Fatigue is a key contributor to quality of life in heart valve disease and after valve replacement/repair

Background Heart valve disease can result in high morbidity and impairment of quality of life (QOL) both before and after intervention. However, there are few descriptions of the QOL of people with heart valve disease across the disease course. Aims We aimed to describe the QOL of people living with heart valve disease through qualitative interviews. Methods Semi-structured interviews were conducted in people with heart valve disease, their family members, and clinical experts. A simple thematic analysis was used to summarise their perceptions of QOL. Results We interviewed 34 people with heart valve disease: seven with aortic stenosis, seven with rheumatic heart disease involving the mitral valve, nine with mitral regurgitation, and 11 with valve replacement/repair (mean age 66, 56% female). Three family members and five clinical experts were also interviewed. A key contributor to QOL was fatigue: most participants experienced fatigue, even mild fatigue impaired QOL directly, and severe fatigue had devastating effects on quality of life. Physical limitations impaired QOL due to the loss of ‘normal’ activity rather than objective physical limitation. Symptoms of heart valve disease impaired QOL directly, but the indirect effects of valve disease inspiring worry that reduced confidence and activity led to greater impairment. Conclusions Fatigue both before and after valve intervention is a contributor to QOL and requires further assessment. Research is recommended into whether fatigue is a specific enough symptom to warrant valvular intervention in heart valve disease.