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  • 101. Claesson, Andreas
    et al.
    Svensson, Leif
    Silfverstolpe, J
    Herlitz, Johan
    Characteristics and outcome among patients suffering out of hospital cardiac arrest due to drowning2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 3, s. 381-387Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 102.
    Claesson, Andreas
    et al.
    [external].
    Svensson, Leif
    Silfverstolpe, Johan
    Herlitz, Johan
    [external].
    Characteristics and outcome among patients suffering out-of-hospital cardiac arrest due to drowning.2008Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 76, nr 3, s. 381-387Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract AIM: To describe the characteristics and outcome among patients with out-of-hospital cardiac arrest (OHCA) caused by drowning as compared with OHCA caused by a cardiac etiology (outside home). PATIENTS AND METHODS: All the patients included in the Swedish OHCA Registry between 1990 and 2005 which were not crew witnessed, in whom cardio-pulmonary resuscitation (CPR) was attempted, were evaluated for inclusion. Those caused by drowning were compared with those with a cardiac etiology (outside home). RESULTS: Patients with OHCA due to drowning (n=255) differed from patients with OHCA with a cardiac etiology (n=7494) as they were younger, less frequently suffered a witnessed OHCA, more frequently received bystander CPR and less frequently were found in a shockable rhythm. Patients with OHCA due to drowning had a prolonged ambulance response time as compared with patients with OHCA with a cardiac etiology. Patients with OHCA due to drowning had a survival rate to 1 month of 11.5% as compared with 8.8% among patients with OHCA due to a cardiac etiology (NS). Among patients with OHCA due to drowning, only one independent predictor of survival was defined, i.e. time from calling for an ambulance until the arrival of the rescue team, with a much higher survival among patients with a shorter ambulance response time. CONCLUSION: Among patients with OHCA 0.9% were caused by drowning. They had a similar survival rate to 1 month as compared with OHCA outside home with a cardiac etiology. The factor associated with survival was the ambulance response time; a higher survival with a shorter response time.

  • 103. Deedwania, PC
    et al.
    Giles, TD
    Klibaner, M
    Ghali, JK
    Herlitz, Johan
    [external].
    Hildebrandt, P
    Kjekshus, J
    Spinar, J
    Vitovec, J
    Stanbrook, H
    Wikstrand, J
    Efficacy, Safety and Tolerability of Metoprolol CR/XL in Patients With Diabetes and Chronic Heart Failure: Experiences From MERIT-HF2005Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 149, nr 1, s. 159-167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 104. Dellborg, M
    et al.
    Herlitz, Johan
    [external].
    Emanuelsson, H
    Swedberg, K
    ECG changes during myocardial ischemia. Differences between men and women1995Inngår i: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 27, nr suppl., s. 42-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Women have a higher short-term mortality in acute myocardial infarction (MI) compared with men. This may be partly explained by differences in risk factors such as age and diabetes. However, several reports have focused on the occurrence of a sex bias making women less likely to be subjected to angiography and revascularization as well as aggressive pharmacologic treatment of acute MI. The decision to initiate these procedures is often based on ischemic changes of the electrocardiogram. It was therefore investigated whether differences between men and women in magnitude of electrocardiographic changes during myocardial ischemia could explain some of the differences previously reported. A total of 178 patients with chest pain suggestive of MI (135 men and 43 women) included in a study of thrombolytics were monitored for 24 hours with continuous vectorcardiography. Also, 81 patients with stable angina pectoris undergoing elective angioplasty were monitored during the procedure. In patients admitted with suspicion of MI, the initial summated ST deviation was 178 +/- 146 microV for men as compared with 105 +/- 91 microV for women (P = .002). During angioplasty, men had significantly more pronounced maximum ST deviation during inflation of the balloon (235 +/- 165 vs 156 +/- 89 microV; P = .036). In conclusion, men have more pronounced ST changes than women during myocardial ischemia. When fixed magnitudes of ST deviation are required for initiating therapy such as thrombolytics, this will favor treatment of men. A sex-adjusted limit for administrating thrombolytic drugs may be warranted in the light of the above findings.

  • 105. Dellborg, M
    et al.
    Herlitz, Johan
    [external].
    Risenfors, M
    Electrocardiographic assessment of infarct size: Comparison between QRS scoring of 12-lead electrocardiography and dynamic vectorcardiography1993Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, ISSN 0167-5273, Vol. 40, nr 2, s. 167-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Myocardial infarct size is one of the most important predictors of prognosis in patients suffering an acute myocardial infarction. It can be assessed by enzymatic and electrocardiographic methods. The present report compares dynamic vectorcardiographic monitoring, serial plasma enzyme activity measurements and QRS scoring according to Palmeri as techniques for infarct size estimation. We report the results from 74 patients with acute myocardial infarction, who participated in a randomized trial of treatment with alteplase. A good correlation was found between myocardial infarct size by estimation from enzymatic measurement and from dynamic vectorcardiography. Dynamic vectorcardiography correlated more closely with enzymatically estimated infarct size in patients with Q-wave infarction, regardless of infarct location, than did QRS scoring of the conventional 12-lead electrocardiogram. Furthermore, dynamic vectorcardiography requires no time-consuming analysis and can be used for on-line monitoring of patients with ongoing infarction to estimate the size of an acute infarction while it is developing.

  • 106. Dellborg, M
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Lindqvist, J
    Karlsson, T
    Sandén, W
    Sjölin, M
    Wedel, H
    Changes in the use of medication after acute myocardial infarction: Possible impact on post-myocardial infarction mortality and long-term outcome2001Inngår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 12, nr 1, s. 61-67Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe the change in the use of medication after acute myocardial infarction (AMI) and discuss its possible impact on risk and risk indicators for death. Patients: All patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital (covering half the community of Goteborg, i.e. 250 000 of 500 000 inhabitants) during 1986-1987 (period I) and at Sahlgrenska Hospital and Ostra Hospital (covering the whole community of Goteborg, 500 000 inhabitants) during 1990-1991 (period II). Methods: Overall mortality was retrospectively evaluated during 5 years of follow-up. Results: In all, 740 patients were included in the study during period I and 1448 during period II. The 5-year mortalities were 44.1% for period I patients and 39.3% for period II patients (P = 0.036). The relative risk of death for period II patients was 0.78 [95% confidence interval (CI) 0.67-0.89, P = 0.0005] after adjustment for differences at baseline. There was a significant interaction with a history of congestive heart failure; improvement in duration of survival was found only for patients without such a history. During period I, only 3% of patients were administered fibrinolytic agents, compared with 33% of patients during period II (P < 0.0001). During period I, aspirin was prescribed for 13% of patients discharged from hospital compared with 79% during period II. Other changes in treatment on going from period I to period II included increases in prescription of [beta]-blockers and angiotensin converting enzyme inhibitors. After adjustment for various risk indicators for death, relative risk of death for those administered fibrinolytic agents was 0.60 (95% CI 0.18-2.02) for patients in the period-I cohort and 0.68% (95% CI 0.51-0.91) for those in the period-II cohort. Adjusted relative risk of death for those prescribed aspirin upon discharge from hospital was 0.81 (95% CI 0.52-1.25) for period-I patients and 0.71 (95% CI 0.56-0.91) for period-II patients. The adjusted relative risk of death for those administered [beta]-blockers was 0.72 (95% CI 0.55-0.96) for period-I patients and 0.70 (95% CI 0.55-0.90) for period-II patients. Conclusion: Increased use of fibrinolytic agents and aspirin for AMI as well as a moderate increase in use of [beta]-blockers and angiotensin converting enzyme inhibitors was associated with a parallel reduction in age-adjusted mortality during the 5 years after discharge from hospital. However, this improvement was seen only for patients without histories of congestive heart failure.

  • 107.
    Djarv, T
    et al.
    Karolinska University Hospital.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Stromsoe, A
    Mälardalen University.
    Israelsson, J
    Linnaeus University.
    Claesson, A
    Linköping University.
    Traumatic cardiac arrest in Sweden 1990-2016 - a population-based national cohort study.2018Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, nr 1, artikkel-id 30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA).

    METHODS: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used.

    RESULTS: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively).

    DISCUSSION: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR.

    CONCLUSION: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 108. Ekström, L
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Wennerblom, B
    Kihlgren, M
    Ambulanssjukvården i Göteborg, en beskrivning av ett dubbelt ambulanssystem1993Inngår i: Nordisk Medicin, ISSN 0029-1420, Vol. 108, nr 3, B7, s. 82-83Artikkel i tidsskrift (Fagfellevurdert)
  • 109. Ekström, L
    et al.
    Herlitz, Johan
    [external].
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival after cardiac arrest outside hospital over a 12-year period in Göteborg1994Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 27, nr 3, s. 181-187Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A two-tiered ambulance system with a mobile coronary care unit and standard ambulance has operated in Gothenburg (population 434 000) since 1980. Mass education in cardiopulmonary resuscitation (CPR) commenced in 1985 and in 1988 semiautomatic defibrillators were introduced. Aim: To describe early and late survival after cardiac arrest outside hospital over a 12-year period. Target population: All patients with prehospital cardiac arrest in Gothenburg reached by mobile coronary care unit or standard ambulance between 1980 and 1992. Results: The number of patients with cardiac arrest remained fairly steady over time. Among patients with witnessed ventricular fibrillation, the time to defibrillation decreased over time. The proportion of patients in whom bystander initiated CPR was increased only moderately over time. The proportion of patients given medication such as lignocaine and adrenaline successively increased. The number of patients with cardiac arrest who were discharged from hospital per year remained steady between 1981 and 1990 (20 per year), but increased during 1991 and 1992 to 41 and 31 respectively. Conclusions: Improvements in the emergency medical service in Gothenburg over a 12-year period have lead to: (1) a shortened delay time between cardiac arrest and first defibrillation and (2) an improved survival of patients with cardiac arrest outside hospital probably explained by this shortened delay time.

  • 110. Ekström, L
    et al.
    Wennerblom, B
    Herlitz, Johan
    [external].
    Axelsson, Å
    Bång, A
    [external].
    Holmberg, S
    Hospital mortality after out of hospital cardiac arrest among patients found in ventricular fibrillation1995Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 1, s. 11-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to describe factors associated with in-hospital mortality among patients being hospitalised after out-of-hospital cardiac arrest and who were found in ventricular fibrillation. The study was set in the community of Göteborg, Sweden. The subjects consisted of all patients who were hospitalised alive after out-of-hospital cardiac arrest, being reached by our mobile coronary care unit and who were found in ventricular fibrillation, between 1981 and 1992. In all, 488 patients fulfilled the inclusion criteria of which 262 (54%) died during initial hospitalization. In a multivariate analysis including age, sex, history of cardiovascular disease, chronic medication prior to arrest and circumstances at the time of arrest, the following appeared as independent predictors of hospital mortality: (1) interval between collapse and first defibrillation (P < 0.001); (2) on chronic medication with diuretics (P < 0.01); (3) age (P < 0.01); (4) bystander initiated CPR (P < 0.05); and (5) a history of diabetes (P < 0.05). In a multivariate analysis considering various aspects of status on admission to hospital, the following were independently associated with death: (1) degree of consciousness (P < 0.001) and (2) systolic blood pressure (P < 0.05). In conclusion, among patients with out of hospital cardiac arrest found in ventricular fibrillation and being hospitalised alive, 54% died in hospital. The in-hospital mortality was related to patient characteristics before the cardiac arrest as well as to factors at the resuscitation itself.

  • 111.
    Elfwén, Ludvig
    et al.
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Lagedal, Rickard
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    James, Stefan
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Jonsson, Martin
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Jensen, Ulf
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute.
    Ringh, Mattias
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Claesson, Andreas
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Oldgren, Jonas
    Uppsala Clinical Research Center and Department of Medical Sciences, Cardiology.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rubertsson, Sten
    Department of Surgical Sciences/Anesthesiology and Intensive Care Medicine, Uppsala University.
    Nordberg, Per
    Department of Medicine, Center for Resuscitation Science, Karolinska Institute, Solna.
    Coronary angiography in out-of-hospital cardiac arrest without ST elevation on ECG-Short- and long-term survival.2018Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 200, s. 90-95, artikkel-id S0002-8703(18)30081-4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The potential benefit of early coronary angiography in out-of-hospital cardiac arrest (OHCA) patients without ST elevation on ECG is unclear. The aim of this study was to evaluate the association between early coronary angiography and survival in these patients.

    METHODS: Nationwide observational study between 2008 and 2013. Included were patients admitted to hospital after witnessed OHCA, with shockable rhythm, age 18 to 80 years and unconscious. Patients with ST-elevation on ECG were excluded. Patients that underwent early CAG (within 24 hours) were compared with no early CAG (later during the hospital stay or not at all). Outcomes were survival at 30 days, 1 year, and 3 years. Multivariate analysis included pre-hospital factors, comorbidity and ECG-findings.

    RESULTS: In total, 799 OHCA patients fulfilled the inclusion criteria, of which 275 (34%) received early CAG versus 524 (66%) with no early CAG. In the early CAG group, the proportion of patients with an occluded coronary artery was 27% and 70% had at least one significant coronary stenosis (defined as narrowing of coronary lumen diameter of ≥50%). The 30-day survival rate was 65% in early CAG group versus 52% with no early CAG (P < .001). The adjusted OR was 1.42 (95% CI 1.00-2.02). The one-year survival rate was 62% in the early CAG group versus 48% in the no early CAG group with the adjusted hazard ratio of 1.35 (95% CI 1.04-1.77).

    CONCLUSION: In this population of bystander-witnessed cases of out-of-hospital cardiac arrest with shockable rhythm and ECG without ST elevation, early coronary angiography may be associated with improved short and long term survival.

  • 112. 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 failure1994Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 15, nr 6, s. 761-768Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 113. Engdahl, J
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    [external].
    Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg2000Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 43, nr 3, s. 201-211Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 114. Engdahl, J
    et al.
    Axelsson, Å
    Bång, A
    [external].
    Karlson, BW
    Herlitz, Johan
    [external].
    The epidemiology of cardiac arrest in children and young adults.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 2, s. 131-138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the epidemiology of children and young adults suffering from out-of-hospital cardiac arrest. PATIENTS: All patients suffering from out-of-hospital cardiac arrest in whom, resuscitation efforts were attempted in the community of Göteborg between 1980 and 2000. METHODS: Between 31 October 1980 and 31 October 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed-up to discharge from hospital. RESULTS: Among 5505 cardiac arrests information on age was available in 5290 cases (96%). Of these 5290 cases 98 (2%) were children (age 0-17 years), 197 (4%) were young adults (age 18-35 years) and the remaining 4995 (94%) were adults (age >35 years). Children and young adults differed from adults by suffering from a witnessed arrest less frequently, being found by the ambulance crew in ventricular fibrillation/tachycardia less frequently and being judged as having an underlying cardiac aetiology less frequently. Of the children only 5% were discharged from hospital alive compared with 8% for young adults and 9% for adults. Among survivors the cerebral performance categories (CPC) score at discharge tended to differ with 38% of young adults registering a CPC score of 1 (no neurological deficit) compared with 52% among adults. CONCLUSION: Children and young adults suffering from out-of-hospital cardiac arrest differed from adults in terms of aetiology and observed initial arrhythmia. Children had a particularly bad outcome whereas young adults had a similar outcome as adults.

  • 115. Engdahl, J
    et al.
    Bång, A
    Karlson, BW
    Lindqvist, J
    Herlitz, Johan
    [external].
    Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 57, nr 1, s. 33-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the epidemiology for out of hospital cardiac arrest of a non-cardiac aetiology. PATIENTS: All patients suffering from out of hospital cardiac arrest in whom resuscitation efforts were attempted in the community of Göteborg between 1981 and 2000. METHODS: Between October 1, 1980 and October 1, 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up to discharge from hospital. RESULTS: In all, 5415 patients participated in the evaluation. Among them 1360 arrests (25%) were judged to be of a non-cardiac aetiology. Among these 24% were caused by a surgical cause or accident, 20% by obstructive pulmonary disease, 13% by drug abuse and the remaining 43% by 'another cause'. Of the patients with out of hospital cardiac arrest of a non-cardiac aetiology 4.0% survived to discharge from hospital as compared with 10.1% of the patients with a cardiac aetiology (P<0.0001). In the various subgroups survival was highest in those with drug abuse (6.8%) and lowest in those with 'another cause' (4.2%). Cerebral performance categories (CPC) score at hospital discharge tended to be worse among survivors from an arrest of non-cardiac than cardiac aetiology. Patients with a cardiac arrest of a non-cardiac aetiology differed from the remaining patients by being younger, including more women, less frequently having a witnessed arrest and less frequently being found in ventricular fibrillation/tachycardia. When simultaneously considering age, sex, witnessed status, presence of bystander cardiopulmonary resuscitation (CPR) and initial arrhythmia, the aetiology (non-cardiac vs. cardiac aetiology) was not an independent predictor of survival. CONCLUSION: Among patients with out of hospital cardiac arrest in whom resuscitation was attempted 25% were judged to be of a non-cardiac aetiology. These patients had a lower survival than patients with a cardiac arrest of cardiac aetiology. However, this was mainly explained by a lower occurrence of ventricular fibrillation and witnessed cardiac arrest.

  • 116. Engdahl, J
    et al.
    Bång, A
    Karlson, BW
    Lindqvist, J
    Sjölin, M
    Herlitz, Johan
    [external].
    Long-term mortality among patients discharged alive after out-of-hospital cardiac arrest does not differ markedly compared with that of myocardial infarct patients without out-of-hospital cardiac arrest2001Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 8, nr 4, s. 253-261Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of our research was to study the long-term prognosis among patients discharged alive after an out-of-hospital cardiac arrest (OHCA) in comparison with patients discharged alive after acute myocardial infarction (AMI) without OHCA, and also to study the long-term influence of AMI in connection with OHCA. Our research was conducted in the municipality of Göteborg. We retrospectively studied patients discharged from hospital 1990-91 after an OHCA of cardiac aetiology and patients discharged after an AMI without prehospital cardiac arrest. During 1980-98, we studied all patients discharged alive after OHCA of cardiac aetiology, divided into groups of precipitating AMI and no AMI. The study includes 48 patients discharged alive after an OHCA 1990-91, 30 (62%) of whom had a simultaneous AMI and 1425 patients with an AMI without OHCA. Compared with AMI survivors, survivors of an OHCA of cardiac origin were younger but had more frequently a history of congestive heart failure. Their mortality rate during the subsequent 5 years was 46%, compared with 40% among survivors of an AMI (NS). The 5-year mortality rate among patients with an OHCA precipitated by an AMI was 40%. When correcting for differences at baseline, the adjusted risk ratio for death among patients with an OHCA of cardiac origin was 1.2 (95% CI 0.8-1.8) compared with patients with an uncomplicated AMI. During 1980-98, 215 patients were judged as having an OHCA precipitated by an AMI and 115 patients had an OHCA of cardiac aetiology but no simultaneous AMI. Five-year mortality was 54% and 50% respectively (NS). It is concluded that survivors of an OHCA of cardiac origin differed from survivors of an uncomplicated AMI in that they were younger and more frequently had a history of cardiovascular disease. Their 5-year mortality after discharge was similar to that of survivors of an AMI without a prehospital cardiac arrest, even after adjusting for differences at baseline.

  • 117. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Can we define patients with no and those with some chance of survival when found in asystole out of hospital?2000Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 86, nr 6, s. 610-614Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with out-of-hospital cardiac arrest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We included all patients in the municipality of Göteborg, regardless of age and etiology, who experienced an OHCA between 1981 and 1997. There were a total of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arrhythmia: 156 of these patients (10%) were admitted alive to hospital, and 32 (2%) were discharged alive. Survivors were younger (median age 58 vs 68 years) and had a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arrest (48% vs 27%). Survivors to discharge also displayed higher degrees of consciousness on arrival to the emergency department in comparison to nonsurvivors. Multivariate analysis among all patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival. Multivariate analysis among witnessed arrests indicated short time to arrival of the MCCU (p < 0.001) and no treatment with atropine (p = 0.05) as independent predictors of survival. Fifty-five percent of patients discharged alive had none or small neurologic deficits (cerebral performance categories 1 or 2). No patients > 70 years old with unwitnessed arrests (n = 211) survived to discharge.

  • 118. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Factors affecting short and long term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity2001Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 51, nr 1, s. 17-25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To describe the epidemiology, resuscitation factors and prognosis among a consecutive population of patients suffering from out-of-hospital cardiac arrest (OHCA) where pulseless electrical activity (PEA) was the first arrhythmia recorded on emergency medical services (EMS) arrival. Methods: Analysis of data collected prospectively on all patients regardless of age succumbing to OHCA during 1980–1997 in the community of Gothenburg where EMS initiated resuscitative measures. Results: 4662 patients with OHCA were attended by the EMS during the study period. Of these, 1069 (23%) were judged as having PEA as the first recorded arrhythmia; 158 (15%) of these were admitted alive to hospital and 26 (2.4%) were discharged alive. Survivors to discharge had a significantly larger share of bystander cardiopulmonary resuscitation (CPR) (28 vs. 8%, P=0.008), significantly higher levels of consciousness (8% awake vs. 0%, P<0.001) and higher median systolic blood pressure (145 vs. 106 mmHg, P<0.001) on arrival at hospital. No patient with unwitnessed cardiac arrest and PEA over 80 years old survived. Conclusion: Survival among patients suffering from OHCA and PEA is poor, especially among the elderly unwitnessed cases and those who do not receive bystander CPR. The latter seems to be of utmost importance among these patients.

  • 119. Engdahl, J
    et al.
    Bång, A
    [external].
    Lindqvist, J
    Herlitz, Johan
    [external].
    Time trends in long-term mortality after out-of-hospital cardiac arrest in 1980-1998 and predictors for death2003Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 145, nr 5, s. 826-833Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract Background We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time. Methods We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients. Results A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05–1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51–2.72), history of smoking (RR 1.77, 95% CI 1.29–2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44–2.02). The prescription of β-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46–0.85). Conclusion The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of β-blockers were independent predictors of outcome.

  • 120. Engdahl, J
    et al.
    Herlitz, Johan
    [external].
    Localization of out-of-hospital cardiac arrest in Göteborg 1994: 2002 and implications for public access defibrillation2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 64, nr 2, s. 171-175Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Göteborg and to identify implications for public access defibrillation (PAD). Methods: Ambulance run reports for the years 1994–2002 were studied retrospectively and manually to establish the location of the cardiac arrest. Results: The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims’ homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners’ offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. Conclusion: Among patients suffering from out-of-hospital cardiac arrest in Göteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.

  • 121. Engdahl, J
    et al.
    Holmberg, S
    Karlson, BW
    Luepker, R
    Herlitz, Johan
    [external].
    The epidemiology of out-of-hospital "sudden" cardiac arrest2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 52, nr 3, s. 235-245Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    It is difficult to assemble data from an previous termout-of-hospital cardiac arrestnext term since there is often lack of objective information. The true incidence of previous termsudden cardiacnext term death previous termout-of-hospitalnext term is not known since far from all of these patients are attended by emergency medical services. The incidence of previous termout-of-hospital cardiac arrestnext term increases with age and is more common among men. Among patients who die, the probability of having a fatal event outside previous termhospitalnext term decreases with age; i. e. younger patients tend to more often die unexpectedly and outside previous termhospital.next term Among the different initial arrhythmias, ventricular fibrillation is the most common among patients with previous termcardiacnext term aetiology. The true distribution of initial arrhythmias is not known since several minutes most often elapse between collapse and rhythm assessment. Most patients with previous termout-of-hospital cardiac arrestnext term have a previous termcardiacnext term aetiology. previous termOut-of-hospital cardiac arrestsnext term most frequently occur in the patient's home, but the prognosis is shown to be better when they occur in a public place. Witnessed previous termarrest,next term ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, previous termcardiac arrestnext term in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and previous termhospitalnext term treatment among patients with prehospital previous termcardiac arrest.

  • 122. 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 pain2002Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, nr 15, s. 1153-1176Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 123. Erhardt, L
    et al.
    Herlitz, Johan
    [external].
    Näslund, U
    Persson, S
    Allt mer komplicerad kombinationsterapi för att angripa ischemisk hjärtsjukdom1989Inngår i: Drugs, ISSN 0012-6667, E-ISSN 1179-1950, Vol. 86, nr 52, s. 495-497Artikkel i tidsskrift (Fagfellevurdert)
  • 124. Everts, B
    et al.
    Karlson, BW
    Abdon, N-J
    Herlitz, Johan
    [external].
    Hedner, T
    A comparison of metoprolol and morphine in the treatment of chest pain in patients with suspected acute myocardial infarction--the MEMO study1998Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 245, nr 2, s. 133-141Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. To compare the analgesic effect of metoprolol and morphine in patients with chest pain due to suspected or definite acute myocardial infarction after initial treatment with intravenous metoprolol. Design. All patients, regardless of age, admitted to the coronary care unit at Uddevalla Central Hospital due to suspected acute myocardial infarction were evaluated for inclusion in the MEMO study (metoprolol–morphine). The effects on chest pain and side-effects of the two treatments were followed during 24 h. Pain was assessed by a numerical rating scale. Results. A total of 265 patients were randomized in this prospective double-blind study and 59% developed a confirmed acute myocardial infarction. In both treatment groups, there were rapid reductions of pain intensity. However, in the patient group treated with morphine, there was a more pronounced pain relief during the first 80 min after start of double-blind treatment. The side-effects were few and were those expected from each therapeutic regimen. During the first 24 h, nausea requiring anti-emetics was more common in the morphine-treated patients. Conclusion. In suspected acute myocardial infarction, if chest pain persists after intravenous beta-adrenergic blockade treatment, standard doses of an opioid analgesic such as morphine will offer better pain relief than increased dosages of metoprolol.

  • 125. Everts, B
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Abdon, N-J
    Hedner, T
    Effects and pharmacokinetics of high dose metoprolol on chest pain in patients with suspected or definite acute myocardial infarction1997Inngår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 53, nr 1, s. 23-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Pain intensity and the plasma concentrations of metoprolol and its major metabolite alpha-hydroxymetoprolol as well as noradrenaline (NA), adrenaline (A) and neuropeptide Y (NPY) were determined in patients with pain due to definite or suspected acute myocardial infarction (AMI) after graded metoprolol infusion. Pain intensity and metoprolol kinetics were assessed over 8 h. METHODS: Twenty-seven patients of either sex, aged 48-84 years with ongoing chest pain upon arrival to the Coronary Care Unit (CCU) were subdivided into two groups: (1) patients with ECG signs of threatening transmural myocardial damage (n = 15); and (2) patients without such ECG signs (n = 12). Pain intensity was assessed by a numerical rating scale (NRS) and venous blood was obtained for determination of plasma catecholamine and NPY concentrations. A continuous infusion of metoprolol (3 mg.min-1 i.v) was started and serial blood samples for plasma catecholamines, NPY as well as metoprolol and its major metabolite alpha-hydroxymetoprolol were obtained from the contralateral arm. RESULTS: Initial pain intensity was 5.9 (arbitrary units) and 5.4 in the groups with and without signs of transmural myocardial damage, respectively. One third of the patients with ST changes reported full pain relief (NRS = 0) within 70 min after starting metoprolol infusion (accumulated dose, 15-180 mg). Among the patients without ST changes upon arrival, full pain relief was obtained in 70% (accumulated dose, 30-120 mg). There was a dose-dependent relation between accumulated metoprolol dose and pain relief. The diagnosis of acute myocardial infarction (AMI) was confirmed in all 15 patients with ECG signs on arrival of transmural myocardial damage. The mean metoprolol dose in this group was 91(12) mg. The mean metoprolol dose in the 12 patients without ST changes was 64(8) mg. In all, seven of these patients developed definite AMI. The terminal half-life of unchanged metoprolol ranged from 2.5 to 8.5 h in group 1 and from 2.2 to 5.2 h in group 2. In group 1, metoprolol half-life was 4.5 h and total plasma clearance (CL) 54.1 1.h-1. In group 2, the metoprolol half-life was 3.7 h and total plasma clearance 75.4 1.h-1. There was a significant difference in clearance between the groups. After the intravenous metoprolol infusion, alpha-hydroxymetoprolol concentrations increased gradually. In groups 1 and 2, maximal concentrations in plasma (Cmax) were 143 and 135 nmol.1(-1) for alpha-hydroxymetoprolol and 2830 and 1653 nmol.1(-1) for metoprolol, respectively. Plasma NA or NPY did not differ between the groups. In contrast, plasma A was significantly higher during the initial 90 min of observation in patients with ECG signs of transmural myocardial damage. CONCLUSION: High-dose intravenous metoprolol was well tolerated in patients with suspected AMI. There was a more rapid and almost complete pain relief in patients without signs of transmural ischaemia compared with the patients with ECG signs of transmural AMI at arrival. In the later group of patients, plasma clearance of metoprolol was significantly reduced.

  • 126. Everts, B
    et al.
    Karlson, BW
    Herlitz, Johan
    [external].
    Hedner, T
    Morphine use and pharmacokinetics in patients with chest pain due to suspected or definite acute myocardial infarction. The Memo Study1998Inngår i: European Journal of Pain, ISSN 1090-3801, E-ISSN 1532-2149, Vol. 2, nr 2, s. 115-125Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The characteristics of chest pain due to suspected acute myocardial infarction and morphine use during the first 3 hospital days are described in a population of 2988 consecutive patients admitted to hospital. The duration of pain was usually less than 24h (mean 20.9±0.55h), and only 24.8% of patients experienced chest pain of longer duration. The majority of patients had only one attack of pain, but 34.4% experienced four or more attacks during hospitalization. A mean morphine dose of 6.7±0.2mg was administered over the 3 hospitalization days, but surprisingly 52.4% of all patients required no morphine analgesia at all. Independent predictors of an increased morphine consumption were initial degree of suspicion of acute myocardial infarction, ST changes on admission ECG, male sex, a history of angina pectoris and a history of congestive heart failure. In a separate pharmacokinetic/pharmacodynamic study in 10 patients, plasma concentrations of morphine and its major metabolites, morphine-3-glucuronide (M3G) and morphine-6-glucuronide (M6G), were measured after intravenous administration of morphine. In this patient group, terminal half-life of unchanged morphine ranged from 0.77 to 3.22h. M3G and M6G plasma concentrations increased gradually up to 60–90 min after the intravenous morphine injection. Initial pain intensity by numerical rating scale was 6.6±0.6 (arbitrary units), and after morphine administration, there was a rapid and significant decrease in pain intensity. After 20 min, pain relief was 69±11% and remained at this level during the following 8 h observation period. It is concluded that the need for morphine administration in patients with suspected or definite acute myocardial infarction, differs among subgroups of patients and, in particular, higher doses are needed in those with a strong suspicion of myocardial infarction at arrival. When intravenous morphine is given, it attains full effect 20 min after injection. Furthermore, the active morphine metabolites M3G and M6G appear rapidly in thecirculation, which could influence the analgesic response to morphine treatment.

  • 127. Everts, B
    et al.
    Karlson, BW
    Währborg, P
    Abdon, N-J
    Herlitz, Johan
    [external].
    Hedner, T
    Pain recollection after chest pain of cardiac origin1999Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 92, nr 2, s. 115-120Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 128. 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 infarction1996Inngår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 25, nr 6, s. 430-437Artikkel i tidsskrift (Fagfellevurdert)
    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.

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

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

  • 130. Fredriksson, M
    et al.
    Aune, S
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Thorén, A-B
    Lindqvist, J
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cardiac arrest outside and inside hospital in a community. Mechanisms behind the differences in outcome and outcome in relation to time of arrest2010Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 159, nr 5, s. 749-756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 131. Fredriksson, M
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Nichol, G
    Variation in outcome in studies of out-of-hospital cardiac arrest: a review of studies conforming to the Utstein guidelines2003Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 21, nr 4, s. 276-281Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of this study was to systematically review studies on out-of-hospital cardiac arrest published according to the Utstein guidelines to describe the variability in factors of resuscitation and outcome. Articles that reported primary data on survival after out-of-hospital cardiac arrest in the Utstein style were included. Forty-seven articles were identified using Medline. Fourteen studies met our criteria for inclusion. The number of patients in whom resuscitation was attempted varied between 78 and 3,243. The proportion of bystander-witnessed cases varied between 38% and 89%; bystander CPR was performed in 21% to 56% of the cases. Patients with a bystander-witnessed cardiac arrest of cardiac etiology were discharged alive in 2% to 49% of the cases. Even when data are reported in a uniform way as suggested by the Utstein template, there is a tremendous variability in outcome. This did not appear to be entirely explained by variability in the traditional risk factors for a low chance of survival. One cannot exclude the possibility of other factors being of ultimate importance for the outcome.

  • 132. Friberg, H
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Rubertsson, S
    Wieloch, T
    Terapeutisk hypotermi efter hjärtstopp: ny länk i kedjan som kan rädda liv2004Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, s. 212-216Artikkel i tidsskrift (Fagfellevurdert)
  • 133. From Attebring, M
    et al.
    Hartford, M
    Berndt, AK
    Herlitz, Johan
    [external].
    Has the interest in secondary prevention increased among the physicians after the 4S study?2000Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, nr 2, s. 164-167Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study evaluates the occurrence of various risk indicators, with particular emphasis on serum lipids one year after a coronary event (development of acute mycoardial infarction (AMI); exposure to either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), prior to and after presentation of the main results from the 4S study. Patients under 70 years of age either hospitalized for AMI or undergoing CABG or PTCA at Sahlgrenska University Hospital in Göteborg were evaluated one year after the event. Patients who had an event during the period January 1, 1993 until December 31, 1993 were evaluated one year later (Period I) and those who had an event during the period September 1, 1995 until August 31, 1996 were evaluated one year thereafter (Period II). In total, 293 patients were evaluated during Period I and 284 during Period II. Mean total serum cholesterol levels fell from 6.2 mmol/l during Period I to 5.3 mmol/l during Period II (p < 0.001). The proportion of patients with serum cholesterol < or =5.0 mmol/l increased from 15% during Period I to 40% during Period II (p < 0.001). The mean low-density lipoprotein (LDL) levels fell from 4.0 mmol/l during Period I to 3.2 mmol/l during Period II (p < 0.001). The proportion of patients with LDL < or =3.5 mmol/l increased from 32% during Period I to 68% during Period II (p < 0.001). The proportion of patients using lipid-lowering drugs increased from 25% during Period I to 57% during Period II (p < 0.001). Among patients with coronary artery disease who had either developed AMI or undergone CABG or PTCA, a marked increase in the use of lipid-lowering drugs has been observed in a university hospital in Sweden after presentation of the results of the 4S study. Parallel to the increased use of lipid-lowering drugs, we observed a substantial lowering of serum lipids.

  • 134. From Attebring, M
    et al.
    Hartford, M
    Hjalmarson, A
    Caidahl, K
    Karlsson, T
    Herlitz, Johan
    [external].
    Smoking habits and predictors of continued smoking in patients with acute coronary syndromes.2004Inngår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 46, nr 6, s. 614-623Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Most patients with acute coronary syndrome quit smoking when hospitalized, although several have been found to relapse and resume smoking within 3 months. AIM: This paper reports a study to identify factors that can predict who will resume smoking after hospitalization for an acute coronary syndrome. METHODS: Patients (n = 1320) below the age of 75 years, admitted to a Swedish university hospital coronary care unit with acute coronary syndromes, between September 1995 and September 1999, were consecutively included. Data were collected from hospital medical records and included information on previous clinical history, former illnesses and smoking. During their hospitalization, an experienced nurse interviewed the patients by using a structured questionnaire to obtain additional information. Patients were followed up 3 months after the discharge. Those who continued to smoke (non-quitters) were compared with those who had stopped (quitters) with regard to age, sex, medical history, clinical course, and intention to quit. To identify factors independently related to continued smoking, a logistical regression in a formal forward stepwise mode was used. RESULTS: Of the patients admitted, 33% were current smokers. Three months after discharge, 51% of these patients were still smoking. There were no significant differences in age, gender or marital status between non-quitters and quitters. In a multivariate analysis, independent predictors of continued smoking were: non-participation in the heart rehabilitation programme (P = 0.0008); use of sedatives/antidepressants at time of admission (P = 0.001); history of cerebral vascular disease (P = 0.002), history of previous cardiac event (P = 0.01); history of smoking-related pulmonary disease (P = 0.03) and cigarette consumption at index (P = 0.03). CONCLUSIONS: Smoking patients who do not participate in a heart rehabilitation programme may need extra help with smoking cessation. The findings may provide means of identifying patients in need of special intervention.

  • 135. From Attebring, M
    et al.
    Hartford, M
    Holm, G
    Wiklund, O
    Währborg, P
    Herlitz, Johan
    [external].
    Risk indicators for recurrence among patients with coronary artery disease. Problems associated with their modification.1998Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 32, nr 1, s. 9-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Various risk indicators associated with recurrence of a new ischemic event among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on such risk indicators is evaluated. At Sahlgrenska Hospital in Göteborg 293 consecutive patients under the age of 70 years were followed for one to two years after an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospital. A secondary preventive nurse was appointed and guidelines for risk factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or triglycerides > 3.0 mmol/l. The mean value for low density lipoprotein (LDL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first screening to 26% at second screening (p < 0.01) It was found that 70% of all the patients had one or more of the following risk indicators at the first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8%) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicators in patients, even with the aid of health-care professionals, in order to achieve risk-factor reduction in coronary artery disease.

  • 136. From Attebring, M
    et al.
    Herlitz, Johan
    [external].
    Berndt, A-K
    Karlsson, T
    Hjalmarsson, A
    Are patients truthfull about their smoking habits? A validation of self-report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease.2001Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 249, nr 2, s. 145-151Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: To validate self-report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease. PATIENTS AND METHODS: Outpatients at the Division of Cardiology, 75 years of age or younger, who had been Hospitalized at Sahlgrenska University Hospital in Göteborg due to an ischaemic event and who consecutively participated in a nurse-monitored routine care programme for secondary prevention, from 6 February 1997 to 5 February 1998. Data concerning smoking habits were collected through interviews. Two chemical markers, cotinine in plasma and carbon monoxide (CO) in expired air, validated self-reports concerning smoking cessation. RESULTS: 260 former smokers were validated. In the vast majority of the study population, the anamnestic information concurred with the chemical marker. However, 17 patients had chemical markers that contradicted their self-report with raised CO (n = 6) and/or raised cotinine levels (n = 13) without alternative nicotine delivery. CONCLUSION: Most patients with coronary artery disease relating information concerning cessation of smoking are truthful. A few patients, however, seem to conceal their smoking. Testing by chemical markers may be questionable for ordinary care but should, however, be included in studies concerning the association between smoking and health.

  • 137. From Attebring, M
    et al.
    Herlitz, Johan
    [external].
    Ekman, I
    Intrusion and confusion--the impact of medication and health professionals after acute myocardial infarction.2005Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 4, nr 2, s. 153-159Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Secondary prevention is important in preventing new cardiovascular events after acute myocardial infarction (AMI). AIM: To explore patients' experiences of secondary prevention after a first AMI. METHODS: A qualitative approach with hermeneutical analysis of in depth interviews was used. RESULTS: Twenty patients (12 men and 8 women, aged 34-79 years) were interviewed. None of the patients was previously treated for cardiovascular disease except one that had a history of angina pectoris. Two main themes emerged from the analysis. 1) Impact of medication: patients interpreted bodily sensations as a consequence of being medicated rather than as a result of their heart attack. The medication led to feelings of being intruded upon but also to positive feelings of security. 2) Impact of health professionals: communication with health professionals resulted in confusion about both treatment and the severity of the coronary disease. Patients expressed a need of being reassured by their physician regarding their physical status. CONCLUSIONS: Health professionals need to consider the impact of pharmacological treatment on patients' life, at least in patients who suffer from a first AMI. The point of departure in secondary preventive work must be patients' beliefs about their condition and the treatment they receive. Nurses and physicians must be aware of the information each patient has been given, and from this starting point, they have to be in concordance with one another. From the patients' perspective it is deemed necessary for the physicians to discuss the disease and the consequences it may have, both in the near future and in the long run, as soon as possible.

  • 138. Gardtman, M
    et al.
    Dellborg, M
    Brunnhage, Ch
    Lindqvist, J
    Waagstein, L
    Herlitz, Johan
    [external].
    Effects of intravenous metoprolol before hospital admission on chest pain in susptected acute myocardial infarction1999Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 137, nr 5, s. 821-829Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The aim of this study was to describe the effect of intravenous metoprolol on the intensity of chest pain before hospital admission in patients with suspected acute myocardial infarction AMI). METHODS AND RESULTS: Two hundred sixty-two patients with acute chest pain and suspected AMI were randomly assigned before hospital admission to either 5 mg morphine plus metoprolol 5 mg x 3 intravenously or 5 mg morphine plus intravenous placebo. Chest pain was evaluated on a 10-grade scale before and for 60 minutes after intravenous injection. One hundred thirty-four patients were randomly assigned to metoprolol and 128 to placebo. Among all patients randomized to metoprolol, the mean chest pain score was reduced by 3.0 +/- 1.9 arbitrary units AU) from before to after intravenous injection compared with 2.6 +/- 2.1 AU for placebo not significant). Among patients with an initially confirmed or strong suspicion of AMI, the corresponding figures were 3.1 +/- 1.8 AU for metoprolol and 2.2 +/- 1.6 AU for placebo P =.02). Among patients with only a vague or moderate suspicion of AMI, there was no difference. The treatment was well tolerated. CONCLUSIONS: When all patients were included in the analyses, there was no significant difference with regard to reduction of chest pain in the patients randomly assigned to metoprolol compared with placebo. A retrospective subgroup analysis indicated a beneficial effect of metoprolol among patients with an initially strong suspicion of or confirmed AMI. Further investigations are warranted to confirm this finding.

  • 139. Gardtman, M
    et al.
    Waagstein, L
    Karlsson, T
    Herlitz, Johan
    [external].
    Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome?2000Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 7, nr 1, s. 15-24Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to evaluate short- and long-term outcome prior to and after the introduction of a more intensified treatment in the ambulance of patients with acute severe heart failure. Consecutive patients with acute severe heart failure transported by the mobile coronary care unit (MCCU) in the community of Göteborg prior to and after the introduction of an intensified treatment (nitroglycerine, continuous positive airway pressure (CPAP) and furosemide). One hundred and fifty-eight patients were evaluated during each period. The median age was 77 and 76.5 years, respectively, and 52% and 42% were women. The proportion of patients given nitroglycerine in the ambulance was 4% and 68% in the two periods; the proportion of patients treated with furosemide was 13% and 84%, respectively. CPAP was used in less than 1% during period 1 and in 91% during period 2. On admission of the ambulance 60% had fulminant pulmonary oedema during period 1 versus 78% during period 2 (p<0.0001). On admission to hospital the opposite was found, 93% during period 1 versus 76% during period 2 (p<0.0001). The median serum creatinine kinase (CK-MB) maximum activity was 13 microkat/l during period 1 and 8 microkat/l during period 2 (p = 0.007). However, the mortality during the first year remained high during both periods (39.2% and 35.8%, p = 0.64). It is concluded that a more intensive treatment in the ambulance of patients with acute severe heart failure seems to have resulted in an improvement in symptoms during transport and less myocardial damage. However, no significant improvement in long-term mortality was observed.

  • 140. Gaston-Johansson, F
    et al.
    Hofgren, C
    Watson, P
    Herlitz, Johan
    [external].
    Myocardial infarction pain: systematic description and analysis1991Inngår i: Intensive Care Nursing, ISSN 0266-612X, Vol. 7, nr 1, s. 3-10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of the study was to describe various components of pain in suspected acute myocardial infarction (MI). Ninety-four patients admitted to a Coronary Care Unit (CCU) complaining of chest pain with the preliminary diagnosis suspect MI were included in the study. Thirty-eight subjects were eventually diagnosed as having MI and 56 subjects as non-MI. A comparison of chest pain description was performed between MI and non-MI subjects. The Pain-o-meter (POM) and the Visual Analogue Scale (VAS) were used to assess pain intensity. MI patients reported more intense sensory and affective pain than non-MI patients. MI patients also reported more intense affective pain than sensory pain, whereas non-MI patients reported just the opposite. The number of affective words chosen by MI patients differentiated them more clearly from non-MI patients than any other factor in the pain description. Pain intensity was significantly correlated to the estimated size of the infarct.

  • 141. Gelberg, Jan
    et al.
    Strömsöe, Anneli
    Hollenberg, Jacob
    Radell, Peter
    Claesson, Andreas
    Svensson, Leif
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Improving Survival and Neurologic Function for Younger Age Groups After Out-of-Hospital Cardiac Arrest in Sweden: A 20-Year Comparison.2015Inngår i: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 16, nr 8, s. 750-757Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups.

    DESIGN: Prospective observational study.

    SETTING: Sweden.

    PATIENTS: Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included.

    INTERVENTION: Cardiopulmonary resuscitation.

    MEASUREMENT AND MAIN RESULTS: The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger , there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge.

    CONCLUSIONS: In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.

  • 142. Gellerstedt, M
    et al.
    Bång, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Andréasson, E
    Johansson, A
    Does sex influence the allocation of life support level by dispatchers in acute chest pain?2010Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 8, s. 922-927Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL. PATIENTS: All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. METHODS: Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. RESULTS: The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. CONCLUSION: This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.

  • 143. Gellerstedt, M
    et al.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, nr 5, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

  • 144. Gellerstedt, M
    et al.
    Bång, Angela
    Herlitz, Johan
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, nr 5, s. 290-294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. Methods: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. Results: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). Conclusion: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

  • 145. Gellerstedt, Martin
    et al.
    Rawshani, Nina
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Bång, Angela
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Gelang, Carita
    Andersson, Jan-Otto
    Larsson, Anna
    Rawshani, Araz
    Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support? A cohort of patients with chest pain.2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, s. 734-738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity.

    METHODS: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model.

    RESULTS: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS.

    CONCLUSION: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

  • 146. Glantz, H
    et al.
    Thunström, E
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Cederin, B
    Nasic, S
    Ejdebäck, J
    Peker, Y
    Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort2013Inngår i: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 10, nr 4, s. 350-356Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 147.
    Glantz, Helena
    et al.
    Skaraborg Hospital, Lidköping.
    Johansson, Magnus C
    Sahlgrenska Academy, University of Gothenburg.
    Thunström, Erik
    Sahlgrenska Academy, University of Gothenburg.
    Guron, Cecilia Wallentin
    Sahlgrenska Academy, University of Gothenburg.
    Uzel, Harun
    Sahlgrenska University Hospital.
    Saygin, Mustafa
    Süleyman Demirel University, Isparta, Turkey.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Peker, Yüksel
    Sahlgrenska Academy, University of Gothenburg.
    Effect of CPAP on diastolic function in coronary artery disease patients with nonsleepy obstructive sleep apnea: A randomized controlled trial.2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 241, s. 12-18, artikkel-id S0167-5273(16)34469-2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Obstructive sleep apnea (OSA) has been associated with worse diastolic function in patients with coronary artery disease (CAD). This analysis determined whether continuous positive airway pressure (CPAP) treatment would improve diastolic function in CAD patients with nonsleepy OSA.

    METHODS: Between December 2005 and November 2010, 244 revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index (AHI) ≥15/h, Epworth Sleepiness Scale [ESS] score<10) were randomly assigned to CPAP or no-CPAP. Echocardiographic measurements were obtained at baseline, and after 3 and 12months.

    RESULTS: A total of 171 patients with preserved left ventricular ejection fraction (≥50%), no atrial fibrillation or severe valve abnormalities, and technically adequate echocardiograms at baseline and follow-up visits were included (CPAP, n=87; no-CPAP, n=84). In the intention-to-treat analysis, CPAP had no significant effect on echocardiographic parameters of mild (enlarged left atrium or decreased diastolic relaxation velocity) or worse (increased E/é filling index [presumed elevated left ventricular filling pressure]) diastolic function. Post-hoc analysis revealed a significant association between CPAP usage for ≥4h/night and an increase in diastolic relaxation velocity at 12months' follow-up (odds ratio 2.3, 95% confidence interval 1.0-4.9; p=0.039) after adjustment for age, sex, body mass index, and left atrium diameter at baseline.

    CONCLUSIONS: CPAP did not improve diastolic dysfunction in CAD patients with nonsleepy OSA. However, good CPAP adherence was significantly associated with an increase in diastolic relaxation velocity after one year.

  • 148. Gottfridsson, C
    et al.
    Nyström, B
    Karlsson, T
    Herlitz, Johan
    [external].
    Edvardsson, N
    Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias.2008Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, nr 3, s. 182-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe gender differences and factors of importance for outcome in patients referred for sustained ventricular arrhythmias. RESULTS: Two hundred and fifty three patients took part in the survey, 126 (20 women) had sustained monomorphic ventricular tachycardia (VT) and 127 (31 women) had polymorphic VT/ventricular fibrillation. Ischemic heart disease was less common in women than in men (47 vs. 80%). At discharge, an ICD implant was similarly common in women (33%) and men (29%). One hundred and twenty five (65%) men and 37 (79%) women were alive at follow-up, p =0.08 (median follow-up 53 months). Independent predictors of long-term mortality were: 1) PVT/VF as the presenting arrhythmia, 2) a low ejection fraction, 3) increased QRS duration and 4) diabetes mellitus. CONCLUSION: The lower proportion of women compared to men being referred for evaluation of sustained ventricular arrhythmias may contribute to the lower number of ICD implants in women. The long-term survival in women and men did not differ significantly.

  • 149. Gottfridsson, C
    et al.
    Nyström, B
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Edvardsson, N
    Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias2008Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, nr 3, s. 182-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe gender differences and factors of importance for outcome in patients referred for sustained ventricular arrhythmias. RESULTS: Two hundred and fifty three patients took part in the survey, 126 (20 women) had sustained monomorphic ventricular tachycardia (VT) and 127 (31 women) had polymorphic VT/ventricular fibrillation. Ischemic heart disease was less common in women than in men (47 vs. 80%). At discharge, an ICD implant was similarly common in women (33%) and men (29%). One hundred and twenty five (65%) men and 37 (79%) women were alive at follow-up, p =0.08 (median follow-up 53 months). Independent predictors of long-term mortality were: 1) PVT/VF as the presenting arrhythmia, 2) a low ejection fraction, 3) increased QRS duration and 4) diabetes mellitus. CONCLUSION: The lower proportion of women compared to men being referred for evaluation of sustained ventricular arrhythmias may contribute to the lower number of ICD implants in women. The long-term survival in women and men did not differ significantly.

  • 150. Graves, JR
    et al.
    Herlitz, Johan
    [external].
    Bång, A
    [external].
    Axelsson, Å
    Ekström, L
    Holmberg, M
    Holmberg, S
    Lindqvist, J
    Sunnerhagen, K
    Survivors of out-of-hospital cardiac arrest. Their prognosis, longevity, and functional status1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, nr 2, s. 117-121Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

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