Comparison of tools for assessing fatigue in patients with heart failure

To compare the distributions of measurements of the Dutch Fatigue Scale (DUFS), Dutch Exertion Fatigue Scale (DEFS), and Fatigue Pictogram tools, according to the New York Heart Association (NYHA) Functional Classification and left ventricular ejection fraction (LVEF).

Method:

Methodological, cross-sectional study with 118 patients with heart failure. Variance analysis, Pearson's correlation, and Fisher's exact tests were carried out, with a significance level of 0.05.

Results:

There was an increase in the DUFS and DEFS means with worsening of the NYHA-FC (p<0.001, for both tools). Correlations among the LVEF resulted in positive and weak magnitude for the DEFS (r=0.18; p=0.05) and for the DUFS (r=0.16; p=0.08). Just the item A on the Fatigue Pictogram had an association with the NYHA-FC (p<0.001) and the LVEF (p=0.03).

Conclusion:

Three tools detected worsening in fatigue levels according to the illness severity assessed by the NYHA-FC.

Descriptors:
Heart Failure; Cardiovascular Nursing; Fatigue; Surveys and Questionnaires; Nursing

Self-reported NYHA-FC^* * New York Heart Association functional classification;		p ^ p values resulting from the post-hoc test of the comparisons of Bonferroni's multiple means.	(95%) Interval of confidence for the difference between means
			Upper limit	Lower limit
I	II	<0.001	-12.14	-2.64
	III	<0.001	-14.96	-5.54
	IV	<0.001	-18.66	-9.44
II	III	0.56	-7.39	1.67
	IV	0.001	-11.09	-2.23
III	IV	0.13	-8.19	0.58

Self-reported NYHA-FC^* * NYHA-FC: New York Heart Association functional classification;		p ^ p values resulting from the post-hoc test of the comparisons of Bonferroni's multiple means.	(95%) Interval of confidence for the difference among the means
			Upper limit	Lower limit
I	II	0.005	-12.35	-1.49
	III	<0.001	-17.42	-6.56
	IV	<0.001	-20.19	-9.56
II	III	0.059	-10.24	0.11
II	IV	0.001	-13.02	-2.90
III	IV	0.77	-7.95	2.17

Fatigue Pictogram		Self-referred NYHA-FC^* * NYHA-FC: New York Heart Association functional classification; (n)				p ^ p values resulting from the Fisher's exact test.
Fatigue Pictogram		I n (%)	II n (%)	III n (%)	IV n (%)	p ^ p values resulting from the Fisher's exact test.
Item A	Not at all tired.	15 (12.8)	6 (5.1)	2 (1.7)	1 (0.8)
	Slightly/moderately tired.	10 (8.5)	18 (15.2)	15 (12.7)	14 (11.9)	<0.001
	Very/extremely tired.	0 (0)	6 (5.1)	13 (11.0)	18 (15.2)
Item B	I can do everything.	8 (6.8)	2 (1.7)	0 (0)	1 (0.8)
	I can do almost everything/a few things.	14 (11.8)	17 (14.4)	12 (10.2)	11 (9.3)	0.001
	I just do what I have to do/I can do very little.	3 (2.5)	11 (9.4)	18 (15.2)	21 (17.9)

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] CORRESPONDING AUTHOR: Rosana Aparecida Spadoti Dantas. E-mail: rsdantas@eerp.usp.br