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Fatigue in the Presence of Coronary Heart Disease

Eckhardt, Ann L.; DeVon, Holli A.; Piano, Mariann R.; Ryan, Catherine J.; Zerwic, Julie J.

doi: 10.1097/NNR.0000000000000019

Background: Fatigue is a prevalent and disabling symptom associated with many acute and chronic conditions, including acute myocardial infarction and chronic heart failure. Fatigue has not been explored in patients with stable coronary heart disease (CHD).

Objectives: The purpose of this partially mixed sequential dominant status study was to (a) describe fatigue in patients with stable CHD; (b) determine if specific demographic (gender, age, education, income), physiological (hypertension, hyperlipidemia), or psychological (depressive symptoms) variables were correlated with fatigue; and (c) determine if fatigue was associated with health-related quality of life. The theory of unpleasant symptoms was used as a conceptual framework.

Methods: Patients (N = 102) attending two cardiology clinics completed the Fatigue Symptom Inventory, Patient Health Questionnaire-9, and Medical Outcomes Study Short Form-36 to measure fatigue, depressive symptoms, and health-related quality of life. Thirteen patients whose interference from fatigue was low, moderate, or high participated in qualitative interviews.

Results: Forty percent of the sample reported fatigue more than 3 days of the week lasting more than one half of the day. Lower interference from fatigue was reported on standardized measures compared with qualitative interviews. Compared with men, women reported a higher fatigue intensity (p = .003) and more interference from fatigue (p = .007). In regression analyses, depressive symptoms were the sole predictor of fatigue intensity and interference.

Discussion: Patients with stable CHD reported clinically relevant levels of fatigue. Patients with stable CHD may discount fatigue as they adapt to their symptoms. Relying solely on standardized measures may provide an incomplete picture of fatigue burden in patients with stable CHD.

Ann L. Eckhardt, PhD, RN, is Assistant Professor, School of Nursing, Illinois Wesleyan University, Bloomington.

Holli A. DeVon, PhD, RN, is Associate Professor; Mariann R. Piano, PhD, RN, is Professor and Department Head; Catherine J. Ryan, PhD, RN, is Clinical Assistant Professor; and Julie J. Zerwic, PhD, RN, is Professor and Executive Associate Dean, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago.

Accepted for publication November 12, 2013.

The authors acknowledge that this research was supported in part by grants from the Midwest Nursing Research Society and Sigma Theta Tau International.

The authors have no conflicts of interest to disclose.

Corresponding author: Ann L. Eckhardt, PhD, RN, School of Nursing, Illinois Wesleyan University, P.O. Box 2900, Bloomington, IL 61702 (e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.