y h p l a t n e m , e c n a m r o f r e p l a n o it c n u f g n il e e f e v it c e f f a d n a n o it a s n e s n e e w t e b t n e m e e r g a r o o p e t a c i d n i s tl u s e R y r o t c a f s it a s d n a s n o it p i r c s e d ' s t n e it a p e u g it a f n o s t r o p e r e r e w e u g it a f f o s c it s i r e t c a r a h c e v it i n g o C t n e u q e r f e r o m e r e w t u b , d e t a l e r y l e r a r s t n e it a p h t i w s w e i v r e t n i g n i r u d 2 0 0
2 (23) Determinetheassociaitonbetweenbeta
, n o i s s e r p e d e k il s m o t p m y s d n a s r e k c o l b n o it c n u f s y d l a u x e s d n a e u g it a f w e i v e r c it a m e t s y s -s l a i r t d e z i m o d n a r l a c i n il c 5 1 -d e z i m o d n a r f o h c r a e s c it a m e t s y s -s e s a b a t a d n i s e i d u t s e u g it a f o t r a li m i s m r e t y n A ) a i n e h t s a , y g r a h t e l , s s e n d e r it ( s a w s t n e it a p y b d e t r o p e r e u g it a F d e d u l c n i h c i h w , s e i d u t s 0 1 n i d e s s e s s a a t e b e h t n i % 4 . 3 3 . s t n e it a p 2 8 6 , 7 1 o b e c a l p e h t n i % 4 . 0 3 d n a p u o r g r e k c o l b e u g it a f d e t r o p e r p u o r g t n e m p o l e v e d e h t t a h t t s e g g u s s t s il a i c e p S s r e k c o l b a t e b g n i s u s t n e it a p n i e u g it a f f o l a r t n e c e h t n i s t c e f f e s t i m o r f tl u s e r n a c f o y t il i b i s s o p e h t d n a m e t s y s s u o v r e n h t i w d e t a i c o s s a t u p t u o c a i d r a c d e s a e r c e d y p a r e h t e h t 2 0 0
2 (24) Describeandcomparefaitgue
d n a n e m y l r e d l e f o p u o r g a n i s e c n e i r e p x e e r u li a f t r a e h e r e v e s h t i w n e m o w s t n e it a p 8 5 1 -y d u t s e v it p i r c s e d -w e i v r e t n I e u g it a F f o n o it a c il p p a -e l u d e h c S e h t f o n o i s r e v d e if i d o m a f o e s u -w e i v r e t n i n a d e d u l c n i h c i h w , S I F , e c n e i r e p x e e u g it a f e h t t u o b a d n a l e v e l e u g it a f f o t n e m s s e s s a d o o m l a r e n e g d n a y t i s n e t n i s e c n e i r e p x e e u g it a f f o s n o it p i r c s e D e r o m t r o p e r o t d n e t n e m o w t a h t d e w o h s y ll a c it s it a t s o n t u b , e u g it a f e s n e t n i s r e d n e g n e e w t e b s e c n e r e f f i d t n a c if i n g i s y t i s n e t n i e u g it a f r o f d n u o f e r e w 9 9 9
1 (25) AssesstheeffectoftheAT-1
e s i c r e x e n o r o t p e c e r II n o i s n e t o i g n a s m o t p m y s F H d n a e c n a r e l o t ) II I d n a II F H ( s t n e it a p 4 4 8 -d n il b -e l b u o d d e z i m o d n a r r e t n e c it l u m -y d u t s d e n i m r e t e d e r e w s e r o c s e u g it a F -n i t n e m r i a p m i g n i r u s a e m y b g n i v il y li a d f o s e it i v it c a y lt n a c if i n g i s g u r d d e t s e t e h t f o s e s o d ll A n i s e r o c s a e n p s y d d n a e u g it a f d e v o r p m i o b e c a l p e h t o t n o it a l e r 9 9 9
1 (26) Idenitfyfactorsrelatedtofaitgue
d n a s r o t c a f d e t a l e r -e u g it a f e z i r a m m u S e h t f o y t i r a n il p i c s i d it l u m e h t e r o l p x e o s l a d n a e u g it a f s n i a l p x e t a h t l e d o m h c r a e s e r s n o it n e v r e t n i f o t n e m p o l e v e d e h t w e i v e r c it a m e t s y s -s e i d u t s 3 5 -s e s a b a t a d n i h c r a e s d e z i m e t s y s -y l p p a t o n s e o
D Sociodemographicfactors,reportedcure e v it i s o p e u g it a f t c e f f a e r a c d e t r o p e r d n a t c u r t s n o c o t m i a s t r o f f e d n a , y l e v it a g e n r o e t a n i m il e r o e s a e r c e d t a h t s n o it n e v r e t n i e u g it a f 8 9 9
1 (27) Developandtestfaitguemeasurement
F H g n o m a ) S F E D d n a S F U D ( s e l a c s s t n e it a p s t n e it a p 8 3 1 -y d u t s l a n o it c e s -s s o r c -e u g it a f f o t s il k c e h c f o n o it a r o b a l e -s e it i v it c a d e t a l e r y l p p a t o n s e o
D DUFSisadequateasameasurement d n a s i s o n g a i d e u g it a f e h t r o f t n e m u r t s n i s tl u s e r e u g it a f f o s n o s i r a p m o c s t i m r e p s p u o r g t n e it a p n e e w t e b o t e c it c a r p l a c i n il c n i d e s u e b n a c S F E D s a w e u g it a F . e u g it a f n o it r e x e e r u s a e m n i ; n e m n a h t n e m o w n i e s n e t n i e r o m a h t i w ; s l e v e l n o it a c u d e r e w o l h t i w e l p o e p n i d n a r e h g i h r o 5 2 f o x e d n i s s a m y d o b a e n p s y d f o s e s a c 5 9 9
1 (28) Determineifthereweredifferences
a d e t p u r r e t n i o h w s t n e it a p F H n e e w t e b e u g it a f d n a a e n p s y d o t e u d t s e t l a c i s y h p s t s e t c i m o n o g r e 2 2 2 -l o c o t o r p y t i v it c a l a c i s y h p f o e s u -d e b i r c s e d t o
N Faitguewasthereasontostopexercising s t n e it a p 0 6 1 e li h w , s t n e it a p 2 6 r o f a e n p s y d o t e u d d e p p o t s 5 9 9
1 (29) Examinehowpsychologicalfactorsand
e u g it a f o t d e t u b i r t n o c s m o t p m y s l a c i s y h p F H h t i w n e m o w y l r e d l e n i s n o it a i r a v n e m o w 0 8 -n a m r e b o H -n e h o C f o n o it a c il p p a -o w t t a s m o t p m y S l a c i s y h P f o y r o t n e v n I ) l a v r e t n i h t n o m -8 1 n a h t i w ( s e m it n a m r e b o H -n e h o C f o e s U -s m o t p m y S l a c i s y h P f o y r o t n e v n I o t s e l a c s h t i w , n o i s r e v d e if i d o m , e u g it a f e k il s m o t p m y s s s e s s a h t a e r b f o t r o h s g n i e b , n i a p t s e h c s n o it a t i p l a p d n a r e h t o n a h t e r o m d e t r o p e r s a w e u g it a F s e m it h t o b t a s m o t p m y s l a c i s y h p 3 9 9
1 (30) Reifneandunderstand ifndingsfroman
d e t a l e r -F H n o d e s u c o f t a h t y d u t s l a n i g i r o n o it p i r c s e d e u g it a f s t n e it a p 8 3 -y d u t s e v it p i r c s e d -w e i v r e t n I e u g it a F d e if i d o m f o n o it a c il p p a -) S I F ( e l u d e h c S w e i v r e t n I e u g it a F f o e s U -e h t m o r f d e if i d o m , ) S I F ( e l u d e h c S s e r u s a e m e d u l c n i o t y d u t s l a n i g i r o e u g it a f e e r h t , y t i r g e t n i l a i c o s f o d o o m , s e r u s a e m y t i s n e t n i l e v e l y t i v it c a d n a t n e m s s e s s a k r o Y w e N e h t o t g n i d r o c c a . ) A H Y N ( n o it a i c o s s A , s s e r t s f o tl u s e r a s a d e r r u c c o e u g it a F e s a e s i d d n a y t i v it c a l a c i s y h p 3 9 9
1 (31) Determineifexeritonfaitgueismore
n o it c n u f s y d l a t e l e k s o l u c s u m o t d e t a l e r n o it c u d e r w o lf d o o l b o t n a h t s t n e it a p 4 3 -t s e t c i r t e m o g r e h t i w l o c o t o r p -n o it u li d o m r e h t y b t u p t u o c a i d r a c -II M M f o t n e m e r u s a e m w o lf d o o l b -d e b i r c s e d t o
N Aconsiderablepercentageofpaitents e u d , e u g it a f n o it r e x e d e p o l e v e d F H h t i w n a h t e r o m n o it c n u f s y d l a t e l e k s o l u c s u m o t e h t o t w o lf d o o l b d e s a e r c e d o t m e t s y s l a t e l e k s o l u c s u m 9 8 9
1 (32) Developascaletomeasuretheimpactof
e f il f o y t il a u q e h t n o e u g it a f d n a a e n p s y d s t n e it a p F H f o s t n e it a p 2 6 3 -y t i d il a v t n a n i m i r c s i d -r e h t o n a n o d e s a b s m e t i f o t n e m p o l e v e d -l a s o p o r p y d u t s y l p p a t o n s e o
D Thescalewasvaildatedtoprovidea x e d n i e u g it a f -a e n p s y d 6 8 9
1 (33) ExamineifexeritonresponsesinHF
n i s e c n e r e f f i d f i d n a r a li m i s e r a s t n e it a p d n a n o it a li t n e v , m s il o b a t e m s e p y t e s i c r e x e o w t g n i r u d s c i m a n y d o m e h f o s g n il e e f n i s n o it a i r a v n i a l p x e n a c a e n p s y d d n a e u g it a f ) II I r o II F H ( s t n e it a p 5 2 -.l o c o t o r p e s i c r e x e w o l s d n a t s a f -d e b i r c s e d t o
DI SCUSSI ON
Te a ch i n g i n t e r v e n t i o n s a n d h e a r t f a i l u r e pat ient assessm ent are fundam ent al t o m aint ain t heir st abilit y( 3 4 ) an d r edu ce t h e n egat iv e im pact s of t h e disease in t he public healt h sy st em( 35). These st udy r esult s suppor t a bet t er under st anding of fat igue, in view of it s im pact on t his populat ion’s qualit y of life.
The num ber of st udies t hat com plied wit h t he sear ch an d select ion cr it er ia in cr eased ov er t im e, w hich indicat es incr easing int er est in fat igue r elat ed t o hear t failur e. Quant it at iv e r esear ch pr edom inat ed. A wide range of fat igue assessm ent st rat egies as a v ar iable in t he included st udies w as obser v ed, and t hr ee st udies( 28, 31, 33) cont ained no descr ipt ion of how t his variable was st udied. I n som e st udies, fat igue w as assessed t hr ough a scale cr eat ed or adapt ed by t h e a u t h o r( 4 , 1 5 , 2 5 ); i n o t h e r s , t h e a u t h o r m e r e l y describes t he pat ient s’ report s( 20) or records in pat ient files( 21), and yet ot hers used full( 10,12,16,18,30) or part ial versions of st andardized inst rum ent s( 13,17,19,22,24,29). Two of t he st udies under analysis aim ed t o develop fat igue a s s e s s m e n t i n s t r u m e n t s( 2 7 , 3 2 ). Fo u r l i t e r a t u r e r ev iew s( 3 , 1 4 , 2 3 , 2 6 ) w er e included w hich, alt hough t hey pr esent ed r esult s on fat igue in hear t failur e, did not r e p o r t o n h o w f a t i g u e h a d b e e n a sse sse d i n t h e r esear ch included in t heir r ev iew s.
Th e r an g e of m et h od s t o assess f at ig u e in h ear t failu r e pat ien t s en t ails difficu lt ies t o in t egr at e r esu lt s on it s f r equ en cy, ch ar act er ist ics an d r elat ed fact or s. Consider ing t his r est r ict ion, and also t hat of r esear ch sam ples w it h dif f er en t ch ar act er ist ics, t h e included st udies showed t hat t he frequency of fat igue in heart failure pat ient s is high( 19,21) ( ranging from 69 t o 88% )( 13,21,30), t hat fat igue figured am ong t he m ost frequent sym pt om s( 21), t hat it w as t he m ost frequent of all physical sym pt om s( 29) and t hat fat igue was m ore i n t e n se i n h e a r t f a i l u r e p a t i e n t s t h a n i n co n t r o l groups( 11,16). The frequency of dyspnea as a sym pt om was sim ilar t o t hat of fat igue( 13). Differences bet ween t he research sam ples in t erm s of age, t reat m ent t ype an d h ear t f ailu r e class, f or ex am ple, do n ot per m it sy n t h esized f at ig u e in t en sit y or f r eq u en cy r esu lt s. Anot her barrier is t hat som e st udies present ed fat igue in t erm s of int ensit y and ot hers in t erm s of presence or ab sen ce. Mor eov er, t h e cr it er ia u sed t o classif y t he pr esence or absence of fat igue could not alw ay s b e id en t if ied w h en u sin g in st r u m en t s w it h or d in al fat igue scores, t hat is, when fat igue was t reat ed as a con t in u ou s v ar iable.
Fat ig u e is ex p er ien ced in ot h er acu t e an d ch r on ic con d it ion s, an d also am on g p eop le w it h ou t diseases. One im por t ant aspect for k now ledge about f at i g u e i n cases of h ear t f ai l u r e i s t o con t r ast i t s fr equency and ot her char act er ist ics w it h w hat occur s in t he gener al populat ion and in ot her diseases.
As for relat ed fact ors, fat igue w as st udied in connect ion w it h qualit y of life and disease ev olut ion, p hy sical act iv it y, social an d dem ogr aph ic v ar iables, com or bidit ies, t r eat m en t an d t h e ev alu at or ( pat ien t or nur se) .
Qualit y of life and disease pr ogr ession
Fat igue in heart failure is a fact or associat ed wit h lim it at ions t o m aint ain a lifest yle t hat is com pat ible wit h a desirable sense of aut onom y and independence. I n a st u d y of 1 9 0 6 h ear t f ai l u r e p at i en t s, f at i g u e explained 38% of variance in qualit y of life scores( 17). Fat ig u e in t en sit y w as ob ser v ed as an in d ep en d en t pr edict iv e fact or of det er ior at ion in hear t failur e( 4).
Ph y sical act iv it y
Physical act ivit y w as ident ified as one of t he pr edict iv e fact or s of fat igue in hear t failur e pat ient s aft er 12 m ont hs of follow- up, t oget her wit h dyspnea, h y per t en sion an d depr essiv e sy m pt om s( 1 2 ). Fat igu e, in t urn, was ident ified as a lim it ing fact or of physical a ct i v i t y( 2 8 , 3 0 , 3 1 , 3 3 ) a n d t h i s l i m i t a t i o n ca n ex er t a n im por t ant im pact on t he per ceiv ed qualit y of life of h ear t f ailu r e p at ien t s. Th ese r esu lt s u n d er lin e t h e aspect highlight ed in t he qualit at ive st udy included in t his r ev iew , i. e. t hat fat igue is a cir cular pr ocess in w hich it s consequences enhance t he fat igue it self( 9), as t h ey su g g est t h at p h y si cal act i v i t y or ex er ci se cap acit y som eh ow con t r ib u t e t o t h e occu r r en ce or i n t en si t y o f f a t i g u e, w h i l e f a t i g u e a l so i n f l u en ces ph y sical act iv it y or ex er cise capacit y. Th ese r esu lt s also indicat e t he im por t ance of fur t her ex plor ing t he associat ion bet w een t hese variables and t he effect of int ervent ions relat ed t o physical act ivit y and exercise cap acit y in st u d ies in v olv in g h ear t f ailu r e p at ien t s. Ex er t i o n f at i g u e seem s t o b e m o r e i n f l u en ced b y
m usculoskelet al dy sfunct ion t han by decr eased blood flow t o t he m usculosk elet al sy st em( 31).
Social an d dem ogr aph ic v ar iables
i n t en se a m o n g w o m en( 2 7 ). On t h e o t h er h a n d , i n anot her st udy of 158 pat ient s ov er 65 y ear s of age, n o sign if ican t dif f er en ce w as f ou n d, alt h ou gh m ean fat igue int ensit y had been higher am ong wom en t han m en( 24). As t o age, one st udy found no differ ence in fat igue int ensit y bet ween pat ient s older t han 60 years and t hose aged 60 or less( 27). That sam e st udy found h igh er in t en sit y am on g pat ien t s w it h low edu cat ion level and no difference in fat igue int ensit y in t erm s of m ar it al st at us( 27).
Th e per ceiv ed degr ee of em ot ion al su ppor t
in 227 heart failure pat ient s older t han 60 years was associat ed w it h higher fat igue int ensit y lev els( 19).
Com or b id it ies
Dy spnea w as t he m ain sy m pt om associat ed wit h fat igue( 4,12,15- 16,27), which was also associat ed wit h
sleep disor der s( 1 4 , 1 6 ) an d depr essiv e sy m pt om s( 1 2 , 1 4 -15)
. I n a st udy of 38 heart failure pat ient s, report s of
st r ess as one of t he fact or s incr easing fat igue w er e v er y fr equent( 30). A st udy t hat com par ed fat igue and ot h er v ar iab les b et w een sam p les w it h an d w it h ou t h ear t f ailu r e sh ow ed associat ion s b et w een f at ig u e,
anxiet y and depression, independent ly of t he sam ple, a n d t h a t t h e t h r e e p a r t i a l l y e x p l a i n e d d y s p n e a variabilit y in t he heart failure sam ple( 16). Anot her fact or correlat ed wit h fat igue in research was t he body m ass index – when higher t han or equal t o 25, fat igue was m or e int ense( 27).
Tr eat m en t s
Th r ee st u dies in clu ded in t h is r ev iew( 3 , 2 0 , 2 3 ) looked at t he relat ion bet ween t he use of bet a blockers
and fat igue in hear t failur e pat ient s. One of t hem( 20) f ou n d t h at f at ig u e an d h y p ot en sion w er e t h e m ost fr equent m ot iv es t o st op t r eat m ent , but a change in t h e b e t a b l o c k e r d e c r e a s e d t h e f r e q u e n c y o f discont inuit y. One r ev iew st udy found no significant associat ion bet w een fat igue and use of bet a blocker, t hat t he discont inuit y of bet a blocker was lesser t han in t he placebo gr oup and t hat bet a block er t her apy w a s a s s o c i a t e d w i t h a d e c r e a s e i n m e d i c a t i o n discont inuit y due t o any cause( 3). I n anot her r ev iew , bet a blocker use w as significant ly associat ed w it h an a n n u a l i n c r e a s e i n t h e r i s k o f f a t i g u e r e p o r t s , cor r esp on d in g t o on e ad d it ion al f at ig u e r ep or t f or ev er y 5 7 pat ien t s t r eat ed each y ear( 2 3 ). I n pat ien t s w it h h ear t f ailu r e w h o w er e t ak in g b et a b lock er s,
f a t i g u e f r e q u e n cy w a s 3 3 . 4 % , a g a i n st 3 0 . 4 % i n pat ient s who were not t aking bet a blockers( 23). I n one of t he st udies included, w hich analy zed t he effect of using t he AT- 1 angiot ension I I r ecept or on ex er cise t o l e r a n c e a n d o t h e r h e a r t f a i l u r e s y m p t o m s i n com par ison w it h a placebo gr oup, found a significant im pr ov em ent in fat igue( 25).
Ev alu at or
I n one of t he st udies( 24), low agreem ent levels w ere found bet w een pat ient s’ verbal descript ions and t h e c o n t e n t o f n u r s i n g r e c o r d s o n f a t i g u e ch ar act er ist ics. Th e pat ien t s pu t st r on ger em ph asis on t he physical charact erist ics of fat igue, while nurses em p h asized m en t al d im en sion s m or e f r eq u en t ly in t heir records. Cognit ive charact erist ics of fat igue, such as concent r at ion difficult y and lack of int er est in t he n ear b y en v ir on m en t , w er e r ar e in t h e r ecor d s an d m or e com m on in pat ient r epor t s.
CONCLUSI ON
Th is r ev iew r ev ealed in cr easin g in t er est in f at ig u e in cases of h ear t f ailu r e an d t h at d if f er en t st rat egies have been used t o charact erize, assess and i n se r t i t i n b r o a d e r co n d i t i o n s. Ho w e v e r, f a t i g u e f r equ en cy dat a appear as secon dar y in f or m at ion in st udies wit h ot her goals, which indicat es t he need for em pir ical st u dies t o ex am in e f at igu e f r equ en cy an d int ensit y in hear t failur e pat ient s.
D i f f i cu l t i es t o i n t eg r at e r esu l t s o n f at i g u e ch a r a ct e r i st i cs, d u e t o t h e r a n g e o f a sse ssm e n t inst r um ent s, dem and r esear cher s’ at t ent ion. Per haps i t i s i n t e r e st i n g t o se t cu t - o f f p o i n t s f o r f a t i g u e assessm en t in st r u m en t s. Th is w ou ld n ot on ly of f er r e su l t s o n f a t i g u e i n t e n si t y, b u t a l so d a t a o n i t s frequency. Despit e lim it at ions t o int egrat e t he result s of t h e an aly zed st u d ies, f at ig u e f r eq u en cy r an g ed from 69 t o 88%( 13,30), wit h higher int ensit y levels t han in cont rol groups( 16).
are needed t o accum ulat e result s on fact ors correlat ed w it h f at igu e, as con t r ov er sial r esu lt s w er e f ou n d in t he analy zed st udies.
Under st anding fat igue inv olv es t he st udy of m ech an ism s p ot en t ially associat ed w it h it s g en esis and ex pr ession. I n cases of hear t failur e, fat igue is at t ribut ed t o low m uscle perfusion. Som e st udies invest
i n t h e i d e n t i f i ca t i o n o f st r u ct u r a l a n d f u n ct i o n a l alt erat ions in skelet al m uscles, besides low perfusion, w h ich m ay con t r ibu t e t o t h e f at igu e sy m pt om . Th e gr eat est challenge is t o find int er v ent ions capable of helping heart failure pat ient s t o deal wit h a sym pt om t h at seem s t o be f r equ en t an d in t en se an d af f ect s t heir liv es in im por t ant and unw ant ed w ay s.
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