Correlates of fatigue in advanced heart failure patients

The Journal of Heart and Lung Transplantation Volume 25, Number 2S Abstracts Reasons for Declining Hearts (n Inotropic Support Haemodynamic Instability ECG Changes Age Past Medical History Abnormal CXR g Smoking Other Primary Reason% Secondary Reason% S117 groups was comparable (5.4%/year; 4.0%/year; 4.5%/year; all P⬎0.05). Conclusion: Donor screening without coronary angiogram over- looks signiﬁcant atherosclerotic lesions in a considerable number of cases (7.0%). Therefore, angiographic screening should be performed in all donors ⱖ40 years old. Donor grafts with single-vessel CAS may be accepted as marginal hearts; however, in our opinion revascular- ization (CABG, PTCA) should be considered. Grafts with diffuse CAS have a serious risk for early graft failure. Beyond the ﬁrst year the outcome of healthy grafts and grafts with donor-transmitted coronary atherosclerosis are comparable. CORRELATES OF FATIGUE IN ADVANCED HEART FAILURE PATIENTS L.S. Evangelista, 1 N. Pike, 1 A. Ter-Galstanyan, 1 M.A. Hamilton, 2 G.C. Fonarow, 2 1 School of Nursing, University of California, Los Angeles, Los Angeles, CA; 2 School of Medicine, University of California, Los Angeles, Los Angeles, CA Conclusions: This study demonstrates that hearts declined on medical grounds by one centre can safely be transplanted and should be offered out nationally. CORONARY ATHEROSCLEROSIS OF THE DONOR HEART O. Grauhan, 1 J. Pazurek, 1 H. Siniawski, 1 M. Dandel, 1 H. Lehmkuhl, 1 C. Knosalla, 1 M. Pasic, 1 M. Huebler, 1 Y. Weng, 1 R. Hetzer, 1 1 Thoracic and Cardiovascular Surgery, German Heart Institute, Berlin, Germany Objectives: Due to the shortage of donor hearts, the criteria for organ acceptability have been considerably extended and donor grafts with coronary atherosclerosis are among those offered. This study evalu- ated whether and to what degree pre-existing coronary atherosclero- sis may be acceptable. Methods: A total of 1253 consecutive HTx recipients were investi- gated retrospectively for donor-transmitted coronary atherosclerosis (DCAS). DCAS was deﬁned as focal atherosclerosis with stenosis of at least 50%. Inclusion criteria were absence of pre-HTx angiogram but performance of angiogram or autopsy within 6 months after HTx. Hazard function and Kaplan-Meier analysis were used. Results: Eight-ﬁve out of 1253 (6.8%) cases were excluded, since coronary evaluation was not performed within 6 months (n⫽45) or hearts had undergone pre-transplant angiography (n⫽40). In 1086 patients no DCAS was found (NDCAS group) and in 82 patients (7%) DCAS was diagnosed by angiography (n⫽49) or autopsy (n⫽33). Single-vessel DCAS was found in 53/82 patients (DCAS1 group) and double- or triple-vessel DCAS in 26/82 patients (DCAS2/3 group). Three of the 82 patients with DCAS were excluded since the autopsy report was unclear regarding degree of DCAS. Early after HTx the instantaneous risk of death in the NDCAS and DCAS1 groups was 0.05 vs. 0.07 (P⬍0.05) whereas in the DCAS2/3 group it was 0.42 (P⬎0.05). However, beyond the ﬁrst year the annual decrease in all Background: Fatigue is one of the most common symptoms associ- ated with heart failure (HF), and is an important impediment to maintain an active lifestyle. Unfortunately, factors associated with fatigue are poorly understood. We conducted this study to identify the signiﬁcant demographic, clinical, and psychological correlates of fatigue in HF patients. Methods: One hundred and ﬁfty HF patients (73% male, 68% Caucasian, mean age 55.4 years), from a single HF center, completed the Proﬁle of Mood States – Fatigue Subscale, the Minnesota Living with Heart Failure, and the Beck Depression Inventory to assess levels of fatigue, quality of life (QOL), physical health, emotional health, and depression. Descriptive statistics and step-wise multiple regression were used to analyze data. Level of signiﬁcance was set at 0.05. Results: Reported mean scores were as follows: fatigue, 2.4 ⫾ 1.0; QOL, 42.2 ⫾ 27.0; physical health, 18.0 ⫾ 12.0; emotional health, 8.4 ⫾ 7.0; and depression 9.9 ⫾ 8.2. Ergometry work rate (watts), lipid-lowering medication, QOL, physical health, emotional health, and depression scores were highly correlated with fatigue (p ⬍ 0.01). Additional demographic and clinical variables were not signiﬁcantly related to levels of fatigue. In a multivariate model, watts, physical health, emotional health, and depression explained 51% of the variance in fatigue (p ⬍ 0.001). Conclusions: Fatigue signiﬁcantly impacts QOL in physical and emotional domains. Our ﬁndings suggest the need for multiple risk factor interventions to decrease fatigue and possibly improve physical and emotional health; patients on lipid-lowering medications and depression warrant increased scrutiny and may be at high risk for this debilitating symptom of HF. ANXIETY AND QUALITY OF LIFE IN CHF PATIENTS AND THEIR CAREGIVERS D.M. Weisshaar, 1 E.L. Heiges, 1 1 CHF/Transplant Service, Kaiser Permanente Santa Teresa, San Jose, CA Background: Caregivers of CHF patients face difﬁcult issues includ- ing concern for the patient’s physical symptoms, ﬁnancial stress, and disruption in their social life. These challenges contribute to anxiety, stress, and a decrease in the perception of quality of life (QOL). Many studies have focused on depression in CHF patients and their caregivers, but few have looked into anxiety. Methods: Patients and their primary caregivers were recruited by mail from a private insured advanced outpatient CHF clinic. 65 patient and 52 caregiver respondents produced 48 patient/caregiver