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  • 1. Bengtson, A
    et al.
    Karlsson, T
    Währborg, P
    Hjalmarson, Å
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Cardiovascular and psychosomatic symptoms among relatives of patients waiting for possible coronary1996Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 25, nr 6, s. 438-443Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To examine the consequences for close family members of patients on a waiting list for possible coronary revascularization. BACKGROUND: An increasing number of patients with symptomatic ischemic heart disease require evaluation for possible revascularization. Many of these patients must wait a long time before receiving treatment. The negative consequences of this long wait for patients and their relatives have not been satisfactorily evaluated previously. DESIGN: Cross-sectional descriptive study. SETTING: All hospital in Southwestern Sweden. STUDY POPULATION: One hundred relatives of patients referred for possible revascularization and a sex- and age-matched reference group. The convenience sample consisted of 85% (n = 76) women and 15% (n = 13) men. OUTCOME MEASURES: Frequency of cardiovascular and psychosomatic symptoms. EVALUATION: One hundred relatives and 100 members of the control group were sent a questionnaire to evaluate their clinical condition; working situation; use of tobacco, alcohol and sedatives; and cardiovascular and psychosomatic symptoms. RESULTS: Family members had a significantly higher frequency of anxiety, depression, and irritability compared with the control group. Furthermore, family members reported sleeping disorders, including difficulty waking, tiredness due to lack of sleep, and restless sleep, more frequently than did the control group. CONCLUSION: Close family members of patients waiting for coronary revascularization have particular difficulties, and these difficulties should receive more attention.

  • 2. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Schröder, U
    Hartford, M
    Karlsson, BW
    Risenfors, M
    Larsson, E
    Luepker, R
    Wennerblom, B
    Holmberg, S
    Reaction to a media campaign focusing on delay in acute myocardial infarction1991Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 20, nr 6, s. 661-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 3. Everts, B
    et al.
    Karlson, BW
    Währborg, P
    Hedner, T
    Herlitz, Johan
    [external].
    Localization of pain in suspected acute myocardial infarction in relation to final diagnosis, age and sex, and site and type of infarction1996Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 25, nr 6, s. 430-437Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe the localization of pain in consecutive patients admitted to the coronary care unit for possible acute myocardial infarction (AMI) and to relate it to the development of AMI, age, and gender. DESIGN: Prospective evaluation. SETTING: Sahlgrenska Hospital, covering half the area of the city of Göteborg, with half a million inhabitants. SUBJECTS: Nine hundred three consecutive patients admitted to the coronary care unit for possible AMI between 24 and 87 years old with a mean age of 64 years. OUTCOME MEASURES: Localizations of pain according to a self-constructed figure. Patient were approached between 1 and 14 days after onset of symptoms and asked to describe the localization of pain according to the figure, including nine positions on the chest, left and right arm, neck, and back. RESULTS: AMI developed in 50% of patients during the first 3 days in hospital. Patients in whom AMI developed localized their pain to an extent similar to those without AMI in seven of nine chest areas. However, patients with AMI reported pain in the upper right square of the chest more frequently (p < 0.001) and in the middle left square of the chest less frequently (p < 0.01) than did patients without AMI. Pain in both the right (p < 0.001) and left arms (p < 0.01) was more frequently reported by patients who had AMI. Among patients with AMI, women reported pain in the neck (p < 0.05) and in the back (p < 0.01) more frequently than did men. Compared with elderly patients, younger patients reported pain more frequently in the left arm (p < 0.01), right arm (p < 0.01), and neck (p < 0.05). CONCLUSIONS: Among consecutive patients with possible AMI admitted to the coronary care unit, patients who had confirmed AMI reported pain in both arms more frequently than did patients without AMI. However, both groups described their chest surface distribution of pain similarly in the majority of positions, thereby indicating that the localization of chest pain is of limited use in predicting which patients will eventually have AMI.

  • 4. Hartford, M
    et al.
    Karlson, BW
    Sjölin, M
    Holmberg, S
    Herlitz, Johan
    [external].
    Symptoms, thoughts and environmental factors in suspected acute myocardial infarction1993Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 22, nr 1, s. 64-70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To increase our understanding of patients' reactions and behavior at onset of symptoms of myocardial infarction. PROCEDURE: During a 5-month period a questionnaire focusing on symptoms, thoughts, and environmental factors at onset of symptoms was administered to all patients admitted to the coronary care unit at Sahlgrenska Hospital in Göteborg, Sweden, because of suspected acute myocardial infarction. RESULTS: A myocardial infarction developed in 48% of the 226 patients answering the questionnaire. In 81% of the patients, chest pain was the main symptom bringing them to the hospital. Forty-three percent characterized their symptoms as an oppression or uncomfortable feeling. Eighty-five percent suspected that the pain emanated from the heart, and yet 51% hesitated to go to the hospital, mainly because they expected the pain to disappear. Efforts to relieve pain were made by 63%, (mostly with nitroglycerin), which was taken more often by patients who did not subsequently develop a myocardial infarction than by those who did. Only 50% of the patients used an ambulance for transportation to hospital. There was a significant relation between subjective assessment of severity of symptoms and 1-year mortality (p < 0.05) and rehospitalization rate (p < 0.01), respectively. CONCLUSION: The majority of patients seem to interpret the symptoms of a myocardial infarction correctly and also have a correct perception of the severity of symptoms. For only a few is the natural next step to immediately call for an ambulance to get to the hospital.

  • 5. Hofgren, K
    et al.
    Karlson, BW
    Gaston-Johansson, F
    Herlitz, Johan
    [external].
    Word descriptors in suspected acute myocardial infarction. A comparison between patients with and without confirmed acute myocardial infarction1994Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 23, nr 5, s. 397-403Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Acute myocardial infarction (AMI) will not develop in a large proportion of patients admitted to the coronary care unit because of suspected AMI. OBJECTIVE: To evaluate whether patients with confirmed AMI use different words to describe their pain than patients in whom AMI was not confirmed. DESIGN: A retrospective descriptive design. METHODS: The Pain-O-Meter, a verbal pain scale composed of 12 sensory and 10 emotional word descriptors, was used to assess pain. SETTING: Coronary care unit in Sahlgrenska Hospital in Goteborg, Sweden. SUBJECTS: A convenience sample of 889 consecutive patients admitted to the coronary care unit because of suspected AMI. RESULTS: SENSORY COMPONENT--patients with confirmed AMI differed from those without AMI in the use of the words "pricking" (12% vs 17%; p < 0.05) and "tearing" (11% vs 6%; p < 0.05). No difference was found in the remaining 10 words. Affective components--Patients with confirmed AMI differed from those without AMI in the use of "terrifying" (29% vs 18%; p < 0.001), "intolerable" (16% vs 10%; p < 0.01), and "worrying" (48% vs 59%; p < 0.01). Women used stronger word descriptors more frequently than men. CONCLUSION: The use of specific or more word descriptors to separate patients with AMI from those without AMI was not supported by the study data. Although patients with AMI more frequently used the sensory word tearing as well as the affective words terrifying and intolerable and less frequently used the sensory word pricking and the affective word worrying than patients without AMI, the differences do not suggest a clinical profile that can be used to differentiate these clinical entities.

  • 6. Hofgren, K
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Prodromal symptoms in subsets of patients hospitalized for suspected acute myocardial infarction1995Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 24, nr 1, s. 3-10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the occurrence of prodromal symptoms in suspected acute myocardial infarction (AMI) and to relate such symptoms to final diagnosis and previous history. DESIGN: Prospective study. SETTING: Coronary care unit in Sahlgrenska Hospital in Göteborg, Sweden. PATIENTS: 914 patients admitted to the coronary care unit for suspected AMI. OUTCOME MEASURES: Chest pain within the last 48 hours or other prodromal symptoms. RESULTS: Among patients in whom AMI developed, 57% reported prodromal chest pain and 61% reported other prodromal symptoms. Size, location, or type (Q-wave versus non-Q-wave AMI) did not influence outcome. Women reported more prodromal symptoms than men (p < 0.05), whereas age did not influence results. A similar proportion of patients with no confirmed AMI reported prodromal symptoms. Fifty-nine percent of patients with prodromal symptoms had wished to contact a physician if possible, and in fact one third did so. Two thirds of all patients were at rest, and one third reported some emotional distress before onset of the symptoms that brought them to hospital. CONCLUSION: A large proportion of patients with suspected AMI experienced prodromal symptoms before onset of suspected AMI. Such symptoms were more common in women but were not affected by size, location, or type of AMI. The symptoms were so severe that 59% of the patients with such symptoms wished to contact a physician before arrival in hospital.

  • 7. Thuresson, M
    et al.
    Berglin Jarlöv, M
    Lindahl, B
    Svensson, L
    Zedigh, C
    Herlitz, Johan
    [external].
    Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome.2007Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 36, nr 6, s. 398-409Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The objective was to study patients' interpretations, thoughts, and actions after symptom onset in acute coronary syndrome (ACS) in total and in relation to gender, age, history of coronary artery disease, type of syndrome, and residential area and its influence on prehospital delay. SETTING: We performed a national survey comprising intensive cardiac care units at 11 hospitals in Sweden. METHOD: A total of 1,939 patients with diagnosed ACS and symptom onset outside hospital completed a questionnaire containing standardized questions within 3 days after admission. RESULTS: Three-quarters of the patients interpreted their symptoms as cardiac in origin, and the most common reason was that they knew someone who had had an acute myocardial infarction. The majority contacted a family member, whereas only 3% directly called for an ambulance. Interpreting the symptoms as cardiac in origin and severe pain were major reasons for deciding to seek medical care. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter prehospital delay, whereas taking medication to relieve pain resulted in the opposite. The reaction pattern was influenced by gender, age, a history of coronary artery disease, and the type of ACS, but to a lesser extent by residential area. CONCLUSIONS: Interpreting symptoms as cardiac in origin and approaching someone after symptom onset were major reasons for a shorter prehospital delay in ACS.

  • 8. Ågård, A
    et al.
    Hermerén, G
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    When is a patient with heart failure adequately informed? A study of patients' knowledge of and attitudes toward medical information2004Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 33, nr 4, s. 219-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The primary aim was to explore patients' knowledge of heart failure and their attitudes toward medical information (prognostic information in particular) and to assess different patient-related factors that might hamper the improvement of patients' knowledge. Moreover, taking the data obtained into account, we analyzed ethical aspects of information disclosure to patients with heart failure. SETTING: The study was performed at Sahlgren's University Hospital in Gothenburg, Sweden. DESIGN: The study was a qualitative analysis of semistructured interviews. PATIENTS: The sample included 40 patients with various stages of chronic heart failure. RESULTS: Many patients had only a limited understanding of their disease, but they still claimed that they were satisfied with the information they received. Some of them seemed to accept, to be indifferent to, or to be unaware of their low level of knowledge. The majority did not request prognostic information. CONCLUSION: We argue that patients with heart failure are adequately informed when they have reached the level of knowledge that enables them to be managed as effectively and securely as possible while being satisfied with the information provided. To give adequate information, health care providers should determine the patients' level of knowledge and explore why those patients who have a limited understanding do not assimilate or request information.

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