Vital exhaustion in chronic heart failure: Symptom profiles and clinical outcome Otto R.F. Smith a, ⁎ , Yori Gidron b , Nina Kupper a , Jobst B. Winter c , Johan Denollet a a Center on Research for Psychology in Somatic Diseases, Tilburg University, The Netherlands b School of Health Sciences and Social Care, Brunel University, London, UK c Department of Cardiology, Twee Steden Hospital, Tilburg, The Netherlands Received 4 November 2007; received in revised form 13 October 2008; accepted 29 October 2008 Abstract Objective: The aim of this study was to examine the components of vital exhaustion (VE) in chronic heart failure (CHF) patients and to examine whether psychological symptom profiles based on these components are differently associated with health status and cardiac rehospitalization. Methods: Consecutive CHF patients (N=381) were assessed for VE at baseline using the Maastricht Questionnaire and assessed for health status at 6- month follow-up using the Minnesota Living with Heart Failure Questionnaire. Information on cardiac rehospitalization was obtained from the patients' medical records. Results: Principal component analysis revealed four essential features of VE: fatigue, cognitive–affective depressive symptoms, sleep difficul- ties, and lack of concentration. Latent class cluster analysis using these components identified three subgroups with different symptom profiles: a subgroup without VE, a first vitally exhausted subgroup (VE1; fatigue and lack of concentration, but with a relative absence of cognitive–affective depressive symptoms and sleep difficulties), and a second more severe, vitally exhausted subgroup (VE2; elevated levels of all compo- nents). Both vitally exhausted subgroups were more likely to have impaired health status (VE1: β=.36, Pb .001; VE2: β=.71, Pb .001). VE2 was also associated with an increased risk of cardiac rehospitalization at 6-month follow-up (odds ratio=2.98; 95% confidence interval=1.01–8.83; P=.049). Conclusions: VE in CHF comprised four components (fatigue, cognitive–affective depressive symptoms, sleep difficulties, and lack of concentration) from which three different symptom profiles were derived. Subgroups with symptoms of VE were associated with adverse clinical outcome in CHF. In clinical practice, these results may help identify distinct groups of patients with potentially differential risks of adverse health outcomes. © 2009 Elsevier Inc. All rights reserved. Keywords: Vital exhaustion; Chronic heart failure; Symptom profiles; Fatigue; Depression Introduction Fatigue and vital exhaustion (VE) are symptoms that are frequently reported by patients with coronary artery disease and chronic heart failure (CHF) [1–3]. The most commonly used definition of VE is that of unusual tiredness, increased irritability, and feelings of demoralization [4]. VE has been associated with a twofold to threefold increased risk of mortality and morbidity in patients with coronary artery disease [2,5], and several potential biological pathways have been identified to explain this association. VE has been shown to relate to increased lipid metabolism [6], hypocor- tisolemia [7,8], reduced fibrinolytic capacity [9,10], para- sympathetic withdrawal [11], and increased levels of cytokines (e.g., IL-6) [12,13]. The 21-item Maastricht Questionnaire (MQ) is often used to assess VE [4]. Previous studies have shown that VE, as measured by the MQ, is not a unidimensional construct, but comprises different factors such as symptoms of fatigue, depressive symptoms, sleep problems, and lack of concen- Journal of Psychosomatic Research 66 (2009) 195 – 201 ⁎ Corresponding author. Department of Medical Psychology, Center of Research for Psychology in Somatic Diseases, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. Tel: +31 13 466 2115; fax: +31 13 466 2067. E-mail address: robert.smith@psy-uvt.nl (O.R.F. Smith). 0022-3999/08/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.jpsychores.2008.10.021