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AHA Statement on Management of Poststroke Fatigue

Stroke; ePub 2017 May 25; Hinkle, Becker, et al

The American Heart Association (AHA) has issued a scientific statement covering the management of poststroke fatigue. The statement is intended to provide an international perspective on the emerging evidence surrounding the incidence, prevalence, quality of life, and complex pathogenesis of poststroke fatigue. Evidence for pharmacological and nonpharmacological intervention for management are reviewed, as well as the effects of poststroke fatigue on both stroke survivors and caregivers. Among the statement’s highlights and recommendations:

  • Poststroke fatigue (PSF) is common and affects at least half of stroke survivors.
  • Defining PSF has been challenging, with no consensus among clinicians or researchers on one best definition of PSF. A consensus definition would lead to more accurate estimates of incidence and prevalence.
  • Depression and poststroke fatigue may exist concurrently.
  • Regarding quality of life in PSF, clinicians, researchers, patients and caregivers all consider PSF important as it affects quality of life.
  • Multidimensional aspects of PSF including demographic, neurological/physical deficits, medical comorbidities, smoking, medications, sleep disturbances, pain, prestroke fatigue, depression, anxiety, and cognitive impairment may all play a part in PSF.
  • The pathophysiology of PSF is not well understood.
  • Patient assessment for PSF is important so that potential remedies can be instituted.
  • Patients discharged from the hospital after a stroke may be prescribed medications such as anticonvulsants that induce fatigue. It is important to determine which medications are more likely to contribute to PSF.
  • Clinicians should be aware of poststroke fatigue, and assess patients accordingly for it.

Citation:

Hinkle JL, Becker KJ, Kim JS, et al. Poststroke fatigue: Emerging evidence and approaches to management. A scientific statement for healthcare professionals from the American Heart Association. [Published online ahead of print May 25, 2017]. Stroke. doi:

Commentary:

This scientific statement reminds us that fatigue, which occurs in about half of patients after a stroke, has serious effects on quality of life. Causes of fatigue after a stroke vary from deconditioning to depression to the effects of sedating medications. Often it is multifactorial in nature. While there is often not one single answer and/or treatment, this statement informs us to ask our patients about fatigue if they have had a stroke and to look for potential causes. —Neil Skolnik, MD