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  • 201.
    Herlitz, Johan
    [external].
    Effect of metoprolol CR/XL in chronic heart failure; Metoprolol CR/XL. Randomised Intervention Trial in Congestive Heart Failure1999Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 353, nr 9169, s. 2001-2007Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Metoprolol can improve haemodynamics in chronic heart failure, but survival benefit has not been proven. We investigated whether metoprolol controlled release/extended release (CR/XL) once daily, in addition to standard therapy, would lower mortality in patients with decreased ejection fraction and symptoms of heart failure. METHODS: We enrolled 3991 patients with chronic heart failure in New York Heart Association (NYHA) functional class II-IV and with ejection fraction of 0.40 or less, stabilised with optimum standard therapy, in a double-blind randomised controlled study. Randomisation was preceded by a 2-week single-blind placebo run-in period. 1990 patients were randomly assigned metoprolol CR/XL 12.5 mg (NYHA III-IV) or 25.0 mg once daily (NYHA II) and 2001 were assigned placebo. The target dose was 200 mg once daily and doses were up-titrated over 8 weeks. Our primary endpoint was all-cause mortality, analysed by intention to treat. FINDINGS: The study was stopped early on the recommendation of the independent safety committee. Mean follow-up time was 1 year. All-cause mortality was lower in the metoprolol CR/XL group than in the placebo group (145 [7.2%, per patient-year of follow-up]) vs 217 deaths [11.0%], relative risk 0.66 [95% CI 0.53-0.81]; p=0.00009 or adjusted for interim analyses p=0.0062). There were fewer sudden deaths in the metoprolol CR/XL group than in the placebo group (79 vs 132, 0.59 [0.45-0.78]; p=0.0002) and deaths from worsening heart failure (30 vs 58, 0.51 [0.33-0.79]; p=0.0023). INTERPRETATION: Metoprolol CR/XL once daily in addition to optimum standard therapy improved survival. The drug was well tolerated.

  • 202.
    Herlitz, Johan
    [external].
    Effect of metoprolol on infarct size1983Inngår i: Cardiovascular information, ISSN 0281-0654, Vol. Special Issue, s. 29-33Artikkel i tidsskrift (Annet vitenskapelig)
  • 203.
    Herlitz, Johan
    [external].
    Effects of metoprolol on development and size of infarction1986Inngår i: Primary Cardiology, ISSN 0363-5104, Vol. 1, s. 22-27Artikkel i tidsskrift (Annet vitenskapelig)
  • 204.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    En letal komplikation till icke utförd koronarangiografi1978Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 75Artikkel i tidsskrift (Fagfellevurdert)
  • 205.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Epidemiologi kring icke kardiella hjärtstopp2014Konferansepaper (Annet vitenskapelig)
  • 206.
    Herlitz, Johan
    [external].
    Förekomsten av livshotande allergiska reaktioner efter trombolys otillfredställande belyst1991Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 88, nr 38, s. 3061-3064Artikkel i tidsskrift (Fagfellevurdert)
  • 207.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hjärtinfarktvård under lupp: De länsvisa öppna jämförelserna måste utvecklas och bli mer trovärdiga2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 35, s. 2117-Artikkel i tidsskrift (Annet vitenskapelig)
  • 208.
    Herlitz, Johan
    [external].
    Hjärtinfarktvård under lupp: De länsvisa öppna jämförelserna måste utvecklas och bli mer trovärdiga2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 35, s. 2117-Artikkel i tidsskrift (Fagfellevurdert)
  • 209.
    Herlitz, Johan
    [external].
    Hjärtstopp. Här står vi och dit går vi2010Inngår i: Incitament, ISSN 1103-503x, Vol. 19, nr 2, s. 85-88Artikkel i tidsskrift (Annet vitenskapelig)
  • 210.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    How should registers improve Emergency Care2016Konferansepaper (Annet vitenskapelig)
  • 211.
    Herlitz, Johan
    [external].
    Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients1994Inngår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 343, nr 8893, s. 311-322Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Large randomised trials have demonstrated that fibrinolytic therapy can reduce mortality in patients with suspected acute myocardial infarction (AMI). The indications for, and contraindications to, this treatment in some categories of patient are disputed, examples being late presentation, elderly patients, and those in cardiogenic shock. This overview aims to help resolve some of the remaining uncertainties. From all trials of fibrinolytic therapy versus control that randomised more than 1000 patients with suspected AMI, information was sought and checked on deaths during the first 5 weeks and on major adverse events occurring during hospitalisation. The nine trials included 58,600 patients, among whom 6177 (10.5%) deaths, 564 (1.0%) strokes, and 436 (0.7%) major non-cerebral bleeds were reported. Fibrinolytic therapy was associated with an excess of deaths during days 0-1 (especially among patients presenting more than 12 h after symptom onset, and in the elderly) but this was outweighed by a much larger benefit during days 2-35. This "early hazard" should not obscure the very clear overall survival advantage that is produced by fibrinolytic therapy. Benefit was observed among patients presenting with ST elevation or bundle-branch block (BBB)--irrespective of age, sex, blood pressure, heart rate, or previous history of myocardial infarction or diabetes--and was greater the earlier treatment began. Among the 45,000 patients presenting with ST elevation or BBB the relation between benefit and delay from symptom onset indicated highly significant absolute mortality reductions of about 30 per 1000 for those presenting within 0-6 h and of about 20 per 1000 for those presenting 7-12 h from onset, and a statistically uncertain benefit of about 10 per 1000 for those presenting at 13-18 h (with more randomised evidence needed in this latter group to assess reliably the net effects of treatment). Fibrinolytic therapy was associated with about 4 extra strokes per 1000 during days 0-1: of these, 2 were associated with early death and so were already accounted for in the overall mortality reduction, 1 was moderately or severely disabling, and 1 was not. This overview indicates that fibrinolytic therapy is beneficial in a much wider range of patients than is currently given such treatment routinely.

  • 212.
    Herlitz, Johan
    [external].
    Intervention programs to reduce patients delays in acute myocardial infarction. Proceedings from the second national congress of chest pain centers in emergency centrals1996Inngår i: Clinician, Vol. 14, s. 29-30Artikkel i tidsskrift (Fagfellevurdert)
  • 213.
    Herlitz, Johan
    [external].
    Kanske två lika viktiga parametrar för skydd mot åderförkalkning2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 43, s. 3272-3273Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Inställningen till LDL-kolesterolsänkning vid kranskärlssjukdom har dramatiskt förändrats de senaste 30 åren. Kanske är behandlingstidens längd en väl så viktig parameter som graden av LDL-kolesterolsänkning för skydd mot åderförkalkning.

  • 214.
    Herlitz, Johan
    [external].
    Klena data om läkemedel vid hjärtstopp. Omfattande, randomiserade studier behövs: vasopressin möjligt alternativ2005Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, nr 49, s. 3777-3778Artikkel i tidsskrift (Fagfellevurdert)
  • 215.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kunskapen bakom kedjan som räddar liv2014Konferansepaper (Annet vitenskapelig)
  • 216.
    Herlitz, Johan
    [external].
    Long-term prognosis after early intervention tieh petoprolol in susptected acute myocardial infarction: experiences from the MIAMI Trial1991Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 230, nr 3, s. 233-238Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A total of 5778 patients with suspected acute myocardial infarction were randomized to early intravenous metoprolol followed by oral treatment for 15 d, or to placebo. Thereafter, the two groups were treated similarly. During a 1-year follow-up period the mortality in patients who were randomized to early metoprolol was 10.6% compared to 10.7% for placebo (P greater than 0.2). Among patients with a higher risk of death, the tendency towards a reduced mortality in the metoprolol group that was observed after 15 d remained similar after 1 year. It is concluded that early intervention with metoprolol in suspected acute myocardial infarction did not improve the long-term prognosis compared to placebo treatment.

  • 217.
    Herlitz, Johan
    [external].
    Management of pain in patients with acute myocardial infarction1990Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 77, nr 6, s. 421-423Artikkel i tidsskrift (Fagfellevurdert)
  • 218.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Arrhythmias. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 35-38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Forty-five patients in the placebo (1.5%) and 29 in the metoprolol (1%) groups, respectively, were receiving antiarrhythmic drugs on a long-term basis before entry into the trial. Before randomization, 2.2% (n = 64) of the placebo and 1.7% (n = 50) of the metoprolol patients developed ventricular fibrillation (VF) in the hospital. The corresponding figures for atrial fibrillation or flutter were 3% (n = 87) and 3.3% (n = 94). After randomization, there was no significant difference in the number of patients who developed VF in the placebo (n = 52) and the metoprolol (n = 48) groups. The total number of episodes of VF tended to be fewer in the metoprolol group (n = 67) compared with the placebo group (n = 96). The tendency was, however, not apparent until after 5 days. When the occurrence of VF was related to high- and low-mortality risk groups, any beneficial effect of metoprolol was confined mainly to the high-risk group. A similar proportion of patients underwent electric conversion for ventricular tachyarrhythmia in the 2 groups. Although antiarrhythmic drugs were intended to be given only for major ventricular tachyarrhythmias a large proportion of patients received such treatment. Significantly more patients were treated with antiarrhythmics in the placebo (21.5%) than in the metoprolol group (19.2%, p = 0.03) during the study period, but predominantly during the first 5 days. Atrial fibrillation or flutter and other supraventricular tachyarrhythmias were significantly less frequent in the metoprolol than in the placebo group, as was the use of cardiac glycosides.

  • 219.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Development of myocardial infarction. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 23-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of metoprolol on the development of an acute myocardial infarction (AMI) during days 0 to 3 and on late first and recurrent infarctions during days 4 to 15 has been investigated. Signs on electrocardiogram (ECG) were well balanced between the treatment groups at entry; 70% of patients had signs of suspected AMI and 19% of patients had normal ECGs. The remaining patients had abnormal ECGs but actual infarction could not be localized. The localization of suspected AMI was equivalently distributed in the 2 groups before randomization. Metoprolol altered the distribution of patients diagnosed during days 0 to 3 as having definite, possible or no AMI (p less than 0.02). In the placebo group, there were more patients with definite AMI (72.5% vs 70.5%) and less with possible AMI (5.6% vs 7.4) than in the metoprolol group. A larger proportion of patients developed a Q-wave infarction during days 0 to 3 in the placebo group (53.9%) compared with the metoprolol group (50.9%, p = 0.024). No difference in the effect of metoprolol regarding localization of the early AMI was observed. Late first myocardial infarction development (days 4 to 15) was observed in 20 patients (0.7%) in each group. Recurrent myocardial infarction tended to develop more frequently during days 4 to 15 in the placebo group compared with the metoprolol group (3.9% vs 3.0%, p = 0.08).

  • 220.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Enzymatic estimation of infarct size. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 27-29Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The maximum serum activity for aspartate aminotransferase (s-ASAT) during the first 3 days was recorded in 5,507 patients with suspected or definite acute myocardial infarction. The s-ASAT activity was corrected for the normal range from each center. The median s-ASAT activity was 4.9 arbitrary units in the placebo group versus 4.6 arbitrary units in the metoprolol group (p = 0.072). Univariate analyses indicated that the delay time between onset of symptoms and randomization and sympathetic activity at entry significantly influenced the effect of metoprolol. A similar decrease in serum enzyme activity after metoprolol treatment was observed independent of signs of infarct localization on the entry electrocardiogram.

  • 221.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Mortality. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 15-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    After 15 days there were 142 deaths in the placebo group (4.9%) and 123 deaths in the metoprolol group (4.3%), a difference of 13% (p = 0.29). The 95% confidence limits for the relative effect of metoprolol ranged from an 8% excess (-8%) to a 33% reduction (+33%) in mortality. There was generally a lower mortality rate for metoprolol-treated patients in most subgroups and a consistent tendency for a more pronounced difference between the treatment groups in those subgroups with a placebo mortality rate higher than the average for all placebo patients. Most deaths were cardiac and occurred among patients who developed a definite myocardial infarction (97%) and most of these had a Q-wave infarction (83%). Using a simple model, the placebo mortality was found to increase with increasing number of 8 risk predictors defined from prestudy experience, from 0% in patients with no risk predictors to 11.6% in patients with any 5 or more of these risk factors. Similarly, there was an increase in the difference between the treatment groups in favor of metoprolol with increasing number of placebo risk factors. Metoprolol had no apparent effect in a low-mortality risk group (less than or equal to 2 risk factors), but there was a difference in mortality of 29% in favor of metoprolol in a high-risk group (greater than or equal to 3 risk factors) comprising one-third of the trial population.

  • 222.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Narcotic analgesics and other antianginal drugs. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 30-34Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of metoprolol on chest pain has been assessed in terms of the duration and the use of narcotic analgesics, nitrates and calcium-channel blockers. Fewer metoprolol-treated patients in the MIAMI trial were given narcotic analgesics (49% of the placebo patients vs 44% of the metoprolol patients, p less than 0.001), nitrates (55% vs 53%, p = 0.10) and calcium-channel blockers (12% vs 9%, p less than 0.001). A total number of 6,697 dose equivalents of narcotic analgesics were given to the placebo group compared with 5,493 dose equivalents to the metoprolol group, a difference of 18% (p less than 0.001). Mean dose equivalents were 2.3 and 1.9, respectively. The analysis of the total use of the 3 types of treatment for ischemic chest pain showed a significantly less frequent use of treatment for chest pain in the metoprolol group than in the placebo group (p less than 0.004). The relative difference in the incidence of drug treatment tended to be more striking for patients with maximal therapy, i.e., receiving high doses of narcotic analgesics, nitrates and calcium-channel blockers. There were 22% fewer patients receiving 4 or more doses of narcotic analgesics in the metoprolol group than in the placebo group. A multivariate analysis disclosed that site of suspected infarction, delay time, entry systolic blood pressure and metoprolol treatment all had a significant effect on the use of narcotic analgesics. There was a nonsignificant tendency for heart rate to be of importance. In the placebo group the use of narcotic analgesics increased with decreasing delay time and increasing systolic blood pressure.

  • 223.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Other clinical findings and tolerability. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 39-46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Fifteen minutes after injection there was a fall in mean heart rate (18%, p less than 0.001), systolic blood pressure (10%, p less than 0.001) and rate-pressure product (27%, p less than 0.0001) in the metoprolol group of patients in the MIAMI trial. Hypotension and bradycardia not necessarily associated with withdrawal of drug were more common in the metoprolol group (p less than 0.001). Atrioventricular block I was more common in the metoprolol group (p less than 0.03), whereas no such difference was observed for atrioventricular block II and III, asystole or pacemaker implantations. Left ventricular failure was observed no more often in the metoprolol group. The occurrence of cardiogenic shock also did not differ between the groups. Cardiac glycosides were used more in the placebo group, but diuretic and furosemide usage did not differ. For all patients mean furosemide doses and number of diuretic injections were similar in both treatment groups. Atropine (4.1 vs 6.4%) and sympathomimetic (3.2 vs 4.6%) agents were used more often in the metoprolol group during days 0 to 5 (p less than 0.05). The trial medication was withdrawn temporarily more often in the metoprolol than in the placebo group (p less than 0.001). However, permanent withdrawal of trial medication occurred with a similar frequency overall in both groups. More patients were withdrawn from the study because of cardiovascular reasons in the metoprolol group (9%) than in the placebo group (5%, p less than 0.001).

  • 224.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Patient population. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 10-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During the recruitment phase of the MIAMI trial (December 1982 to March 1984), data on 26,439 patients eligible for inclusion were entered. Of these, 5,778 patients were included. Current treatment with either beta blockers or calcium-channel blockers (51%) was the most predominant reason for exclusion. The randomized and excluded patients differed. The randomized patients were younger and more often men. The mean age of the patients was 59 years in both the placebo and the metoprolol groups. The 2 groups were evenly balanced with regard to basic demographic variables. The median delay between onset of symptoms and randomization was 7 hours, and 25% of the patients were included within 4 hours. Previous clinical history and pharmacologic treatment given before admission were well balanced in the groups. Mean heart rate for the 2 groups before randomization was 83 beats/min and systolic blood pressure was 141 mm Hg. Approximately 15% of randomized patients presented with pulmonary rales. Before randomization 20% of the patients had normal electrocardiograms; 70% could be classified as having electrocardiographic signs of acute myocardial infarction; and 10% presented with other electrocardiographic abnormalities. Electrocardiographic signs at entry suggested a predominance of anterior wall infarctions. The randomized patients were not representative of eligible patients and the treatment groups were well balanced at entry.

  • 225.
    Herlitz, Johan
    [external].
    Metoprolol in acute myocardial infarction. Patients and methods. The MIAMI Trial Research Group1985Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 56, nr 14, s. 3-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effects of early intervention with metoprolol in patients with suspected or definite acute myocardial infarction (AMI) have been assessed in a randomized, double-blind, placebo-controlled international study. Patients aged 75 years or younger were eligible for entry if they presented to a coronary care unit within 24 hours of the onset of symptoms of an AMI. Exclusion criteria included current treatment with a beta blocker or calcium-channel blocker, heart rate less than or equal to 65 beats/min, systolic blood pressure less than or equal to 105 mm Hg, contraindications and other administrative reasons. Treatment began with an intravenous loading dose (3 X 5 mg injections of metoprolol or placebo at 2-minute intervals) followed by an oral regime of 200-mg metoprolol daily or placebo. The study period was 15 days in addition to the day of randomization. The patients' clinical history and status at entry were documented. The following outcome variables were recorded: mortality, development of AMI, serum enzyme activity, electrocardiographic signs of AMI, late or recurrent AMI, arrhythmias, treatment of chest pain, concomitant treatment, adverse events and details of treatment with trial medication.

  • 226.
    Herlitz, Johan
    [external].
    MIAMI trial development of myocardial infarction1985Inngår i: Drugs, ISSN 0012-6667, E-ISSN 1179-1950, Vol. 29, nr 1, s. 4-Artikkel i tidsskrift (Fagfellevurdert)
  • 227. Herlitz, Johan
    Möjligheter att begränsa infarktstorleken med betablockad på människa1982Inngår i: Ischemisk hjärtsjukdom / [ed] Å Hjalmarson, E Varnauskas, Lindgren & Söner AB , 1982, s. 220-226Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 228.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Nyheter från det Svenska Hjärt-Lungräddningsregistret2012Konferansepaper (Annet vitenskapelig)
  • 229.
    Herlitz, Johan
    [external].
    Nyttjas betablockad optimalt i tidiga skedet av misstänkt hjärtinfarkt?1994Inngår i: Hässle Information, ISSN 0346-9751, Vol. 5, nr 94, s. 25-27Artikkel i tidsskrift (Fagfellevurdert)
  • 230.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Post resuscitation care. Letter to editor2007Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, nr 1, s. 163-164Artikkel i tidsskrift (Annet vitenskapelig)
  • 231.
    Herlitz, Johan
    [external].
    Post-discharge survival following pre-hospital cardiopulmonary arrest due to cardiac aetiology: temporal trends and impact of changes in clinical management.2006Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 27, nr 4, s. 377-378Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 232.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rapport från det Svenska Hjärt-lungräddningsregistret2015Konferansepaper (Annet vitenskapelig)
  • 233.
    Herlitz, Johan
    [external].
    Rationale, design, and organisation of the metoprolol CR/XL randomized trial in heart failure (MERIT-HF)1997Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 80, nr 9B, s. 54-58Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Metoprolol is a cardioselective beta blocker that has been shown to improve left ventricular function and symptoms of congestive heart failure (CHF) and also to decrease the number of hospitalizations due to CHF. However, the effects of metoprolol on mortality in patients with CHF have yet to be determined. Accordingly, the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF) has been designed to investigate the effect of once-daily dosing of metoprolol succinate controlled release/extended release (CR/XL) when added to standard therapy in patients with CHF. A total of 3,200 patients will be recruited for this international, double-blind, randomized, placebo-controlled survival study. The 2 primary objectives of MERIT-HF are to determine the effect of metoprolol CR/XL on (1) total mortality and (2) the combined endpoint of all-cause mortality and all-cause hospitalizations (time to first event). Eligible patients are 40-80 years old, with a reduced left ventricular ejection fraction (< or =0.40) and symptoms of CHF (New York Heart Association functional classes II-IV). After a 2-week placebo run-in period, an optimal allocation procedure will be used to randomize patients in a 1:1 ratio to metoprolol CR/XL or matching placebo. After an initial titration phase starting with 12.5 mg or 25 mg once daily (depending on functional class), the target dose will be 200 mg in all patients who tolerate this dose. The mean follow-up is estimated to be 2.4 years. The study data will be analyzed on an intention-to-treat basis. An Independent Safety Committee will monitor the safety aspects of the trial, and an Independent Endpoint Committee will classify all endpoints.

  • 234.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Report from the Swedish Cardiac Arrest Register2011Konferansepaper (Fagfellevurdert)
  • 235.
    Herlitz, Johan
    [external].
    Secondary Prevention After Coronary Artery Bypass Graft Surgery2004Inngår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, s. 69-74Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
    Abstract [en]

    There is insufficient knowledge about secondary prevention after coronary artery bypass grafting (CABG). Most of it is gathered from patients suffering from myocardial infarction and angina pectoris, only a minority of whom have undergone CABG. Whereas it seems clear that these patients should give up smoking and reduce low‐density lipoprotein (LDL) cholesterol, there is uncertainty about the optimal antiplatelet regimen and antithrombotic treatment. There are some data indicating the benefit of behaviour modification. There is room for improvement and more knowledge when it comes to secondary prevention after CABG.

  • 236.
    Herlitz, Johan
    [external].
    Stig Holmberg: A visionary giant in cardiopulmonary resuscitation2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 68, nr 1, s. 5-7Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    “How does it feel to be so small?” This question was addressed to Stig on the day of his retirement, when a couple of hundred people had assembled to acknowledge his skilful work over the years. “I don’t understand what you mean”, was the reply. “It's you guys who are unnecessarily tall.” Stig was born in 1927 and started his medical career as a surgeon in the north of Sweden. He came to Sahlgrenska University Hospital in Göteborg in 1962 at the age of 35. Here, he started working in internal medicine but switched to cardiology in 1963 and continued as a cardiologist at this hospital until he retired in 1992.

  • 237.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Survival after out of hospital cardiac arrest in relation to whether bystander CPR was performed by lay persons or health care professionals2012Konferansepaper (Annet vitenskapelig)
  • 238.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svenska hjärt-lungräddningsregistret: Årsrapport 20122012Rapport (Annet vitenskapelig)
    Abstract [sv]

    Det Svenska Hjärt-lungräddningsregistret (tidigare benämnt det svenska hjärtstoppsregistret) är det enda kvalitetsregistret i Sverige (oss veterligen) som rapporterar hur många människoliv som verksamheten räddar årligen. För år 2011 rapporterar registret att 1000 patienter räddades till livet efter ett plötsligt och oväntat hjärtstopp i Sverige. Av dessa har 500 inträffat innanför sjukhusets väggar och 500 utanför sjukhusets väggar. Bland samtliga överlevande har det stora flertalet (mer än 90 %) en god eller en relativt god cerebral funktion.

  • 239.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Svenska hjärt-lungräddningsregistret.: Årsrapport20152015Rapport (Annet vitenskapelig)
  • 240.
    Herlitz, Johan
    [external].
    The importance of reducing delay in acute myocardial infarction1996Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, nr 3, s. 338-340Artikkel i tidsskrift (Fagfellevurdert)
  • 241.
    Herlitz, Johan
    [external].
    The MACB Study Group. Effect of metoprolol on death and cardiac events during a 2-year period after coronary artery bypass grafting1995Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 16, nr 12, s. 1825-1832Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 242.
    Herlitz, Johan
    [external].
    Very early trombolytic therapy in suspected acute myocardial infarction1990Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 65, nr 7, s. 401-407Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Three hundred fifty-two patients with suspected acute myocardial infarction (AMI) were randomized to placebo (175) or tissue-type plasminogen activator (rt-PA) (177). Patients were eligible if evaluated within 165 minutes from onset of chest pain and if age was <75 years. Electrocardiographic criteria were not required. A mobile coronary care unit with a cardiologist present was used to initiate treatment at home in 29% of the patients. Primary endpoints were infarct size (serum lactate dehydrogenase isoenzyme1 activity), left ventricular function (radioangiography) and exercise capacity at 30 days. AMI was diagnosed in 59% of all randomized patients. The incidence was similar in the 2 groups (placebo, 108, rt-PA, 101). Among all randomized patients, rt-PA was associated with significantly decreased infarct size and an increased ejection fraction. Among rt-PA-treated patients there were significantly fewer Q-wave infarctions. No difference in exercise capacity could be detected. No benefit was found in subgroups of patients without ST-segment elevation on the initial electrocardiogram. There were 18 (10.3%) and 11 (6.2%) deaths (p = 0.23) within 30 days in the placebo and rt-PA groups, respectively. Adverse reactions were similar in both groups with no excess of complications in the home-treated group. Very early treatment with rt-PA in patients with a strong suspicion of AMI and ST-segment elevation limits infarct size and improves left ventricular function. The infarct pattern is shifted from Q-wave to non-Q-wave infarcts by rt-PA. The study suggests that thrombolysis can be given before hospital admission without additional risk. Furthermore, etectrocardiographic records are useful for selection of patients.

  • 243.
    Herlitz, Johan
    [external].
    Vård i den initiala fasen av misstänkt hjärtinfarkt. Kunskaperna brister, behandlingen i kläm1997Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 28-29, s. 2536-2538Artikkel i tidsskrift (Fagfellevurdert)
  • 244.
    Herlitz, Johan
    [external].
    Warfarin i kombination med ASA imponerar. Anrika medel minskar reinfarkt- och strokerisk efter akut koronart syndrom2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, nr 30-31, s. 2208-2209Artikkel i tidsskrift (Fagfellevurdert)
  • 245.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Är etikprövningslagen i sin nuvarande form tillämpbar på patienter med akuta livshotande sjukdomstillstånd2011Konferansepaper (Fagfellevurdert)
  • 246.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Årsrapport för Svenska Hjärt-Lungräddningsregistret2016Rapport (Annet vitenskapelig)
  • 247.
    Herlitz, Johan
    [external].
    Överlevnad efter hjärtstopp på sjukhus2001Inngår i: Akuttjournalen: Tidsskrift for avansert akuttmedisin, ISSN 0805-6129, E-ISSN 1500-7480, Vol. 98, s. 152-157Artikkel i tidsskrift (Fagfellevurdert)
  • 248.
    Herlitz, Johan
    et al.
    [external].
    Abrahamsson, P
    Dellborg, M
    Karlson, BW
    Karlsson, T
    Lindqvist, J
    Long term survival after development of acute myocardial infarction has improved after a more widespread use of thrombolysis and aspirin1999Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 91, nr 4, s. 250-255Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

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

  • 249.
    Herlitz, Johan
    et al.
    [external].
    Albertsson, P
    Brandrup-Wognsen, G
    Emanuelsson, H
    Haglid, M
    Hartford, M
    Hjalmarson, Å
    Karlsson, T
    Karlson, BW
    Sandén, W
    Predictors of hospital readmission two years after coronary artery bypass grafting1997Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 77, nr 5, s. 437-442Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To determine the clinical factors before, and in association with, coronary artery bypass grafting (CABG) that increase the risk of readmission to hospital in the first two years after surgery. PATIENTS: All patients in western Sweden who had CABG without simultaneous valve surgery between 1 June 1988 and 1 June 1991. METHODS: All patients who were readmitted to hospital were evaluated by postal inquiry and hospital records. RESULTS: A total of 2121 patients were operated on, of whom 2037 were discharged from hospital. Information regarding readmission was missing in four patients, leaving 2033 patients; 44% were readmitted to hospital. The most common reasons for readmission were angina pectoris and congestive heart failure. There were 12 independent significant predictors for readmission: clinical history (a previous history of either congestive heart failure or myocardial infarction, or CABG); acute operation; postoperative complications (time in intensive care unit greater than two days, neurological complications); clinical findings four to seven days after the operation (arrhythmia, systolic murmur equivalent to mitral regurgitation); medication four to seven days after the operation (antidiabetics, diuretics for heart failure, other antiarrhythmics (other than beta blockers, calcium antagonists, and digitalis), and lack of treatment with aspirin). CONCLUSION: 44% of patients were readmitted to hospital two years after CABG. The most common reasons for readmission were angina pectoris and congestive heart failure. Four clinical markers predicted readmission: clinical history; acute operation status; postoperative complications; and clinical findings and medication four to seven days after operation.

  • 250.
    Herlitz, Johan
    et al.
    [external].
    Albertsson, P
    Haglid, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Sandén, W
    The cost-benefit balance of coronary artery bypass grafting: need for hospitalization during two years before and the two years after1996Inngår i: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 44, nr 5, s. 239-244Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To derive and compare the need for hospitalization during 2 years prior to coronary artery bypass grafting (CABG) and 2 years after, all the patients from western Sweden in whom CABG without simultaneous valve surgery was performed between June 1988 and June 1991 were evaluated. Hospitalization prior to and after surgery was derived via questionnaires sent to the patients and via data from their hospital medical record forms. In all, 2099 patients were studied. The mean total number of days in hospital was 16 during the 2 years before and 24 including surgery and postoperative complications during the 2 years after the operation (p < 0.001). When the days for operation and postoperative complications were excluded, the mean number of days after operation was 7 (p < 0.001). Hospitalization due to myocardial infarction, angina pectoris, percutaneous transluminal coronary angioplasty and other investigations for heart disease were significantly reduced after CABG. On the other hand, hospitalization due to chest pain with causes other than ischemic heart disease, congestive heart failure, arrhythmias, and reoperation was more frequent during the 2 years after surgery. The total number of days in hospital was higher during the 2 years after CABG than during the 2 years before, despite the fact that hospitalization due to ischemic events was significantly reduced after the operation.

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