Gwent Healthcare Trust, Nevill Hall Hospital, Abergavenny, Monmouthshire, NP7 9SA, UK.
Eur J Cardiovasc Nurs. 2012 Dec;11(4):439-44. doi: 10.1016/j.ejcnurse.2011.04.002. Epub 2012 Apr 4.
Progression of fatigue in elderly heart failure patients is not well documented.
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).
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.
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.
Severe fatigue progresses differently in elderly patients and is a modifiable symptom in the early phases of CR.
老年人心力衰竭患者的疲劳进展情况记录不佳。
报告存活患者（n=112，平均年龄 75 岁）在 5 年心力衰竭计划（HFP）中的疲劳模式和严重程度。
患者（基线时 n=200）参加了为期 6 个月的心脏康复（CR 与标准护理）试验，然后接受相同的规定维持计划（第四阶段和/或独立运动）。疲劳通过 MLHF 问卷进行评估，并与生活质量（QoL）、身体和临床指标进行比较。在整个样本中描述了疲劳模式。根据基线随机分组、病因、性别、合并症和生存情况，对亚组进行数据分析。在 5 年随访时间点新诊断为心力衰竭的患者（n=29）提供了他们对疲劳体验的信息。
在基线和 5 年时，45%的患者将疲劳评为严重程度的两个最高类别，而 10%的患者在评估时没有症状。在 5 年内，样本中的疲劳模式为与 HFP 一致的持续改善（37%）、从基线开始的不良模式（37%）、持续改善（18%）或总体无变化（8%）。有联合问题的患者疲劳程度更高，并对干预措施有反应。在 5 年内，血红蛋白水平降低和严重疲劳的患者比例显著增加（p<0.05）。疲劳评分与 QoL 和身体测量显著相关（p<0.01）。
老年患者的严重疲劳进展不同，在 CR 的早期阶段是一种可改变的症状。
