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  • 1. Aasa, M
    et al.
    Dellborg, M
    Herlitz, Johan
    [external].
    Svensson, L
    Grip, L
    Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial)2010Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 106, nr 12, s. 1685-1691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.

  • 2. Abdon, NJ
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andrersson, B
    Peripartumcardiomyopathi an often mised diagnosis2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 23-24, s. 1152-1154Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.

  • 3.
    Acuña Mora, Mariela
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;KU Leuven Department of Public Health and Primary Care, Belgium.
    Sparud-Lundin, Carina
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Burström, Åsa
    Institution for Women’s and Children’s Health, Karolinska Institute, Sweden;Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Sweden.
    Hanseus, Katarina
    Department of Pediatric Cardiology, Skåne University Hospital, Sweden.
    Rydberg, Annika
    Department of Clinical Sciences, Pediatrics, Umeå University, Sweden.
    Moons, Philip
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;KU Leuven Department of Public Health and Primary Care, Belgium;Department of Paediatrics and Child Health, University of Cape Town, South Africa.
    Bratt, Ewa-Lena
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Sweden.
    Patient empowerment and its correlates in young persons with congenital heart disease2019Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, nr 5, s. 389-398Artikel i tidskrift (Refereegranskat)
  • 4.
    Adielsson, Anna
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielsson, Christian
    Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Forkman, Pontus
    Department of Adult Psychiatry, Mora Hospital, Mora, Sweden.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pettersson, Linda
    Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundin, Stefan
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Outcome prediction for patients assessed by the medical emergency team: a retrospective cohort study2022Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, nr 1, artikel-id 200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days.

    Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality.

    Results: The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774-0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762-0.773).

    Conclusions: Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.

     

  • 5.
    Adielsson, Anna
    et al.
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Djärv, Therese
    Department of Medicine, K2, Solna Karolinska Institutet, SE-171 77 Stockholm, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, SE-413 45 Gothenburg, Sweden.
    Lundin, Stefan
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest - A population-based registry study of nearly 24,000 cases.2020Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 157, s. 135-140, artikel-id S0300-9572(20)30522-0Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To determine changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest, from a countrywide perspective.

    METHODS: Patient information from the Swedish Registry for Cardiopulmonary Resuscitation was analysed in relation to monitoring level of ward and initial rhythm. The primary outcome was defined as survival at 30 days. Changes in survival and incidence of shockable rhythms were reported per year from 2008 to 2018. Also, epidemiological data were compared between two time periods, 2008-2013 and 2014-2018.

    RESULTS: In all, 23,186 unique patients (38.6% female) were included in the study. The mean age was 72.6 (SD 13.2) years. Adjusted trends indicated an overall increase in 30-day survival from 24.7% in 2008 to 32.5% in 2018, (on monitoring wards from 32.5% to 43.1% and on non-monitoring wards from 17.6% to 23.1%). The proportion of patients found in shockable rhythms decreased overall from 31.6% in 2008 to 23.6% in 2018, (on monitoring wards from 42.5% to 35.8 % and on non-monitoring wards from 20.1% to 12.9%). Among the patients found in shockable rhythms, the proportion of patients defibrillated before the arrival of cardiac arrest team increased from 71.0% to 80.9%.

    CONCLUSIONS: In an 11-year perspective, resuscitation in in-hospital cardiac arrest in Sweden was characterised by an overall increase in the adjusted 30-day survival, despite a decrease in shockable rhythms. An increased proportion, among the patients found in a shockable rhythm, who were defibrillated before the arrival of a cardiac arrest team may have contributed to the finding.

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  • 6.
    Agerström, Jens
    et al.
    Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University.
    Carlsson, Magnus
    Department of Economics and Statistics, School of Business and Economics, Linnaeus University.
    Bremer, Anders
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Cardiology, Sahlgrenska University Hospital.
    Israelsson, Johan
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Årestedt, Kristofer
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest.2021Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, nr 8, s. 861-869Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

    METHODS AND RESULTS: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

    CONCLUSION: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

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  • 7.
    Agerström, Jens
    et al.
    Linnéuniversitetet.
    Carlsson, Magnus
    Linnéuniversitetet.
    Bremer, Anders
    Linnéuniversitetet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Göteborgs universitet.
    Årestedt, Kristofer
    Linnéuniversitetet.
    Israelsson, Johan
    Linnéuniversitetet.
    Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?2021Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, artikel-id zvab079Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS : Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

    METHODS AND RESULTS: In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

    CONCLUSION: Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

  • 8.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Forsberg, Sune
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Ringh, Mattias
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Claesson, Andreas
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Thuccani, Meena
    Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lundgren, Peter
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Jonsson, Martin
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sjukhusbacken 10, 118 83 Stockholm, Sweden; Functional Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Aetiology and outcome in hospitalized cardiac arrest patients.2023Ingår i: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, nr 4, artikel-id oead066Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: To study aetiologies of in-hospital cardiac arrests (IHCAs) and their association with 30-day survival.

    METHODS AND RESULTS: Observational study with data from national registries. Specific aetiologies (n = 22) of IHCA patients between April 2018 and December 2020 were categorized into cardiac vs. non-cardiac and six main aetiology categories: myocardial ischemia, other cardiac causes, pulmonary causes, infection, haemorrhage, and other non-cardiac causes. Main endpoints were proportions in each aetiology, 30-day survival, and favourable neurological outcome (Cerebral Performance Category scale 1-2) at discharge. Among, 4320 included IHCA patients (median age 74 years, 63.1% were men), approximate 50% had cardiac causes with a 30-day survival of 48.4% compared to 18.7% among non-cardiac causes (P < 0.001). The proportion in each category were: myocardial ischemia 29.9%, pulmonary 21.4%, other cardiac causes 19.6%, other non-cardiac causes 11.6%, infection 9%, and haemorrhage 8.5%. The odds ratio (OR) for 30-day survival compared to myocardial ischemia for each category were: other cardiac causes OR 1.48 (CI 1.24-1.76); pulmonary causes OR 0.36 (CI 0.3-0.44); infection OR 0.25 (CI 0.18-0.33); haemorrhage OR 0.22 (CI 0.16-0.3); and other non-cardiac causes OR 0.56 (CI 0.45-0.69). IHCA caused by myocardial ischemia had the best favourable neurological outcome while those caused by infection had the lowest OR 0.06 (CI 0.03-0.13).

    CONCLUSION: In this nationwide observational study, aetiologies with cardiac and non-cardiac causes of IHCA were evenly distributed. IHCA caused by myocardial ischemia and other cardiac causes had the strongest associations with 30-day survival and neurological outcome.

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  • 9.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Sodersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska academy, Gothenburg, Sweden.
    Ringh, Mattias
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Djärv, Therese
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Nordberg, Per
    Department of Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden.
    Cardiac arrest after pulmonary aspiration in hospitalised patients: a national observational study.2020Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 10, nr 3, artikel-id e032264Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study characteristics and outcomes among patients with in-hospital cardiac arrest (IHCA) due to pulmonary aspiration.

    DESIGN: A retrospective observational study based on data from the Swedish Registry of Cardiopulmonary Resuscitation (SRCR).

    SETTING: The SRCR is a nationwide quality registry that covers 96% of all Swedish hospitals. Participating hospitals vary in size from secondary hospitals to university hospitals.

    PARTICIPANTS: The study included patients registered in the SRCR in the period 2008 to 2017. We compared patients with IHCA caused by pulmonary aspiration (n=127), to those with IHCA caused by respiratory failure of other causes (n=2197).

    PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome was 30-day survival. Secondary outcome was sustained return of spontaneous circulation (ROSC) defined as ROSC at the scene and admitted alive to the intensive care unit.

    RESULTS: In the aspiration group 80% of IHCA occurred on general wards, as compared with 63.6% in the respiratory failure group (p<0.001). Patients in the aspiration group were less likely to be monitored at the time of the arrest (18.5% vs 38%, p<0.001) and had a significantly lower rate of sustained ROSC (36.5% vs 51.6%, p=0.001). The unadjusted 30-day survival rate compared with the respiratory failure group was 7.9% versus 18.0%, p=0.024. In a propensity score analysis (including variables; year, age, gender, location of arrest, initial heart rhythm, ECG monitoring, witnessed collapse and a previous medical history of; cancer, myocardial infarction or heart failure) the OR for 30-day survival was 0.46 (95% CI 0.19 to 0.94).

    CONCLUSIONS: In-hospital cardiac arrest preceded by pulmonary aspiration occurred more often on general wards among unmonitored patients. These patients had a lower 30-day survival rate compared with IHCA caused by respiratory failure of other causes.

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  • 10.
    Albert, Malin
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
    Thonander, Marie
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Forsberg, Sune
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
    Lindgren, Frida
    Norrtälje Hospital, Norrtälje, Sweden.
    Thuccani, Meena
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Odell, Annika
    Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden; Institute of Health and Care Science at University of Gothenburg, Sweden.
    Skoglund, Kristofer
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Bergh, Niklas
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden.
    Hollenberg, Jacob
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
    Ringh, Mattias
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
    Jonsson, Martin
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden.
    Nordberg, Per
    Department of Clinical Science and Education, Södersjukhuset, Centre for Resuscitation Science, Karolinska Institutet, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden ; Department of Physiology and Pharmacology, Karolinska Institute, Sweden.
    Lundgren, Peter
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Cardiology, Gothenburg, Sweden; Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 17176 Stockholm, Sweden; .
    Hospitalized patients’ attitudes towards participating in a randomized control trial in case of a cardiac arrest2024Ingår i: Resuscitation Plus, ISSN 2666-5204, Vol. 18, artikel-id 100645Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    No previous study has evaluated patients attitudes towards inclusion in an ongoing cardiac arrest clinical trial. The aim of this study was to assess patientś willingness and motives to participate in the ongoing randomized controlled drug trial “Vasopressin and Steroids in addition to Adrenaline in cardiac arrest” (VAST-A trial) in case of an in-hospital cardiac arrest (IHCA).

    Objectives

    Hospitalized patients, men ≥ 18 and women ≥ 50 years, were asked for informed consent for inclusion in the VAST-A trial in case of an IHCA, the reason for approving or declining inclusion in the trial and baseline characteristics.

    Methods

    Patients admitted to hospital were asked to give informed consent of inclusion in VAST-A in case of an IHCA during their hospital stay. Patients were also asked why they approved or declined inclusion as well as baseline characteristics questions.

    Results

    1,064 patients were asked about willingness to participate in the VAST-A trial, of these 902 (84.8%) patients approved inclusion. A subgroup of 411 patients were, except willingness, also asked about motives to participate or not and basic characteristics. The main reason for approving inclusion was to contribute to research (n = 328, 83.9%). The main reason for declining inclusion was concerns regarding testing the drug treatment (n = 6, 30%).

    Conclusion

    Among hospitalized patients the vast majority gave informed consent to inclusion in an ongoing randomized cardiac arrest drug trial. The main reason for approving inclusion was to contribute to research.

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  • 11.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Sweden;Ostfold Hosp Kalnes, Norway.
    Ravn-Fischer, Annica
    University of Gothenburg, Sweden;Sahlgrenska university hospital, Sweden.
    Hollenberg, Jacob
    Karolinska Institutet, Sweden.
    Israelsson, Johan
    Linnéuniversitetet, Sjöfartshögskolan (SJÖ).
    Nordberg, Per
    Södersjukhuset, Sweden;Karolinska Institutet, Sweden.
    Stromsoe, Anneli
    Mälardalen University, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. University of Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Identifying the relative importance of predictors of survival in out of hospital cardiac arrest: a machine learning study2020Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 28, nr 1, s. 1-8, artikel-id 60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Studies examining the factors linked to survival after out of hospital cardiac arrest (OHCA) have either aimed to describe the characteristics and outcomes of OHCA in different parts of the world, or focused on certain factors and whether they were associated with survival. Unfortunately, this approach does not measure how strong each factor is in predicting survival after OHCA. Aim: To investigate the relative importance of 16 well-recognized factors in OHCA at the time point of ambulance arrival, and before any interventions or medications were given, by using a machine learning approach that implies building models directly from the data, and arranging those factors in order of importance in predicting survival. Methods: Using a data-driven approach with a machine learning algorithm, we studied the relative importance of 16 factors assessed during the pre-hospital phase of OHCA We examined 45,000 cases of OHCA between 2008 and 2016. Results: Overall, the top five factors to predict survival in order of importance were: initial rhythm, age, early Cardiopulmonary Resuscitation (CPR, time to CPR and CPR before arrival of EMS), time from EMS dispatch until EMS arrival, and place of cardiac arrest The largest difference in importance was noted between initial rhythm and the remaining predictors. A number of factors, including time of arrest and sex were of little importance. Conclusion: Using machine learning, we confirm that the most important predictor of survival in OHCA is initial rhythm, followed by age, time to start of CPR, EMS response time and place of OHCA. Several factors traditionally viewed as important e.g. sex, were of little importance.

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  • 12.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Karlsson, Thomas
    Health Metrics at the Sahlgrenska Academy, University of Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Ravn-Fischer, Annica
    University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    The influence of age and gender on delay to treatment and its association with survival after out of hospital cardiac arrest.2021Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 42, s. 198-202Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
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  • 13.
    Alfredsson, J.
    et al.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    James, S. K.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Erlinge, D.
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Fröbert, O.
    Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Dworeck, C.
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden.
    Redfors, B.
    Department of Molecular and Clinical Medicine and Sahlgrenska University Hospital, Department of Cardiology, University of Gothenburg, Gothenburg, Sweden.
    Arefalk, G.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Östlund, O.
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Jernberg, T.
    Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Mars, K.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet-Södersjukhuset, Stockholm, Sweden.
    Haaga, U.
    Department of Cardiology, Karlstad Central Hospital, Karlstad, Sweden.
    Lindahl, B.
    Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Swahn, E.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Lawesson, S. S.
    Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
    Hofmann, R.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet-Södersjukhuset, Stockholm, Sweden.
    Investigators, for the DETO2X-SWEDEHEART
    Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction: Sex-related outcomes from DETO2X-AMI2021Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 237, s. 13-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI).

    Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex.

    Results: Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found (P=.16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment.

    Conclusion: Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age

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  • 14.
    Andell, Pontus
    et al.
    Unit of Cardiology, Karolinska Institutet,.
    James, Stefan
    Uppsala Clinical Research Center, Uppsala University.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Yndigegn, Troels
    Department of Cardiology, Lund University.
    Sparv, David
    Department of Cardiology, Lund University.
    Pernow, John
    Unit of Cardiology, Karolinska Institutet.
    Jernberg, Tomas
    Department of Clinical Sciences, Karolinska Institutet.
    Lindahl, Bertil
    Department of Medical Sciences, Uppsala University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Erlinge, David
    Department of Cardiology, Lund University.
    Hofmann, Robin
    Department of Clinical Science and Education, Karolinska Institutet.
    Oxygen therapy in suspected acute myocardial infarction and concurrent normoxemic chronic obstructive pulmonary disease: a prespecified subgroup analysis from the DETO2X-AMI trial.2020Ingår i: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 9, nr 8, s. 984-992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial did not find any benefit of oxygen therapy compared to ambient air in normoxemic patients with suspected acute myocardial infarction. Patients with chronic obstructive pulmonary disease may both benefit and be harmed by supplemental oxygen. Thus we evaluated the effect of routine oxygen therapy compared to ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction.

    METHODS AND RESULTS: =0.77]); there were no significant treatment-by-chronic obstructive pulmonary disease interactions.

    CONCLUSIONS: Although chronic obstructive pulmonary disease patients had twice the mortality rate compared to non-chronic obstructive pulmonary disease patients, this prespecified subgroup analysis from the DETO2X-AMI trial on oxygen therapy versus ambient air in normoxemic chronic obstructive pulmonary disease patients with suspected acute myocardial infarction revealed no evidence for benefit of routine oxygen therapy consistent with the main trial's findings.

    CLINICAL TRIALS REGISTRATION: NCT02290080.

  • 15. Atefi, Seyed Reza
    et al.
    Seoane, Fernando
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The Emergence of Electrical Bioimpedance Monitoring for Prompt Detection of Stroke Damage2014Konferensbidrag (Refereegranskat)
  • 16.
    Aune, E
    et al.
    Univ Gothenburg, Inst Med, Gothenburg, Sweden.
    McMurray, J
    Univ Glasgow, British Heart Fdn BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.
    Lundgren, P
    Univ Gothenburg, Inst Med, Gothenburg, Sweden.
    Sattar, N
    Univ Glasgow, British Heart Fdn BHF Cardiovasc Res Ctr, Glasgow, Lanark, Scotland.
    Israelsson, J
    Kalmar Cty Hosp, Reg Kalmar Cty, Div Cardiol, Dept Internal Med, Kalmar, Sweden.
    Nordberg, P
    Karolinska Inst, Ctr Resuscitat Sci, Dept Med, Solna, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, A
    Univ Gothenburg, Inst Med, Gothenburg, Sweden; Swedish Registry Cardiopulm Resuscitat, Gothenburg, Sweden.
    Clinical characteristics and survival in patients with heart failure experiencing in hospital cardiac arrest2022Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 12, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In patients with heart failure (HF) who suffered in-hospital cardiac arrest (IHCA), little is known about the characteristics, survival and neurological outcome. We used the Swedish Registry of Cardiopulmonary Resuscitation to study this, including patients aged >= 18 years suffering IHCA (2008-2019), categorised as HF alone, HF with acute myocardial infarction (AMI), AMI alone, or other. Odds ratios (OR) for 30-day survival, trends in 30-day survival, and the implication of HF phenotype was studied. 6378 patients had HF alone, 2111 had HF with AMI, 4210 had AMI alone. Crude 5-year survival was 9.6% for HF alone, 12.9% for HF with AMI and 34.6% for AMI alone. The 5-year survival was 7.9% for patients with HF and left ventricular ejection fraction (LVEF) >= 50%, 15.4% for LVEF < 40% and 12.3% for LVEF 40-49%. Compared with AMI alone, adjusted OR (95% CI) for 30-day survival was 0.66 (0.60-0.74) for HF alone, and 0.49 (0.43-0.57) for HF with AMI. OR for 30-day survival in 2017-2019 compared with 2008-2010 were 1.55 (1.24-1.93) for AMI alone, 1.37 (1.00-1.87) for HF with AMI and 1.30 (1.07-1.58) for HF alone. Survivors with HF had good neurological outcome in 92% of cases.

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  • 17.
    Axelsson, C
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herrera, MJ
    Fredriksson, M
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Implementation of mechanical chest compression in out-of-hospital carfdiac arrest in an emergency medical service system2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 8, s. 1196-1200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to describe the outcome changes after out-of-hospital cardiac arrest (OHCA) in Gothenburg, Sweden, after introduction of mechanical chest compression (MCC). METHODS: Following introduction of MCC, 1183 OHCA patients were treated from November 1, 2007, to December 31, 2011 (period 2). They were compared with 1218 OHCA patients before MCC was introduced from January 1, 1998, to May 30, 2003 (period 1). Patients in period 2 were evaluated for survival in relation to MCC use. RESULTS: The percentage of patients admitted to hospital alive increased from 25.4% to 31.9% (P < .0001). Survival to 1 month increased from 7.1% to 10.7% (P = .002) from period 1 to period 2. The proportion of ventricular fibrillation/ventricular tachycardia decreased in period 2 (P = .002). However, bystander cardiopulmonary resuscitation (P < .0001), crew-witnessed cases (P = .04), percutaneous coronary intervention (P < .0001), therapeutic hypothermia (P < .0001), and implantable cardioverter-defibrillator use (P = .01) increased, as did time from call to emergency medicine service arrival (P < .0001) and to defibrillation (P = .006). In period 2, 60% of OHCA patients were treated with MCC. The percentages admitted alive to hospital (MCC vs no MCC) were 28.6% and 36.1% (P = .008). Corresponding figures for survival to 1 month were 5.6% and 17.6% (P < .0001). In the MCC group, we found increase in the delay from collapse to defibrillation (P < .0001), greater use of adrenaline (P < .0001), and fewer crew-witnessed cases (P < .0001). CONCLUSION: Survival to 1 month after implementation of MCC was higher than before introduction. However, patients receiving MCC had low survival. Although case selection might play a role, results do not support a widespread use of MCC after OHCA.

  • 18. Axelsson, Å
    et al.
    Stibrant Sunnerhagen, K
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Comparision of respondents and non-respondents in a follow-upsurvey after cardiac arrest2013Konferensbidrag (Refereegranskat)
  • 19.
    Azeli, Y.
    et al.
    Sistema d’Emergències Mèdiques de Catalunya, Carrer de Pablo Iglesias 101–115, L’Hospitalet de Llobregat, Barcelona, Spain.
    Bardají, A.
    Institut d’Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
    Barbería, E.
    Universitat Rovira i Virgili, Tarragona, Spain.
    Lopez-Madrid, V.
    Emergency Department, Sant Joan University Hospital, Reus, Spain.
    Bladé-Creixenti, J.
    Atenció Primaria, Institut Català de la Salut, Tarragona, Spain.
    Fernández-Sender, L.
    Llevant Clinic Unit, Santa Tecla Hospital, Tarragona, Spain.
    Bonet, G.
    Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain.
    Rica, E.
    Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain.
    Álvarez, S.
    Department de Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain.
    Fernández, A.
    Departament d’Enginyeria Química, Universitat Rovira i Virgili, Tarragona, Spain.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jiménez-Herrera, M. F.
    Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain.
    Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial2021Ingår i: Critical Care, ISSN 1364-8535, E-ISSN 1466-609X, Vol. 25, nr 1, artikel-id 176Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There are data suggesting that passive leg raising (PLR) improves hemodynamics during cardiopulmonary resuscitation (CPR). This trial aimed to determine the effectiveness and safety of PLR during CPR in out-of-hospital cardiac arrest (OHCA).

    Methods: We conducted a randomized controlled trial with blinded assessment of the outcomes that assigned adults OHCA to be treated with PLR or in the flat position. The trial was conducted in the Camp de Tarragona region. The main end point was survival to hospital discharge with good neurological outcome defined as cerebral performance category (CPC 1–2). To study possible adverse effects, we assessed the presence of pulmonary complications on the first chest X-rays, brain edema on the computerized tomography (CT) in survivors and brain and lungs weights from autopsies in non-survivors.

    Results: In total, 588 randomized cases were included, 301 were treated with PLR and 287 were controls. Overall, 67.8% were men and the median age was 72 (IQR 60–82) years. At hospital discharge, 3.3% in the PLR group and 3.5% in the control group were alive with CPC 1–2 (OR 0.9; 95% CI 0.4–2.3, p = 0.91). No significant differences in survival at hospital admission were found in all patients (OR 1.0; 95% CI 0.7–1.6, p = 0.95) and among patients with an initial shockable rhythm (OR 1.7; 95% CI 0.8–3.4, p = 0.15). There were no differences in pulmonary complication rates in chest X-rays [7 (25.9%) vs 5 (17.9%), p = 0.47] and brain edema on CT [5 (29.4%) vs 10 (32.6%), p = 0.84]. There were no differences in lung weight [1223 mg (IQR 909–1500) vs 1239 mg (IQR 900–1507), p = 0.82] or brain weight [1352 mg (IQR 1227–1457) vs 1380 mg (IQR 1255–1470), p = 0.43] among the 106 autopsies performed.

    Conclusion: In this trial, PLR during CPR did not improve survival to hospital discharge with CPC 1–2. No evidence of adverse effects has been found.

    Clinical trial registration ClinicalTrials.gov: NCT01952197, registration date: September 27, 2013, https://clinicaltrials.gov/ct2/show/NCT01952197. [Figure not available: see fulltext.] 

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  • 20. Berglind, L
    et al.
    Karlsson, T
    Hirlekar, G
    Albertsson, P
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ravn-Fischer, A
    Delay and inequality in treatment of the elderly with suspected acute coronary syndrome2014Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, nr 3, s. 946-950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The aim of this study is to determine differences between elderly patients (≥80 years) and younger patients with suspected acute coronary syndrome (ACS) regarding delay times before diagnostic tests and treatments. METHODS: All patients with chest pain who were admitted to a hospital in the Gothenburg area were included consecutively over a 3-month period. They were divided into an elderly group (≥80 years) and a reference group (<80 years). Previous medical history, ECG findings, treatments, diagnostic tests, and delay times were registered. RESULTS: Altogether, 2588 patients were included (478 elderly and 2110 reference). There were no significant differences in delay time to hospital ward admission, to first medical therapy with aspirin, or to investigation with coronary angiography (CA) between the two groups. The elderly patients had a significantly shorter median time from first medical contact to first ECG (12 vs. 14 min, p=0.002) but after adjustment for confounding factors, especially mode of transport, the opposite was found to be the case (p=0.002). Elderly hospitalized patients with ACS were less often investigated with CA (44% vs. 89%, p<0.0001) and received less medical treatment with P2Y12 antagonists and lipid lowering drugs. CONCLUSIONS: Elderly individuals with chest pain could not be shown to have a delay to hospital admission compared to their younger counterparts. Nevertheless, higher age was associated with a longer time to first ECG. The elderly patients received less active therapy, and fear of age-related side effects might explain this difference.

  • 21.
    Berglund, Sara
    et al.
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Andreasson, Axel
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Rawshani, Aidin
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Hirlekar, Geir
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Lundgren, Peter
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Angeras, Oscar
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Mandalenakis, Zacharias
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Redfors, Björn
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Holm, Astrid
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Hagberg, Eva
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Ricksten, Sven Erik
    Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Friberg, Hans
    Lund Univ, Skane Univ Hosp, Dept Clin Sci Anesthesia & Intens Care, Malmo, Sweden.
    Gustafsson, Linnea
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Dworeck, Christian
    Univ Gothenburg, Inst Med, Dept Mol & Clin Med, Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Cardiorenal function and survival in in-hospital cardiac arrest: A nationwide study of 22,819 cases2022Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 172, s. 9-16Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital Methods: We included cases aged 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). Results: We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15-29, 30-44, 45-59, 60-89, 90-130 and 130-150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR < 15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m2, and least for those with normal eGFR. Conclusions: All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.

  • 22. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Hartford, M
    Karlson, BW
    Risenfors, M
    Luepker, RV
    Sjölin, M
    Holmberg, S
    Consequences of a media campaign focusing on delay in acute myocardial infarction1992Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, ISSN 0002-914, Vol. 69, nr 4, s. 411-413Artikel i tidskrift (Övrigt vetenskapligt)
  • 23. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Schröder, U
    Hartford, M
    Karlsson, BW
    Risenfors, M
    Larsson, E
    Luepker, R
    Wennerblom, B
    Holmberg, S
    Reaction to a media campaign focusing on delay in acute myocardial infarction1991Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 20, nr 6, s. 661-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A media campaign conducted to reduce delay time and to increase the use of ambulance transport in acute myocardial infarction was performed in an urban area with about half a million inhabitants during 1 year. The main message was that chest pain lasting more than 15 minutes might indicate acute myocardial infarction; dial 90,000 immediately for ambulance transport to the hospital. The target population was the general public. After 6 and 12 months 400 and 610 randomly chosen persons, respectively, were contacted by telephone to evaluate the reaction of the general public to the campaign. Of these, 60% and 71%, respectively, had heard of the campaign, and all parts of the message were spontaneously remembered by 15% and 19%, respectively. The reaction to the campaign was generally positive. Among all patients admitted to the coronary care unit of one of the two city hospitals, 65% were aware of the campaign and 31% of them were of the opinion that they came to the hospital faster because of the campaign. In conclusion, a media campaign aimed at reducing patient delay time in acute myocardial infarction was shown to reach a majority of people in the community and patients with ischemic heart disease. The reaction was positive and about one fifth of interviewed people spontaneously remembered the total message.

  • 24.
    Bratt, Ewa-Lena
    et al.
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Children's Heart Center, Gothenburg, Sweden.
    Mora, Mariela Acuna
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Sparud-Lundin, Carina
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; .
    Saarijärvi, Markus
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.
    Burström, Åsa
    Department of Neurobiology, Care Sciences and Society Karolinska Institutet, Stockholm, Sweden.
    Skogby, Sandra
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Paediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
    Fernlund, Eva
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Division of Paediatrics, Crown Princess Victoria Childreńs Hospital, Linköping University Hospital, Linköping, Sweden; Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, paediatric Cardiology, Lund, Sweden.
    Fadl, Shalan
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Rydberg, Annika
    Department of Clinical Sciences, Umeå University, Umeå, Sweden.
    Hanseus, Katarina
    Children's Heart Centre, Skåne University Hospital Lund, Lund, Sweden.
    Kazamia, Kalliopi
    Children's Heart Centre Stockholm-Uppsala, Karolinska University Hospital and Akademiska University Hospital, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Moons, Philip
    Institute of Health and Care Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
    Effectiveness of the STEPSTONES Transition Program for Adolescents With Congenital Heart Disease: A Randomized Controlled Trial2023Ingår i: Journal of Adolescent Health, ISSN 1054-139X, E-ISSN 1879-1972Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Adolescents with congenital heart disease transition from childhood to adulthood and transfer from pediatric-oriented to adult-oriented care. High-level empirical evidence on the effectiveness of transitional care is scarce. This study investigated the empowering effect (primary outcome) of a structured person-centered transition program for adolescents with congenital heart disease and studied its effectiveness on transition readiness, patient-reported health, quality of life, health behaviors, disease-related knowledge, and parental outcomes e.g., parental uncertainty, readiness for transition as perceived by the parents (secondary outcomes). Methods: The STEPSTONES-trial comprised a hybrid experimental design whereby a randomized controlled trial was embedded in a longitudinal observational study. The trial was conducted in seven centers in Sweden. Two centers were allocated to the randomized controlled trial-arm, randomizing participants to intervention or control group. The other five centers were intervention-naïve centers and served as contamination check control group. Outcomes were measured at the age of 16 years (baseline), 17 years, and 18.5 years. Results: The change in empowerment from 16 years to 18.5 years differed significantly between the intervention group and control group (mean difference = 3.44; 95% confidence interval = 0.27–6.65; p = .036) in favor of intervention group. For the secondary outcomes, significant differences in change over time were found in parental involvement (p = .008), disease-related knowledge (p = .0002), and satisfaction with physical appearance (p = .039). No differences in primary or secondary outcomes were detected between the control group and contamination check control group, indicating that there was no contamination in the control group. Discussion: The STEPSTONES transition program was effective in increasing patient empowerment, reducing parental involvement, improving satisfaction with physical appearance, and increasing disease-related knowledge. © 2023 Society for Adolescent Health and Medicine

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  • 25.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Att överleva hjärtstopp2007Konferensbidrag (Övrigt vetenskapligt)
  • 26.
    Burström, Åsa
    et al.
    Institution for Women's and Children's Health Karolinska Institutet Stockholm Sweden;Department of Pediatric Cardiology Astrid Lindgren Children's Hospital Stockholm Sweden.
    Acuña Mora, Mariela
    Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden;KU Leuven Department of Public Health and Primary Care Leuven Belgium.
    Öjmyr‐Joelsson, Maria
    Institution for Women's and Children's Health Karolinska Institutet Stockholm Sweden;Department of Pediatric Surgery Astrid Lindgren Children's Hospital Stockholm Sweden.
    Sparud‐Lundin, Carina
    Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden.
    Rydberg, Annika
    Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden.
    Hanseus, Katarina
    Department of Pediatric Cardiology Skåne University Hospital Lund Sweden.
    Frenckner, Björn
    Institution for Women's and Children's Health Karolinska Institutet Stockholm Sweden;Department of Pediatric Surgery Astrid Lindgren Children's Hospital Stockholm Sweden.
    Nisell, Margret
    Institution for Women's and Children's Health Karolinska Institutet Stockholm Sweden;The Red Cross University College Stockholm Sweden.
    Moons, Philip
    Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden;KU Leuven Department of Public Health and Primary Care Leuven Belgium.
    Bratt, Ewa‐Lena
    Institute of Health and Care Sciences University of Gothenburg Gothenburg Sweden;Department of Pediatric Cardiology The Queen Silvia Children's Hospital Gothenburg Sweden.
    Parental uncertainty about transferring their adolescent with congenital heart disease to adult care2018Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 75, nr 2, s. 380-387Artikel i tidskrift (Refereegranskat)
  • 27.
    Bylow, H.
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Karlsson, T.
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lepp, M.
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Claesson, A.
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden.
    Lindqvist, J.
    Centre of Registers Västra Götaland, Gothenburg, Sweden.
    Svensson, L.
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Learning Outcome After Different Combinations of Seven Learning Activities in Basic Life Support on Laypersons in Workplaces: a Cluster Randomised, Controlled Trial2021Ingår i: Medical Science Educator, E-ISSN 2156-8650, Vol. 31, nr 1, s. 161-173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The goal for laypersons after training in basic life support (BLS) is to act effectively in an out-of-hospital cardiac arrest situation. However, it is still unclear whether BLS training targeting laypersons at workplaces is optimal or whether other effective learning activities are possible.

    Aim: The primary aim was to evaluate whether there were other modes of BLS training that improved learning outcome as compared with a control group, i.e. standard BLS training, six months after training, and secondarily directly after training.

    Methods: In this multi-arm trial, lay participants (n = 2623) from workplaces were cluster randomised into 16 different BLS interventions, of which one, instructor-led and film-based BLS training, was classified as control and standard, with which the other 15 were compared. The learning outcome was the total score for practical skills in BLS calculated using the modified Cardiff Test.

    Results: Four different training modes showed a significantly higher total score compared with standard (mean difference 2.3–2.9). The highest score was for the BLS intervention including a preparatory web-based education, instructor-led training, film-based instructions, reflective questions and a chest compression feedback device (95% CI for difference 0.9–5.0), 6 months after training.

    Conclusion: BLS training adding several different combinations of a preparatory web-based education, reflective questions and chest compression feedback to instructor-led training and film-based instructions obtained higher modified Cardiff Test total scores 6 months after training compared with standard BLS training alone. The differences were small in magnitude and the clinical relevance of our findings needs to be further explored.

    Trial Registration: ClinicalTrials.gov Identifier: NCT03618888. Registered August 07, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03618888 © 2020, The Author(s).

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  • 28.
    Bylow, H
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Rawshani, A
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Claesson, A
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden.
    Lepp, M
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Østfold University College, Halden, Norway; School of Nursing and Midwifery, Griffith University, Brisbane, Australia.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics and outcome after out-of-hospital cardiac arrest with the emphasis on workplaces: an observational study from the Swedish Registry of Cardiopulmonary Resuscitation2021Ingår i: Resuscitation Plus, E-ISSN 2666-5204, Vol. 5, artikel-id 100090Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Characteristics and outcome in out-of-hospital cardiac arrest (OHCA) occurring at workplaces is sparsely studied.

    Aim: To describe (1) the characteristics and 30-day survival of OHCAs occurring at workplaces in comparison to OHCAs at other places and (2) factors associated with survival after OHCAs at workplaces.

    Methods: Data on OHCAs were obtained from the Swedish Registry of Cardiopulmonary Resuscitation from 1 January 2008 to 31 December 2018. Characteristics and factors associated with survival were analysed with emphasis on the location of OHCAs.

    Results: Among 47,685 OHCAs, 529 cases (1%) occurred at workplaces. Overall, in the fully adjusted model, all locations of OHCA, with the exception of crowded public places, displayed significantly lower probability of survival than workplaces. Exhibiting a shockable rhythm was the strongest predictor of survival among patients with OHCAs at workplaces; odds ratio (95% CI) 5.80 (2.92-12.31). Odds ratio for survival for women was 2.08 (95% CI 1.07-4.03), compared with men. At workplaces other than private offices, odds ratio for survival was 0.41 (95% CI 0.16-0.95) for cases who did not receive bystander CPR, as compared to those who did receive CPR. Among patients who were found in a shockable rhythm were 23% defibrillated before arrival of ambulance, which was more frequent than in any other location.

    Conclusion: Out-of-hospital cardiac arrest occurring at workplaces and crowded public places display the highest probability of survival, as compared with other places outside hospital. An initial shockable cardiac rhythm was the strongest predictor of survival for OHCA at workplaces.

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  • 29.
    Bylow, Helene
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Lepp, Margret
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Lindqvist, Jonny
    Centre of Registers Västra Götaland, Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, s. 122-132, artikel-id S0300-9572(19)30094-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To compare the effectiveness of two basic life support (BLS) training interventions.

    METHODS: This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training.

    RESULTS: For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training.

    CONCLUSIONS: There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.

  • 30.
    Bylow, Helene
    et al.
    Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg.
    Karlsson, Thomas
    Health Metrics Unit, Institute of Medicine, University of Gothenburg.
    Lepp, Margret
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Claesson, Andreas
    Department of Medicine, Centre for Resuscitation Science, Karolinska Institute.
    Lindqvist, Jonny
    Centre of Registers Västra Götaland.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial.2019Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 14, nr 7, artikel-id e0219341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED).

    AIM: To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD).

    METHODS: Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes.

    RESULTS: BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004).

    CONCLUSION: A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.

  • 31. Bäck, M
    et al.
    Cider, Å
    Gillström, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Physical activity in relation to cardiac risk markers in secondary prevention of coronary artery disease2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 1, s. 478-483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The relationship between physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) is uncertain. The aims of the study were therefore to examine the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. METHODS: In total, 332 patients, mean age, 65 ± 9.1 years, diagnosed with CAD at a university hospital were included in the study 6 months after their cardiac event. Physical activity was measured with a pedometer (steps/day) and two questionnaires. Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index (BMI), waist-hip ratio, and muscle endurance. The study had a cross-sectional design. RESULTS: The patients performed a median of 7,027 steps/day. After adjustment for confounders, statistically significant correlations between steps/day and risk markers were found with regard to; high-density lipoprotein cholesterol (HDL-C) (r=0.19, p<0.001), muscle endurance measures (r ranging from 0.19 to 0.25, p=0.001 or less) triglycerides (r=-0.19, p<0.001), glucose-tolerance (r=-0.23, p<0.001), BMI (r=-0.21, p<0.001), 24-h heart rate recording during night (r=-0.17, p=0.004), and average 24-h heart rate (r=-0.13, p=0.02). CONCLUSIONS: A relatively high level of physical activity was found among patients with CAD. There was a weak, but significant, association between pedometer steps/day and HDL-C, muscle endurance, triglycerides, glucose-tolerance, BMI and 24-h heart rate, indicating potential positive effects of physical activity on these parameters. However, before clinical implications can be formed, more confirmatory data are needed.

  • 32. Bäck, M
    et al.
    Cider, Å
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Jansson, B
    What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?2014Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Material and methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusion Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.

  • 33. Bäck, M
    et al.
    Jansson, B
    Cider, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease.2012Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 4, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease. Design: Methodological research (cross-sectional study). Subjects: A total of 332 patients, mean age 65 years (standard deviation 9.1) diagnosed with coronary artery disease at a university hospital were included in the study. Methods: The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face, content, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. Results: In terms of reliability, the TSK-SV Heart was found to be stable over time (intra-class correlation coefficient 0.83) and internally consistent (Cronbach's alpha 0.78). Confirmatory factor analysis provided acceptable fit for a hypothesized 4-factor model with inclusion of a method factor. Conclusion: These results provide support for the reliability of the TSK-SV Heart. The questionnaire appears to be valid for use in patients with coronary artery disease. However, some items require further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future research concerning their implications for the target group.

  • 34.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, S
    Karlsson, T
    Caidahl, K
    Hartford, M
    Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.2008Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 35. Caidahl, K
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Pettersson, K
    de Faire, U
    Frostegård, J
    IGM-phosphorylcholine autoantibodies and outcome in acute coronary syndromes.2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 2, s. 464-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Antibodies against proinflammatory phosphorylcholine (anti-PC) seem to be protective and reduce morbidity. We sought to determine whether low levels of immunoglobulin-M (IgM) autoantibodies against PC add prognostic information in acute coronary syndromes (ACS). METHODS: IgM anti-PC titers were measured in serum obtained within 24h of admission from 1185 ACS patients (median age 66 years, 30% women). We evaluated major acute cardiovascular events (MACE) and all-cause mortality short--(6 months), intermediate--(18 months) and long--(72 months) terms. RESULTS: Low anti-PC titers were associated with MACE and all-cause mortality at all follow-up times. After adjusting for clinical variables, plasma troponin-I, proBNP and CRP levels, associations remained at all times with MACE, short and intermediate terms also with all-cause mortality. With anti-PC titers below median, adjusted hazard ratios at 18months were for MACE 1.79 (95% confidence interval [CI]: 1.31 to 2.44; p=0.0002) and for all-cause mortality 2.28 (95% CI: 1.32 to 3.92; p=0.003). Anti-PC and plasma CRP were unrelated and added to risk prediction. CONCLUSIONS: Serum IgM anti-PC titers provide prognostic information above traditional risk factors in ACS. The ease of measurement and potential therapeutic perspective indicate that it may be a valuable novel biomarker in ACS.

  • 36. Claesson, A
    et al.
    Druid, H
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac disease and probable intent after drowning2013Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 31, nr 7, s. 1073-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: The aim of this study is to determine the prevalence of cardiac disease and its relationship to the victim's probable intent among patients with cardiac arrest due to drowning. METHOD: Retrospective autopsied drowning cases reported to the Swedish National Board of Forensic Medicine between 1990 and 2010 were included, alongside reported and treated out-of-hospital cardiac arrests due to drowning from the Swedish Out of Hospital Cardiac Arrest Registry that matched events in the National Board of Forensic Medicine registry (n = 272). RESULTS: Of 2166 drowned victims, most (72%) were males; the median age was 58 years (interquartile range, 42-71 years). Drowning was determined to be accidental in 55%, suicidal in 28%, and murder in 0.5%, whereas the intent was unclear in 16%. A contributory cause of death was found in 21%, and cardiac disease as a possible contributor was found in 9% of all autopsy cases. Coronary artery sclerosis (5%) and myocardial infarction (2%) were most frequent. Overall, cardiac disease was found in 14% of all accidental drownings, as compared with no cases (0%) in the suicide group; P = .05. Ventricular fibrillation was found to be similar in both cardiac and noncardiac cases (7%). This arrhythmia was found in 6% of accidents and 11% of suicides (P = .23). CONCLUSION: Among 2166 autopsied cases of drowning, more than half were considered to be accidental, and less than one-third, suicidal. Among accidents, 14% were found to have a cardiac disease as a possible contributory factor; among suicides, the proportion was 0%. The low proportion of cases showing ventricular fibrillation was similar, regardless of the presence of a cardiac disease.

  • 37. Claesson, A
    et al.
    Lindqvist, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest due to drowning-changes over time and factors of importance for survival2014Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 5, s. 644-648Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate changes in characteristics and survival over time in out-of-hospital cardiac arrest (OHCA) due to drowning and describe factors of importance for survival. METHOD: Retrospectively reported and treated drowning cases reported to the Swedish OHCA registry between 1990 and 2012, n=529. The data were clustered into three seven-year intervals for comparisons of changes over time. RESULTS: There were no changes in age, gender, witnessed status, shockable rhythm or place of OHCA during the time periods. Bystander CPR increased over time, 59% in interval 1992-1998, versus 74% in interval 2006-2012 (p=0.005). There was a decrease in delay between OHCA and calling for the Emergency Medical Service (EMS) over the years, while calling for the EMS to arrival increased in terms of time. Survival to hospital admission appears to have increased over the years (p=0.009), whereas survival to one month did not change significantly over time. In a multivariate analysis, witnessed status, female gender, bystander CPR, place-home and EMS response time were associated with survival to hospital admission. For survival to one month, place, age, shockable rhythm and logarithmised delay from calling for an ambulance to arrival were of significance for survival. CONCLUSION: In OHCA due to drowning, over a period of 20 years, bystanders have called for help at an earlier stage and administered CPR more frequently in the past few years. Survival to hospital admission has increased, while shockable rhythm and early arrival of the EMS appear to be the most important factors for survival to one month.

  • 38. Deedwania, PC
    et al.
    Giles, TD
    Klibaner, M
    Ghali, JK
    Herlitz, Johan
    [external].
    Hildebrandt, P
    Kjekshus, J
    Spinar, J
    Vitovec, J
    Stanbrook, H
    Wikstrand, J
    Efficacy, Safety and Tolerability of Metoprolol CR/XL in Patients With Diabetes and Chronic Heart Failure: Experiences From MERIT-HF2005Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 149, nr 1, s. 159-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The objective of the current study was to examine the efficacy and tolerability of the β-blocker metoprolol succinate controlled release/extended release (CR/XL) in patients with diabetes in the Metoprolol CR/XL Randomized Intervention Trial in Chronic Heart Failure (MERIT-HF). Methods: The Cox proportional hazards model was used to calculate hazard ratios (HR) for convenience expressed as relative risks (risk reduction = 1-HR), and 95% confidence intervals (CI). Results: The risk of hospitalization for heart failure was 76% higher in diabetics compared to non-diabetics (95% CI 38% to 123%). Metoprolol CR/XL was well tolerated and reduced the risk of hospitalization for heart failure by 37% in the diabetic group (95% CI 53% to 15%), and by 35% in the non-diabetic group (95% CI 48% to 19%). Pooling of mortality data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II), MERIT-HF, and the Carvedilol Prospective Randomized Cumulative Survival Study (COPERNICUS) showed similar survival benefits in patients with diabetes (25%; 95% CI 40% to 4%) and without diabetes (36%; 95% CI 44% to 27%); test of diabetes by treatment interaction was non-significant. Adverse events were reported more often on placebo than on metoprolol CR/XL. Conclusions: Patients with heart failure and diabetes have a much higher risk of hospitalization than patients without diabetes. Regardless of diabetic status, a highly significant reduction in hospitalizations for heart failure was observed with metoprolol CR/XL therapy, which was very well tolerated also by patients with diabetes. Furthermore, the pooled data showed a statistically significant survival benefit in patients with diabetes.

  • 39.
    Dejby, Ellen
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden.
    Bhatt, Deepak L
    Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Skoglund, Kristofer
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.
    Rawshani, Aidin
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.
    Omerovic, Elmir
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Redfors, Björn
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden; Clinical Trial Center, Cardiovascular Research Foundation, New York, NY, USA; Department of Cardiology, New York-Presbyterian Hospital/Columbia University Medical Center, New York, USA.
    Myredal, Anna
    Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Petursson, Petur
    Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Angerås, Oskar
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Gustafsson, Arvid
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden.
    Isaksén, Daniella
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden.
    Herlitz, Johan
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Gothenburg, Sweden; Department of Cardiology, The Sahlgrenska University Hospital, Gothenburg, Sweden; The Swedish Cardiopulmonary Resuscitation Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden.
    Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.2023Ingår i: Scientific Reports, E-ISSN 2045-2322, Vol. 13, artikel-id 12662Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7 years in AS, 4.5 years in AR and 4.1 years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30 days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46-0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.

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  • 40. dos Santos, MA
    et al.
    Tygessen, H
    Eriksson, H
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Clinical decision support system (CDSS)-effects on care quality.2014Ingår i: International Journal of Health Care Quality Assurance, ISSN 0952-6862, E-ISSN 1758-6542, Vol. 27, nr 8, s. 707-718Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Despite their efficacy, some recommended therapies are underused. The purpose of this paper is to describe clinical decision support system (CDSS) development and its impact on clinical guideline adherence. DESIGN/METHODOLOGY/APPROACH: A new CDSS was developed and introduced in a cardiac intensive care unit (CICU) in 2003, which provided physicians with patient-tailored reminders and permitted data export from electronic patient records into a national quality registry. To evaluate CDSS effects in the CICU, process indicators were compared to a control group using registry data. All CICUs were in the same region and only patients with acute coronary syndrome were included. FINDINGS: CDSS introduction was associated with increases in guideline adherence, which ranged from 16 to 35 per cent, depending on the therapy. Statistically significant associations between guideline adherence and CDSS use remained over the five-year period after its introduction. During the same period, no relapses occurred in the intervention CICU. PRACTICAL IMPLICATIONS: Guideline adherence and healthcare quality can be enhanced using CDSS. This study suggests that practitioners should turn to CDSS to improve healthcare quality. ORIGINALITY/VALUE: This paper describes and evaluates an intervention that successfully increased guideline adherence, which improved healthcare quality when the intervention CICU was compared to the control group.

  • 41.
    Dyson, Kylie
    et al.
    Centre for Research and Evaluation, Ambulance Victoria, VIC, Australia.
    Brown, Siobhan P
    University of Washington Clinical Trial Center, Department of Biostatistics, University of Washington.
    May, Susanne
    Centre for Research and Evaluation, Ambulance Victoria.
    Smith, Karen
    Centre for Research and Evaluation, Ambulance Victoria.
    Koster, Rudolph W
    Academic Medical Center, Amsterdam.
    Beesems, Stefanie G
    Academic Medical Center, Amsterdam.
    Kuisma, Markku
    Department of Emergency Medicine and Services, Helsinki University Hospital.
    Salo, Ari
    Department of Emergency Medicine and Services, Helsinki University Hospital.
    Finn, Judith
    School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia.
    Sterz, Fritz
    Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna.
    Nürnberger, Alexander
    Department of Emergency Medicine, Medical University of Vienna, and Municipal Ambulance Service, Vienna.
    Morrison, Laurie J
    Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto.
    Olasveengen, Theresa M
    Oslo University Hospital.
    Callaway, Clifton W
    Department of Emergency Medicine, University of Pittsburgh Medical Center.
    Shin, Sang Do
    Seoul National University, College of Medicine, Seoul.
    Gräsner, Jan-Thorsten
    Department of Anesthesiology and Intensive Medicine, University-Medical Center Hospital, Schleswig-Campus Kiel.
    Daya, Mohamud
    Department of Emergency Medicine, Oregon Health and Science University.
    Ma, Matthew Huei-Ming
    Department of Emergency Medicine, National Taiwan University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Strömsöe, Anneli
    School of Health and Social Sciences, University of Dalarna.
    Aufderheide, Tom P
    Department of Emergency Medicine, Medical College of Wisconsin.
    Masterson, Siobhán
    On behalf of the National Out-of-Hospital Cardiac Arrest Register (OHCAR). Discipline of General Practice, National University of Ireland, Galway, Ireland and National Ambulance Service, Health Service Executive, Dublin.
    Wang, Henry
    Department of Emergency Medicine, University of Texas Health Science Center.
    Christenson, Jim
    Department of Emergency Medicine, University of British Columbia.
    Stiell, Ian
    Department of Emergency Medicine, University of Ottawa.
    Vilke, Gary M
    Department of Emergency Medicine, University of California San Diego.
    Idris, Ahamed
    Department of Emergency Medicine, University of Texas Southwester.
    Nishiyama, Chika
    Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science.
    Iwami, Taku
    Kyoto University Health Service.
    Nichol, Graham
    University of Washington - Harborview Center for Prehospital Emergency Care, Departments of Emergency Medicine and Medicine, University of Washington.
    International variation in survival after out-of-hospital cardiac arrest: A validation study of the Utstein template.2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 138, s. 168-181, artikel-id S0300-9572(18)30957-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) survival varies greatly between communities. The Utstein template was developed and promulgated to improve the comparability of OHCA outcome reports, but it has undergone limited empiric validation. We sought to assess how much of the variation in OHCA survival between emergency medical services (EMS) across the globe is explained by differences in the Utstein factors. We also assessed how accurately the Utstein factors predict OHCA survival.

    METHODS: We performed a retrospective analysis of patient-level prospectively collected data from 12 OHCA registries from 12 countries for the period 1 Jan 2006 through 31 Dec 2011. We used generalized linear mixed models to examine the variation in survival between EMS agencies (n=232).

    RESULTS: Twelve registries contributed 86,759 cases. Patient arrest characteristics, EMS treatment and patient outcomes varied across registries. Overall survival to hospital discharge was 10% (range, 6% to 22%). Overall survival with Cerebral Performance Category of 1 or 2 (available for 8/12 registries) was 8% (range, 2% to 20%). The area-under-the-curve for the Utstein model was 0.85 (Wald CI: 0.85-0.85). The Utstein factors explained 51% of the EMS agency variation in OHCA survival.

    CONCLUSIONS: The Utstein factors explained 51% of the variation in survival to hospital discharge among multiple large geographically separate EMS agencies. This suggests that quality improvement and public health efforts should continue to target modifiable Utstein factors to improve OHCA survival. Further study is required to identify the reasons for the variation that is incompletely understood.

  • 42. Engdahl, J
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    [external].
    Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, nr 3, s. 201-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.

  • 43. Erhardt, L
    et al.
    Herlitz, Johan
    [external].
    Näslund, U
    Persson, S
    Allt mer komplicerad kombinationsterapi för att angripa ischemisk hjärtsjukdom1989Ingår i: Drugs, ISSN 0012-6667, E-ISSN 1179-1950, Vol. 86, nr 52, s. 495-497Artikel i tidskrift (Refereegranskat)
  • 44. Everts, B
    et al.
    Karlson, BW
    Währborg, P
    Abdon, N-J
    Herlitz, Johan
    [external].
    Hedner, T
    Pain recollection after chest pain of cardiac origin1999Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 92, nr 2, s. 115-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Memory for pain is an important research and clinical issue since patients ability to accurately recall pain plays a prominent role in medical practice. The purpose of this prospective study was to find out if patients, with an episode of chest pain due to suspected acute myocardial infarction could accurately retrieve the pain initially experienced at home and during the first day of hospitalization after 6 months. A total of 177 patients were included in this analysis. The patients rated their experience of pain on a numerical rating scale. The maximal pain at home was retrospectively assessed, thereafter pain assessments were made at several points of time after admission. After 6 months they were asked to recall the intensity of pain and once again rate it on the numerical rating scale. The results from the initial and 6-month registrations were compared. In general, patients rated their maximal intensity of chest pain as being higher at the 6-month recollection as compared with the assessments made during the initial hospitalization. In particular, in patients with a high level of emotional distress, there was a systematic overestimation of the pain intensity at recall.

  • 45.
    Faxén, Jonas
    et al.
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Hollenberg, Jacob
    Karolinska Institutet, Department of Medicine, Centre for Resuscitation Science, Stockholm, Sweden.
    Gadler, Fredrik
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Szummer, Karolina
    Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Incidence and Predictors of Out-of-Hospital Cardiac Arrest Within 90 Days After Myocardial Infarction.2020Ingår i: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 76, nr 25, s. 2926-2936, artikel-id S0735-1097(20)37627-0Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The risk of sudden cardiac death (SCD) is high early after myocardial infarction (MI). Current knowledge and guidelines mainly rely on results from older clinical trials and registry studies. Left ventricular ejection fraction (LVEF) alone has not been proven a reliable predictor of SCD.

    OBJECTIVES: This study sought to identify the incidence and additional predictors of SCD early after MI in a contemporary nationwide setting.

    METHODS: The authors used data from SWEDEHEART, the Swedish Cardiopulmonary Resuscitation Registry, and the Swedish Pacemaker and Implantable Cardioverter-Defibrillator (ICD) Registry. Cases of MI, which had undergone coronary angiography and were discharged alive between 2009 to 2017 without a prior ICD, were followed up to 90 days. Cox regression models were used to assess associations between clinical parameters and out-of-hospital cardiac arrest (OHCA).

    RESULTS: Among 121,379 cases, OHCA occurred in 349 (0.29%) and non-OHCA death in 2,194 (1.8%). A total of 6 variables (male sex, diabetes, estimated glomerular filtration rate <30 ml/min/1.73 m2, Killip class ≥II, new-onset atrial fibrillation/flutter, and impaired LVEF [reference ≥50%] categorized as 40% to 49%, 30% to 39%, and <30%) were identified as independent predictors, were assigned points, and were grouped into 3 categories, where the incidence of OHCA ranged from 0.12% to 2.0% and non-OHCA death from 0.76% to 11.7%. Stratified by LVEF <40% alone, the incidence of OHCA was 0.20% and 0.76% and for non-OHCA death 1.1% and 4.9%.

    CONCLUSIONS: In this nationwide study, the incidence of OHCA within 90 days after MI was <0.3%. A total of 5 clinical parameters in addition to LVEF predicted OHCA and non-OHCA death better than LVEF alone.

  • 46.
    Fovaeus, Hannah
    et al.
    Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Holmen, Johan
    Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Mandalenakis, Zacharias
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Medicine, Adult Congenital Unit, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden..
    Castellheim, Albert Gyllencreutz
    Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study2024Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, artikel-id 110103Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SETTING This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods.

    Results: We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 minutes. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006).

    Conclusion: Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

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  • 47. Fredriksson, M
    et al.
    Aune, S
    Bång, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Thorén, A-B
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest outside and inside hospital in a community: mechanisms behind the differences in outcome and outcome in relation to time of arrest.2010Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 159, nr 5, s. 749-756Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The aim was to compare characteristics and outcome after cardiac arrest where cardiopulmonary resuscitation was attempted outside and inside hospital over 12 years. METHODS: All out-of-hospital cardiac arrests (OHCAs) in Göteborg between 1994 and 2006 and all in-hospital cardiac arrests (IHCAs) in 1 of the city's 2 hospitals for whom the rescue team was called between 1994 and 2006 were included in the survey. RESULTS: The study included 2,984 cases of OHCA and 1,478 cases of IHCA. Patients with OHCA differed from those with an IHCA; they were younger, included fewer women, were less frequently found in ventricular fibrillation, and were treated later. If patients were found in a shockable rhythm, survival to 1 month/discharge was 18% after OHCA and 61% after IHCA (P < .0001). Corresponding values for a nonshockable rhythm were 3% and 21% (P < .0001). Survival was higher on daytime and weekdays as compared with nighttime and weekends after IHCA but not after OHCA. Among patients found in a shockable rhythm, a multivariate analysis considering age, gender, witnessed status, delay to defibrillation, time of day, day of week, and location showed that IHCA was associated with increased survival compared with OHCA (adjusted odds ratio 3.18, 95% CI 2.07-4.88). CONCLUSION: Compared with OHCA, the survival of patients with IHCA increased 3-fold for shockable rhythm and 7-fold for nonshockable rhythm in our practice setting. If patients were found in a shockable rhythm, the higher survival after IHCA was only partly explained by a shorter treatment delay. The time and day of CA were associated with survival in IHCA but not OHCA.

  • 48.
    Frisk Torell, Matilda
    et al.
    Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden friskmatilda@gmail.com..
    Strömsöe, Anneli
    Center for Clinical Research, Dalarna University, Falun, Sweden..
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Center for resuscitation science, Karolinska Institute, Stockholm, Sweden.
    Rawshani, Araz
    University of Gothenburg, Goteborg, Sweden.
    Borjesson, Mats
    Molecular and Clinical Medicine, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden; Östra Sjukhuset, Goteborg, Sweden.
    Better outcomes from exercise-related out-of-hospital cardiac arrest in males and in the young: findings from the Swedish Registry of Cardiopulmonary Resuscitation2022Ingår i: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480, Vol. 56, nr 18, s. 1026-1031Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Survival from out-of-hospital cardiac arrest (OHCA) is higher if the arrest is witnessed and occurs during exercise, however, there is contradicting data on prognosis with regards to sex and age. The purpose of this study was to compare the outcomes and circumstances of exercise-related OHCA in different age groups and between sexes in a large unselected population.

    Methods: Data from exercise-related OHCAs reported to the Swedish Registry of Cardiopulmonary Resuscitation from 2011 to 2014 and from 2016 to 2018 were analysed. All cases of exercise-related OHCA in which emergency medical services attempted resuscitation were included. The primary outcome was survival to 30 days.

    Results: In total, 635 cases of exercise-related OHCA outside of the home were identified. The overall 30-day survival rate was 44.5% with highest survival rate in the age group 0-35 years, compared with 36-65 years and >65 years (59.6% vs 46.0% and 40.4%, p=0.01). A subgroup analysis of 0-25 years showed a survival rate of 68.8%. Exercise-related OHCA in females (9.1% of total) were witnessed to a lower extent (66.7% vs 79.6%, p=0.03) and median time to cardiopulmonary resuscitation (CPR) was longer (2.0 vs 1.0 min, p=0.001) than in males. Females also had lower rates of ventricular fibrillation (43.4% vs 64.7%, p=0.003) and a lower 30-day survival rate (29.3% vs 46.0%, p=0.02).

    Conclusion: In exercise-related OHCA, younger victims have a higher survival rate. Exercise-related OHCA in females was rare, however, survival rates were lower compared with males and partly explained by a lower proportion of witnessed events, longer time to CPR and lower frequency of a shockable rhythm.

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  • 49.
    Frisk Torell, Matilda
    et al.
    Institution of Neuroscience and physiology, Gothenburg University.
    Strömsöe, Anneli
    County Council of Dalarna, Dalarna University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Claesson, Andreas
    Center of Resuscitation and Science, Karolinska Institute.
    Svensson, Leif
    Center of Resuscitation and Science, Karolinska Institute.
    Börjesson, Mats
    Institution of Neuroscience and physiology, Institution of Nutrition and Sport Science, University of Gothenburg, Sahlgrenska University Hospital/Östra.
    Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.2019Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 14, nr 2, artikel-id e0211723Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.

    METHODS: Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.

    RESULTS: 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).

    CONCLUSION: The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

  • 50. Glantz, H
    et al.
    Thunström, E
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cederin, B
    Nasic, S
    Ejdebäck, J
    Peker, Y
    Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort2013Ingår i: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 10, nr 4, s. 350-356Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Knowledge about the prevalence of obstructive sleep apnea (OSA) in coronary artery disease (CAD) is insufficient. The aim of the current report was to evaluate the occurrence and predictors of OSA among revascularized patients with CAD within the framework of a randomized controlled trial (Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea [RICCADSA]), evaluating the impact of continuous positive airway pressure on cardiovascular outcomes in CAD patients with OSA. Material and Methods: All patients undergoing percutaneous coronary intervention or coronary artery bypass grafting between September 2005 and November 2010 (n = 1,291) were invited to participate. Anthropometrics and medical history were obtained, ambulatory sleep recording was performed, and all subjects completed the Epworth Sleepiness Scale (ESS) questionnaire. Results: In total, 662 patients participated in the sleep study. OSA, defined as an apnea–hypopnea index equal to or greater than 15/hour, was found among 422 (63.7%). The prevalence of hypertension was 55.9%; obesity (body mass index ≥ 30 kg/m2), 25.2%; diabetes mellitus, 22.1%; and current smoking, 18.9%. The patients with CAD who did not participate in the study demonstrated an almost similar anthropometric and clinical profile compared with the studied group. The majority (61.8%) of the patients with OSA were nonsleepy (ESS score < 10). Patients with OSA had a higher prevalence of obesity, hypertension, diabetes mellitus, and history of atrial fibrillation, whereas current smoking was more common in the non-OSA group. Age, male sex, body mass index, and ESS score, but not comorbidities, were independent predictors of OSA. Conclusions: The occurrence of unrecognized OSA in this revascularized CAD cohort was higher than previously reported. We suggest that OSA should be considered in the secondary prevention protocols in CAD. Read More: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201211-106OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed&

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