title: Patterns of fatigue in elderly heart failure patients measured by a quality of life scale (Minnesota living with heart failure).
abstract: BACKGROUND
  Progression of fatigue in elderly heart failure patients is not well documented.
  
  
  OBJECTIVE
  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 (p < 0.05) in the proportion of patients with reduced haemoglobin level and severe fatigue at 5 years. Fatigue scores correlated significantly (p < 0.01) with QoL and physical measures.
  
  
  CONCLUSIONS
  Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.
authors.affiliation: Gwent Healthcare Trust, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 9SA, UK.
authors.forename: Jacky
authors.initials: J
authors.lastname: Austin
authors.forename: W Robert
authors.initials: WR
authors.lastname: Williams
authors.forename: Stephen
authors.initials: S
authors.lastname: Hutchison
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005081:Exercise Therapy / Q000379:methods* / Q000706:statistics & numerical data; D017079:Exercise Tolerance / Q000502:physiology; D005221:Fatigue / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006333:Heart Failure / Q000175:diagnosis / Q000534:rehabilitation* / Q000628:therapy; D006801:Humans; D008297:Male; D009043:Motor Activity / Q000502:physiology; D011788:Quality of Life; D012047:Rehabilitation Centers; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom