Fatigue in Heart Failure A Scoping Review Using the Theory of Unpleasant Symptoms

BackgroundFatigue in heart failure (HF) is a burdensome symptom with profoundly negative effects on quality of life and an association with worsening prognosis and mortality. Despite its deleterious outcomes, HF-related fatigue remains poorly understood with limited treatment modalities.ObjectiveThe objective of this study was to identify correlates of HF-related fatigue.MethodsA scoping review was completed using the Arksey and O'Malley framework. The theory of unpleasant symptoms was used as a basis for organizing key findings into concepts related to HF-related fatigue. Published, primary studies in English that explored correlates or predictors of fatigue in adult patients with HF were included.ResultsThe search identified 655 articles, of which 38 were retained. An additional 4 articles were included for final review (N = 42). Nineteen concepts were identified as having a relationship with HF-related fatigue: age, sex, disease severity, inflammation, anemia, volume status, dyspnea, pain, body weight, depression, anxiety, perception of symptoms/health, sleep disturbances, poor social support, poor self-care, polypharmacy, reduced quality of life, risk for hospitalization, and mortality. Concepts were grouped into 4 categories: physiologic, psychologic, situational, and outcome.ConclusionsHeart failure-related fatigue is a complex symptom that has physiologic, psychologic, and situational antecedents that influence the symptom and patient outcomes, all of which should be addressed when developing treatment modalities. Cultural and societal norms, racial disparities, and the co-occurrence of multiple symptoms should also be considered. Inconsistent or weak relationships with multiple physiologic correlates suggest the presence of unrecognized influencing factors.