Effects of Nonpharmacological Interventions for Fatigue in Patients with Heart Failure: A Systematic Review and Meta-Analysis


Background: Fatigue is the primary symptom accompanied with dyspnea in heart failure (HF). The symptoms limit activities of daily living, lower quality of life, drive the need for HF-related hospitalizations, and signal a poor prognosis in the HF condition. Although fatigue has been noted as a common symptom in HF, there has been limited research measuring the quantitative and qualitative aspects of fatigue in HF. Moreover, relatively few studies have been designed to manage fatigue in HF patients compared to those of cancer-related fatigue. Objective: This study aims to analyze the trend of research on management of fatigue for patients with HF and to determine the effects of nonpharmacological interventions through a systematic review and meta-analysis. Methods: The databases of MEDLINE, EMBASE, the Cochrane library were systematically explored for eligible studies, using the combinations of MeSH terms, free-text terms, and Boolean operators. The authors independently evaluated the eligibility of the studies published before March 1st, 2018, and extracted the data. The quality assessment was then conducted individually using the Cochrane Collaboration’s Risk of Bias Tool. Each of the study results was compared and synthesized using the effect sizes, such as standardized mean difference (SMD), weighted mean difference (WMD) with a 95% confidence intervals (CIs). Heterogeneity was confirmed through the I2 statistic. Results: Eight studies were included-7 were randomized controlled trials; the other was a quasi-experimental study. The types of the interventions involved exercise, education, muscle relaxation, meditation, and biofeedback. The primary outcome was the level of the fatigue measured from the HF patients in the studies. Meta package in R version 3.4.3 was employed to conduct the meta-analysis for the overall 514 participants across the studies. Figure 1 illustrates the forest plot for the results. Random-effects model reveals that nonpharmacological interventions had a significant effect on fatigue in HF patients (SMD=-0.77; 95% CI -1.04 to -0.50). The heterogeneity of the effect sizes was moderately high (I2=57%, X2 =0.10, p =0.01). Conclusion: Findings suggest that a nonpharmacological intervention decreases the fatigue in HF population. This calls for more methodological and intervention-driven research devoted to advancing fatigue management programs for the better quality of life of patients with HF.

Journal of Cardiac Failure