Fatigue as a Symptom of Coronary Heart Disease

It has been suggested that fatigue is a prodromal symptom of myocardial infarction and a potential indicator of coronary heart disease (CHD). However, no published research has examined fatigue in the stable CHD population. The purpose of this mixed-methods study was to describe fatigue reported by CHD patients using the theory of unpleasant symptoms. Data were collected from questionnaires (N = 102) and qualitative interviews (n = 13). Participants completed the Fatigue Symptom Inventory, Medical Outcomes Study Short Form 36 (SF36), and Patient Health Questionnaire-9 (PHQ-9) to measure fatigue, health-related quality of life, and depressive symptoms, respectively. Participants were then sampled from low (n= 5), moderate (n= 4), and high (n=4) fatigue groups for qualitative interviews. Integrated qualitative and quantitative findings confirmed that CHD patients experience high levels of fatigue. Seventy-two percent of the sample reported fatigue interfering with their general activity level. Over 40% of participants reported fatigue more than half the days each week lasting more than half the day. Participants who reported a PHQ-9 score > 4, indicating depressed mood, reported higher levels of fatigue (χ2 = 20.45; p < .0001). Participants reported lower interference from fatigue on the standardized measures compared to qualitative interviews. When compared to published data for cancer patients, CHD patients report similar fatigue to those individuals undergoing active cancer treatment. Fatigue was associated with depression and lower quality of life. Combining qualitative and quantitative findings provides descriptive depth as participants did not always report fatigue on standardized measures. This finding illuminates the need for clinicians to ask not only whether a person is experiencing fatigue, but if they have compensated for fatigue in some way. Relying on standardized measures of fatigue provides an incomplete picture of fatigue in this population.