title: Distinct trajectories of fatigue in chronic heart failure and their association with prognosis.
abstract: OBJECTIVE
  To identify distinct trajectories of fatigue over a 12-month period and to examine their impact on mortality in chronic heart failure (CHF).
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Psychology, CoRPS-Center of Research on Psychology in Somatic diseases, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
authors.forename: Otto R F
authors.initials: OR
authors.lastname: Smith
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.forename: Peter
authors.initials: P
authors.lastname: de Jonge
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D016001:Confidence Intervals; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D006305:Health Status Indicators; D006306:Health Surveys; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D016277:Ventricular Function, Left