UC Irvine

Background

The attributes of fatigue after orthotopic heart transplantation (OHT) are poorly understood. We conducted this study to assess the prevalence, severity and correlates of fatigue among female OHT survivors.

Methods

Fifty women (age 54.7 +/- 13.0 years) from a single heart transplant center, who underwent OHT 5.1 +/- 4.4 (mean +/- SD) years earlier, completed a battery of questionnaires including the Profile of Mood States-fatigue sub-scale to assess levels of fatigue, the Beck Depression Inventory to measure depression, and the Short Form-36 to measure functional status and mental health. Demographic and clinical data were obtained from self-reports and medical chart reviews.

Results

Women reported mean scores of 15.7 +/- 6.8 (range 3 to 27), 13.2 +/- 8.2 (range 0 to 38), 37.2 +/- 10.8 (range 22 to 62) and 41.5 +/- 11.2 (range 17 to 60) for fatigue, depression, functional status and mental health, respectively. Univariate analyses revealed that sociodemographic and clinical variables (e.g., age, employment status, anemia, renal insufficiency) were significantly related to fatigue (p < 0.001). Likewise, depression, functional status and mental health were also significantly related to fatigue (p < 0.001). In a multivariate model, age (adjusted R(2) = 0.23, p < 0.001), anemia (adjusted R(2) = 0.39, p < 0.001), functional status (adjusted R(2) = 0.60, p < 0.001) and depression (adjusted R(2) = 0.69, p < 0.001) were significant predictors of fatigue. The model explained 69% of the variance in fatigue (p < 0.001).

Conclusions

Fatigue is common in women after OHT and is associated with both physiologic and psychologic factors. Clinicians should evaluate all female recipients for symptoms of fatigue, especially those with anemia, renal insufficiency, poor functional status and depression. Other potential mediators of fatigue, such as the denervated donor heart and type of immunosuppressive regimen, may also play a role and require further study.