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  • 151. Gellerstedt, M
    et al.
    Bång, Angela
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, no 5, p. 290-294Article in journal (Refereed)
    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.

  • 152. 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?2006In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, no 5, p. 290-294Article in journal (Refereed)
    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.

  • 153. Gellerstedt, Martin
    et al.
    Rawshani, Nina
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    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.2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, p. 734-738Article in journal (Refereed)
    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.

  • 154. Glantz, H
    et al.
    Thunström, E
    Herlitz, J
    University of Borås, School of Health Science.
    Cederin, B
    Nasic, S
    Ejdebäck, J
    Peker, Y
    Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort2013In: Annals of the American Thoracic Society, ISSN 2329-6933, E-ISSN 2325-6621, Vol. 10, no 4, p. 350-356Article in journal (Refereed)
    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&

  • 155.
    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
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    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.2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 241, p. 12-18, article id S0167-5273(16)34469-2Article in journal (Refereed)
    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.

  • 156. 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.2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 182-191Article in journal (Refereed)
    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.

  • 157. Gottfridsson, C
    et al.
    Nyström, B
    Karlsson, T
    Herlitz, Johan
    University of Borås, School of Health Science.
    Edvardsson, N
    Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias2008In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 42, no 3, p. 182-191Article in journal (Refereed)
    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.

  • 158. 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 status1997In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 35, no 2, p. 117-121Article in journal (Refereed)
    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.

  • 159. Gräsner, Jan-Thorsten
    et al.
    Lefering, Rolf
    Koster, Rudolph W
    Masterson, Siobhán
    Böttiger, Bernd W
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wnent, Jan
    Tjelmeland, Ingvild B M
    Ortiz, Fernando Rosell
    Maurer, Holger
    Baubin, Michael
    Mols, Pierre
    Hadžibegović, Irzal
    Ioannides, Marios
    Škulec, Roman
    Wissenberg, Mads
    Salo, Ari
    Hubert, Hervé
    Nikolaou, Nikolaos I
    Lóczi, Gerda
    Svavarsdóttir, Hildigunnur
    Semeraro, Federico
    Wright, Peter J
    Clarens, Carlo
    Pijls, Ruud
    Cebula, Grzegorz
    Correia, Vitor Gouveia
    Cimpoesu, Diana
    Raffay, Violetta
    Trenkler, Stefan
    Markota, Andrej
    Strömsöe, Anneli
    Burkart, Roman
    Perkins, Gavin D
    Bossaert, Leo L
    EuReCa ONE-27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.2016In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 105, p. 188-195Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The aim of the EuReCa ONE study was to determine the incidence, process, and outcome for out of hospital cardiac arrest (OHCA) throughout Europe.

    METHODS: This was an international, prospective, multi-centre one-month study. Patients who suffered an OHCA during October 2014 who were attended and/or treated by an Emergency Medical Service (EMS) were eligible for inclusion in the study. Data were extracted from national, regional or local registries.

    RESULTS: Data on 10,682 confirmed OHCAs from 248 regions in 27 countries, covering an estimated population of 174 million. In 7146 (66%) cases, CPR was started by a bystander or by the EMS. The incidence of CPR attempts ranged from 19.0 to 104.0 per 100,000 population per year. 1735 had ROSC on arrival at hospital (25.2%), Overall, 662/6414 (10.3%) in all cases with CPR attempted survived for at least 30 days or to hospital discharge.

    CONCLUSION: The results of EuReCa ONE highlight that OHCA is still a major public health problem accounting for a substantial number of deaths in Europe. EuReCa ONE very clearly demonstrates marked differences in the processes for data collection and reported outcomes following OHCA all over Europe. Using these data and analyses, different countries, regions, systems, and concepts can benchmark themselves and may learn from each other to further improve survival following one of our major health care events.

  • 160. Gräsner, JT
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. [external].
    Koster, RW
    Ortiz, FR
    Stamatakis, L
    Bossaert, L
    Quality management in resuscitation--towards a European cardiac arrest registry (EuReCa).2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 8, p. 989-994Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge about the epidemiology of cardiac arrest in Europe is inadequate. AIM: To describe the first attempt to build up a Common European Registry of out-of-hospital cardiac arrest, called EuReCa. METHODS: After approaching key persons in participating countries of the European Resuscitation Council, five countries or areas within countries (Belgium, Germany, Andalusia, North Holland, Sweden) agreed to participate. A standardized questionnaire including 28 items, that identified various aspects of resuscitation, was developed to explore the nature of the regional/national registries. This comprises inclusion criteria, data sources, and core data, as well as technical details of the structure of the databases. RESULTS: The participating registers represent a population of 35 million inhabitants in Europe. During 2008, 12,446 cardiac arrests were recorded. The structure as well as the level of complexity varied markedly between the 5 regional/national registries. The incidence of attempted resuscitation ranged between registers from 17 to 53 per 100,000 inhabitants each year whilst the number of patients admitted to hospital alive ranged from 5 to 18 per 100,000 inhabitants each year. Bystander CPR varied 3-fold from 20% to 60%. CONCLUSION: Five countries agreed to participate in an attempt to build up a common European Registry for out-of-hospital cardiac arrest. These regional/national registries show a marked difference in terms of structure and complexity. A marked variation was found between countries in the number of reported resuscitation attempts, the number of patients brought to hospital alive, and the proportion that received bystander CPR. At present, we are unable to explain the reason for the variability but our first findings could be a 'wake-up-call' for building up a high quality registry that could provide answers to this and other key questions in relation to the management of out-of-hospital cardiac arrest.

  • 161. Guron, CW
    et al.
    Hartford, M
    Persson, A
    Herlitz, Johan
    [external].
    Thelle, D
    Caidahl, K
    Timing of regional left ventricular lengthening by pulsed tissue Doppler2004In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 17, no 4, p. 307-312Article in journal (Refereed)
    Abstract [en]

    Pulsed tissue Doppler can measure myocardial velocities with high temporal resolution. Our aim was to determine the onset timing of the regional left ventricular longitudinal early lengthening (e) in relation to the mitral inflow (E) in acute coronary syndromes. We applied pulsed tissue Doppler to the septal, lateral, inferior, and anterior left ventricular basal walls of 160 patients with acute coronary syndromes and 60 control subjects. Maximum systolic and early diastolic velocities were lower for patient than for control walls (6.1 +/- 1.7 vs 7.9 +/- 1.4 cm/s, P <.0001, and 6.9 +/- 2.3 vs 10.0 +/- 2.3 cm/s, P <.0001, respectively) and e started later than E (12 +/- 30 vs 2 +/- 19 milliseconds later, P <.0001). All 3 variables related to the degree of visual left ventricular wall pathology. The intraindividual time range for all 4 e starts was wider for patients (43 +/- 27 vs 30 +/- 18 milliseconds, P <.0001). Our results show that pulsed tissue Doppler can identify a delayed and asynchronous initial wall lengthening in acute coronary syndromes.

  • 162. Gustafsson, I
    et al.
    Malmberg, K
    Rydén, L
    Wedel, H
    Birkeland, K
    Bootsma, M
    Dickstein, K
    Efendic, S
    Fisher, M
    Hamsten, A
    Herlitz, Johan
    [external].
    Hildebrandt, PR
    MacLeod, K
    Laakso, M
    Torp-Pedersen, CT
    Waldentrom, A
    Metabolic control by means of insulin in patients with type 2 diabetes and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity--secondary publication2006In: Ugeskrift for læger, ISSN 0041-5782, E-ISSN 1603-6824, Vol. 168, no 6, p. 581-584Article in journal (Refereed)
    Abstract [en]

    Patients with diabetes have an unfavourable prognosis after an acute myocardial infarction. The DIGAMI 2 study investigated the effect of various metabolic treatment strategies in type 2 diabetic patients with acute myocardial infarction: acutely introduced, long-term insulin treatment did not improve survival when compared with conventional management at similar levels of glucose control. However, good glucose control seems important since the glucose level was found to be a strong predictor of long-term mortality in this patient category.

  • 163.
    Hagiwara, M
    et al.
    University of Borås, School of Health Science.
    Bremer, A
    University of Borås, School of Health Science.
    Claesson, A
    University of Borås, School of Health Science.
    Axelsson, C
    University of Borås, School of Health Science.
    Norberg, Gabriella
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis2014In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, no 67Article in journal (Refereed)
    Abstract [en]

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

  • 164. Hallstrom, A
    et al.
    Herlitz, Johan
    [external].
    Kajino, K
    Olasveengen, TM
    Treatment of asystole and PEA2009In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 9, p. 975-976Article in journal (Refereed)
    Abstract [en]

    Recent reports consistently point to a substantial decline in the incidence of ventricular fibrillation (VF) as the initial rhythm observed by Emergency Medical Service (EMS) responders and a complementary increase in pulseless electrical activity (PEA) and asystole. Historically, efforts at improving survival have focused primarily on patients found in VF. Consequently, the approach for other patients has included frequent pauses in cardiopulmonary resuscitation (CPR) to check for VF followed by shock when VF is observed. However, the "yield" of survivors comes largely from the non-shocked patients. Therefore, it is critical that we start evaluating treatments specifically for the PEA and asystole groups.

  • 165. Hallstrom, A
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Kajino, K
    Olasveengen, TM
    Treatment of Asystole and PEA2009In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 80, no 9, p. 975-6Article in journal (Refereed)
    Abstract [en]

    Recent reports consistently point to a substantial decline in the incidence of ventricular fibrillation (VF) as the initial rhythm observed by Emergency Medical Service (EMS) responders and a complementary increase in pulseless electrical activity (PEA) and asystole. Historically, efforts at improving survival have focused primarily on patients found in VF. Consequently, the approach for other patients has included frequent pauses in cardiopulmonary resuscitation (CPR) to check for VF followed by shock when VF is observed. However, the "yield" of survivors comes largely from the non-shocked patients. Therefore, it is critical that we start evaluating treatments specifically for the PEA and asystole groups.

  • 166.
    Hansson, Per-Olof
    et al.
    Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Brink, Peter
    University West.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital identification of factors associated with death during one-year follow-up after acute stroke.2018In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, article id e00987Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke.

    MATERIAL AND METHODS: All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria.

    RESULTS: In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of <90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03.

    CONCLUSIONS: Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.

  • 167.
    Hansson, P-O
    et al.
    Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg.
    Andersson Hagiwara, Magnus
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Brink, P
    Intensive Care Unit, NU-hospital.
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital assessment of suspected stroke and TIA: an observational study.2019In: Acta Neurologica Scandinavica, ISSN 0001-6314, E-ISSN 1600-0404Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Symptoms related to stroke diverge and may mimic many other conditions.

    AIMS: To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA) METHODS: An observational multi-centre study including nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the EMS clinician before hospital admission during a four-month period were included.

    RESULTS: Of 1,081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, p=0.007, a history of myocardial infarction (OR: 1.77, p= 0.01), facial droop (OR: 2.81, p<0.0001), arm weakness (OR: 2.61, p<0.0001), speech disturbance (OR: 1.92, p<0.0001) and high systolic blood pressure (OR: 1.50, p=0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, p=0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up.

    CONCLUSIONS: Seven factors including the three symptoms included in the Face Arm Speech Test (FAST) were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke. This article is protected by copyright. All rights reserved.

  • 168.
    Hardig, Bjarne Madsen
    et al.
    Physio-Control, Lund.
    Lindgren, Erik
    Uppsala University.
    Östlund, Ollie
    Uppsala University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Karlsten, Rolf
    Uppsala University.
    Rubertsson, Sten
    Uppsala University.
    Outcome among VF/VT patients in the LINC (LUCAS IN cardiac arrest) trial-A randomised, controlled trial.2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 115, p. 155-162, article id S0300-9572(17)30156-9Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The LINC trial evaluated two ALS-CPR algorithms for OHCA patients, consisting of 3min' mechanical chest compression (LUCAS) cycles with defibrillation attempt through compressions vs. 2min' manual compressions with compression pause for defibrillation. The PARAMEDIC trial, using 2min' algorithm found worse outcome for patients with initial VF/VT in the LUCAS group and they received more adrenalin compared to the manual group. We wanted to evaluate if these algorithms had any outcome effect for patients still in VF/VT after the initial defibrillation and how adrenalin timing impacted it.

    METHOD: Both groups received manual chest compressions first. Based on non-electronic CPR process documentation, outcome, neurologic status and its relation to CPR duration prior to the first detected return of spontaneous circulation (ROSC), time to defibrillation and adrenalin given were analysed in the subgroup of VF/VT patients.

    RESULTS: Seven hundred and fifty-seven patients had still VF/VT after initial chest compressions combined with a defibrillation attempt (374 received mechanical CPR) or not (383 received manual CPR). No differences were found for ROSC (mechanical CPR 58.3% vs. manual CPR 58.6%, p=0.94), or 6-month survival with good neurologic outcome (mechanical CPR 25.1% vs. manual CPR 23.0%, p=0.50). A significant difference was found regarding the time from start of manual chest compression to the first defibrillation (mechanical CPR: 4 (2-5) min vs manual CPR 3 (2-4) min, P<0.001). The time from the start of manual chest compressions to ROSC was longer in the mechanical CPR group.

    CONCLUSIONS: No difference in short- or long-term outcomes was found between the 2 algorithms for patients still in VF/VT after the initial defibrillation. The time to the 1st defibrillation and the interval between defibrillations were longer in the mechanical CPR group without impacting the overall outcome. The number of defibrillations required to achieve ROSC or adrenalin doses did not differ between the groups.

  • 169. Hartford, M
    et al.
    Herlitz, Johan
    [external].
    Karlsson, BW
    Risenfors, M
    Components of delay time in suspected acute myocardinal infarction with particular emphasis on patient delay1990In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 228, no 5, p. 519-523Article in journal (Refereed)
    Abstract [en]

    Two hundred and thirty-four patients admitted to a coronary care unit (CCU) were interviewed a few days after arrival in hospital to determine reasons for patient delay and the various components of total delay time from onset of symptoms to arrival in CCU. Of the three major components of delay, decision time (time from onset of symptoms to decision to go to hospital), and hospital procedure time (time from arrival in hospital to arrival in the CCU), were of the same magnitude, 1 h 15 min and 1 h 30 min (median), whereas the median time for preparation and transportation to hospital was somewhat shorter, being 45 min. Decision time appeared to be similar in patients with confirmed and non-confirmed acute myocardial infarction (AMI) and was not associated with intensity of pain or infarct size. Half of the patients hesitated to go to hospital, which resulted in a prolonged decision delay (3 h). It is concluded that patient indecision to seek medical help is the most important reason for delay in hospital arrival in patients with suspected AMI.

  • 170. Hartford, M
    et al.
    Karlson, BW
    Sjölin, M
    Holmberg, S
    Herlitz, Johan
    [external].
    Symptoms, thoughts and environmental factors in suspected acute myocardial infarction1993In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 22, no 1, p. 64-70Article in journal (Refereed)
    Abstract [en]

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

  • 171. Hartford, M
    et al.
    Wiklund, O
    Hultén, LM
    Persson, A
    Karlsson, T
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hulthe, J
    Caidahl, K
    Interleukin-18 as a predictor of future events in patients with acute coronary syndromes2010In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 30, no 10, p. 2039-2046Article in journal (Refereed)
    Abstract [en]

    Objective—The aim of this study was to assess the short- and long-term prognostic significance of interleukin-18 (IL-18) levels in patients with acute coronary syndromes (ACS). Methods and Results—In patients hospitalized with ACS (median age, 66 years; 30% females), we evaluated associations of serum IL-18 levels from day 1 (n=1261) with the short- (<3 months) and long-term (median, 7.6 years) risk of death, development of congestive heart failure (CHF), and myocardial infarction (MI). IL-18 was not significantly associated with short-term mortality. In the long term, IL-18 levels were significantly related to all-cause mortality, even after adjustment for clinical confounders (hazard ratio [HR], 1.19; 95% confidence interval, 1.07 to 1.33; P=0.002). Long-term, cardiovascular mortality was univariately related to IL-18, and the adjusted relation between noncardiovascular mortality and IL-18 was highly significant (HR, 1.36; 95% confidence interval, 1.11 to 1.67; P=0.003). IL-18 independently predicted CHF, MI, and cardiovascular death/CHF/MI in both the short and long term. Measurements from day 1 of ACS and 3 months after ACS had a similar power to predict late outcome. Conclusion—The addition of the measurement of IL-18 to clinical variables improved the prediction of risk of all-cause and noncardiovascular mortality. The association between IL-18 and noncardiovascular mortality is intriguing and warrants further study.

  • 172. Hartford, M
    et al.
    Wiklund, O
    Hultén, LM
    Persson, A
    Karlsson, T
    Herlitz, Johan
    University of Borås, School of Health Science.
    Hulthe, J
    Caidahl, K
    Interleukin-18 as a Predictor of Future Events in Patients With Acute Coronary Syndromes2010In: Arteriosclerosis, Thrombosis and Vascular Biology, ISSN 1079-5642, E-ISSN 1524-4636, Vol. 30, no 10, p. 2039-2046Article in journal (Refereed)
    Abstract [en]

    Objective—The aim of this study was to assess the short- and long-term prognostic significance of interleukin-18 (IL-18) levels in patients with acute coronary syndromes (ACS). Methods and Results—In patients hospitalized with ACS (median age, 66 years; 30% females), we evaluated associations of serum IL-18 levels from day 1 (n=1261) with the short- (<3 months) and long-term (median, 7.6 years) risk of death, development of congestive heart failure (CHF), and myocardial infarction (MI). IL-18 was not significantly associated with short-term mortality. In the long term, IL-18 levels were significantly related to all-cause mortality, even after adjustment for clinical confounders (hazard ratio [HR], 1.19; 95% confidence interval, 1.07 to 1.33; P=0.002). Long-term, cardiovascular mortality was univariately related to IL-18, and the adjusted relation between noncardiovascular mortality and IL-18 was highly significant (HR, 1.36; 95% confidence interval, 1.11 to 1.67; P=0.003). IL-18 independently predicted CHF, MI, and cardiovascular death/CHF/MI in both the short and long term. Measurements from day 1 of ACS and 3 months after ACS had a similar power to predict late outcome. Conclusion—The addition of the measurement of IL-18 to clinical variables improved the prediction of risk of all-cause and noncardiovascular mortality. The association between IL-18 and noncardiovascular mortality is intriguing and warrants further study.

  • 173. Hartford, M
    et al.
    Wiklund, O
    Mattsson Hultén, L
    Persson, A
    Karlsson, T
    Herlitz, Johan
    [external].
    Caidahl, K
    C-reactive protein, interleukin-6, secretory phospholipase A2 group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes.2007In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 5, p. 526-536Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We investigated whether levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A(2) group IIA (sPLA(2)-IIA) and intercellular adhesion molecule-1 (ICAM-I) predict late outcomes in patients with acute coronary syndromes (ACS). DESIGN: Prospective longitudinal study. CRP (mg L(-1)), IL-6 (pg mL(-1)), sPLA(2)-IIA (ng mL(-1)) and ICAM-1 (ng mL(-1)) were measured at days 1 (n = 757) and 4 (n = 533) after hospital admission for ACS. Their relations to mortality and rehospitalization for myocardial infarction (MI) and congestive heart failure (CHF) were determined. SETTING: Coronary Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. SUBJECTS: Patients with ACS alive at day 30; median follow-up 75 months. RESULTS: Survival was related to day 1 levels of all markers. After adjustment for confounders, CRP, IL-6 and ICAM-1, but not sPLA(2)-IIA, independently predicted mortality and rehospitalization for CHF. For CRP, the hazard ratio (HR) was 1.3 for mortality (95% confidence interval (CI): 1.1-1.5, P = 0.003) and 1.4 for CHF (95% CI: 1.1-1.9, P = 0.006). For IL-6, HR was 1.3 for mortality (95% CI: 1.1-1.6, P < 0.001) and 1.4 for CHF (95% CI: 1.1-1.8, P = 0.02). For ICAM-1, HR was 1.2 for mortality (95% CI: 1.0-1.4, P = 0.04) and 1.3 for CHF (95% CI: 1.0-1.7, P = 0.03). No marker predicted MI. Marker levels on day 4 provided no additional predictive value. CONCLUSIONS: In patients with ACS, CRP, IL-6, sPLA(2)-IIA and ICAM-1 are associated with long-term mortality and CHF, but not reinfarction. CRP, IL-6 and ICAM-1 provide prognostic information beyond that obtained by clinical variables.

  • 174. Hartford, M
    et al.
    Wiklund, O
    Mattsson-Hultén, L
    Perers, E
    Person, A
    Herlitz, Johan
    [external].
    Hurt-Camejo, E
    CRP, interleukin-6, secretory phospholipase A2 group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up.2006In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 108, no 1, p. 55-62Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The objectives of this study were to examine the time course of the inflammatory response in acute coronary syndromes (ACS) and to assess the markers of inflammation and their relation to disease severity. METHODS: We prospectively studied 134 patients with ACS who survived for at least 30 months. The patients were divided into four groups: acute myocardial infarction (MI) with (n=54) or without (n=46) ST-segment elevation and unstable angina with (n=14) or without (n=20) increased risk. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A2 group IIA (sPLA2-IIA), and intercellular adhesion molecule-1 (ICAM-1) were measured on days 1 and 4 and after 3 and 30 months. RESULTS: The highest levels of CRP and sPLA2-IIA were seen on day 4 but for IL-6 on day 1. These three markers, but not ICAM-1, were significantly related to disease severity, CKMB, and ejection fraction. Patients in Killip class II-IV had higher levels than those in Killip class I. The individual acute-phase responses correlated with marker levels at 3 and 30 months. ICAM-1 correlated with the development of congestive heart failure. CONCLUSIONS: In ACS there seems to be an individual predisposition to inflammatory response. Plasma IL-6 is the first marker to rise, while sPLA2-IIA and CRP peak later. All three markers, especially CRP, may discriminate between MI and non-MI. ICAM-1 seems to reflect other aspects of the inflammatory processes than the other markers. The results emphasize the complexity of the inflammatory response in ACS and stress the need for further studies involving multiple markers.

  • 175. Hasselqvist, Ingela
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Svensson, Leif
    Impact of bystander CPR on survival after out of hospital cardiac arrest2012Conference paper (Refereed)
  • 176. Hasselqvist-Ax, I
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Rosenqvist, M
    Hollenberg, J
    Nordberg, P
    Ringh, M
    Jonsson, M
    Axelsson, C
    Lindqvist, J
    Svensson, L
    The Assessment aand Value of Bystander Cardiopulmonary Resuscitation2013Conference paper (Refereed)
  • 177. Hasselqvist-Ax, Ingela
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, Leif
    Axelsson, Christer
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Early CPR in Out-of-Hospital Cardiac Arrest.2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 373, no 16Article in journal (Refereed)
  • 178.
    Hasselqvist-Ax, Ingela
    et al.
    Karolinska Institutet.
    Nordberg, Per
    Karolinska Institutet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Svensson, Leif
    Karolinska Institutet.
    Jonsson, Martin
    Karolinska Institutet.
    Lindqvist, Jonny
    Sahlgrenska University Hospital.
    Ringh, Mattias
    Karolinska Institutet.
    Claesson, Andreas
    Karolinska Institutet.
    Björklund, Johan
    Fire and Rescue Service Dala Middle, Falun.
    Andersson, Jan-Otto
    Emergency Medical Services, Skövde Emergency Department, Skövde.
    Ericson, Caroline
    Sahlgrenska University Hospital.
    Lindblad, Pär
    Värnamo County Hospital, Jönköping County.
    Engerström, Lars
    SOS Alarm Centers, Stockholm.
    Rosenqvist, Mårten
    Karolinska Institutet.
    Hollenberg, Jacob
    Karolinska Institutet.
    Dispatch of Firefighters and Police Officers in Out-of-Hospital Cardiac Arrest: A Nationwide Prospective Cohort Trial Using Propensity Score Analysis.2017In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 6, no 10, article id e005873Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dispatch of basic life support-trained first responders equipped with automated external defibrillators in addition to advanced life support-trained emergency medical services personnel in out-of-hospital cardiac arrest (OHCA) has, in some minor cohort studies, been associated with improved survival. The aim of this study was to evaluate the association between basic life support plus advanced life support response and survival in OHCA at a national level.

    METHODS AND RESULTS: This prospective cohort study was conducted from January 1, 2012, to December 31, 2014. People who experienced OHCA in 9 Swedish counties covered by basic life support plus advanced life support response were compared with a propensity-matched contemporary control group of people who experienced OHCA in 12 counties where only emergency medical services was dispatched, providing advanced life support. Primary outcome was survival to 30 days. The analytic sample consisted of 2786 pairs (n=5572) derived from the total cohort of 7308 complete cases. The median time from emergency call to arrival of emergency medical services or first responder was 9 minutes in the intervention group versus 10 minutes in the controls (P<0.001). The proportion of patients admitted alive to the hospital after resuscitation was 31.4% (875/2786) in the intervention group versus 24.9% (694/2786) in the controls (conditional odds ratio, 1.40; 95% confidence interval, 1.24-1.57). Thirty-day survival was 9.5% (266/2786) in the intervention group versus 7.7% (214/2786) in the controls (conditional odds ratio, 1.27; 95% confidence interval, 1.05-1.54).

    CONCLUSIONS: In this nationwide interventional trial, using propensity score matching, dispatch of first responders in addition to emergency medical services in OHCA was associated with a moderate, but significant, increase in 30-day survival.

    CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02184468.

  • 179. Hasselqvist-Ax, Ingela
    et al.
    Riva, Gabriel
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rosenqvist, Mårten
    Hollenberg, Jacob
    Nordberg, Per
    Ringh, Mattias
    Jonsson, Martin
    Axelsson, Christer
    Lindqvist, Jonny
    Karlsson, Thomas
    Svensson, Leif
    Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest.2015In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 372, no 24Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Three million people in Sweden are trained in cardiopulmonary resuscitation (CPR). Whether this training increases the frequency of bystander CPR or the survival rate among persons who have out-of-hospital cardiac arrests has been questioned.

    METHODS: We analyzed a total of 30,381 out-of-hospital cardiac arrests witnessed in Sweden from January 1, 1990, through December 31, 2011, to determine whether CPR was performed before the arrival of emergency medical services (EMS) and whether early CPR was correlated with survival.

    RESULTS: CPR was performed before the arrival of EMS in 15,512 cases (51.1%) and was not performed before the arrival of EMS in 14,869 cases (48.9%). The 30-day survival rate was 10.5% when CPR was performed before EMS arrival versus 4.0% when CPR was not performed before EMS arrival (P<0.001). When adjustment was made for a propensity score (which included the variables of age, sex, location of cardiac arrest, cause of cardiac arrest, initial cardiac rhythm, EMS response time, time from collapse to call for EMS, and year of event), CPR before the arrival of EMS was associated with an increased 30-day survival rate (odds ratio, 2.15; 95% confidence interval, 1.88 to 2.45). When the time to defibrillation in patients who were found to be in ventricular fibrillation was included in the propensity score, the results were similar. The positive correlation between early CPR and survival rate remained stable over the course of the study period. An association was also observed between the time from collapse to the start of CPR and the 30-day survival rate.

    CONCLUSIONS: CPR performed before EMS arrival was associated with a 30-day survival rate after an out-of-hospital cardiac arrest that was more than twice as high as that associated with no CPR before EMS arrival. (Funded by the Laerdal Foundation for Acute Medicine and others.).

  • 180. Hedner, J
    et al.
    Caidahl, K
    Sjöland, H
    Karlsson, T
    Herlitz, Johan
    [external].
    Sleep habits and their association with mortality during 5-year follow-up after coronary artery bypass surgery2002In: Acta Cardiologica, ISSN 0001-5385, E-ISSN 1784-973X, Vol. 57, no 5, p. 341-348Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study various aspects of sleep quality and sleep patterns prior to and after coronary artery bypass surgery and their implications for 5-year survival. METHODS: All patients from western Sweden who underwent coronary artery bypass grafting (CABG) between 1988 and 1991 (n = 2,121) received a questionnaire addressing sleep habits prior to and I year after surgery. Various symptoms and habits related to sleep at the two evaluations were compared. Symptoms and habits related to sleep prior to CABG were then related to 5-year survival. RESULTS: In all, 1,224 patients took part in the evaluation. A highly significant improvement was observed with regard to the following symptoms and habits related to sleep: feeling refreshed upon awakening, feeling tired during daytime, waking up with headache, nightmares, sweating during night time, medication for pain relief at bedtime, involuntarily falling asleep during daytime, apnoea during sleep and mouth dryness during the night. Various symptoms and habits associated with sleep prior to CABG were generally not strongly related to prognosis. Exceptions were feeling refreshed upon awakening and infrequent consumption of pain relief medication at bedtime which both were associated with an improved long-term survival. CONCLUSIONS: A variety of symptoms associated with sleep improve highly significantly after CABG. The occurrence of these symptoms prior to CABG do not generally seem to influence the long-term prognosis.

  • 181. Hein, A
    et al.
    Thorén, A-B
    Herlitz, Johan
    [external].
    Characteristics and outcome of false cardiac arrests in hospital.2006In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 69, no 2, p. 191-197Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Not all hospitalised patients with symptoms of a presumed or threatened cardiac arrest, for whom the rescue team is alerted, eventually suffer a cardiac arrest. This article aims to describe the characteristics and outcome of "false cardiac arrests". METHODS: All patients hospitalised at Sahlgrenska University Hospital for whom the rescue team was alerted between 1 November 1994 and 15 October 2002 were included. RESULTS: In all, there were 1538 calls for the rescue team, of which 70% were caused by cardiac arrest, 9% by respiratory arrest and 21% by "other causes". Survival to discharge was 36% among patients with cardiac arrest, 64% among patients with respiratory arrest and 77% among patients with "other reasons for calling" (p<0.0001 for trend). Among survivors, a cerebral performance categories (CPC) score of 1 at hospital discharge was found in 83% of those with a cardiac arrest, 59% with respiratory arrest and 82% with other reasons for calling (NS for trend). CONCLUSION: Among patients at a Swedish university hospital for whom the rescue team was alerted, about one-third have a "false cardiac arrest". These patients had a survival rate which was about twice that of patients with a "true cardiac arrest". However, among survivors, cerebral function at discharge was similar, regardless of "false" or "true" cardiac arrest.

  • 182. Henriksson, C
    et al.
    Larsson, M
    Arnetz, J
    Berglin-Jarlov, M
    Herlitz, Johan
    University of Borås, School of Health Science.
    Karlsson, JE
    Svensson, L
    Thuresson, M
    Zedigh, C
    Wernroth, L
    Lindahl, Berit
    Knowledge and Attitudes toward Seeking Medical Care for AMI symptoms2011In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 147, no 2, p. 224-227Article in journal (Refereed)
    Abstract [en]

    Background Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. Aim To investigate and compare patients' and relatives' knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. Methods The present study was a descriptive, multicentre study. Participants were AMI-patients ≤ 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants' knowledge of AMI and attitudes toward seeking medical care. Results Both patients and relatives appeared to act more appropriate to someone else's chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65–75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. Conclusions There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients' delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI

  • 183. Henriksson, C
    et al.
    Larsson, M
    Arnetz, J
    Berglin-Jarlöv, M
    Herlitz, Johan
    [external].
    Karlsson, JE
    Svensson, L
    Thuresson, M
    Zedigh, C
    Wernroth, L
    Lindahl, B
    Knowledge and attitudes toward seeking medical care for AMI-symptoms2009In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 147, no 2, p. 224-227Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. AIM: To investigate and compare patients' and relatives' knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. METHODS: The present study was a descriptive, multicentre study. Participants were AMI-patients ≤ 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants' knowledge of AMI and attitudes toward seeking medical care. RESULTS: Both patients and relatives appeared to act more appropriate to someone else's chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65-75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. CONCLUSIONS: There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients' delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI.

  • 184. Henriksson, C
    et al.
    Larsson, M
    Herlitz, J
    University of Borås, School of Health Science.
    Karlsson, JE
    Wernroth, L
    Lindahl, B
    Influence of health related quality of life on time from symptom onset to hospital arrival and the risk of readmission in patients with myocardial infarction2014In: Open heart, E-ISSN 2053-3624, Vol. 1, no 1Article in journal (Refereed)
    Abstract [en]

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

  • 185.
    Herlitz, J
    University of Borås, School of Health Science.
    Nationella kvalitetsregister. Till vad nytta?2014Conference paper (Other academic)
  • 186.
    Herlitz, J
    University of Borås, School of Health Science.
    Rapport från det Svenska Hjärt-lungräddningsregistret2014Conference paper (Other academic)
  • 187.
    Herlitz, J
    University of Borås, School of Health Science.
    Svenska Hjärt-lungräddningsregistret. Årsrapport 20132013Report (Other academic)
  • 188.
    Herlitz, J
    University of Borås, School of Health Science.
    Årsrapport för det Svenska Hjärt-lungräddningsregistret 20142014Report (Other academic)
  • 189.
    Herlitz, Johan
    [external].
    A survey of treatment routines and educational level of health care providers in the initial phase of suspected acute myocardial infarction in Sweden in 19941996In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 3, no 3, p. 149-156Article in journal (Refereed)
    Abstract [en]

    The aim of this survey was to explore treatment routines with regard to early heart attack care at various hospitals in Sweden. All the hospitals in Sweden with a coronary care unit or its equivalent were sent a postal enquiry about early heart attack care including use of various medications and educational level of health care providers. In all, 84 of 86 hospitals (98%) answered the enquiry. Prior to hospital admission, 10% of the hospitals used thrombolytic agents, 10% used beta-blockers and 55% used aspirin. In only 4% of hospitals was thrombolytic treatment initiated in the emergency department and in 17% beta-blockers were initiated. The proportion of acute myocardial infarction (AMI) patients who received thrombolytic treatment varied from 10% to more than 80%, with a mean value of 41%. The proportion of AMI patients who received intravenous beta-blockade varied from 0 to 93%, with a mean value of 24%. This survey indicates that the vast majority of hospitals in Sweden use thrombolytic agents in more than 30% of AMI patients and aspirin in more than 80% of AMI patients. The use of intravenous beta-blockade is lower than expected. Considering the strong association between the delay before instituting therapy and outcome, it is surprising that treatment is not initiated more frequently outside hospital or in the emergency department.

  • 190.
    Herlitz, Johan
    [external].
    Analgesia in acute myocardial infarction1989In: Drugs, ISSN 0012-6667, E-ISSN 1179-1950, Vol. 37, no 6, p. 939-944Article in journal (Refereed)
  • 191.
    Herlitz, Johan
    [external].
    Antiischemisk behandling. Användande av betablockerare, nitrater och kalciumantagonister vid akut kranskärlssjukdom2000In: Akut kranskärlssjukdom / [ed] Lars Wallentin, Svenska cardiologföreningens service , 2000, p. 109-114Chapter in book (Other academic)
  • 192.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Antiischemisk behandling vid akut kranskärlssjukdom2010In: Akut kranskärlssjukdom, 4:e upplagan / [ed] Lars Wallentin, Bertil Lindahl, Liber AB: Elanders Tryck , 2010Chapter in book (Other academic)
  • 193.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Bedömning av behov av vård. Ett etiskt dilemma.2012Conference paper (Other academic)
  • 194. Herlitz, Johan
    Bedömning och begränsning av hjärtinfarktens storlek en interventionsstudie med Metoprolol1982Doctoral thesis, monograph (Other academic)
  • 195.
    Herlitz, Johan
    [external].
    Benign monoklonal gammapati. Ett tillstånd av svårbedömd signifikans1986In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 83, no 47, p. 3995-3997Article in journal (Refereed)
  • 196.
    Herlitz, Johan
    [external].
    Beta-blockerare vid hjärtsvikt: tid för omvärdering1997In: Hässle Information, ISSN 0346-9751, Vol. 10, p. 15-18Article in journal (Refereed)
  • 197.
    Herlitz, Johan
    [external].
    Can we change patients' behaviour in the early phase of an acute coronary syndrome?2003In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 37, no 4, p. 181-182Article in journal (Other (popular science, discussion, etc.))
  • 198.
    Herlitz, Johan
    [external].
    Comparison of lisinopril versus digoxin for congestive heart failure during maintenance diuretic therapy1992In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 70, no 10, p. 84-90Article in journal (Refereed)
    Abstract [en]

    Lisinopril 5–20 mg once daily was compared with digoxin 0.125–0.375 mg once daily in a double-blind, randomized, parallel-group study involving 217 patients with mild-to-moderate heart failure (New York Heart Association [NYHA] grades II–III) who were maintained on optimized diuretic therapy. After 6 weeks of treatment, digoxin and lisinopril had increased exercise duration by 18 seconds (p = 0.015) and 32 seconds (p = 0.0007), respectively, versus the baseline run-in period. The difference between treatments was not statistically significant (p = 0.1343). After 12 weeks, digoxin and lisinopril had increased exercise duration by 29 seconds and 51 seconds, respectively. The effect of digoxin compared with the baseline value was not significant but that for lisinopril was (p = 0.0027). The difference between treatments approached statistical significance (p = 0.0813). There was no difference between lisinopril and digoxin with regard to their effects on the frequency of ventricular ectopic counts, couplets, or nonsustained ventricular tachycardia. Blood pressures were not significantly different between treatments, although both systolic and diastolic blood pressure were consistently lower in the lisinopril group throughout randomized treatment. The proportions of patients demonstrating an improvement in NYHA grading were similar for both lisinopril and digoxin. Both treatments had similar effects on the symptoms of heart failure. Both drugs appeared to be equally well tolerated with a similar frequency of adverse events reported for both drugs (30% for lisinopril vs 29% for digoxin). Withdrawals from treatment were of a similar frequency for both treatments. It is concluded that lisinopril may be a useful alternative to digitalis in patients with heart failure who remain symptomatic on diuretic therapy.

  • 199.
    Herlitz, Johan
    [external].
    Consent for research in emergency situations.2002In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, no 3, p. 239-Article in journal (Refereed)
    Abstract [en]

    Patients suffering from cardiac arrest cannot give informed consent for participation in interventional trials. This requirement would stop the process of improving survival through research among such patients.

  • 200.
    Herlitz, Johan
    [external].
    Dramatisk sänkning av dödligheten i hjärtinfarkt2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 3369-3372Article in journal (Refereed)
1234567 151 - 200 of 860
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