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  • 1. Bengtson, A
    et al.
    Karlsson, T
    Hjalmarson, Å
    Herlitz, Johan
    [external].
    Complications prior to revascularisation among patients waiting for coronary artery bypass grafting and percutaneous transluminal coronary angioplasty1996In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, no 12, p. 1846-1851Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the occurrence of death, development of acute myocardial infarction and need for hospitalization among patients on the waiting list for coronary artery bypass grafting and percutaneous transluminal coronary angioplasty. PATIENTS AND METHODS: All the patients on the waiting list for possible coronary revascularization in September 1990 in western Sweden. RESULTS: Of 718 patients waiting for either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty, 15 (2.1%) died between the actual week in September 1990 and prior to revascularization and 12 (1.7%) developed a non-fatal acute myocardial infarction during the same period. All 15 patients who died before undergoing revascularization died a cardiac death. Death and/or the development of an acute myocardial infarction was significantly more frequent among the elderly, among patients with a low ejection fraction and among patients with a history of diabetes mellitus. In all, 29% required hospitalization prior to the procedure. The most common reason was symptoms of angina pectoris requiring hospitalization in 23% of the patients. CONCLUSION: Among patients on the waiting list before either coronary artery bypass grafting or percutaneous transluminal coronary angioplasty, 15 (2.1%) died prior to the procedure and 1.7% developed a non-fatal acute myocardial infarction. The risk of either death or developing an acute myocardial infarction was highest among patients in the older age groups, among patients with a history of diabetes mellitus and among patients with a lower ejection fraction.

  • 2. Blomberg, S
    et al.
    Curelaru, I
    Emanuelsson, H
    Herlitz, Johan
    [external].
    Pontén, J
    Ricksten, S-E
    Thoracic epidural anaesthesia in patients with unstable angina pectoris1989In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, no 5, p. 437-444Article in journal (Refereed)
    Abstract [en]

    The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated wth nitroglycerin infusion for gt;24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest < 2 days after infarction. 4.4 ± 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments ( Th1-7) for 98 ± 9min. Heart rate decreased significantly from 70 ± 3 to 64 ± 3 beats min-1 while blood pressure was unaffected by thoracic epidural anaesthesia. In 27 patients (96%) the anaesthesia induced complete analgesia. Nitroglycerin infusion was discontinued definitely within 3 h in 26 patients (93%) and pain was thereafter controlled by means of thoracic epidural anaesthesia as the sole treatment in 23 patients (82%) and as the major treatment in 25 patients (89%). Twenty-one patients (75%) were fully mobilized and stabilized. Treatment with thoracic epidural anaesthesia lasted for 6.0 ± 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 ±0.3 the first day to 0.9 ± 0.3 the fourth day (P>0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died. Exercise stress testing was performed on eight patients three to five days after the start of thoracic epidural anaesthesia. At a comparable workload, ST-segment depression was significantly (P>0.05) less pronounced during anaesthesia ( − 0.6 ± 0.1 mm) compared with control ( − 1.3 ± 0.2mm). The respective heart rate values were 95 ± 7 and 107 ± 7 beats min -1 (P > 0.05), while systolic or diastolic blood pressure did not differ between the two conditions. We conclude that blockade of cardiac sympathetic afferents and efferents by means of thoracic epidural anaesthesia can effectively treat pain and stabilize patients with unstable angina pectoris refractory to medical treatment. Furthermore, thoracic epidural anaesthesia attenuates stress-induced myocardial ischaemia; thus, it may be an efficient supplementary treatment for the control of pain and for stabilizing patients with unstable angina pectoris during diagnostic procedures and prior to coronary surgery or angioplasty.

  • 3. Brandrup-Wognsen, G
    et al.
    Berggren, H
    Hartford, M
    Hjalmarson, Å
    Karlsson, T
    Herlitz, Johan
    [external].
    Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting1996In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, no 9, p. 1426-1431Article in journal (Refereed)
    Abstract [en]

    Objective To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting in relation to gender. Design Prospective follow-up study. Setting Two regional cardiothoracic centres which performed all the coronary artery bypass operations in western Sweden at the time. Sub|ects A total of 2129 (1727 (81%) men and 402 (19%) women) consecutive patients undergoing coronary artery bypass surgery between June 1988 and June 1991 without concomitant procedures. Results Females were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, renal dysfunction and obesity. In a multivariate analysis, taking account of age, history of cardiovascular diseases and renal dysfunction, female sex appeared as a significant independent predictor of mortality during the 30 days after coronary artery bypass grafting (/><0-05), but not thereafter. Various postoperative complications including neurological deficit, hydro- and pneumo-thorax, perioperative myocardial damage and the need for assist devices and prolonged reperfusion were more common in females than males. Conclusion Females run an increased risk of early death and the development of postoperative complications after coronary artery bypass surgery as compared with males. Late mortality does not appear to be influenced by gender and the long-term benefit of the coronary artery bypass graft operation is similar in men and women.

  • 4. Emanuelsson, H
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure1994In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 15, no 6, p. 761-768Article in journal (Refereed)
    Abstract [en]

    Congestive heart failure is one of the major symptoms accompanying acute myocardial infarction (AMI). The study aimed to describe the occurrence, characteristics and prognosis of congestive heart failure in AMI and to compare post-MI patients with and without congestive heart failure. The methods used included baseline characteristics, initial symptoms, electrocardiogram (ECG), mortality during hospitalization and one year follow-up in consecutive patients with AMI admitted to Sahlgrenska Hospital, Göteborg, Sweden. Congestive heart failure was observed in 51% of the cases. Patients with congestive heart failure were older, more frequently had a history of previous cardiovascular disease, and, less frequently had chest pain on admission to hospital. They had a higher occurrence of life-threatening ventricular arrhythmias during initial hospitalization, and their mortality during one year follow-up was 39% as compared to 17% in patients without congestive heart failure (P<0.001). This difference remained significant when correcting for differences at baseline. Patients with severe congestive heart failure had a one year mortality of 47% vs 31% in patients with moderate congestive heart failure (P<0.01). Signs and symptoms of congestive heart failure occur in every second patient admitted to hospital due to AMI, and indicate a bad prognosis, which is directly related to the severity of congestive heart failure.

  • 5. Erhardt, L
    et al.
    Herlitz, Johan
    [external].
    Bossaert, L
    Halinen, M
    Keltai, M
    Koster, R
    Marcassa, C
    Quinn, T
    van Weert, H
    Task force on the management of chest pain2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 15, p. 1153-1176Article in journal (Refereed)
    Abstract [en]

    The Task Force on the management of chest pain was created by the committee for Scientific and Clinical Initiatives on 28 June 1997 after formal approval by the Board of the European Society of Cardiology. The document was circulated to the members of the Committee for Scientific and Clinical Initiatives, to the members of the Board and to the following reviewers: J. Adgey, C. Blomstro¨m-Lundqvist, R. Erbel, W. Klein, J. L. Lopez-Sendon, L. Ryde´n, M. L. Simoons, C. Stefanadis, M. Tendera, K. Thygesen. After further revision it was submitted for approval to the Committee for Practise Guidelines and Policy Conferences. The Task Force Report was supported financially in its entirety by The European Society of Cardiology and was developed without any involvement of the pharmaceutical industry.

  • 6.
    Herlitz, Johan
    [external].
    Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management.2006In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 27, no 4, p. 377-378Article in journal (Refereed)
    Abstract [en]

    AIMS: To determine whether survival after discharge following pre-hospital cardiopulmonary arrest has improved. METHODS AND RESULTS: The Heartstart Register was used to identify all 1659 patients discharged alive from Scottish hospitals during 1991-01 following pre-hospital arrest due to cardiac aetiology. The cohort was split into tertiles using year of arrest. A Cox proportional hazards model was used to determine risk of death relative to 1991-93. Patients who survived cardiopulmonary arrest in 1997-01 were less likely to die from any cause (unadjusted HR 0.60, 95% CI 0.48-0.75, P<0.001) or cardiac disease (unadjusted HR 0.50, 95% CI 0.38-0.65, P<0.001). After adjustment for case-mix, there remained significant declines in all-cause (adjusted HR 0.62, 95% CI 0.50-0.78, P<0.001) and cardiac death (adjusted HR 0.52, 95% CI 0.39-0.68, P<0.001). Clinical management had improved, with increased use of thrombolysis (47-63%, chi2 trend, P<0.001), beta-blockers (28-53%, chi2 trend, P<0.001), ACE-inhibitors (48-69%, chi2 trend, P<0.001), and anti-thrombotics (79-88%, chi2 trend, P<001). Adjustment for recorded changes in management attenuated the decline in all-cause death (adjusted HR 0.77, 95% CI 0.60-0.98, P=0.03). CONCLUSION: Survival following cardiopulmonary arrest has improved after adjusting for changes in case-mix. Better clinical management has contributed to this improvement.

  • 7.
    Herlitz, Johan
    [external].
    The importance of reducing delay in acute myocardial infarction1996In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, no 3, p. 338-340Article in journal (Refereed)
  • 8.
    Herlitz, Johan
    [external].
    The MACB Study Group. Effect of metoprolol on death and cardiac events during a 2-year period after coronary artery bypass grafting1995In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 16, no 12, p. 1825-1832Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To evaluate the effect of long-term treatment with metoprolol after coronary bypass grafting on death and cardiac events. METHODS: Patients in western Sweden on whom coronary artery bypass grafting was performed between June 1988 and June 1991 were evaluated for inclusion during the first 3 weeks after surgery. Major exclusion criteria were age > 75 years, concomitant valve surgery, traditional contraindications to beta-blockers and unwillingness to participate. Patients were randomized in a double-blind fashion to 100 mg of metoprolol/placebo daily for 2 weeks and thereafter 200 mg daily for 2 years. RESULTS: Of 2365 patients who were operated on, 967 were randomized to either metoprolol (n = 480) or placebo (n = 487). Primary end points (death, non-fatal myocardial infarction, unstable angina pectoris, need for coronary artery bypass grafting or percutaneous transluminal angioplasty), were reached by 42 patients in the metoprolol group (8.8%), as compared with 39 in the placebo group (8.0%) (P = 0.73). Of all the patients randomized to metoprolol, 34% withdrew from blind treatment prematurely compared with 44% for placebo (P < 0.01). CONCLUSION: Prophylactic treatment with metoprolol over a 2-year period after coronary artery bypass grafting did not reduce death or the development of cardiac events. However, the 95% confidence limits ranged from the possibility of a 30% reduction in events to a 68% increase in events if patients were treated with metoprolol as compared with placebo.

  • 9.
    Herlitz, Johan
    et al.
    [external].
    Andersson, E
    Bång, A
    [external].
    Engdahl, J
    Holmberg, M
    Lindqvist, J
    Karlson, BW
    Waagstein, L
    Experiences from treatment of out-of-hospital cardiac arrest during 17 years in Göteborg2000In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 21, no 15, p. 1251-1258Article in journal (Refereed)
    Abstract [en]

    AIMS: To describe changes in different factors at resuscitation and survival in a 17-year survey of patients suffering from out-of-hospital cardiac arrest. METHOD: The investigation was carried out in the community of Göteborg with 450 000 inhabitants during 1981-1997 on all patients suffering out-of-hospital cardiac arrest in whom resuscitation was attempted. RESULTS: The number of cases per year, the proportion of witnessed arrests and the proportion of arrests of cardiac aetiology remained similar over time. There was an increase in median age from 68 to 73 years (P<0.0001), in the proportion of females from 27% to 33% (P=0.035) and in the proportion of patients receiving bystander cardiopulmonary resuscitation from 14% to 28% (P<0.0001) with time. There was a shortening of the median interval from collapse until defibrillation from 9 min to 6 min (P<0.0001) over time but a decrease in the occurrence of ventricular fibrillation as the initially recorded arrhythmia from 39% to 32% (P=0.022). There was an increase in the proportion of patients having a bystander witnessed cardiac arrest of cardiac aetiology being hospitalized alive from 32% to 45% (P<0. 0001 for change over time). The proportion of patients discharged alive from hospital increased from 16% to 29% until 1993, but thereafter decreased to 13% in 1997 (P=0.002 for change over time). CONCLUSION: In a survey covering 17 years of resuscitation of out-of-hospital cardiac arrest patients we found that the occurrence of ventricular fibrillation as the initially recorded arrhythmia decreased. There was an increase in age, in the proportion of females and in the use of bystander cardiopulmonary resuscitation. The interval between collapse and defibrillation was shortened. Survival changed over time with an increase until 1993 but with a decrease thereafter.

  • 10.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Karlson, BW
    Luepker, R
    Holmberg, S
    Risenfors, M
    Wennerblom, B
    Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction1992In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 13, no 2, p. 171-177Article in journal (Refereed)
    Abstract [en]

    In order to reduce the delay times from onset of symptoms to arrival in hospital, and increase the use of ambulance in patients with suspected acute myocardial infarction (AMI), a media campaign was initiated in an urban area. An initial 3-week intense campaign was followed by a maintenance phase of 1 year. Delay times and ambulance use during the campaign were compared with the previous 21 months. Among patients admitted to a coronary care unit (CCU) due to suspected AMI, the median delay time was reduced from 3 h to 2 h 40 min and the mean delay time was reduced from 11 h 33 min to 7 h 42 min (P <0.001). Among patients with confirmed AMI the median delay time was reduced from 3 h to 2 h 20 min and the mean delay time from 10 h to 6 h 27 min (P <0.001). We conclude that a 1-year media campaign can reduce delay times in suspected AMI, and that this effect appears to continue at 1 year, but ambulance use seems to be more djfficult to influence.

  • 11.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Karlsson, BW
    Luepker, RV
    Holmberg, S
    Risenfors, M
    Wennerblom, B
    Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction1992In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 13, no 2, p. 171-177Article in journal (Refereed)
    Abstract [en]

    In order to reduce the delay times from onset of symptoms to arrival in hospital, and increase the use of ambulance in patients with suspected acute myocardial infarction (AMI), a media campaign was initiated in an urban area. An initial 3-week intense campaign was followed by a maintenance phase of 1 year. Delay times and ambulance use during the campaign were compared with the previous 21 months. Among patients admitted to a coronary care unit (CCU) due to suspected AMI, the median delay time was reduced from 3 h to 2 h 40 min and the mean delay time was reduced from 11 h 33 min to 7 h 42 min (P less than 0.001). Among patients with confirmed AMI the median delay time was reduced from 3 h to 2 h 20 min and the mean delay time from 10 h to 6 h 27 min (P less than 0.001). We conclude that a 1-year media campaign can reduce delay times in suspected AMI, and that this effect appears to continue at 1 year, but ambulance use seems to be more difficult to influence.

  • 12.
    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 pain1995In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 16, no 12, p. 1789-1794Article in journal (Refereed)
    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.

  • 13.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival in patients found to have ventricular fibrillation after cardiac arrest witnessed outside hospital1994In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 15, no 12, p. 1628-1633Article in journal (Refereed)
    Abstract [en]

    Since 1980 an Emergency Medical Service (EMS) system with a two-tier ambulance service has been operating in Goteborg. During this 12-year period, all cardiac arrests outside hospital have been monitored. Cardiopulmonary resuscitation (CPR) training for the general public began in 1985 and, by the end of 1992, 125 000 persons had been trained. The aim of this study was to define the factors associated with an increased chance of survival after cardiac arrest witnessed out-of-hospital and secondary to ventricular fibrillation. The study group comprises all patients with cardiac arrest witnessed outside hospital in Goteborg between 1980 and 1992, in whom CPR was initiated by our EMS and ventricular fibrillation observed at the first ECG recording. In a multivariate analysis of age, sex, time of collapse, interval between collapse and first defibrillation, bystander-initiated CPR, the following factors were associated with an increased chance of being discharged from hospital: (1) Short interval between collapse and first defibrillation (P < 0.001); (2) Bystander-initiated CPR (P < 0.001); and (3) Age (P < 0.05). Among patients with an out-of-hospital cardiac arrest who were found by the EMS personnel to have ventricular fibrillation, the predictors of survival were: interval between collapse and defibrillation, bystander-initiated CPR and age.

  • 14.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    A short delay from out of hospital cardiac arrest to call for ambulance increases survival2003In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 24, no 19, p. 1750-1755Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the relative impact on survival of the delay from estimated time of collapse to call for an ambulance among patients who suffer from a bystander witnessed out of hospital cardiac arrest of a cardiac aetiology. METHODS: A majority of all ambulance organizations in Sweden (covering 85% of Sweden inhabitants) participate in a National survey of out of hospital cardiac arrest. RESULTS: In all there were 9340 patients with a bystander witnessed cardiac arrest of a cardiac aetiology in whom cardiopulmonary resuscitation (CPR) was attempted participating in this survey. Survival at one month among patients with a delay between estimated time of collapse and call for ambulance of < or =4 min (median) was 6.9% versus 2.8% among patients with a median of >4 min (P<0.0001). When adjusting for age, sex, initial rhythm, estimated interval between collapse and start of CPR, place of arrest and the interval between call for ambulance and arrival of the rescue team, the odds ratio for survival was 0.70 (0.95% CI. 0.58-0.84) per unit increase of the natural logarithm of delay in minutes between collapse and call. CONCLUSION: Among patients with a bystander witnessed out of hospital cardiac arrest of a cardiac aetiology increased delay from estimated time of collapse to call for an ambulance decreased the chance of survival.

  • 15.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Metoprolol in acute myocardial infarction (MIAMI). A randomised placebo-controlled international trial1985In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 6, no 3, p. 199-226Article in journal (Refereed)
    Abstract [en]

    The effect of metoprolol on mortality and morbidity after 15 days, was compared with that of placebo in a double-blind randomised international trial (the MIAMI trial) in patients with definite or suspected acute myocardial infarction (AMI). Treatment with intravenous metoprolol (15mg) or placebo was started shortly after the patient's arrival in hospital within 24 h of the onset of symptoms, and then oral treatment (200 mg daily) was continued for the study period (15 days). Of the 5778 patients included, 2901 were allocated to placebo and 2877 to metoprolol. Definite AMI was confirmed in 4127 patients. There were 142 deaths in the placebo group (4.9%) and 123 deaths in the metoprolol group (4.3%), a difference of 13 per cent with 95 per cent confidence limits of −8 to +33 per cent, not statistically significant (P=0.29). Previously recorded risk indicators of mortality were analysed in retrospect. These indicated that there was a category which showed higher risk which contained approximately 30% of all randomized patients. In these, the mortality rate in the metoprolol treated group was 29% less than in the placebo group. In the remaining lower risk categories there was no difference between the treatment groups. This subset analysis must be interpreted with caution in view of the findings from other similar studies. Positive effects were observed on the incidence of definite AMI and on serum enzyme activity in patients treated early ( <7h). There was no significant effect on ventricular fibrillation but the number of episodes tended to be lower in the metoprolol treated patients during the later phase (6–15 days; 24 vs 54 episodes). The incidence of supraventricular tachyarrhythmias, the use of cardiac glycosides and other antiarrhythmics, and the need for pain-relieving treatment were significantly diminished by metoprolol amongst all randomised patients. Adverse events associated with metoprolol were infrequent, expected, and relatively mild.

  • 16.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    The role of beta blockade in the limitation of infarct development1986In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 7, no 11, p. 916-924Article in journal (Refereed)
    Abstract [en]

    This review article deals with the role of beta blockade in the limitation of infarct development. A large number of studies have reported that early administration of beta blockers limits infarct size in animals. In a few, however, these results were not reconfirmed. In man, several large randomized trials have shown that early administration of beta blockade limits infarct development judged from serum enzyme activity and ECG recordings. Delay time between the onset of symptoms and start of treatment is of major importance. It appears as though patients with a higher initial rate pressure product respond most favourably. Although these results are encouraging, the role of infarct limitation in relation to effects on early mortality, chest pain and arrhythmias have not been clearly defined.

  • 17.
    Herlitz, Johan
    et al.
    [external].
    Hjalmarson, Å
    Holmberg, S
    Richter, A
    Wennerblom, B
    Mortality and morbidity in suspected acute myocardial infarction in relation to ambulance transport1987In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 8, no 5, p. 503-509Article in journal (Refereed)
    Abstract [en]

    In 681 patients admitted to the coronary care unit (CCU) at Sahlgrenska hospital between 1 May 1983 and 31 May 1984, due to suspected acute myocardial infarction (MI), the hospital mortality and morbidity were related to whether the patients were transferred to hospital by ambulance or not. In the ambulance group acute MI developed in 48% (during the first 3 days in hospital) compared with 41% in the non-ambulance group (P= 0.10). The overall mortality rate was 10.4% in the ambulance group versus 3.8% in the non-ambulance group (P= 0.001). Corresponding figures for MIpatients were 193% versus 9.1% (P=0.02) In all, patients referred by ambulance had larger infarcts according to maximum serum enzyme activity and a higher incidence of congestive heart failure. Similar findings were observed when MI patients were analysed separately. On the other hand, the incidence of ventricular fibrillation, requirement for lidocaine, and the course of pain was fairly similar in the two groups. In a multivariate analysis, infarct size was the major independent predictor for early mortality rate. We conclude that patients who call for an ambulance due to suspected acute MI appear to have a different early mortality and morbidity pattern compared to those who do not. The most obvious observation was a higher early mortality. These patients therefore might be the most suitable candidates for early intervention studies.

  • 18.
    Herlitz, Johan
    et al.
    [external].
    Holm, J
    Petersson, M
    Karlson, BW
    Haglid Evander, M
    Erhardt, L
    Effect of fixed low-dose warfarin added to aspirin in the long term after acute myocardial infarction2004In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 25, no 3, p. 232-239Article in journal (Refereed)
  • 19.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Richter, A
    Liljeqvist, J-Å
    Wiklund, O
    Hjalmarson, Å
    Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis1993In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, no 4, p. 484-491Article in journal (Refereed)
    Abstract [en]

    In 917 patients with acute myocardial infarction (AMI) we evaluated the impact of previous angina pectoris on the prognosis. Thirty-four percent of the patients had chronic angina prior to AMI, and 22% had angina pectoris of short duration. Patients with chronic angina pectoris differed from the remaining patients having a more frequent previous history of AMI, diabetes mellitus, hypertension, and congestive heart failure. They less frequently developed a Q-wave AMI, and had smaller infarcts according to maximum serum-enzyme activity as compared with the remaining patients. They had a higher one-year mortality rate (36%) as compared with those having angina pectoris of short duration (22%), and those with no angina pectoris (26%). Their reinfarction rate was also higher (26%) as compared with that in the other two groups (15% and 9% respectively). In a multivariate analysis considering age, sex, clinical history, initial symptoms, initial electrocardiogram and estimated infarct size, previous chronic angina pectoris was not an independent risk factor for death, but was independently associated with the risk of reinfarction (P<0.001) Among patients with a history of angina pectoris the outcome was related to medication prior to onset of AMI and at discharge from hospital. Patients in whom beta-blockers were prescribed at discharge had a one-year mortality of 13% as compared with 30% in the remaining patients

  • 20.
    Herlitz, Johan
    et al.
    [external].
    Reid Graves, J
    Non-cardiac origin of out-of-hospital cardiac arrests: do we underestimate their frequency and prognosis?1997In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 19, no 7, p. 1047-1049Article in journal (Other academic)
  • 21. Hollenberg, J
    et al.
    Riva, G
    Bohm, K
    Nordberg, P
    Larsen, R
    Herlitz, Johan
    University of Borås, School of Health Science.
    Pettersson, H
    Rosenqvist, M
    Svensson, L
    Dual Dispatch Early Defibrillation in Out-Of-Hospital Cardiac Arrest: The SALSA Pilot2009In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, no 14, p. 1781-1789Article in journal (Refereed)
  • 22. Hollenberg, J
    et al.
    Riva, G
    Bohm, K
    Nordberg, P
    Larsen, R
    Herlitz, Johan
    [external].
    Pettersson, H
    Rosenqvist, M
    Svensson, L
    Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot.2009In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 30, no 14, p. 1781-1789Article in journal (Refereed)
    Abstract [en]

    AIMS: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. The objective of this study is to explore the effects of a dual dispatch early defibrillation programme. METHODS AND RESULTS: In this pilot study, automated external defibrillators (AEDs) were provided to all 43 fire stations in Stockholm during 2005. Fire-fighters were dispatched in parallel with traditional emergency medical responders (EMS) to all suspected cases of OHCA. Additionally, 65 larger public venues were equipped with AEDs. All 863 OHCA from December 2005 to December 2006 were included during the intervention, whereas all 657 OHCA from 2004 served as historical controls. Among dual dispatches, fire-fighters assisted with cardiopulmonary resuscitation (CPR) in 94% of the cases and arrived first on scene in 36%. The median time from call to arrival of first responder decreased from 7.5 min during the control period to 7.1 min during the intervention (P = 0.004). The proportion of patients in shockable rhythm remained unchanged. The proportion of patients alive 1 month after OHCA rose from 4.4 to 6.8% [adjusted odds ratio (OR): 1.6; 95% confidence interval (CI): 0.9-2.9]. One-month survival in witnessed cases rose from 5.7 to 9.7% (adjusted OR: 2.0; 95% CI: 1.1-3.7). Survival after OHCA in the rest of Sweden (Stockholm excluded) declined from 8.3 to 6.6% during the corresponding time period (unadjusted OR: 0.8; 95% CI: 0.6-1.0). Only three OHCA occurred at public venues equipped with AEDs. CONCLUSION: An introduction of a dual dispatch early defibrillation programme in Stockholm has shortened response times and is likely to have improved survival in patients with OHCA, especially in the group of witnessed cardiac arrests. The increase in survival is believed to be associated with improved CPR and shortened time intervals.

  • 23. Holmberg, M
    et al.
    Holmberg, S
    Herlitz, Johan
    [external].
    Factors modifying the effect of bystander-CPR on survival in out-of-hospital cardiac arrest patients in Sweden2001In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 22, no 6, p. 511-519Article in journal (Refereed)
    Abstract [en]

    AIM: To describe possible factors modifying the effect of bystander cardiopulmonary resuscitation on survival among patients suffering an out-of-hospital cardiac arrest. PATIENTS: A national survey in Sweden among patients suffering out-of-hospital cardiac arrest and in whom resuscitative efforts were attempted. Sixty per cent of ambulance organizations were included. DESIGN: Prospective evaluation. Survival was defined as survival 1 month after cardiac arrest. RESULTS: In all, 14065 reports were included in the evaluation. Of these, resuscitation efforts were attempted in 10966 cases, of which 1089 were witnessed by ambulance crews. The report deals with the remaining 9877 patients, of whom bystander cardiopulmonary resuscitation was attempted in 36%. Survival to 1 month was 8.2% among patients who received bystander cardiopulmonary resuscitation vs 2.5% among patients who did not receive it (odds ratio 3.5, 95% confidence interval 2.9-4.3). The effect of bystander cardiopulmonary resuscitation on survival was related to: (1) the interval between collapse and the start of bystander cardiopulmonary resuscitation (effect more marked in patients who experienced a short delay); (2) the quality of bystander cardiopulmonary resuscitation (effect more marked if both chest compressions and ventilation were performed than if either of them was performed alone); (3) the category of bystander (effect more marked if bystander cardiopulmonary resuscitation was performed by a non-layperson); (4) interval between collapse and arrival of the ambulance (effect more marked if this interval was prolonged); (5) age (effect more marked in bystander cardiopulmonary resuscitation among the elderly); and (6) the location of the arrest (effect more marked if the arrest took place outside the home). CONCLUSION: The effect of bystander cardiopulmonary resuscitation on survival after an out-of-hospital cardiac arrest can be modified by various factors. Factors that were associated with the effect of bystander cardiopulmonary resuscitation were the interval between the collapse and the start of bystander cardiopulmonary resuscitation, the quality of bystander cardiopulmonary resuscitation, whether or not the bystander was a layperson, the interval between collapse and the arrival of the ambulance, age and the place of arrest.

  • 24. Karlson, BW
    et al.
    Herlitz, Johan
    [external].
    Hallgren, P
    Liljeqvist, J-Å
    Odén, A
    Hjalmarson, Å
    Emergency room prediction of mortality and severe complications in patients hospitalized for suspected acute myocardial infarction1995In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 15, no 11, p. 1558-1565Article in journal (Refereed)
    Abstract [en]

    This study aims at describing the in-hospital prognosis of patients admitted with suspected acute myocardial infarction, focusing on the possibility of emergency room prediction of the risk for death and severe complications. From 7157 consecutive patients with chest pain or other symptoms suggestive of acute myocardial infarction in the emergency room, 4690 were hospitalized. Of these, 246 (5%) died in hospital, with a mortality rate among the 921 patients who developed myocardial infarction of 14%, and among those without infarction of 3%. From the clinical history, examination and electrocardiogram in the emergency room, independent predictors of death and death or any severe complication were determined by logistic regression analysis. These included age, initial degree of suspicion of infarction, electrocardiographic pattern, history of diabetes mellitus, history of congestive heart failure and on admission arrhythmias, loss of consciousness, acute congestive heart failure, or unspecific symptoms. From these analyses the probability of death or death or any severe complication can be calculated. Thus, 18% of patients hospitalized due to suspected acute myocardial infarction suffered a severe complication or died in hospital. From a statistical model it is possible to predict the in-hospital prognosis of every such patient.

  • 25. Malmberg, C
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Rydén, L
    Hjalmarson, Å
    Effects of metoprolol on mortality and late infarction in diabetics with suspected acute myocardial infarction. Retrospective data from two large studies1990In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, no 5, p. 423-428Article in journal (Refereed)
    Abstract [en]

    From two large scale studies in patients with suspected acute myocardial infarction we report the outcome in diabetics after treatment with either metoprolol or placebo. In the Göteborg Metoprolol Trial mortality at 3 months was reduced by metoprolol from 17.9% to 7.5% and late infarction was reduced from 16.4% to 3.8%. In the MIAMI Trial, mortality was decreased by metoprolol from 11.3% to 5.7% and the occurrence of late infarction was decreased from 4.5% to 3.1% during 15-day follow-up. Compared with the overall results, the effect of metoprolol on mortality appears particularly impressive in diabetics.

  • 26. Malmberg, K
    et al.
    Rydén, L
    Hamsten, A
    Herlitz, Johan
    [external].
    Waldenström, A
    Wedel, H
    Effects of insulin treatment on cause specific one-year mortality and morbidity in diabetic patients with acute myocardial infarction1996In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, no 9, p. 1337-1344Article in journal (Refereed)
    Abstract [en]

    Diabetic patients with acute myocardial infarction have a poor prognosis, which has been attributed to a higher incidence of congestive heart failure and fatal reinfarction. This study reports on the one-year morbidity and mortality in a randomized study with the aim of testing whether insulin-glucose infusion initiated as soon as possible after onset of myocardial infarction and followed by long-term subcutaneous insulin treatment may have a beneficial effect on outcome in diabetic patients. In all, 306 patients were recruited to the insulin-treated group, while 314 patients served as controls. The overall mortality after one year was 19% in the insulin group compared to 26% among controls (P < 0.05). The treatment effect was most pronounced in patients without prior insulin medication and at low cardiovascular risk. In this stratum the in-hospital mortality was reduced by 58% (P < 0.05) and the one-year mortality by 52% (P < 0.02). The most frequent cause of death in all patients was congestive heart failure (66%), but cardiovascular mortality (congestive heart failure, fatal reinfarction, sudden death and stroke) tended to be decreased in insulin-treated patients. However, this difference did not reach the level of statistical significance. The number of reinfarctions was 53 (28% fatal) in the insulin group compared to 55 (45% fatal) in the control group. The two groups did not differ as regards need for hospital care or coronary revascularization during the year of follow-up. In summary, left ventricular failure and fatal reinfarctions contribute to increased mortality in diabetic patients following acute myocardial infarction. Intensive insulin treatment lowered this mortality during one year of follow-up.

  • 27. Malmberg, K
    et al.
    Rydén, L
    Wedel, H
    Birkeland, K
    Bootsma, A
    Dickstein, K
    Efendic, S
    Fischer, M
    Hamsten, A
    Herlitz, Johan
    [external].
    Hilderbrandt, P
    MacLeod, K
    Laakso, M
    Torp-Pedersen, C
    Waldenström, A
    Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity.2005In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 26, no 7, p. 650-661Article in journal (Refereed)
    Abstract [en]

    AIMS: Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. In the first DIGAMI study, an insulin-based glucose management improved survival. In DIGAMI 2, three treatment strategies were compared: group 1, acute insulin-glucose infusion followed by insulin-based long-term glucose control; group 2, insulin-glucose infusion followed by standard glucose control; and group 3, routine metabolic management according to local practice. METHODS AND RESULTS: DIGAMI 2 recruited 1253 patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial infarction randomly assigned to groups 1 (n=474), 2 (n=473), and 3 (n=306). The primary endpoint was all-cause mortality between groups 1 and 2, and a difference was hypothesized as the primary objective. The secondary objective was to compare total mortality between groups 2 and 3, whereas morbidity differences served as tertiary objectives. The median study duration was 2.1 (interquartile range 1.03-3.00) years. At randomization, HbA1c was 7.2, 7.3, and 7.3% in groups 1, 2, and 3, respectively, whereas blood glucose was 12.8, 12.5, and 12.9 mmol/L, respectively. Blood glucose was significantly reduced after 24 h in all groups, more in groups 1 and 2 (9.1 and 9.1 mmol/L) receiving insulin-glucose infusion than in group 3 (10.0 mmol/L). Long-term glucose-lowering treatment differed between groups with multidose insulin (> or =3 doses/day) given to 15 and 13% of patients in groups 2 and 3, respectively compared with 42% in group 1 at hospital discharge. By the end of follow-up, HbA1c did not differ significantly among groups 1-3 ( approximately 6.8%). The corresponding values for fasting blood glucose were 8.0, 8.3, and 8.6 mmol/L. Hence, the target fasting blood glucose for patients in group 1 of 5-7 mmol/L was never reached. The study mortality (groups 1-3 combined) was 18.4%. Mortality between groups 1 (23.4%) and 2 (22.6%; primary endpoint) did not differ significantly (HR 1.03; 95% CI 0.79-1.34; P=0.831), nor did mortality between groups 2 (22.6%) and 3 (19.3%; secondary endpoint) (HR 1.23; CI 0.89-1.69; P=0.203). There were no significant differences in morbidity expressed as non-fatal reinfarctions and strokes among the three groups. CONCLUSION: DIGAMI 2 did not support the fact that an acutely introduced, long-term insulin treatment improves survival in type 2 diabetic patients following myocardial infarction when compared with a conventional management at similar levels of glucose control or that insulin-based treatment lowers the number of non-fatal myocardial reinfarctions and strokes. However, an epidemiological analysis confirms that the glucose level is a strong, independent predictor of long-term mortality in this patient category, underlining that glucose control seems to be an important part of their management.

  • 28. Mannheimer, C
    et al.
    Camici, P
    Chester, M
    Eliasson, T
    Follath, F
    Hellemans, I
    Herlitz, Johan
    [external].
    Luscher, T
    Pasic, M
    The problem of chronic refractory angina2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 5, p. 355-370Article in journal (Refereed)
    Abstract [en]

    It has been recognized that there is a group of patients with severe disabling angina and coronary artery disease who are refractory to conventional forms of treatment. Although this issue has already been debated at the level of the National Societies, we felt that it was appropriate to also tackle it at the European level. This is particularly important in view of the rapid pace of growth of this problem and the lack of a standardized approach. This has encouraged the development of a variety of treatments that vary considerably in terms of cost-effectiveness and safety and require proper validation procedures. The aim of this paper is to draw attention to the problem and start a process that will lead to improvement and harmonization of the care of patients with refractory angina.

  • 29. Olsson, G
    et al.
    Wikstrand, J
    Warnold, I
    Manger Cats, V
    McBoyle, D
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Hjalmarson, Å
    Sonnenblick, EH
    Metoprolol-induced reduction in post-infarction mortality: pooled results from five double-blind randomized trials1992In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 13, no 1, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Several postinfarction trials have evaluated the effect of secondary prophylaxis with different beta-blockers. Although so called meta-analysis of the results from all the trials have shown a beneficial effect of postinfarction beta-blockade, many of the individual studies have shown inconclusive results, mainly due to low statistical power. In order to obtain an evaluation of the merits of postinfarction therapy with metoprolol, data from the five available studies with metoprolol have been pooled into one database. In the total material 5474 patients (4353 men, 1121 women) have been studied during double-blind therapy with metoprolol 100 mg twice daily or matching placebo. The follow-up ranges from 3 months to 3 years. In total 4732 patient years of observation have been obtained. In total there were 223 deaths in the placebo-treated patients as compared to 188 deaths in the metoprolol-treated patients (P = 0.036), which corresponds to mortality rates of 97.0 and 78.3 per 1000 patient years, respectively. The mortality reduction was found both in men and women. As has been reported from individual postinfarction beta-blocker trials, the pooled results showed a marked reduction in sudden deaths (104 in the placebo group, 62 in the metoprolol group, P = 0.002). In a Cox regression model the influence of sex, age and smoking habits on the effect of metoprolol was evaluated. None of these factors influenced the metoprolol effect significantly. It is concluded that metoprolol therapy after acute myocardial infarction reduces the total number of deaths, and especially sudden cardiac deaths. The mortality reduction was independent of gender, age and smoking habits. Available data support a continuous beneficial effect.

  • 30. Richter, A
    et al.
    Herlitz, Johan
    [external].
    Hjalmarson, Å
    Effect of acupuncture in patients with angina pectoris1991In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 12, no 2, p. 175-178Article in journal (Refereed)
    Abstract [en]

    Twenty-one patients with stable effort angina pectoris were randomized in a crossover study to 4 weeks traditional Chinese acupuncture or placebo tablet treatment. The patients had at least five anginal attacks per week in spite of intensive treatment. Acupuncture was given three times per week at main points Neiguan (Pericardium 6), Tongli (Heart 5), Xinshu (Urinary Bladder 15), Pishu (Urinary Bladder 20) and Zusanli (Stomach 36). Previous antianginal treatment remained unchanged during the whole study. During the acupuncture period, the number of anginal attacks per week was reduced from 10.6 to 6.1 compared with placebo (P less than 0.01). Accordingly, the performance before onset of pain during exercise test increased from 82 W to 94 W (P less than 0.05). However, maximal performance did not increase after acupuncture. Intensity of pain at maximal workload decreased from 1.4 to 0.8 (scale 0-4, P less than 0.01). Further, ST-segment depressions at maximal comparable load decreased from 1.03 to 0.71 mm after acupuncture (P less than 0.01). A life quality questionnaire confirmed improved feeling of well-being. Thus, acupuncture showed an additional beneficial effect in patients with severe, intensively treated angina pectoris.

  • 31. Smith, LG
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsson, T
    Berger, AK
    Luepker, RV
    International comparision of treatment and long-term outcomes for acute myocardial infarction in the elederly: Minneapolis/St Paul, MN, USA and Goteborg, Sweden2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 41, p. 3191-3197Article in journal (Refereed)
    Abstract [en]

    AIMS: International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and Göteborg, Sweden (GB). METHODS AND RESULTS: A population-based sample of hospitalized AMI (ICD-9 410) patients aged ≥75 in MSP and GB in 2001-02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83 ± 7, GB 82 ± 5; women: MSP 84 ± 6, GB 84 ± 6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline-based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% among GB patients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50-0.88] and women (HR: 0.49, 95% CI: 0.36-0.67) compared with GB. CONCLUSION: In MSP and GB, guideline-based therapy use was high. However, PCI use was markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.

  • 32. Strömsöe, A
    et al.
    Svensson, L
    Axelsson, AB
    Claesson, A
    University of Borås, School of Health Science.
    Göransson, KE
    Nordberg, P
    Herlitz, J
    University of Borås, School of Health Science.
    Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival2014In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, ISSN 0195-668, Vol. 36, no 14Article in journal (Refereed)
    Abstract [en]

    Aims To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation. Methods and results All cases of OHCA (n = 59 926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100 000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P < 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008–2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008–2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm. Conclusion From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.

  • 33. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Hjalmarson, Å
    Quality of life five years after myocardial infarction1989In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, no 5, p. 464-472Article in journal (Refereed)
    Abstract [en]

    In 539 patients 5 years after myocardial infarction (MI), quality of life and factors influencing life quality were studied. All patients originally participated in an early intervention trial with metoprolol. A cardiac follow-up questionnaire and the Nottingham Health Profile were answered by 82%. In the former, information about subjective symptoms, smoking, work and current medication was obtained; the latter described health-related quality of life in terms of energy, sleep, emotions, mobility, pain and social isolation. The rate of and the reasons for rehospitalization were registered in the patients' records. The MI patients reported a comparatively high quality of life. Compared with ‘normal’ population, a decrease was noted in energy, sleep and mobility, and in sex life, hobby-activity and holiday activity. A non-parametric multivariate analysis disclosed that dyspnoea, angina pectoris and anxiety were closely associated with decreased quality of life. In conclusion, 5 years after MI most patients seemed well-adjusted. Impaired quality of life was reported by patients suffering from angina pectoris, dyspnoea and emotional distress. No relationship was found between health-related quality of life and the beta blocker, metoprolol, which was the most frequently used drug.

  • 34. Wiklund, I
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science. [external].
    Johansson, S
    Bengtsson, A
    Karlson, BW
    Persson, NG
    Subjective symptoms and wellbeing differ in women and men after myocardial infarction1993In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, no 10, p. 1315-1319Article in journal (Refereed)
    Abstract [en]

    The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

  • 35. Wiklund, I
    et al.
    Karlson, BW
    Bengtsson, A
    Herlitz, Johan
    [external].
    Subjective symptoms and wellbeing one year after acute myocardial infarction in relation to age1993In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 14, no 10, p. 1315-1319Article in journal (Refereed)
    Abstract [en]

    The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.

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