Fatigue in pediatric congenital heart disease: integrative insight into cardiology-focused, lifestyle, psychological and social factors

Abstract

Objective: To investigate fatigue in children with congenital heart disease (CHD) and its associated factors. Methods: Children with CHD ages 2–18 were included from the PROactive cohort study. Fatigue prevalence was assessed using the PedsQL Multidimensional Fatigue Scale. Cardiology-focused factors reflecting disease severity were extracted from electronic health records. Generic lifestyle, psychological and social (i.e. transdiagnostic) factors were assessed via Patient Reported Outcome Measurements. Linear regression analyses explored associations with fatigue in children ages 8-18. Results: The study included 442 children (mean age 8.4, 56% male). Fatigue prevalence was 32.8%, with 17.7% reporting severe fatigue. Among children ages 8–18 (n = 211), the cardiology-focused factors lower exercise capacity and comorbidity were significantly associated with more fatigue. Considering transdiagnostic factors, poorer physical, social and emotional functioning, lower self-rated health and sleep/rest quality, more internalizing symptoms, and school absence were positively associated with fatigue. Cardiology-focused factors explained 13.2% of fatigue variance, while transdiagnostic factors explained 61.4%. Conclusions: Fatigue is a clinically relevant symptom in children with CHD. It is more strongly associated with transdiagnostic lifestyle, psychological and social factors than cardiology-focused factors. Transdiagnostic early fatigue interventions addressing modifiable factors are needed to prevent fatigue-related impairments.