Chronic Fatigue Syndrome and Cardiovascular Disease

JACC State-of-the-Art Review

Benjamin H. Natelson, MD; Danielle L. Brunjes, PHD; Donna Mancini, MD


J Am Coll Cardiol. 2021;78(10):1056-1067. 

In This Article


This review was conducted using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis). Articles were identified using PubMed, and the search was done between July 17, 2020, and August 7, 2020. Search terms are as follows: "chronic fatigue syndrome" AND "heart" OR "cardiovascular" OR "cardiac function" OR post-exertional malaise" OR "postural tachycardia syndrome" OR "physical activity" OR "exercise capacity" OR "CPET." After duplicates were removed, a total of 760 papers were reviewed. A prescreen was completed to exclude papers that were not published in English and did not have adult populations, as well as papers published before 1995. Three exceptions were made for older publications that remained relevant to this paper. The remaining 656 papers were accessed for predetermined exclusion criteria, which included the following: 1) interventional studies that focused on pain, nutritional, cognitive, or behavioral changes; 2) drug or device interventions; 3) focused on other diseases, such as multiple sclerosis, cancer, or post-traumatic stress disorder; 4) studies unrelated to chronic fatigue syndrome or cardiovascular disease; and 5) animal studies. Papers were included or excluded first based on title, second on abstract, and then third on a review of the full paper. Overall, 128 full papers were considered (Figure 2). Papers were further evaluated based on redundancy, relevance to medical practice, methodological quality, and validity of inference made.

Figure 2.

PRISMA Flowchart
The PRISMA flowchart shows the systematic approach and exclusion criteria used during the literature review. CFS = chronic fatigue syndrome; CVD = cardiovascular disease; MS = multiple sclerosis; PTSD = post-traumatic stress disorder.