Vital exhaustion and sudden cardiac death in the Atherosclerosis Risk in Communities Study.

OBJECTIVE: Vital exhaustion (VE), a construct defined as lack of energy, increased fatigue and irritability, and feelings of demoralisation, has been associated with cardiovascular events. We sought to examine the relation between VE and sudden cardiac death (SCD) in the Atherosclerosis Risk in Communities (ARIC) Study. METHODS: The ARIC Study is a predominately biracial cohort of men and women, aged 45-64 at baseline, initiated in 1987 through random sampling in four US communities. VE was measured using the Maastricht questionnaire between 1990 and 1992 among 13 923 individuals. Cox proportional hazards models were used to examine the hazard of out-of-hospital SCD across tertiles of VE scores. RESULTS: Through 2012, 457 SCD cases, defined as a sudden pulseless condition presumed due to a ventricular tachyarrhythmia in a previously stable individual, were identified in ARIC by physician record review. Adjusting for age, sex and race/centre, participants in the highest VE tertile had an increased risk of SCD (HR 1.48, 95% CI 1.17 to 1.87), but these findings did not remain significant after adjustment for established cardiovascular disease risk factors (HR 0.94, 95% CI 0.73 to 1.20). CONCLUSIONS: Among participants of the ARIC study, VE was not associated with an increased risk for SCD after adjustment for cardiovascular risk factors.

Tiredness, fatigue, and exhaustion in the context of a major depressive disorder.

Framed in a multimethod design using ethnoscience and grounded theory, the purpose of this study was to characterize the attributes of tiredness, fatigue, and exhaustion, and to explore their influences on illness experiences in individuals with major depressive disorder. Two domains, mind (attributes: cognitive function, sleep quality, emotional reactivity, social interaction) and body (attributes: stamina and control over body processes), were identified. These attributes changed qualitatively with participants' progression from tiredness to fatigue and from fatigue to exhaustion, and determined whether participants "faced outward" to engage with others or "faced inward" to protect energy reserves--a decision largely influenced by the capacity "to hold up a mask" to conceal symptoms. The mask was energy depleting, and if participants could not hold up their mask, they withdrew to preserve energy. Findings regarding the role of the mask could contribute to the development of patient self-care strategies and caregiver interventions.