Objective: To examine the role of clinical and psychological characteristics as predictors of fatigue in CHF. Background: Little is known about predictors of fatigue in CHF. Next to heart failure characteristics, depressive symptoms and type-D personality may explain individual differences in fatigue. Methods: At baseline, 136 CHF outpatients (age ≤ 80 years) completed a questionnaire to assess depressive symptoms, type-D personality and cardiac symptoms. At one-year follow-up, they completed the Dutch Exertion Fatigue Scale and the Fatigue Assessment Scale to assess symptoms of fatigue. Medical information was obtained from the patients' medical records. Results: Exertion fatigue and general fatigue were identified as different manifestations of fatigue. We found that exertion fatigue at 12-month follow-up was predicted by decreased exercise capacity (β = −.35; p b .001), dyspnoea (β = 24; p = .002), hypertension (β = .16; p = .03), and depressive symptoms (β = .16; p = .05). In contrast, general fatigue at 12-month follow-up was predicted by dyspnoea (β = .24; p = .003), depressive symptoms (β = .27; p b .001), type-D personality (β = 17; p = .03), and sleep problems (β = .20; p = .01). Together, these variables explained 32% and 37% of the variance, respectively. Conclusion: The present study showed that fatigue was related to both clinical and psychological characteristics. The use of this knowledge may lead to a better understanding and treatment of the clinical manifestations of fatigue in CHF.

Type D was associated with impaired health status and increased depressive symptoms in CHF patients. These preliminary findings demonstrate the value of including personality factors in CHF research.

Symptoms of depression tend to persist during the first year post-MI. Cardiac history, prior depression and Type-D personality were identified as independent risk factors for persistence of depressive symptoms. The results of this study strongly argue for routine psychological screening during hospitalization for acute MI in order to identify patients who are at risk for chronicity of depressive symptoms and its deleterious effects on prognosis.

CHF patients with Type D personality are characterized by an increased oxidative stress burden, apparent in the decreased antioxidant levels and an increased oxidative stress ratio.

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The current understanding of the pathophysiology of atherosclerosis leading to coronary artery disease (CAD) emphasizes the role of inflammatory mediators. Given the bidirectional communication between the immune and central nervous systems, an important question is whether the brain can be "informed" about and modulate CAD-related inflammation. A candidate communicator and modulator is the vagus nerve. Until now, the vagus nerve has received attention in cardiology mainly due to its role in the parasympathetic cardiovascular response. However, the vagus nerve can also "inform" the brain about peripheral inflammation since its paraganglia have receptors for interleukin-1. Furthermore, its efferent branch has a local anti-inflammatory effect. These effects have not been considered in research on the vagus nerve in CAD or in vagus nerve stimulation trials in CAD. In addition, various behavioural interventions, including relaxation, may influence CAD prognosis by affecting vagal activity. Based on this converging evidence, we propose a neuroimmunomodulation approach to atherogenesis. In this model, the vagus nerve "informs" the brain about CAD-related cytokines; in turn, activation of the vagus (via vagus nerve stimulation, vagomimetic drugs or relaxation) induces an anti-inflammatory response that can slow down the chronic process of atherogenesis.