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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. 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)
  • 4.
    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.

  • 5. 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)
  • 6. 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.

  • 7. 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)
  • 8. 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.

  • 9.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Att överleva hjärtstopp2007Konferensbidrag (Övrigt vetenskapligt)
  • 10. 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.

  • 11. 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.

  • 12. 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.

  • 13.
    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.

  • 14. 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.

  • 15. 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.

  • 16. 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.

  • 17. 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.

  • 18. 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.

  • 19. 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.

  • 20. 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)
  • 21. 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.

  • 22. 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.

  • 23. 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&

  • 24. Graves, JR
    et al.
    Herlitz, Johan
    [external].
    Bång, A
    [external].
    Axelsson, Å
    Ekström, L
    Holmberg, M
    Holmberg, S
    Lindqvist, J
    Sunnerhagen, K
    Survivors of out-of-hospital cardiac arrest. Their prognosis, longevity, and functional status1997Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, nr 2, s. 117-121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper reports, consistent with Utstein Style definitions, 13 years experience observing out-of-hospital cardiac arrest survivors' prognosis, longevity and functional status. We report for all patients, available outcome information for out-of-hospital cardiac arrest survivors in Göteborg Sweden between 1980 and 1993. Patients were followed for at least 1 year and some for over 14 years. From 1980 to 1993 Göteborg EMS treated 3754 out-of-hospital cardiac arrests. 9% (n = 324) were discharged from the hospital alive. Survivors' median age was 67 and 21% (n = 67) were women. Mortality rate was: 21% (n = 61) at 1 year; 56% (n = 78) by 5 years; and 82% (n = 32) by 10 years following the arrest. During the first 3 years, 16% (n = 46) experienced another cardiac arrest, 19% (n = 53) had an acute myocardial infraction and a total of 81% (n = 232) were rehospitalized for various conditions. 14% (n = 40) returned to previous employment, and 74% (n = 229) had retired before their arrest occurred. Cerebral performance categories (CPC) scores were: At hospital discharge N = 324; Data available for 320-1 = 53% (n = 171), 2 = 21% (n = 66), 3 = 24% (n = 77), 4 = 2% (n = 6). One year post arrest N = 263; Data available for 212-1 = 73% (n = 156), 2 = 9% (n = 18), 3 = 17% (n = 36), 4 = 1% (n = 2). Overall, 21% (n = 61) of cardiac arrest survivors died during the first year, and an additional 16% (n = 46) experienced another arrest. 73% of those patients who were still alive after 1 year returned to pre-arrest function.

  • 25.
    Hagiwara, M
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Claesson, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Norberg, Gabriella
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis2014Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome. Methods Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality. Results Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%. Conclusion An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.

  • 26. Hasselqvist, Ingela
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif
    Impact of bystander CPR on survival after out of hospital cardiac arrest2012Konferensbidrag (Refereegranskat)
  • 27. Hasselqvist-Ax, I
    et al.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Rosenqvist, M
    Hollenberg, J
    Nordberg, P
    Ringh, M
    Jonsson, M
    Axelsson, C
    Lindqvist, J
    Svensson, L
    The Assessment aand Value of Bystander Cardiopulmonary Resuscitation2013Konferensbidrag (Refereegranskat)
  • 28. Henriksson, C
    et al.
    Larsson, M
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, JE
    Wernroth, L
    Lindahl, B
    Influence of health related quality of life on time from symptom onset to hospital arrival and the risk of readmission in patients with myocardial infarction2014Ingår i: Open heart, E-ISSN 2053-3624, Vol. 1, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Despite increased awareness of the importance of early treatment in acute myocardial infarction (AMI), the delay from symptom onset to hospital arrival is still too long and rehospitalisations are frequent. Little is known about how health-related quality of life (HRQL) affects delay time and the frequency of readmissions. METHOD: We used quality registers to investigate whether patients' HRQL has any impact on delay time with a new AMI, and on the rate of readmissions during the first year. Patients with AMI <75 years, with HRQL assessed with EQ-5D at 1-year follow-up, and who thereafter had a new AMI registered, were evaluated for the correlation between HRQL and delay time (n=454). The association between HRQL and readmissions was evaluated among those who had an additional AMI and a new 1-year follow-up registration (n=216). RESULTS: Patients who reported poor total health status (EQ-VAS ≤50), compared to those who reported EQ-VAS 81-100, had tripled risk to delay ≥2 h from symptom onset to hospital arrival (adjusted OR 3.01, 95% CI 1.43 to 6.34). Patients scoring EQ-VAS ≤50 had also a higher risk of readmissions in the univariate analysis (OR 3.08, 95% CI 1.71 to 5.53). However, the correlation did not remain significant after adjustment (OR 1.99, 95% CI 0.90 to 4.38). EQ-index was not independently associated with delay time or readmissions. CONCLUSIONS: Aspects of total health status post-AMI were independently associated with delay time to hospital arrival in case of a new AMI. However, the influence of total health status on the risk of readmissions was less clear.

  • 29.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Rapport från det Svenska Hjärt-lungräddningsregistret2014Konferensbidrag (Övrigt vetenskapligt)
  • 30.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svenska Hjärt-lungräddningsregistret. Årsrapport 20132013Rapport (Övrigt vetenskapligt)
  • 31.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Årsrapport för det Svenska Hjärt-lungräddningsregistret 20142014Rapport (Övrigt vetenskapligt)
  • 32.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Epidemiologi kring icke kardiella hjärtstopp2014Konferensbidrag (Övrigt vetenskapligt)
  • 33.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Predictors of death during 5 years after coronary artery bypass grafting1998Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 64, nr 1, s. 15-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe predictors of death during five years of follow-up after coronary artery bypass grafting (CABG). Methods: All patients who underwent CABG during a period of three years in Western Sweden were included in the analysis and were prospectively followed for five years. Mortality was related to preoperative and peroperative factors as well as findings at physical examination and medication 4–7 days after the operation. Results: In all 2121 patients underwent CABG without simultaneous valve surgery during the study period. The overall five-year mortality was 14.6%. The following appeared as independent predictors of death during five years but >30 days after CABG: Current smoking (relative risk ratio 2.43 [95% Ci 1.64–3.61]) degree of impairment of left ventricular function (1.51 [1.23–1.86]), a history of congestive heart failure (1.91 [1.35–2.70]), age (1.04 [1.02–1.06]) arrhythmia 4–7 days after CABG (1.89 [1.26–2.83]), intermittent claudication (1.73 [1.19–2.52]), a history of diabetes (1.71 [1.16–2.51]), time in respirator (1.43 [1.13–1.81]), a history of cerebrovascular disease (1.72 [1.13–2.64]), treatment with digitalis at day 4–7 (1.48 [1.07–2.05]), enzyme release (1.49 [1.03–2.16]). Conclusion: Among patients who underwent CABG 11 independent predictors for mortality were found including smoking habits at CABG, history of cardiovascular diseases, left ventricular dysfunction, age, post operative complications and medication after CABG.

  • 34.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Isaksson, L
    Karlsson, T
    Ambulance despatchers´ estimation of intensity of pain and presence of associated symptoms in relation to outcome among patients who call for an ambulance because of acute chest pain1995Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 16, nr 12, s. 1789-1794Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.

  • 35.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Hartford, M
    Karlsson, T
    Risenfors, M
    Karlsson, BW
    Luepker, R
    Holmberg, S
    Swedberg, K
    Hjalmarson, Å
    Mortality and morbidity 1 year after early thrombolysis in suspected AMI: results from the TEAHAT Study1991Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 734, nr suppl 1, s. 43-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We randomized 352 patients with suspected acute myocardial infarction (AMI) to treatment with rt-PA (n = 177) or placebo (n = 175). Patients were eligible if evaluated within 2 h and 45 min from onset of chest pain, and if aged less than 75 years. There were no ECG criteria for inclusion. A mobile coronary-care unit with a cardiologist present was used to initiate treatment at home in 29% of cases. During 1 year of follow-up the mortality in patients treated with rt-PA was 10.2%, as compared with 14.3% in patients the initial ECG, the mortality during the first year was 8% in the rt-PA group vs. 18% in the placebo group (P less than 0.05). Among patients without ST-elevation the mortality was 9% for the rt-PA group vs. 12% for the placebo group (NS). Requirement for rehospitalization, symptoms of angina pectoris and congestive heart failure, time of return to work and requirement for various medications did not differ significantly between the two groups, regardless of the initial ECG pattern.

  • 36.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden2004Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 60, nr 3, s. 283-290Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P < 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P < 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P < 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.

  • 37.
    Herlitz, Johan
    et al.
    [external].
    Haglid, M
    Wiklund, I
    Caidahl, K
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Improvement in Quality of Life during 5 years after coronary artery bypass grafting1998Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 9, nr 8, s. 519-526Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the changes in various aspects of quality of life (QOL) from before coronary artery bypass grafting (CABG) to 5 years after the procedure. PATIENTS AND METHODS: Patients who underwent CABG in the western region of Sweden in 1988-1991 were approached with questionnaires evaluating their QOL prior to and 3 months and 1, 2, and 5 years after the operation. Three different instruments were used: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: In all 2121 patients underwent CABG, of whom 310 died during 5 years of follow-up. With all three instruments QOL had improved 5 years after CABG compared with prior to the operation. However, all three instruments revealed a slight but significant deterioration in estimated QOL between 2 and 5 years after CABG. CONCLUSIONS: QOL 5 years after CABG is better than that prior to the operation, but between 2 and 5 years after the operation a slight deterioration in QOL is observed.

  • 38.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Slutredovisning av metoprololstudien från göteborg1984Ingår i: Hässle Information, ISSN 0346-9751, Vol. 7, s. 1-14Artikel i tidskrift (Refereegranskat)
  • 39.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Lomsky, M
    Wiklund, I
    The relationship between infarct size and morbidity and mortality during short-term and long-term follow-up after acute myocardial infarction1988Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 116, nr 5, s. 1378-1382Artikel i tidskrift (Refereegranskat)
  • 40.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Lindqvist, J
    Characteristics and outcome for patients with acute chest pain in relation to whether or not they were transported by ambulance2000Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 7, nr 3, s. 195-200Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe the characteristics and long-term outcome for patients suffering from acute chest pain in relation to whether or not they were transported to hospital by ambulance. All patients with acute chest pain who were admitted over a 21-month period to the emergency department at Sahlgrenska Hospital in Göteborg with symptoms of acute chest pain were included in the study. Consecutive patients were prospectively registered and followed with regard to mortality and morbidity over 5 years. In all, 4270 patients took part in the evaluation, of whom 1445 (34%) were transported by ambulance. Patients transported by ambulance were older (p < 0.0001) and had a higher prevalence of previous myocardial infarction, angina pectoris, hypertension, diabetes mellitus, and congestive heart failure (p < 0.0001 for all) than the others. They more frequently developed acute myocardial infarction (28% vs. 11%; p < 0.0001) and there was a final diagnosis of either confirmed or possible myocardial infarction/ischaemia in 69% compared with 38% for patients not transported by ambulance (p < 0.0001). The 5-year mortality among ambulance-transported patients was 41% vs. 16% among those who were not (p < 0.0001). When correcting for dissimilarities at baseline including final diagnosis the adjusted risk ratio for death among ambulance transported patients was 1.44 (95% confidence limit 1.26-1.65). However, we did not correct for severe non-cardiac diseases. It is concluded that among patients admitted to the emergency department with acute chest pain, those transported by ambulance had a much higher mortality during the subsequent 5 years than those who were not transported by ambulance. This was not entirely explained by observed differences at baseline. This information should be considered when ambulance organizations are being constructed.

  • 41.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Sjölin, M
    Lindqvist, J
    Ten year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis2002Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 251, nr 6, s. 526-253Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Keywords: mortality; myocardial infarction; myocardial ischaemia; prognosis Abstract. Herlitz J, Karlson BW, Sjölin M, Lindqvist J (Sahlgrenska University Hospital, Göteborg, Sweden). Ten-year mortality for patients discharged after hospitalization for chest pain or other symptoms raising suspicion of acute myocardial infarction in relation to hospital discharge diagnosis. J Intern Med 2002; 251: 526–532. Aim. To describe the 10-year prognosis for patients discharged after hospitalization for chest pain or other symptoms giving an initial suspicion of acute myocardial infarction (AMI) in relation to the final hospital diagnosis and furthermore to compare the outcome amongst these patients with the outcome amongst a sex-, age- and community-matched con- trol population. Methods. All patients who were hospitalized because of chest pain or other symptoms raising a suspicion of AMI and who were discharged alive from hospital. Patients were divided into three groups according to the final diagnosis: (1) confirmed or possible AMI, (2) confirmed or possible myocardial ischaemia and (3) other aetiology. Information on 10-year mortality was available in 3103 patients. A sex-, age- and community-matched control population (n=3221) was compared with the study population in terms of 10-year mortality. Time of the survey. 15 February 1986 to 9 November 1987. Setting. Sahlgrenska University Hospital. Results. Patients with confirmed or possible AMI (n=849) had a significantly higher mortality (59.4%) than patients with confirmed or possible myocardial ischaemia (n=1191) who had a mortality of 49.5% (P < 0.0001). The latter group had a higher mortality than patients with `other aetiology' (n=1063) of whom 40.6% died (P < 0.0001). When comparing the prognosis for patients with AMI and myocardial ischaemia, there was a significant interaction with sex, with a more marked difference in women than in men. Amongst all patients, the 10-year mortality was 49.1 vs. 37.3% in the control group (P < 0.0001). Conclusion. The very long term prognosis was strongly associated with diagnosis amongst patients hospitalized and discharged alive because of chest pain or other symptoms raising suspicion of AMI. The absolute mortality difference between patients who were discharged from hospital with confirmed diagnosis of AMI and those whose symptoms were considered to have other aetiology than AMI or ischaemia was nearly 20%. However, the absolute mortality difference between the patients included in the survey and a control population was only 12%.

  • 42.
    Herlitz, Johan
    et al.
    [external].
    Starke, M
    Hansson, E
    Ringvall, E
    Karlson, BW
    Waagstein, L
    Characteristics and outcome among women and men transported by ambulance due to symptoms arousing suspicion of acute coronary syndrome2002Ingår i: Medical Science Monitor, ISSN 1234-1010, E-ISSN 1643-3750, Vol. 8, nr 4, s. 251-256Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The purpose of this study was to describe the characteristics and outcome in relation to sex in consecutive patients who were transported by an ambulance due to symptoms arousing suspicion of acute coronary syndrome. MATERIAL/METHODS: Our research involved all patients transported by ambulance over a 3-month period in the community of Göteborg due to such symptoms. The P-values were age adjusted. RESULTS: Of the 930 transported patients fulfilling the given criteria, 452 (49%) were of women. The women were older and had a lower incidence of previous acute myocardial infarction, angina pectoris, and current smoking. Women less frequently had a final diagnosis of acute coronary syndrome (22.3% vs 36.6%; p<0.0001) or acute myocardial infarction (10.1% vs 17.9%; p<0.0001). However, the mortality rate during one year was the same in women (17.2%) and men (18.7%). Women were less frequently clammy on admission to the ambulance (17% vs 30%; p<0.0001) and less frequently showed signs of myocardial ischemia in ECG upon admission to the emergency department (26% vs 38%; p<0.0001) compared to men. Among those patients with an acute coronary syndrome, women more frequently complained of dyspnea than men (27% vs 12%; p=0.018). CONCLUSIONS: Our study suggests that among ambulance transported patients with suspicion of acute coronary syndrome there are some differences between women and men in terms of their characteristics and underlying etiology, but not in terms of the risk of mortality.

  • 43.
    Herlitz, Johan
    et al.
    [external].
    Wiklund, I
    Caidahl, K
    Hartford, M
    Haglid, M
    Karlson, BW
    Sjöland, H
    Karlsson, T
    The feeling of loneliness prior to coronary artery bypass grafting might be a predictor of short and long term postoperative mortality1998Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 16, nr 2, s. 120-125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To evaluate the effect of different aspects of quality of life (QL) upon mortality during short-and long-term follow-up after coronary artery bypass grafting (CABG). DESIGN: Prospective evaluation. MATERIALS: Consecutive patients from western Sweden who during 3 years underwent CABG. METHODS: They answered a questionnaire at the time of coronary angiography prior to CABG. Quality of life was measured with questions from the Nottingham Health Profile (NHP) part I. RESULTS: In all, 1290 patients were included in the analyses. When accounting for various preoperative factors known to be independently associated with morality the NHP question "I feel lonely" was found to be associated with mortality, both at 30 days (RR 2.61; 95% CI 1.15-5.95; p = 0.02) and at 5 years (RR 1.78; 95% CI 1.17-2.71; p = 0.007) after the operation. Thirteen per cent reported they felt lonely. At 5 years was, in addition, the statement "I have difficulty climbing stairs" also independently associated with mortality (RR 1.50; 95% CI 1.02-2.22; p = 0.04). CONCLUSION: Among the 38 statements in NHP as a judgment of QL prior to CABG, one of them, "I feel lonely" was independently associated with survival both at 30 days and 5 years after CABG.

  • 44. Hoffman, R
    et al.
    James, SK
    Svensson, L
    Frick, Mats
    Lindahl, B
    Ekelund, U
    Omerovic, E
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Witt, N
    Determination of the role of Oxygen in Acute Myocardial Infarction(DETO2X-AMI trial)2013Konferensbidrag (Refereegranskat)
  • 45. Hofmann, R
    et al.
    James, SK
    Svensson, L
    Witt, N
    Frick, M
    Lindahl, B
    Östlund, O
    Ekelund, U
    Erlinge, D
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jernberg, T
    DETermination of the role of OXygen in suspected Acute Myocardial Infarction trial2014Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 167, nr 3, s. 322-328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The use of supplemental oxygen in the setting of suspected acute myocardial infarction (AMI) is recommended in international treatment guidelines and established in prehospital and hospital clinical routine throughout the world. However, to date there is no conclusive evidence from adequately designed and powered trials supporting this practice. Existing data are conflicting and fail to clarify the role of supplemental oxygen in AMI. METHODS: A total of 6,600 normoxemic (oxygen saturation [SpO2] ≥90%) patients with suspected AMI will be randomly assigned to either supplemental oxygen 6 L/min delivered by Oxymask (MedCore Sweden AB, Kista, Sweden) for 6 to 12 hours in the treatment group or room air in the control group. Patient inclusion and randomization will take place at first medical contact, either before hospital admission or at the emergency department. The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry will be used for online randomization, allowing inclusion of a broad population of all-comers. Follow-up will be carried out in nationwide health registries and Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies. The primary objective is to evaluate whether oxygen reduces 1-year all-cause mortality. Secondary end points include 30-day mortality, major adverse cardiac events, and health economy. Prespecified subgroups include patients with confirmed AMI and certain risk groups. In a 3-month pilot study, the study concept was found to be safe and feasible. CONCLUSION: The need to clarify the uncertainty of the role of supplemental oxygen therapy in the setting of suspected AMI is urgent. The DETO2X-AMI trial is designed and powered to address this important issue and may have a direct impact on future recommendations.

  • 46.
    Hofmann, Robin
    et al.
    Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
    Witt, Nils
    Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet.
    Lagerqvist, Bo
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Jernberg, Tomas
    Cardiology, Department of Clinical Sciences, Karolinska Institutet.
    Lindahl, Bertil
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Erlinge, David
    Department of Cardiology, Clinical Sciences, Lund University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Cardiology, Sahlgrenska University Hospital.
    Alfredsson, Joakim
    Department of Medical and Health Sciences, Linköping University.
    Linder, Rikard
    Cardiology, Department of Clinical Sciences, Karolinska Institutet.
    Omerovic, Elmir
    Department of Cardiology, Sahlgrenska University Hospital.
    Angerås, Oskar
    Department of Cardiology, Sahlgrenska University Hospital.
    Venetsanos, Dimitrios
    Department of Medical and Health Sciences, Linköping University.
    Kellerth, Thomas
    Department of Cardiology, Örebro University Hospital.
    Sparv, David
    Department of Cardiology, Clinical Sciences, Lund University.
    Lauermann, Jörg
    Division of Cardiology, Department of Internal Medicine, Ryhov Hospital.
    Barmano, Neshro
    Division of Cardiology, Department of Internal Medicine, Ryhov Hospital.
    Verouhis, Dinos
    Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital.
    Östlund, Ollie
    Uppsala Clinical Research Center, Uppsala University.
    Svensson, Leif
    Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital.
    James, Stefan K
    Cardiology, Department of Medical Sciences, Uppsala University, Akademiska Sjukhuset.
    Oxygen therapy in ST-elevation myocardial infarction.2018Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr 29, s. 2730-2739Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To determine whether supplemental oxygen in patients with ST-elevation myocardial infarction (STEMI) impacts on procedure-related and clinical outcomes.

    Methods and results: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized patients with suspected myocardial infarction (MI) to receive oxygen at 6 L/min for 6-12 h or ambient air. In this pre-specified analysis, we included only STEMI patients who underwent percutaneous coronary intervention (PCI). In total, 2807 patients were included, 1361 assigned to receive oxygen, and 1446 assigned to ambient air. The pre-specified primary composite endpoint of all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis at 1 year occurred in 6.3% (86 of 1361) of patients allocated to oxygen compared to 7.5% (108 of 1446) allocated to ambient air [hazard ratio (HR) 0.85, 95% confidence interval (95% CI) 0.64-1.13; P = 0.27]. There was no difference in the rate of death from any cause (HR 0.86, 95% CI 0.61-1.22; P = 0.41), rate of rehospitalization for MI (HR 0.92, 95% CI 0.57-1.48; P = 0.73), rehospitalization for cardiogenic shock (HR 1.05, 95% CI 0.21-5.22; P = 0.95), or stent thrombosis (HR 1.27, 95% CI 0.46-3.51; P = 0.64). The primary composite endpoint was consistent across all subgroups, as well as at different time points, such as during hospital stay, at 30 days and the total duration of follow-up up to 1356 days.

    Conclusions: Routine use of supplemental oxygen in normoxemic patients with STEMI undergoing primary PCI did not significantly affect 1-year all-cause death, rehospitalization with MI, cardiogenic shock, or stent thrombosis.

  • 47. Hollenberg, J
    et al.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lindqvist, J
    Herlitz, Johan
    [external].
    Nordlander, R
    Svensson, L
    Rosenqvist, M
    Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?2005Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 257, nr 3, s. 247-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS: All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P <0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Goteborg (P=0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Goteborg. CONCLUSION: Survival was almost three times higher in Goteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Goteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Goteborg as one possible explanation.

  • 48. Hollenberg, J
    et al.
    Ringh, M
    Fredman, D
    Nordberg, P
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Rosenqvist, M
    Svensson, L
    replik till Bengt Fagrell: Fler hjärtstartare behövs i samhället2013Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 19-20, s. 959-Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Fler hjärtstartare behövs, men konceptet behöver utvecklas. Vi måste dessutom finna nya sätt att mobilisera hjärtstartare till platsen för hjärtstoppet.

  • 49. Holmberg, M
    et al.
    Holmberg, S
    Herlitz, Johan
    [external].
    Effect of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients in Sweden.2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 47, nr 1, s. 59-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Information from the Swedish Cardiac Arrest Registry was used to investigate: (a) The proportion of patients suffering an out-of-hospital cardiac arrest who were given bystander cardiopulmonary resuscitation (B-CPR). (b) Where and by whom B-CPR was given. (c) The effect of B-CPR on survival. METHOD: a prospective, observational study of cardiac arrests reported to the Swedish Cardiac Arrest Registry. Analyses were based on standardised reports of out-of-hospital cardiac arrests from ambulance organisations in Sweden, serving 60% of the Swedish population. From 1983 to 1995 approximately 15-20% of the population had been trained in CPR. RESULTS: Of 9877 patients, collected between January 1990 and May 1995, B-CPR was attempted in 36%. In 56% of these cases, the bystanders were lay persons and in 25% they were medical personnel. Most of the arrests took place at home (69%) and only 23% of these patients were given B-CPR in contrast to cardiac arrest in other places where 53% were given CPR. Survival to 1 month was significantly higher in all cases that received B-CPR (8.2 vs. 2.5%). The odds ratio for survival to 1 month with B-CPR was in a logistic regression analysis 2.5 (95% CI 1.9-3.1). CONCLUSIONS: In Sweden, the willingness and ability to perform B-CPR appears to be relatively widespread. More than half of B-CPR was performed by laypersons. B-CPR resulted in a two to threefold increase in survival.

  • 50. Holmgren, CM
    et al.
    Abdon, NJ
    Bergfeldt, LB
    Edvardsson, NG
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlsson, T
    Svensson, LG
    Åstrand, BH
    Changes in medication preceededing out-of hopital cardiac arrest where resuscitation was attempted2014Ingår i: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, nr 6, s. 497-503Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. METHODS: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. RESULTS: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 ± 16 years vs. 54 ± 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. CONCLUSIONS: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.

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