Abstract
BACKGROUND: Chronic heart failure (CHF) has a prolonged clinical course, and patients commonly experience fatigue. It remains unclear whether anxiety and depression exacerbate fatigue in patients with CHF. AIM: To examine the correlation of fatigue status with anxiety and depression in patients with CHF and identify factors influencing fatigue. METHODS: This observational study included 162 patients with CHF who visited the Department of Cardiology, Suzhou Ninth Hospital Affiliated to Soochow University, between May 2023 and May 2025. Fatigue was assessed using the Chinese version of the Multidimensional Fatigue Scale (MFI-20). Anxiety and depression were evaluated with the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Patient demographic and clinical data were collected using a general information questionnaire. Pearson correlation analysis was used to assess the relationship between fatigue, anxiety, and depression, while multiple linear regression analysis was conducted to identify factors influencing fatigue levels. RESULTS: The mean MFI-20 fatigue score among the 162 patients with CHF was 70.76 ± 8.42. The mean SAS score was 58.87 ± 9.92, and the mean SDS score was 54.76 ± 7.91. Both SAS and SDS scores were positively correlated with MFI-20 scores (r = 0.479, r = 0.468; both P < 0.001). Multivariate regression analysis identified comorbidities [β = 0.903, 95% confidence interval (CI): 0.258-1.695], New York Heart Association functional class (III-IV) (β = 0.319, 95%CI: 0.269-0.743), poor sleep quality (β = 0.465, 95%CI: 0.294-0.948), anxiety (β = 1.728, 95%CI: 0.693-3.642), and depression (β = 1.649, 95%CI: 0.712-3.517) as significant factors influencing fatigue (P < 0.05). CONCLUSION: Fatigue levels in patients with CHF were high and significantly influenced by comorbidities, advanced New York Heart Association functional class (III-IV), poor sleep quality, anxiety, and depression. Clinical interventions that address comorbid conditions, improve cardiac function, and provide sleep and psychological support may help alleviate fatigue in this population.