# Fatigue in adults with congenital heart disease aged over 40 years

## TL;DR

Adults with complex congenital heart disease over 40 experience more severe physical fatigue and worse heart function compared to those with less complex heart disease.

## Contribution

This study is the first to compare fatigue levels and heart function in adults over 40 with complex versus moderately complex congenital heart disease.

## Key findings

- Physical fatigue was more common in complex CHD patients (52%) compared to moderately complex CHD patients (25%).
- Complex CHD patients were three times more likely to report severe to very severe physical fatigue.
- All fatigue dimensions were positively associated with self-reported NYHA class in CHD patients.

## Abstract

Fatigue is a symptom that has been described among adult patients with congenital heart disease (CHD), but the prevalence and impact of fatigue on the patient's daily life has been poorly studied. This study (i) examines the prevalence of fatigue in patients aged over 40 years with moderately complex or complex congenital heart disease compared to controls and (ii) explores the relationship between fatigue, heart disease complexity, clinical characteristics and self-reported New York Heart Association Functional Class (self-reported NYHA class).

The Multidimensional Fatigue Inventory (MFI-20) was applied in 166 patients with moderately complex CHD or complex CHD (44 % females, median age 55.3 years, IQR 47.6–64.8) along with 89 controls (43 % female, median age 54.0, IQR 46.0–65.9). MFI-20 measured general fatigue, physical fatigue, mental fatigue, reduced motivation and reduced activity.

Physical fatigue (severe to very severe) was more common in complex CHD compared with moderately complex CHD (25 % vs. 52 %, p = 0.006). Complex CHD was associated with severe to very severe physical fatigue (odds ratio 3.1 (95 % CI 1.1–9.1). Patients with complex CHD had higher levels of self-reported NYHA class than patients with moderately complex CHD. All dimensions of fatigue were positively associated with self-reported NYHA class.

Patients over the age of 40 with complex CHD were three times more likely to report severe to very severe physical fatigue and reported higher levels of self-reported NYHA class than patients with moderately complex CHD. This highlights the importance of considering CHD complexity in clinical practice.

•Fatigue has been described among adult patients with congenital heart disease (CHD).•We examined fatigue in patients aged over 40 years with moderately complex and complex CHD.•Physical fatigue (severe to very severe) was more common in complex CHD.•Patients with complex CHD reported higher levels of self-reported NYHA class than those with moderately complex CHD.

Fatigue has been described among adult patients with congenital heart disease (CHD).

We examined fatigue in patients aged over 40 years with moderately complex and complex CHD.

Physical fatigue (severe to very severe) was more common in complex CHD.

Patients with complex CHD reported higher levels of self-reported NYHA class than those with moderately complex CHD.