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  • 1. Everts, B
    et al.
    Karlson, BW
    Währborg, P
    Abdon, N-J
    Herlitz, Johan
    [external].
    Hedner, T
    Pain recollection after chest pain of cardiac origin1999In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 92, no 2, p. 115-120Article in journal (Refereed)
    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.

  • 2.
    Herlitz, Johan
    [external].
    Management of pain in patients with acute myocardial infarction1990In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 77, no 6, p. 421-423Article in journal (Refereed)
  • 3.
    Herlitz, Johan
    et al.
    [external].
    Abrahamsson, P
    Dellborg, M
    Karlson, BW
    Karlsson, T
    Lindqvist, J
    Long term survival after development of acute myocardial infarction has improved after a more widespread use of thrombolysis and aspirin1999In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 91, no 4, p. 250-255Article in journal (Refereed)
    Abstract [en]

    We describe the mortality during the subsequent 5 years after development of acute myocardial infarction prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin in the community of Göteborg. During period I, 4% received thrombolysis as compared with 32% during period II (p < 0.0001). The corresponding figures for prescription of aspirin at discharge were 14 and 84%, respectively (p < 0.0001). The overall 5-year mortality was 48% during period I and 46% during period II (p = 0.09). However, the age-adjusted mortality during period II was significantly reduced (risk ratio 0.86; 95% confidence interval 0.78-0.95; p = 0. 004). There was no significant interaction between improvement in survival and sex or any other parameter reflecting patients' clinical history.

  • 4.
    Herlitz, Johan
    et al.
    [external].
    Bengtson, A
    Hjalmarson, A
    Karlson, BW
    Smoking habits in consecutive patients with acute myocardial infarction: Prognosis in relation to other risk indicators and to whether or not they quit smoking1995In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 86, no 6, p. 496-502Article in journal (Refereed)
    Abstract [en]

    In all patients hospitalized in one single hospital due to acute myocardial infarction (AMI) during a period of 21 months, we describe the prognosis in relation to smoking habits and other risk indicators with death. Of 862 AMI patients, 37% reported smoking at the onset of AMI. Of the patients who smoked at the onset of AMI and who survived the first year, 53% reported having quit smoking. Patients who had quit smoking reported fewer symptoms of chest pain (p < 0.01), headache (p < 0.01) and dizziness (p < 0.001) as compared with patients who continued to smoke after one year. Of the patients who had quit smoking, the mortality during the subsequent 4 years was 17% as compared with 31% for patients who continued to smoke (p < 0.05). However, patients who quit smoking less frequently had a previous history of myocardial infarction and congestive heart failure. When correcting for such dissimilarities, quitting smoking did not remain significantly associated with prognosis.

  • 5.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Wiklund, J
    Hjalmarson, Å
    Morbidity and quality of life five years after early intervention with metoprolol in suspected acute myocardial infarction1988In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 75, no 5, p. 357-364Article in journal (Refereed)
    Abstract [en]

    In 1,395 patients in the age range 40-74 years participating in a double-blind trial with metoprolol in suspected acute myocardial infarction morbidity and quality of life were assessed during the first 5 years after randomization. During the first 3 months patients were given 200 mg metoprolol daily or placebo. Thereafter the two groups were treated similarly. Mortality during 5 years was 24.2% in patients originally randomized to metoprolol versus 25.7% in patients originally randomized to placebo (p greater than 0.2). No difference was observed regarding reinfarction rate, stroke or occurrence of bypass surgery during the 5-year follow-up. During the first 3 months 10% of patients in the metoprolol group were rehospitalized for various reasons versus 13% in the placebo group. The corresponding figures for 5 years were 59 and 60%, respectively. Among patients surviving 5 years 84% in both groups were on some medication of which beta-blockade was the dominating one. Symptoms of chest pain, dyspnea, claudicatio, smoking habits and working capacity did not differ and neither did quality of life according to the Nottingham Health Profile. We thus conclude that morbidity and quality of life were not significantly affected 5 years after early intervention with metoprolol in patients with suspected acute myocardial infarction.

  • 6.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid, M
    Karlson, BW
    Karlsson, T
    Sjöland, H
    Caidahl, K
    Symptoms of chest pain and dyspnea and factors associated with chest pain after coronary artery bypass grafting1999In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 91, no 4, p. 220-226Article in journal (Refereed)
    Abstract [en]

    Patients in western Sweden who underwent CABG from 1988 to 1991 received prior to coronary angiography and 2 and 5 years after CABG a questionnaire, in which they were asked about symptoms of chest pain and dyspnea. In all, 1,226 patients answered the inquiry prior to CABG, 1,531 patients 2 years and 1,359 patients 5 years after surgery. Both in terms of chest pain and dyspnea there was a marked improvement 2 and 5 years after CABG as compared with prior to surgery. However, between 2 and 5 years after surgery there was a minor deterioration, both regarding chest pain and dyspnea. The most statistically significant preoperative predictors for the occurrence of chest pain more than twice a week 5 years after surgery were concomitant valvular heart disease and obesity.

  • 7.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlsson, T
    Karlson, BW
    Haglid, M
    Sjöland, H
    Predictors of death and other cardiac events within two years after coronary artery bypass grafting1998In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 90, no 2, p. 110-114Article in journal (Refereed)
    Abstract [en]

    RESULTS: In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG. CONCLUSION: When using various definitions of a cardiac event after CABG, various risk indicators for death or such an event can be found. Our data suggest that anamnestic information prior to CABG indicating a depressed myocardial function or severe myocardial ischemia are more important predictors of outcome than the information gained from cardioangiography.

  • 8.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Mortality, place and mode of death and reinfarction during a period of five years after acute myocardial infarction in diabetic and non diabetic patients1996In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, no 5, p. 423-428Article in journal (Refereed)
    Abstract [en]

    We describe the prognosis during a 5-year follow-up of 858 consecutive patients with confirmed acute myocardial infarction (AMI), of which 97 (11%) had a history of diabetes mellitus. Diabetic patients had a 5-year mortality of 72% versus 50% for non-diabetic patients (p < 0.001). In a multivariate analysis considering age, sex, diabetes and a history of cardiovascular disease, diabetes was an independent predictor of death (p < 0.001) together with age (p < 0.001), previous AMI (p < 0.001) and a history of congestive heart failure (p < 0.05). Among diabetic patients, 55% developed a reinfarction versus 22% among non-diabetic patients (p < 0.001). Mode and place of death appeared to be similar in diabetic and non-diabetic patients.

  • 9.
    Herlitz, Johan
    et al.
    [external].
    Haglid, M
    Albertsson, P
    Westberg, S
    Karlson, BW
    Hartford, M
    Lurje, L
    Caidahl, K
    Short- and long term prognosis after coronary artery bypass grafting in relation to smoking habits1997In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 88, no 6, p. 492-497Article in journal (Refereed)
    Abstract [en]

    We describe the 2- and 5-year prognoses following coronary artery bypass grafting (CABG) in relation to smoking habits among consecutive patients being operated on in western Sweden during a 3-year period. Among the 2,121 patients, 10.2% admitted smoking at coronary angiography as compared with 7.5% 2 years after CABG (NS). Among smokers, the mortality during the subsequent 2 years was 8.9% as compared with 6.5% for exsmokers and 7.3% for never smokers (NS). During the 5-year follow-up, smokers had a mortality of 18.8% as compared with 13.6% for exsmokers and 12.5% for never smokers (p = 0.03). When correcting for dissimilarities in previous history, smoking was a strongly significant independent (p < 0.0001) predictor of 5-year mortality.

  • 10.
    Herlitz, Johan
    et al.
    [external].
    Hartford, M
    Aune, S
    Karlsson, T
    Hjalmarson, Å
    Delay time between onset of myocardial infarction and start of thrombolysis in relation to prognosis1993In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 82, no 2, p. 347-353Article in journal (Refereed)
    Abstract [en]

    In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.

  • 11.
    Herlitz, Johan
    et al.
    [external].
    Hartford, M
    Karlson, BW
    Dellborg, M
    Källström, G
    Karlsson, T
    One year mortality after acute myocardial infarction prior to and after the implementation of a widespread use of thrombolysis and aspirin1997In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 89, no 3, p. 216-221Article in journal (Refereed)
    Abstract [en]

    During 1 year of follow-up, we compared the mortality after acute myocardial infarction (AMI) prior to and after the introduction of a more widespread use of thrombolytic agents and aspirin. STUDY PERIOD: Two periods (I = 1986-1987 and II = 1989-1990) were compared. PATIENTS: All patients admitted to the coronary care units at the two city hospitals in the community of Goteborg who fulfilled the criteria for development of AMI participated in the evaluation. RESULTS: The overall 1-year mortality rate was 27% [corrected] during period I and 23% during period II (NS). However, among patients up to 70 years of age, the mortality was reduced from 15 to 11% (p < 0.05), whereas among patients aged over 70 years the mortality remained almost unchanged (34 vs. 35%; NS). CONCLUSION: The introduction of a more widespread use of thrombolytic agents and aspirin has not substantially changed the overall mortality in AMI. However, among younger patients, the mortality appears to have been reduced but not among the elderly.

  • 12.
    Herlitz, Johan
    et al.
    [external].
    Hartford, M
    Karlsson, BW
    Risenfors, M
    Blohm, M
    Luepker, RV
    Wennerblom, B
    Holmberg, S
    Effects of a media campaign to reduce delay times for acute myocardial infarction on the burden of chest pain patients in the emergency department1991In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 79, no 2, p. 127-134Article in journal (Refereed)
    Abstract [en]

    We evaluated the effect of a media campaign aimed at reducing delay times in suspected acute myocardial infarction (AMI) on the volume of chest pain patients seen in the emergency department. During the 1st week of the campaign, the mean number of chest pain patients increased from 10.5 per day prior to the start to 25.4. However, the number declined rapidly in subsequent months. The greatest increase was observed in patients with chest pain in whom AMI was not suspected on examination. During the campaign, 4,805 patients with chest pain appeared in the emergency department as compared with 4,407 patients during the same time period prior to its start, an increase of 9%. The number of patients with confirmed AMI increased from 595 to 629 (6%).

  • 13.
    Herlitz, Johan
    et al.
    [external].
    Helgesson, I
    Hjalmarson, B-M
    Hjalmarson, Å
    Jonsteg, C
    von Sudow, B
    Waldenström, J
    Relationship between serum enzyme activity in acute myocardial infarction and morbidity during a 2-year follow-up1986In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 73, no 2, p. 85-93Article in journal (Refereed)
    Abstract [en]

    In 585 patients with a first myocardial infarction the enzymatically estimated infarct size was related to the clinical course during a 2-year follow-up. Infarct size was estimated from maximum heat-stable lactate dehydrogenase activity. A higher maximum serum activity was associated with a higher mortality rate, more treatment with diuretics, digitalis and antiarrhythmics and a lower frequency of return to work. Patients with smaller infarcts according to maximum serum activity, however, had a higher incidence of angina pectoris and a higher reinfarction rate. We conclude that although there is a strong association between serum enzyme activity and mortality during a 2-year follow-up, the relation with morbidity appears to be more complex.

  • 14.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Prediction of the severity of acute myocardial infarction1985In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 72, no 4, p. 174-184Article in journal (Refereed)
    Abstract [en]

    In 698 patients with suspected and definite acute myocardial infarction we tried to predict the severity of the infarction from clinical history and simple bedside evaluation soon after arrival in hospital. The severity of the infarction was judged from serum enzyme activity, 2-year survival, incidence and severity of congestive heart failure and incidence of severe ventricular arrhythmias during initial hospitalization. Entry characteristics which were positively associated with the severity of the infarction were intensity of pain, sign of congestive heart failure, high heart rate, ECG signs of acute myocardial infarction and presence of Q waves. Elderly patients and those with a history of hypertension also had a more severe clinical course.

  • 15.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Holmberg, S
    Rydén, L
    Swedberg, K
    Waagstein, F
    Waldenström, A
    Variability, prediction and prognostic significance of chest pain in acute myocardial infarction1986In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 73, no 1, p. 13-21Article in journal (Refereed)
    Abstract [en]

    The variability of chest pain is described in 389 patients with acute myocardial infarction. Whereas 17% were free from severe pain after arrival in hospital, 11% required more than 10 analgesic injections. In 27% of the series analgesics were given more than 24 h after arrival in hospital. Predictors for the severity of chest pain were the rate-pressure product and degree of chest pain soon after arrival in hospital as well as electrocardiographic signs of myocardial infarction at entry. Patients with more severe chest pain had a higher 2-year mortality rate and a higher incidence of ventricular fibrillation and congestive heart failure during hospitalization.

  • 16.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Karlsson, BW
    Bengtsson, A
    Five-year mortality rate in patients with suspected acute myocardial infarction in relation to early diagnosis1988In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 75, no 4, p. 250-259Article in journal (Refereed)
  • 17.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Waldenström, J
    Waagstein, F
    Waldenström, A
    Swedberg, K
    Enzymatically and electrocardiographically estimated infarct size in relation to pain in acute myocardial infarction1984In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 71, no 5, p. 239-246Article in journal (Refereed)
    Abstract [en]

    In 563 patients with acute myocardial infarction and no previous myocardial infarction, the estimated infarct size was related to the estimated duration of pain and the amount of analgesics given. The size of infarction estimated from analyses of heat-stable lactate dehydrogenase (EC 1.1.1.27) at 12-hour intervals for 48-108 h and from Q- and R-wave changes in the ECG correlated positively, although weakly with duration of the pain and the amount of analgesics given. These data support the hypothesis that larger infarcts, as a group, evolve over a longer time period than smaller infarcts and that the duration of pain in many patients might be an indicator of the infarct size. In the individual patient, however, one cannot predict the size of the infarction from the severity of pain.

  • 18.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Sjölin, M
    Mortality and risk indicators for death during five years after acute myocardial infarction among patients with and without ST-elevation on admission electrocardiogram1998In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 89, no 1, p. 33-39Article in journal (Refereed)
    Abstract [en]

    We related observations in the electrocardiogram (ECG) on admission to hospital among consecutive patients hospitalized in one single hospital with acute myocardial infarction (AMI) and related the prognosis during the following 5 years to these observations. Results: Of 863 patients, 63% had ECG signs of myocardial ischemia, but only 41% had ST elevation on ED admission. Patients with ST elevation had a 5-year mortality of 44% as compared with 58% in patients without ST elevation (p < 0.001). Patients with the highest mortality were those with a pathologic ECG including signs of previous AMI, bundle branch block and pacemaker ECG, but with no ECG sign of acute ischemia. Patients with the lowest mortality were those with a nonpathologic ECG on admission. Conclusion: Among consecutive patients hospitalized with AMI, less than half had ST elevation on admission to hospital. These patients had a lower mortality during 5 years of follow-up than patients without ST elevation.

  • 19.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Sjölin, M
    Survival, mode of death, reinfarction and use of medication during a period of 5 years ater acute myocardial infarction in different age groups1996In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, no 6, p. 529-536Article in journal (Refereed)
    Abstract [en]

    We describe the prognosis during 5 years of follow-up among consecutive patients hospitalized in a single hospital due to acute myocardial infarction in various age groups. When considering various aspects of clinical history, age was the strongest independent predictor of total 5-year mortality and of 5-year mortality after discharge from hospital. The overall 5-year mortality was: age < 65, 23%; age 65-75, 49%; age > 75, 79% (p < 0.001). The relationship between age and death appeared to be similar regardless of the development of Q waves, infarct size and infarct site. Among patients who died, younger patients more frequently died a sudden death associated with ventricular fibrillation, whereas the elderly more frequently died in association with congestive heart failure.

  • 20.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Edvardsson, N
    Emanuelsson, H
    Hjalmarson, Å
    Prognosis in diabetics with chest pain or other symptoms suggestive of acute myocardial infarction1992In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 80, no 3-4, p. 237-245Article in journal (Refereed)
    Abstract [en]

    We evaluated the prognosis of 599 diabetics who came to the emergency department with chest pain or other symptoms suggestive of acute myocardial infarction (AMI). They made up 8% of the patients with such symptoms (n = 7,157). Diabetics had a 1-year mortality rate of 25% as compared with 10% for nondiabetics (p less than 0.001). The difference remained significant regardless of whether there was a strong or a vague initial suspicion of AMI. On admission, independent risk factors for death were age, acute congestive heart failure and initial degree of suspicion of AMI. We conclude that among diabetics who appear in the emergency department with chest pain or other symptoms suggestive of AMI, 25% are dead within 1 year. The prognosis is directly related to the initial suspicion of AMI.

  • 21.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Occurence of chest pain more than 24 hours after hospital admission in acute myocardial infarction and its relation to prognosis1992In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 81, no 1, p. 46-53Article in journal (Refereed)
    Abstract [en]

    In 857 consecutive patients with acute myocardial infarction (AMI), the occurrence of chest pain more than 24 h after hospital admission is described and related to death or reinfarction during one year of follow-up. Prolonged chest pain was observed in 333 patients (39%). In this group 15% died and 7% developed reinfarction during the first month as compared with 10% (p < 0.05) and 2% (p < 0.01) respectively in patients without prolonged pain. However, during one year of follow-up mortality did not differ significantly between patients with (27%) and without (24%) prolonged pain. The 1-year reinfarction rate was similar in the two groups (18% and 14%, respectively; NS). We conclude that AMI patients with prolonged chest pain have a particularly high mortality during the first month. However, during a longer follow-up the prognosis is similar in patients with and without prolonged chest pain.

  • 22.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Prognosis in patients with acute chest pain in relation to chronic beta-blocker treatment prior to admission to hospital1995In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 86, no 1, p. 56-59Article in journal (Refereed)
    Abstract [en]

    We evaluated the prognosis among consecutive patients hospitalized for acute chest pain or other symptoms suggestive of acute myocardial infarction (AMI) in relation to whether they were on chronic treatment with beta-blockers at onset of symptoms or not. In all, 3,504 patients were included in the analyses, of whom 936 (27%) were on chronic beta-blockade. Of the patients on beta-blockade, 25% developed AMI as compared with 21% of the remaining patients (p > 0.2). The mortality during the first 28 days was 7% in patients on chronic beta-blockade as compared with 5% in those not on beta-blockade (p > 0.2). When correcting for differences at baseline, chronic treatment with beta-blockers did not significantly influence the outcome.

  • 23.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Hjalmarson, Å
    Ten-year mortality among patients with suspected acute myocardial infarction in relation to early diagnosis1994In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 84, no 2, p. 114-120Article in journal (Refereed)
    Abstract [en]

    Previous studies have compared the outcome between patients with and without a confirmed acute myocardial infarction (AMI) mainly during the first few years after its onset. Our aim was to compare the prognosis between patients with and without a confirmed AMI during 10 years of follow-up. Patients participating in an early intervention trial with metoprolol in suspected AMI between 1976 and 1981 took part in this evaluation. The total 10-year mortality rate including hospital mortality was 51% for patients with confirmed AMI as compared with 32% for patients with a possible AMI and 23% for patients in whom AMI was definitely ruled out (p < 0.001). The 10-year mortality after discharge from hospital was in AMI 46%, possible AMI 32% and in definitely ruled out AMI 23% (p < 0.001). When simultaneously considering age, sex, previous history of cardiovascular disease and smoking, the development of AMI appeared as an independent predictor of death (p < 0.001). Thus, among patients hospitalized due to suspected AMI, 10-year mortality after discharge from hospital was directly related to the diagnosis during the first 3 days in hospital.

  • 24.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Karlsson, T
    Dellborg, M
    Hartford, M
    Luepker, RV
    Diagnostic accuracy of physicians for identifying patients with acute myocardial infarction without an electrocardiogram. Experiences from the TEAHAT trial1995In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 86, no 1, p. 25-27Article in journal (Refereed)
    Abstract [en]

    AIM: To determine the diagnostic accuracy of physicians for identifying patients with acute myocardial infarction (AMI) without an electrocardiogram (ECG). PATIENTS: All patients in Göteborg with suspected AMI below 75 years of age who called for an ambulance or came directly to one of the two city hospitals with a delay time of less than 2 h 45 min from the start of symptoms. METHODS: As part of the TEAHAT study (comparing rt-PA and placebo in AMI), we asked physicians to judge on a 1-5 scale (1 = no suspicion; 5 = convinced) how strong their suspicion of AMI was prior to interpreting the ECG. RESULTS: Among patients evaluated outside hospital with 4 or 5 on the scale, i.e. either a strong suspicion of AMI or the physician felt convinced about the diagnosis, 45% had ST elevation and 48% developed AMI during the first 3 days in hospital. The corresponding values for patients evaluated in hospital were 67 and 70%, respectively. CONCLUSION: We found that physicians could not accurately distinguish patients with AMI from those without based on clinical criteria without the help of an ECG.

  • 25.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Karlsson, T
    Stensdotter, L
    Sjölin, M
    Rate of admission and long-term prognosis among patients with acute chest pain in the 1990s compared with the 1980s2005In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 104, no 1, p. 51-56Article in journal (Refereed)
  • 26.
    Herlitz, Johan
    et al.
    [external].
    Waldenström, J
    Hjalmarson, Å
    Infarct size limitation after early intervention with metoprolol in the MIAMI Trial1988In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 75, no 2, p. 117-122Article in journal (Refereed)
    Abstract [en]

    One of the secondary objectives of the MIAMI Trial which evaluated the role of the beta-1-selective blocker metoprolol in suspected acute myocardial infarction was to further assess whether early intervention with beta-blockade can limit infarct size. A total of 5,778 patients from 104 worldwide centres were randomized into the trial. Various enzymes such as aspartate aminotransferase (ASAT), creatine kinase (CK), CK MB, CK B, lactate dehydrogenase (LD) and LD isoenzyme I were analysed. All enzymes were used according to the clinical routine of the respective hospital, except ASAT which was analysed once daily for 3 days in the majority of cases and LD I which was analysed every 12 h for 72 h in a subsample. A consistent observation was the lower serum enzyme activity among patients receiving metoprolol and randomized early after onset of symptoms, whereas no difference between metoprolol and placebo was observed in patients treated later in the course. The results of the MIAMI Trial support previous observations that early institution of metoprolol therapy limits infarct size, as indicated by the maximum serum enzyme activity.

  • 27. Karlson, BW
    et al.
    Emanuelsson, H
    Herlitz, Johan
    [external].
    Patients with suspected acute myocardial infarction and acute heart failure: Does it matter whether an infarction was developed or not?1994In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 84, no 2, p. 126-134Article in journal (Refereed)
    Abstract [en]

    Symptoms of acute severe congestive heart failure always raise the suspicion of acute myocardial infarction (AMI). Our aim was to describe the characteristics and the prognosis among patients with acute severe congestive heart failure in relation to whether or not it was caused by AMI. Consecutive patients admitted to one single hospital during 21 months due to suspected AMI, who either had initial symptoms of acute severe congestive heart failure or developed such symptoms during the subsequent days, were prospectively followed for 1 year in terms of mortality and morbidity. Of 531 patients who fulfilled previously defined criteria for severe congestive heart failure, 40% developed AMI during the first 3 days in hospital. At baseline, these patients differed from the others, having a less frequent history of known congestive heart failure. Mortality during 1 year of follow-up was 47% among patients who developed AMI versus 38% among those who did not (p < 0.05). In addition to age and a history of diabetes, development of AMI was independently associated with death.

  • 28. Karlson, BW
    et al.
    Hartford, M
    Herlitz, Johan
    [external].
    Treatment of patients with acute myocardial infarction in relation to gender1996In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, no 3, p. 230-234Article in journal (Refereed)
    Abstract [en]

    The question whether women and men with acute myocardial infarction (AMI) are treated differently is currently debated. In this analysis we compared pharmacological treatments and revascularization procedures during hospitalization and during 1 year of follow-up in 300 women and 621 men who suffered an AMI in 1986 or 1987 at our hospital. During hospitalization, the mean dose of morphine (+/- SD) during the first 3 days was higher in men compared to women (14.5 +/- 15.7 vs. 9.8 +/- 10.3 mg, p < 0.001), more men than women were given morphine after the first 24 h (65.4 vs. 49.0%, p < 0.01), and more men were prescribed anticoagulants at discharge (18 vs. 12%, p < 0.05). After 1 year more women than men were on diuretics (61.3 vs. 42.8%, p < 0.001) and a similar observation was made at discharge. This study was performed before thrombolytic therapy was routinely used. The frequency of revascularization procedures did not differ between men and women during hospitalization or during the year of follow-up. In conclusion, no major treatment differences, which could affect the prognosis, were found between women and men hospitalized due to AMI in this study in the prethrombolytic era.

  • 29. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Wiklund, O
    Pettersson, P
    Hallgren, P
    Hjalmarson, Å
    Characteristics and prognosis of patients with acute myocardial infarction in relation to whether they were treated in the coronary care unit or in other ward1992In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 81, no 2-3, p. 134-144Article in journal (Refereed)
    Abstract [en]

    The characteristics and the prognosis in 921 consecutive patients with acute myocardial infarction (AMI) admitted to one single hospital are described and related to whether they were treated in the coronary care unit or not. Patients treated in the coronary care unit (n = 779) had a 1-year mortality rate of 26% as compared with 41% for patients treated in general wards (n = 115; p < 0.001) and 74% for patients treated in the intensive care unit (n = 27; p < 0.001). Patients treated outside the coronary care unit had a different risk factor pattern including a higher age and a higher prevalence of a previous cardiovascular disease. Independent clinical risk indicators for death among patients in the coronary care unit were in order of significance, high age (p < 0.001), arrhythmia on admission (p < 0.01), acute congestive heart failure on admission (p < 0.01) and a history of diabetes mellitus (p < 0.05). In patients treated in general wards, the only risk indicator for death was a history of congestive heart failure.

  • 30. Karlson, BW
    et al.
    Sjölin, M
    Herlitz, Johan
    [external].
    Clinical factors associated with pain in acute myocardial infarction1993In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 83, no 1-2, p. 107-117Article in journal (Refereed)
    Abstract [en]

    In an unselected population of 921 consecutive patients with acute myocardial infarction admitted to one single hospital, regardless of age and whether they were admitted to the coronary care unit or not, we describe the course of pain during hospitalization. Patients with a history of angina pectoris, patients with a particularly long delay time, and patients not transported by ambulance had the longest duration of pain.

  • 31. Karlsson, B W
    et al.
    Dellborg, M
    Gullestad, L
    Åberg, L
    Sugg, J
    Herlitz, J
    University of Borås, School of Health Science.
    A pharmacokinetic and pharmacodynamic comparison of immediate-release metoprolol and extended-release metoprolol CR/XL in patients with suspected acute myocardial infarction: a randomized, open-label study2014In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 127, no 2, p. 73-82Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous metoprolol studies in myocardial infarction patients were performed with immediate-release (IR) metoprolol. This study aims to evaluate if extended-release metoprolol CR/XL once daily gives a similar β-blockade over 24 h compared to multiple dosing of metoprolol IR. METHODS: After 2 days of routine metoprolol treatment, 27 patients with suspected acute myocardial infarction were randomized to open-label treatment with metoprolol IR (50 mg four times daily or 100 mg twice daily) or metoprolol CR/XL 200 mg once daily for 3 days. RESULTS: Metoprolol CR/XL 200 mg once daily gave more pronounced suppression of peak heart rate, with lower peak and less variation in peak to trough plasma levels. There were no differences in AUC between the CR/XL and IR formulations, although the trough plasma metoprolol levels were comparable for metoprolol CR/XL 200 mg once daily and metoprolol IR 50 mg four times daily, but lower for metoprolol IR 100 mg twice daily. Both treatments were well tolerated. CONCLUSIONS: Metoprolol CR/XL 200 mg once daily showed lower peak and less variation in peak to trough plasma levels compared to multiple dosing of metoprolol IR with the same AUC. This was accompanied by a more uniform β-blockade over time, which was reflected by heart rate, and a more pronounced suppression of peak heart rate with similar tolerability. This suggests metoprolol CR/XL may be used as an alternative to metoprolol IR in patients with myocardial infarction.

  • 32. Karlsson, BW
    et al.
    Dellborg, M
    Gullestad, L
    Åberg, J
    Sugg, J
    Herlitz, J
    University of Borås, School of Health Science.
    A Pharmacokinetic and Pharmacodynamic Comparison of Immediate-Release Metoprolol and Extended-Release Metoprolol CR/XL in Patients with Suspected Acute Myocardial Infarction: A Randomized, Open-Label Study2014In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 127, no 2, p. 73-82Article in journal (Refereed)
    Abstract [en]

    Background: Previous metoprolol studies in myocardial infarction patients were performed with immediate-release (IR) metoprolol. This study aims to evaluate if extended-release metoprolol CR/XL once daily gives a similar β-blockade over 24 h compared to multiple dosing of metoprolol IR. Methods: After 2 days of routine metoprolol treatment, 27 patients with suspected acute myocardial infarction were randomized to open-label treatment with metoprolol IR (50 mg four times daily or 100 mg twice daily) or metoprolol CR/XL 200 mg once daily for 3 days. Results: Metoprolol CR/XL 200 mg once daily gave more pronounced suppression of peak heart rate, with lower peak and less variation in peak to trough plasma levels. There were no differences in AUC between the CR/XL and IR formulations, although the trough plasma metoprolol levels were comparable for metoprolol CR/XL 200 mg once daily and metoprolol IR 50 mg four times daily, but lower for metoprolol IR 100 mg twice daily. Both treatments were well tolerated. Conclusions: Metoprolol CR/XL 200 mg once daily showed lower peak and less variation in peak to trough plasma levels compared to multiple dosing of metoprolol IR with the same AUC. This was accompanied by a more uniform β-blockade over time, which was reflected by heart rate, and a more pronounced suppression of peak heart rate with similar tolerability. This suggests metoprolol CR/XL may be used as an alternative to metoprolol IR in patients with myocardial infarction.

  • 33. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Liljeqvist, J-Å
    Pettersson, P
    Hallgren, P
    Strömbom, U
    Hjalmarson, Å
    Prognosis in suspected acute myocardial infarction in relation to delay time between onset of symptoms and arrival in hospital1991In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 78, no 2, p. 131-137Article in journal (Refereed)
    Abstract [en]

    During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.

  • 34. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Richter, Johan
    Sjölin, M
    Hjalmarson, Å
    Prognosis in patients with ST-T wave chamges but no rise in serum enzyme activity as compared with non Q-wave infarction1991In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 79, no 4, p. 271-279Article in journal (Refereed)
    Abstract [en]

    We evaluated the prognosis for 419 patients admitted to hospital due to suspected acute myocardial infarction (AMI) who developed ST-T changes, but no rise in serum enzyme activity, and compared it to that of 508 patients developing non-Q-wave AMIs. We conclude that these patients have a high 1-year mortality (13%), although significantly lower than in patients with non-Q-wave AMIs (31%). The mortality is higher in patients with only ST depression (n = 86; 22%) than in patients with only T-wave inversion (n = 264; 8%).

  • 35. Perers, E
    et al.
    Caidahl, K
    Herlitz, Johan
    [external].
    Sjölin, M
    Karlson, BW
    Karlsson, T
    Hartford, M
    Spectrum of acute coronary syndromes: history and clinical presentation in relation to sex and age.2004In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 102, no 2, p. 67-76Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study sex-based differences in the clinical presentation in relation to age and type of acute coronary syndrome (ACS) in patients under 80 years of age. METHODS: The study includes 1,744 consecutive patients with the full spectrum of ACS (ST elevation myocardial infarction (MI), non-ST elevation MI, and unstable angina of high- and low-risk types) admitted to the coronary care unit in a university hospital. RESULTS: The women were older than the men and were as likely to present with ST elevation MI. They had lower rates of prior MI and prior coronary artery bypass surgery than men but similar rates of percutaneous coronary interventions. Further, women were less likely to have a short delay before admission to hospital and they were attended to less rapidly in the emergency department. The prevalence of risk factors, prior cardiovascular disease and ongoing treatment with cardiovascular drugs were strongly associated with less severe type of ACS with no significant sex interaction. Presentation with non-ST elevation MI was significantly associated with older age while the opposite was true for unstable low-risk angina. ECG signs of acute ischemia were not associated with age. Significant interactions between age and sex were observed for the prevalence of treatment with diuretics as well as hypotension at presentation, both more prevalent among women than men below 65 years of age. CONCLUSIONS: Women are struck by ACS at a higher age than men, are less likely to present early for hospital care, and at younger age women are more likely to present with hypotension. There is a striking difference in risk factors and previous history depending on type of ACS in both sexes.

  • 36. Sjöland, H
    et al.
    Herlitz, Johan
    [external].
    Lamm, C
    Hartford, M
    Caidahl, K
    Prediction of left ventricular dysfunction in coronary artery disease from clinical and exercise test findings1997In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 88, no 3, p. 246-253Article in journal (Refereed)
    Abstract [en]

    We studied the ability to predict depressed left ventricular ejection fraction (LVEF) from clinical and exercise test findings prior to surgery in consecutive patients who underwent coronary artery bypass grafting (CABG) from 1988 to 1991 (n = 663). Multivariate analysis showed a history of myocardial infarction, pathological Q-wave in resting ECG, systolic blood pressure at maximal exercise and the degree of mitral regurgitation as significant independent predictors of impaired LVEF. The relative risk (RR) of depressed LVEF was markedly increased for a previous history of myocardial infarction (RR 3.3, p < 0.0001) and a pathological Q-wave in resting ECG (RR 2.4, p < 0.0001). All associations found between depressed LVEF and exercise test results were poor, and of little value for discriminating patients with depressed LVEF. Thus, clinical data appear to be better markers of low LVEF than the information obtained from the exercise test.

  • 37. Sjöland, H
    et al.
    Tengborn, L
    Stensdotter, L
    Herlitz, Johan
    [external].
    Lack of very strong association between pre-treatment fibrinogen and PAI-1 with long-term mortality after coronary bypass surgery.2007In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 108, no 2, p. 82-89Article in journal (Refereed)
    Abstract [en]

    AIM: To explore the association between the coagulation protein fibrinogen and the fibrinolytic biomarker plasminogen activator inhibitor-1 (PAI-1) and the long-term mortality after coronary artery bypass grafting (CABG). PATIENTS AND METHODS: In 729 patients undergoing CABG at Sahlgrenska University Hospital, a blood sample for fibrinogen and PAI-1 was collected prior to the procedure. Patients were followed for 10 years. RESULTS: Among patients with high levels of fibrinogen (>3.6 g/l; median), the 10-year mortality was 32.3 vs. 20.7% among patients with fibrinogen levels below the median (p = 0.0005). However, patients with higher levels of fibrinogen were older and had an adverse risk factor pattern. When adjusting for these differences, pre-operative fibrinogen levels did not clearly appear as an independent predictor of long-term mortality. The 10-year mortality was similar in patients with high (25.3%) and low (26.5%) levels of PAI-1. CONCLUSION: Our results do not suggest that fibrinogen and PAI-1, when evaluated prior to the operative procedure, are strongly associated with increased mortality in the long-term after CABG, when other co-morbidity factors are simultaneously considered.

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