BACKGROUND:Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes.METHODS:We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011–2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression.RESULTS:Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue.CONCLUSIONS:We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.

中文翻译：

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流行性心力衰竭中疲劳亚型及其相关性的识别：社区研究中动脉粥样硬化风险的二次分析

背景：在心力衰竭（HF）患者中，疲劳很常见，并且与生活质量和功能状态有关。假设疲劳表现为多种类型，包括一般疲劳和劳力疲劳。心力衰竭的独特疲劳亚型可能需要差异化评估和治疗以改善结果。我们进行这项研究的目的是确定 ARIC 研究（社区动脉粥样硬化风险）中常见心力衰竭患者的疲劳亚型，并描述不同亚型的特征分布。方法：我们对 1065 名在 ARIC 就诊时患有常见心力衰竭的参与者进行了横断面分析5（2011-2013）。我们使用改良医学研究委员会呼吸困难量表测量劳累性疲劳，并使用患者报告结果测量信息系统疲劳量表测量一般疲劳。我们使用潜在类别分析来识别疲劳的亚型。使用模型拟合统计数据确定类别数量，并根据给定类别认可调查项目的条件概率来解释类别并分配疲劳严重程度评级。我们使用多项回归比较了不同类别的特征。结果：总体而言，参与者中有 54% 是女性，38% 是黑人，平均年龄为 77 岁。我们确定了 4 种潜在类别（疲劳亚型）：(1) 高度一般/高度劳累疲劳 (18 ％），（2）高度一般性/低度劳累性疲劳（27％），（3）中度一般性/中度劳力性疲劳（20％），以及（4）低度/无一般性和劳力性疲劳（35％）。女性、黑人种族、较低的教育水平、较高的体重指数、抑郁症状增加以及糖尿病患病率较高与较高水平的全身性疲劳和劳力性疲劳相关。之前已经描述过。在亚型中，全身性疲劳和劳累性疲劳的严重程度大多一致，并且劳力性疲劳仅与全身性疲劳一起发生，而不是单独发生。进一步了解这些疲劳类型及其与结果的关系可能会增强我们对症状体验的理解，并为心力衰竭患者的预测和二级预防工作提供信息。