General and Exertional Fatigue, Quality of Life, and Risk of Incident Clinical Heart Failure in Those With Pre‐heart Failure in the ARIC Study

Background General and exertional fatigue are associated with worse outcomes in clinical heart failure (HF). Little is known about their prognostic importance in stage B HF. Methods We included 2972 individuals at visit 5 (2011–2013) of the ARIC (Atherosclerosis Risk in Communities) study without clinical HF but with echocardiographic or biomarker evidence for stage B HF. Using general and exertional fatigue scale scores, individuals were categorized as low/no fatigue, high general fatigue only, high exertional fatigue only, or high general and high exertional fatigue. We determined their associations with quality of life and incident HF events using adjusted linear and Cox regression, respectively. Results Participants were 60% female, 18% Black, with a mean age of 76 years. Compared with low/no fatigue, all fatigue categories were associated with lower quality of life, with high general and high exertional fatigue having the lowest scores (physical: β=−11.48 [95% CI, −12.80 to −10.17]; mental: β=−5.97 [95% CI, −7.03 to −4.92]). There were 338 incident HF events over a median of 8.4 years. Compared with low/no fatigue, increased incident HF overall was found for high exertional fatigue only (hazard ratio [HR], 1.86 [95% CI, 1.39–2.49]) and high general and high exertional fatigue (HR, 2.16 [95% CI, 1.46–3.20]) but not general fatigue only (HR, 1.42 [95% CI, 0.99–2.04]). All 3 categories were independently associated with increased risk of incident HF with preserved ejection fraction but not with HF with reduced ejection fraction. Conclusions General and exertional fatigue demonstrate prognostic importance in pre‐HF and appear to be linked to underrecognized poor quality of life before the onset of clinical HF.