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  • 251.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Hjalmarson, Å
    Early use of metoprolol and serum potassium in suspected acute myocardial infarction1989Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 22, nr 2, s. 169-175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 1350 patients with suspected acute myocardial infarction, serum potassium was analysed in the emergency ward. The effect of metoprolol was compared with placebo in a double-blind randomized trial. Metoprolol increased serum potassium from 4.11 ± 0.02 mmol/l to 4.27 ± 0.02 mmol/l (P<0.001) during the 1st day after hospital admission, whereas serum potassium levels remained fairly constant in patients given placebo during the same time (4.11 ± 0.02 to 4.14 ± 0.02 mmol/l; P>0.2). Similar results were obtained when analysing patients with a confirmed myocardial infarction separately. The effects appeared homogeneously distributed in subgroups related to sex, clinical history, infarct site, infarct size and delay time from onset of symptoms to start of treatment. We conclude that early treatment with the beta-1-selective blocker metoprolol in patients with suspected acute myocardial infarction increases serum potassium.

  • 252.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Hjalmarson, Å
    Karlsson, BW
    Morbidity during five years after myocardial infarction and its relation to infarct size1988Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 11, nr 10, s. 672-677Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 809 patients with a recent myocardial infarction, morbidity during 5-year follow-up was assessed. The overall 5-year mortality rate was 33% (39% in patients with larger infarcts and 26% in patients with smaller infarcts) as judged from maximum serum enzyme activity (p<.001). In terms of morbidity, no significant association with estimated infarct size was observed. Patients with smaller infarcts tended to have a higher reinfarction rate and were rehospitalized more often, whereas a similar proportion of patients with large and small infarcts developed stroke. Among survivors, chest pain tended to be more common in patients having smaller infarcts, whereas symptoms of dyspnea and claudicatio intermittens were similar in both groups, as were smoking habits, work capability, and varying forms of medication. We thus conclude that during a 5-year follow-up after acute myocardial infarction, mortality, but not morbidity, was related to the original infarct size.

  • 253.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Hjalmarson, Å
    Wilhelmsen, L
    Body temperature in acute myocardial infarction and its relation to early intervention with metoprolol1988Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 20, nr 1, s. 65-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a subsample of 223 patients participating in a double-blind trial with metoprolol in suspected acute myocardial infarction, body temperature during the first 5 days in hospital was recorded. Patients developing infarction had a mean temperature of 37.3°C compared with 36.8° C for those with no infarction (P < 0.001). A positive association was observed between enzyme-estimated infarct size and body temperature (P < 0.001). Patients given metoprolol had a mean temperature of 37.0° C as compared with 37.2° C in those given placebo (P = 0.03). The most marked difference between metoprolol and placebo was observed among those treated very early. We conclude that early treatment with metoprolol in suspected acute myocardial infarction appears to lower body temperature during the following days. This might reflect limitation of the infarct size.

  • 254.
    Herlitz, Johan
    et al.
    [external].
    Bengtsson, A
    Wiklund, J
    Hjalmarson, Å
    Morbidity and quality of life five years after early intervention with metoprolol in suspected acute myocardial infarction1988Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 75, nr 5, s. 357-364Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 1,395 patients in the age range 40-74 years participating in a double-blind trial with metoprolol in suspected acute myocardial infarction morbidity and quality of life were assessed during the first 5 years after randomization. During the first 3 months patients were given 200 mg metoprolol daily or placebo. Thereafter the two groups were treated similarly. Mortality during 5 years was 24.2% in patients originally randomized to metoprolol versus 25.7% in patients originally randomized to placebo (p greater than 0.2). No difference was observed regarding reinfarction rate, stroke or occurrence of bypass surgery during the 5-year follow-up. During the first 3 months 10% of patients in the metoprolol group were rehospitalized for various reasons versus 13% in the placebo group. The corresponding figures for 5 years were 59 and 60%, respectively. Among patients surviving 5 years 84% in both groups were on some medication of which beta-blockade was the dominating one. Symptoms of chest pain, dyspnea, claudicatio, smoking habits and working capacity did not differ and neither did quality of life according to the Nottingham Health Profile. We thus conclude that morbidity and quality of life were not significantly affected 5 years after early intervention with metoprolol in patients with suspected acute myocardial infarction.

  • 255.
    Herlitz, Johan
    et al.
    [external].
    Berggren, H
    Ekroth, R
    Hjalmarson, Å
    Waldenström, A
    William-Olsson, G
    Electrocardiographic changes and their relation to serum enzyme activity after heart surgery1984Ingår i: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 32, nr 6, s. 365-368Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 80 patients who underwent heart surgery the incidence of electrocardiographic (ECG) changes after the operation was analysed. A precordial grid containing 24 leads and leads II, III and aVF was used. Electrocardiographic measurements were taken the day before the operation and again 5 days after the operation. New Q-waves were observed in 2 patients (2.5%) in the 24 precordial leads, in 2 patients in leads II, III and aVF, and in one patient in both precordial leads and leads II, III and aVF. New T-wave inversions were observed in 20 patients (25%) in the 24 precordial leads, in 5 patients (6%) in leads II, III and aVF, and in 3 patients in both precordial leads and leads II, III and aVF. A similar serum enzyme activity was observed both in patients developing Q-waves as well as T-wave inversions compared with cases in whom ECG changes did not appear.

  • 256.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Ekström, L
    Karlsson, BW
    Risenfors, M
    Wennerblom, B
    Holmberg, S
    Kampanj: Hjärta - Smärta 90.000. Ett försök att förkorta fördröjningstiden vid misstänkt akut hjärtinfarkt1988Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 85, s. 1999-2001Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 257.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Hjalmarson, Å
    Holmberg, S
    Karlsson, BW
    Delay time in suspected acute myocardial infarction and the importance of its modification1989Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 12, nr 7, s. 370-374Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper summarizes the present knowledge of delay time in suspected acute myocardial infarction. More than 50% of deaths in acute myocardial infarction occur outside of the hospital setting. Recent experiences indicate that early and even late mortality can be dramatically reduced by intervention in the early phase. This points up the importance of bringing patients with suspected acute myocardial infarction to the hospital as early in the course of MI as possible. The predominating cause of delay is the time it takes for the patient to decide to go to hospital regardless of a previous history of cardiovascular disease. Patients arriving in hospital in later stages of MI are at a very high risk of mortality. Therefore one of the most important problems to be resolved is how to reduce delay time in suspected acute myocardial infarction. Such efforts have been surprisingly few. Limited experiences indicate that public education can reduce delay time dramatically.

  • 258.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Karlson, BW
    Luepker, R
    Holmberg, S
    Risenfors, M
    Wennerblom, B
    Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction1992Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 13, nr 2, s. 171-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 259.
    Herlitz, Johan
    et al.
    [external].
    Blohm, M
    Hartford, M
    Karlsson, BW
    Luepker, RV
    Holmberg, S
    Risenfors, M
    Wennerblom, B
    Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction1992Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 13, nr 2, s. 171-177Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 260.
    Herlitz, Johan
    et al.
    [external].
    Bondestam, E
    Hjalmarson, Å
    Holmberg, S
    Smärtintensitet och smärtduration vid akut hjärtinfarkt: en översikt1987Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 84, nr 24, s. 2112-2114Artikel i tidskrift (Refereegranskat)
  • 261.
    Herlitz, Johan
    et al.
    [external].
    Brandrup, G
    Emanuelsson, H
    Haglid, M
    Karlsson, T
    Karlson, BW
    Sandén, W
    Determinants of time to discharge following coronary artery bypass grafting1997Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 11, nr 3, s. 533-538Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe clinical factors prior to and at the time of coronary artery bypass grafting (CABG) associated with the number of days until hospital discharge. PATIENTS: All patients from western Sweden in whom during the time period June 1 1988-June 1 1991 CABG was performed without simultaneous valve surgery. METHODS: The time between operation and hospital discharge was calculated for every patient and related to various factors prior to and at the operation. RESULTS: Among 2035 patients the time between operation and discharged alive from hospital varied between 2 and 191 days (median 15 days). When simultaneously considering pre-, per- and postoperative factors the following appeared as independent predictors for a longer hospital time: age (years) (P < 0.0001); female sex, (P < 0.0001); time in respirator (P = 0.0004); previous congestive heart failure (P = 0.0007); reoperation (P = 0.0008); neurological complication (P = 0.001); maximum activity of serum aspartate amino transferase (P = 0.002); pneumo/hydrothorax (P = 0.002), previous cerebrovascular disease (P = 0.004), non-smoker (P = 0.006); supraventricular arrhythmia (0.006); time in intensive care unit (P = 0.007); aortic cross-clamp time (P = 0.009); obesity (P = 0.02). CONCLUSION: A large number of pre- and postoperative factors are associated with an increased time between operation and time to discharge.

  • 262.
    Herlitz, Johan
    et al.
    [external].
    Brandrup, G
    Haglid, M
    Karlson, BW
    Albertsson, P
    Lurje, L
    Westberg, S
    Karlsson, T
    Death, mode of death, morbidity, and rehospitalization after coronary artery bypass grafting in relation to occurrence of and time since a previous myocardial infarction.1997Ingår i: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 45, nr 3, s. 109-113Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To describe the prognosis during 2 years after coronary artery bypass grafting (CABG) in relation to occurrence of and time since a previous acute myocardial infarction (AMI), data of all patients in western Sweden who underwent CABG without simultaneous valve surgery in the period June 1988-June 1991 were evaluated. In all, 2120 patients were included in the analyses. Of these, 1296 (61%) had a history of AMI and 127 (6%) had suffered an AMI within the last month before CABG. Mortality during the first 30 days after CABG was for patients with no previous AMI, previous AMI > 30 days prior to CABG, and previous AMI < or = 30 days prior to CABG 2.4%, 4.1%, and 5.5%, respectively (p < 0.05). The corresponding figures for the period between 30 days and 2 years after CABG were 3.6%, 4.4%, and 3.4% respectively (NS). In a multivariate analysis among patients with a previous AMI, a recent infarction (< or = 30 days prior to CABG) did not turn out as an independent predictor of death during 2 years of follow-up. A history of AMI was associated with increased mortality during the first 30 days but not thereafter, but recent AMI was not an independent predictor of total 2-year mortality.

  • 263.
    Herlitz, Johan
    et al.
    [external].
    Brandrup Wognsen, G
    Caidahl, K
    Haglid Evander, M
    Hartford, M
    Karlson, BW
    Karlsson, T
    Sjöland, H
    Symptoms of chest pain and dyspnea and factors associated with chest pain and dyspnea 10 years after coronary artery bypass grafting.2008Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 156, nr 3, s. 580-587Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The purpose of the study is to describe (a) changes in physical activity and symptoms of chest pain and dyspnea during 10 years after coronary artery bypass grafting (CABG) and (b) risk indicators for chest pain and dyspnea 10 years after CABG. METHODS: This is a prospective observational study in Western Sweden. The study includes all patients who underwent CABG without simultaneous valve surgery and with no previous CABG between June 1, 1988, and June 1, 1991. All patients were prospectively followed up for 10 years. Evaluation of symptoms took place via postal inquiries before, 5, and 10 years after the operation. RESULTS: In all, 2,000 patients participated in a survey evaluating chest pain and dyspnea during 10 years after CABG. The overall 10-year mortality was 32%. The proportion of patients with no chest pain increased from 3% before surgery to 56% 5 years after the operation and 54% after 10 years. There was only one predictor for chest pain after 10 years and that was the duration of angina pectoris before surgery. The proportion of patients with no dyspnea increased from 12% before surgery to 40% after 5 years but decreased to 31% after 10 years. The most significant predictors for dyspnea after 10 years were female sex, obesity, diabetes mellitus, high age, duration of angina pectoris, functional class before CABG, and number of days in intensive care unit after CABG. CONCLUSION: During 10 years after CABG, one third died. After 10 years, 54% of the survivors were free from chest pain and 31% were free from dyspnea. Predictors for chest pain and dyspnea could be defined and reflected age, history, sex, obesity, preoperative complications, and symptom severity.

  • 264.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Kranskärlskirurgi ofta effektiv även vid diabetes2001Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, s. 4830-4832Artikel i tidskrift (Refereegranskat)
  • 265.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid Evander, M
    Hartford, M
    Karlson, BW
    Karlsson, T
    Sjöland, H
    Determinants of an impaired quality of life ten years after coronary artery bypass surgery2005Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 98, nr 3, s. 447-452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To identify determinants of an inferior quality of life (QoL) 10 years after coronary artery bypass grafting (CABG). SETTING: Sahlgrenska University Hospital, Göteborg, Sweden. PARTICIPANTS: All patients from Western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery and no previous CABG. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL 10 years after the operation. Three different instruments were used: The Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the Physical Activity Score (PAS). RESULTS: 2000 patients underwent CABG, of whom 633 died during 10 years of follow-up. Information on QoL at 10 years was available in 976 patients (71% of survivors). A history of diabetes and chronic obstructive pulmonary disease were the two independent predictors for an inferior QoL with all three instruments. Furthermore, there were three predictors of an inferior QoL with two of the instruments: high age, female sex and a history of hypertension. A number of factors predicted an inferior QoL with one of the instruments. These were the duration of angina pectoris and functional class prior to CABG, renal dysfunction, a history of cerebrovascular disease, obesity, height, duration of respirator treatment and requirement of inotropic drugs postoperatively. In addition, when introducing preoperative QoL into the model a low QoL before surgery was a strong independent predictor also of an inferior QoL 10 years after CABG. CONCLUSION: Variables independently predictive of an impaired QoL 10 years after CABG, irrespective of the instrument used, were an impaired QoL prior to surgery, chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, the previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.

  • 266.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid Evander, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Sjöland, H
    Predictors of death during 10 years after coronary artery bypass grafting with particular emphasis on age2004Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 15, nr 3, s. 163-170Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe predictors of death during 10 years of follow-up after coronary artery bypass grafting (CABG); to evaluate whether age interacts with the influence of various predictors on outcome; and to compare the mortality during 10 years after CABG with the mortality in an age- and sex-matched control population. DESIGN: Prospective, observational study. SETTING: Department of Thoracic and Cardiovascular Surgery at Sahlgrenska University Hospital and Scandinavian Heart Centre in Göteborg, Sweden. PARTICIPANTS: All patients from western Sweden who underwent CABG between 1 June 1988 and 1 June 1991 without simultaneous valve surgery and with no previous CABG. MAIN OUTCOME MEASUREMENTS: All-cause mortality during 10 years but more than 30 days after CABG. RESULTS: In all, 2000 patients participated in the survey. The following factors appeared as independent predictors of death: preoperative factors-age, history of congestive heart failure, cerebrovascular disease, history of intermittent claudication, current smoking, degree of left ventricular impairment, valvular disease and duration of angina pectoris; peroperative factors-ventilator time and neurological complications; postoperative factors-arrhythmia, requirement of digitalis and requirement of antidiabetics. There was an interaction between age and history of cerebrovascular disease with a stronger impact on outcome in younger patients. The late (>30 days after CABG) 10-year mortality in the study cohort was 29.6% compared with 25.9% in the control population (P=0.02). CONCLUSION: Among patients who underwent CABG, 13 independent predictors for mortality were found, mainly among preoperative factors but also among peroperative factors, postoperative complications and medication requirement after CABG.

  • 267.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid, M
    Albertsson, P
    Karlson, BW
    Lurje, L
    Karlsson, T
    Hjalmarson, Å
    Death, mode of death, morbidity and requirement for rehospitalization during 2 years after coronary artery bypass grafting in relation to preoperative ejection fraction1996Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 7, nr 11, s. 807-812Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the impact of ejection fraction on the prognosis during 2 years after coronary artery bypass grafting (CABG). PATIENTS: All patients in western Sweden who underwent CABG without concomitant valve surgery between June 1988 and June 1991. RESULTS: In all, 2121 patients were operated upon and information on ejection fraction was available for 1961 patients (92%). Of these patients, 178 (9%) had an ejection fraction < 40%, 517 (26%) an ejection fraction of 40-59% and 1266 (65%) an ejection fraction > or = 60%. In these groups the mortalities during the first 30 days after CABG were 5.1, 4.3 and 2.2%, respectively (P < 0.01). The corresponding values for mortalities between 30 days and 2 years were 7.7, 4.3 and 3.3%, respectively (P < 0.01). Patients with a lower ejection fraction were more frequently men and more frequently had a history of cardiovascular disease. In multivariate analysis the preoperative ejection fraction was an independent predictor for total 2-year mortality. Patients with a low ejection fraction died more frequently in association with ventricular fibrillation. Morbidity was, with the exception of that for rehospitalization due to heart failure and infection, not associated significantly with the preoperative ejection fraction. CONCLUSION: During the 2 years after CABG a low preoperative ejection fraction was associated with a higher mortality, but the association with morbidity was more complex.

  • 268.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Sjöland, H
    Improvement and factors associated with improvement in quality of life during 10 years after coronary artery bypass grafting2003Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 14, nr 7, s. 509-517Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe (1) the improvement in various aspects of quality of life (QoL) and (2) predictors of improvement, during 10 years after coronary artery bypass grafting (CABG). PATIENTS AND METHODS: All patients who underwent CABG in western Sweden between June 1988 and June 1991 without simultaneous valve surgery and with no previous CABG were approached with an inquiry prior to and 5 and 10 years after the operation. QoL was measured with three different instruments: (1) Nottingham health profile (NHP), (2) psychological general well-being index (PGWBI) and (3) physical activity score (PAS). RESULTS: There was a significant improvement in QoL with all three instruments from before to 10 years after the operation. The mean improvements +/-SD were for NHP, - 4.2+/-17.0 (P<0.0001), for PGWBI, +9.7+/-17.6 (P<0.0001) and for PAS, -0.96+/-1.23 (P<0.0001). However, there was also a deterioration with all three instruments between 5 and 10 years after surgery. The mean deteriorations +/-SD were for NHP, +4.4+/-12.8 (P<0.0001), for PGWBI, -4.6+/-14.8 (P<0.0001) and for PAS, +0.44+/-0.94 (P<0.0001). Independent predictors for an improvement in QoL with at least one of the instruments were low preoperative QoL, a younger age, being a man, high functional class (New York Heart Association), no hypertension, proximal left anterior descending coronary artery stenosis, short extracorporeal circulation time, use of internal mammary artery and a short postoperative time in the intensive care unit. CONCLUSION: There is a higher estimated QoL 10 years after CABG than before, despite the fact that the patients are 10 years older. However, there is also a deterioration in QoL between 5 and 10 years after surgery. Predictors of improvement during the 10 years included age, sex, previous history, localization of stenosis, type of graft and preoperative and postoperative factors.

  • 269.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid, M
    Karlson, BW
    Karlsson, T
    Albertsson, P
    Lindelöw, B
    Mortality and morbidity among patients who undergo combined valve and coronary artery bypass surgery. Early and late results1998Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 12, nr 6, s. 836-846Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe mortality and morbidity early and late after combined valve surgery and coronary artery bypass grafting (CABG) as compared with CABG alone. PATIENTS and METHODS: All patients from western Sweden in whom CABG in combination with valve surgery or CABG alone was carried out in 1988-1991. RESULTS: Among 2116 patients who underwent CABG, 35 (2%) had this combined with mitral valve surgery and 134 (6%) had this combined with aortic valve surgery, whereas the remaining 92% underwent CABG alone. Patients who underwent combined valve surgery and CABG were older, included more women and had a higher prevalence of previous congestive heart failure and renal dysfunction but on the other hand a less severe coronary artery disease. Among patients who underwent mitral valve surgery in combination with CABG the mortality over the subsequent 5 years was 45%). The corresponding figure for patients who underwent aortic valve surgery in combination with CABG was 24%. Both were higher than for CABG alone (14%; P < 0.0001 and P = 0.003, respectively). In a stepwise multiple regression model mitral valve surgery in combination with CABG was found to be an independent significant predictor for death but aortic valve surgery in combination with CABG was not. Among patients who underwent mitral valve surgery in combination with CABG and were discharged alive from hospital 77% were rehospitalized during the 2 years following the operation as compared with 48% among patients who underwent aortic valve surgery in combination with CABG and 43% among patients with CABG alone. Multiple regression identified mitral valve surgery in combination with CABG as a significant independent predictor for rehospitalization but not aortic valve plus CABG. CONCLUSION: Among patients who either underwent CABG in combination with mitral valve surgery or aortic valve surgery or CABG alone, mitral valve surgery in combination with CABG was independently associated with death and rehospitalization, but the combination of aortic valve surgery and CABG was not.

  • 270.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Caidahl, K
    Haglid-Evander, M
    Hartford, M
    Karlsson, T
    Karlson, BW
    Sjöland, H
    Cause of death during 13 years after coronary artery bypass grafting with emphasis on cardiac death.2004Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 38, nr 5, s. 283-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the cause of death in the long term after coronary artery bypass grafting (CABG) with particular emphasis on cardiac death. PATIENTS AND SETTING: All the patients in western Sweden without simultaneous valve surgery and without previous CABG who underwent CABG in 1988-1991 in Göteborg, Sweden. DESIGN: Prospective, observational study for 10.6-13.6 years (i.e. until the end of 2001). Various factors contributing to death were described, with the emphasis on cardiac death. RESULTS: In all, 2000 patients were included in the survey. The all-cause mortality rate was 39%. Fifty-eight per cent of all deaths were judged as cardiac deaths. The most frequent cause of death was heart failure (65% among patients who died within 30 days after CABG and 36% among those who died >30 days after CABG). The second most common cause of death was myocardial infarction (56 and 29%, respectively), followed by cancer (0 and 24%, respectively), stroke (21 and 18%, respectively) and infection (8 and 11%, respectively). CONCLUSION: The factors most commonly contributing to death in the long term after CABG were, in order of frequency, heart failure, myocardial infarction, cancer, stroke and infection.

  • 271.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Emanuelsson, H
    Haglid, M
    Karlson, BW
    Karlsson, T
    Albertsson, P
    Westberg, S
    Mortality and morbidity in diabetic and non diabetic patients during a 2-year period after coronary artery bypass grafting1996Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 19, nr 7, s. 698-703Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe mortality and morbidity during a 2-year period after coronary artery bypass grafting (CABG) among diabetic and nondiabetic patients. RESEARCH DESIGN AND METHODS: All the patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom concomitant procedures were not performed were registered prospectively. The study was a prospective follow-up. RESULTS: Diabetic patients (n = 268) differed from nondiabetic patients (n = 1,859) in that more women were included, and the patients more frequently had a previous history of myocardial infarction (MI), hypertension, congestive heart failure, intermittent claudication, and obesity. Diabetic patients more frequently required reoperation and had a higher incidence of peri- and postoperative neurological complications. Mortality during the 30 days after CABG was 6.7% in diabetic patients versus 3.0% in nondiabetic patients (P < 0.01). Mortality between day 30 and 2 years was 7.8 and 3.6%, respectively (P < 0.01). During 2 years of follow-up, a history of diabetes appeared to be a significant independent predictor of death. Whereas the development of MI after discharge from the hospital did not significantly differ between the two groups; 6.3% of diabetic patients developed stroke versus 2.5% in nondiabetic patients (P < 0.001). CONCLUSIONS: Diabetic patients have a mortality rate during the 2-year period after CABG that is about twice that of nondiabetic patients during both the early and late phase after the operation.

  • 272.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Brandrup-Wognsen, G.
    Evander, MH
    Caidahl, K
    Hartford, M
    Karlson, BW
    Karlsson, T
    Karason, K
    Symptoms of Chest Pain and Dyspnoea during a Period of 15 Years after Coronary Artery Bypass Grafting2010Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, nr 1, s. 112-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting (CABG) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years. DESIGN: Prospective observational study in western Sweden. SUBJECTS: All patients who underwent first-time CABG, without simultaneous valve surgery, between 1 June 1988 and 1 June 1991. There were no exclusion criteria. FOLLOW-UP: All patients were followed up prospectively for 15 years. The evaluation of symptoms took place through postal questionnaires prior to and 5, 10 and 15 years after the operation. RESULTS: Totally, 2000 patients were included in the survey and 904 (45%) of them survived to 15 years. Among these 904 survivors, the percentage of patients with chest pain increased from 44% to 50% between the 5- and 15-year follow-up (p=0.004). The percentage of patients who reported symptoms of dyspnoea increased from 60% after 5 years to 74% after 15 years (p<0.001). Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age (p=0.04) and prolonged duration of symptoms prior to surgery (p=0.04). Predictors of dyspnoea after 15 years were higher age (p<0.0001), the use of inotropic drugs at the time of surgery (p=0.001), a history of diabetes (p=0.01) and obesity (p=0.01). CONCLUSION: After CABG, relief from chest pain and dyspnoea is generally maintained over a long period of time. Eventually, however, functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain, while three-quarters report dyspnoea after 15 years. Even if no clear predictor of chest pain was found at the time of surgery, age, the use of inotropic drugs, diabetes and obesity predicted dyspnoea.

  • 273.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Brandrup-Wognsen, G
    Evander, MH
    Libungan, B
    Sjoland, H
    Caidahl, K
    Hartford, M
    Karlson, BW
    Karlsson, T
    Karason, K
    Quality of Life 15 Years after Coronary Artery Bypass Grafting2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 6, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.

  • 274.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid Evander, M
    Caidahl, K
    Hartford, M
    Karlson, BW
    Karlsson, T
    Karason, nK
    Symptoms of chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting.2010Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 37, nr 1, s. 112-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting (CABG) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years. DESIGN: Prospective observational study in western Sweden. SUBJECTS: All patients who underwent first-time CABG, without simultaneous valve surgery, between 1 June 1988 and 1 June 1991. There were no exclusion criteria. FOLLOW-UP: All patients were followed up prospectively for 15 years. The evaluation of symptoms took place through postal questionnaires prior to and 5, 10 and 15 years after the operation. RESULTS: Totally, 2000 patients were included in the survey and 904 (45%) of them survived to 15 years. Among these 904 survivors, the percentage of patients with chest pain increased from 44% to 50% between the 5- and 15-year follow-up (p=0.004). The percentage of patients who reported symptoms of dyspnoea increased from 60% after 5 years to 74% after 15 years (p<0.001). Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age (p=0.04) and prolonged duration of symptoms prior to surgery (p=0.04). Predictors of dyspnoea after 15 years were higher age (p<0.0001), the use of inotropic drugs at the time of surgery (p=0.001), a history of diabetes (p=0.01) and obesity (p=0.01). CONCLUSION: After CABG, relief from chest pain and dyspnoea is generally maintained over a long period of time. Eventually, however, functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain, while three-quarters report dyspnoea after 15 years. Even if no clear predictor of chest pain was found at the time of surgery, age, the use of inotropic drugs, diabetes and obesity predicted dyspnoea.

  • 275.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid Evander, M
    Libungan, B
    Sjöland, H
    Caidahl, K
    Hartford, M
    Karlsson, T
    Karlson, BW
    Karason, K
    Quality of life 15 years after coronary artery bypass grafting.2009Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 20, nr 6, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe changes in quality of life (QoL) during 15 years after coronary artery bypass grafting (CABG) and prediction of impaired QoL after 15 years. METHODS: All patients in western Sweden who underwent primary CABG without simultaneous valve surgery between 1988 and 1991 were included. QoL during a period of 15 years after CABG was evaluated with three instruments: the Nottingham Health Profile, the Psychological General Well-Being Index, and the Physical Activity Score. RESULTS: A total of 2000 patients took part in the survey, (none excluded) of whom 808 were still alive after 15 years and 79% answered the inquiry. Despite an ongoing decline in QoL over the years, an improvement in QoL was maintained in most sub-dimensions at the 15-year follow-up compared with that prior to surgery. Seven factors emerged as predictors of impaired QoL 15 years after CABG. They are as follows: (i) high age, (ii) female sex, (iii) history of diabetes, (iv) obesity, (v) prolonged stay in the intensive care unit, (vi) prolonged treatment on a ventilator, (vii) need for inotropic drugs at the time of surgery; of which the latter three might be secondary to left ventricular dysfunction. CONCLUSION: Despite an ongoing decline in QoL over the years, there was still an improvement in most aspects of QoL 15 years after CABG compared with that before surgery. Intensified early treatment of diabetes, obesity, and left ventricular dysfunction in CABG patients might allow an even better long-term QoL.

  • 276.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid, M
    Hartford, M
    Hjalmarson, Å
    Karlson, BW
    Karlsson, T
    Risk indicators for cerebrovascular complications after coronary artery bypass grafting1997Ingår i: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 46, nr 1, s. 20-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    All patients from western Sweden were retrospectively studied in whom CABG was performed between June 1, 1988 and June 1, 1991 without simultaneous valve surgery. The aim was to detect clinical factors prior to and at the time of coronary artery bypass grafting (CABG) which were associated with the risk of neurological complications during the postoperative hospital stay. A neurological complication during the hospital stay was registered if a neurological consultation was made and if this consultation diagnosed a neurological deficit. In all, there were 2121 patients in the study, of whom 81 (3.8%) had a neurological complication. 23 of the latter (28%) died before discharge. Among preoperative factors the following appeared as significant independent predictors of a neurological complication: a history of cerebrovascular disease (p < 0.001), diabetes mellitus (p < 0.01), hypertension (p < 0.05), degree of urgency of the operation (p < 0.01), and age (p < 0.01). Among pre- and post-operative events the following predicted a neurological complication: intensive care unit treatment for more than two days (p < 0.001) and respirator required for more than 24 hours (p < 0.001).

  • 277.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid, M
    Karlson, BW
    Hartford, M
    Karlsson, T
    Predictors of death during 5 years after coronary artery bypass grafting1998Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 64, nr 1, s. 15-23Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe predictors of death during five years of follow-up after coronary artery bypass grafting (CABG). Methods: All patients who underwent CABG during a period of three years in Western Sweden were included in the analysis and were prospectively followed for five years. Mortality was related to preoperative and peroperative factors as well as findings at physical examination and medication 4–7 days after the operation. Results: In all 2121 patients underwent CABG without simultaneous valve surgery during the study period. The overall five-year mortality was 14.6%. The following appeared as independent predictors of death during five years but >30 days after CABG: Current smoking (relative risk ratio 2.43 [95% Ci 1.64–3.61]) degree of impairment of left ventricular function (1.51 [1.23–1.86]), a history of congestive heart failure (1.91 [1.35–2.70]), age (1.04 [1.02–1.06]) arrhythmia 4–7 days after CABG (1.89 [1.26–2.83]), intermittent claudication (1.73 [1.19–2.52]), a history of diabetes (1.71 [1.16–2.51]), time in respirator (1.43 [1.13–1.81]), a history of cerebrovascular disease (1.72 [1.13–2.64]), treatment with digitalis at day 4–7 (1.48 [1.07–2.05]), enzyme release (1.49 [1.03–2.16]). Conclusion: Among patients who underwent CABG 11 independent predictors for mortality were found including smoking habits at CABG, history of cardiovascular diseases, left ventricular dysfunction, age, post operative complications and medication after CABG.

  • 278.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Haglid, M
    Karlson, BW
    Karlsson, T
    Sjöland, H
    Caidahl, K
    Symptoms of chest pain and dyspnea and factors associated with chest pain after coronary artery bypass grafting1999Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 91, nr 4, s. 220-226Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients in western Sweden who underwent CABG from 1988 to 1991 received prior to coronary angiography and 2 and 5 years after CABG a questionnaire, in which they were asked about symptoms of chest pain and dyspnea. In all, 1,226 patients answered the inquiry prior to CABG, 1,531 patients 2 years and 1,359 patients 5 years after surgery. Both in terms of chest pain and dyspnea there was a marked improvement 2 and 5 years after CABG as compared with prior to surgery. However, between 2 and 5 years after surgery there was a minor deterioration, both regarding chest pain and dyspnea. The most statistically significant preoperative predictors for the occurrence of chest pain more than twice a week 5 years after surgery were concomitant valvular heart disease and obesity.

  • 279.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Karlsson, T
    Hartford, M
    Caidahl, K
    Limitation of physical activity, dyspnea and chest pain prior to and two years after coronary artery bypass grafting in relation to preoperative ejection fraction2000Ingår i: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 34, nr 1, s. 65-72Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To investigate the relationships between limitation of physical activity and dyspnoea and chest pain before and 2 years after coronary artery bypass grafting (CABG) and preoperative left ventricular ejection fraction (LVEF), questionnaires were issued to all patients from Western Sweden who underwent CABG during 1988-1991. The analysis comprised 985 patients. Physical activity improved significantly after CABG regardless of the preoperative LVEF. No significant association was found between LVEF and degree of limitation of physical activity before or after surgery. Dyspnoea and chest pain improved markedly, irrespective of LVEF. There was significant association between freedom from dyspnoea and LVEF preoperatively (less dyspnoea with higher LVEF), but not after CABG. The frequency of chest-pain attacks was not related to LVEF, before or after the operation. Thus physical activity, dyspnoea and chest pain improved in the 2 years after CABG irrespective of preoperative LVEF. Absence of dyspnoea was related to LVEF before, but not after surgery, and there was no association between preoperative LVEF and frequency of anginal attacks before or after CABG.

  • 280.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, mode of death and risk indicators for death during 5 years after coronary artery bypass grafting among patients with and without a history of diabetes mellitus2000Ingår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 11, nr 4, s. 339-346Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe mortality, mode of death, risk indicators for death and symptoms of angina pectoris among survivors during 5 years after coronary artery bypass grafting (CABG) among patients with and without a history of diabetes mellitus. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and who had no previous CABG between June 1988 and June 1991 were entered prospectively in this study. After 5 years, information on deaths that had occurred was obtained for the analysis. RESULTS: In all, 1998 patients were included in the analysis; 242 (12%) had a history of diabetes. Among the non-diabetic patients, 5-year mortality was 12.5%; the corresponding relative risk for diabetic patients was 2.1 (95% confidence interval 1.6 to 2.9). A history of diabetes was an independent risk indicator of death; there was no significant interaction between any other risk indicator and diabetes. Independent risk indicators for death among diabetic patients were: current smoking, renal dysfunction and left ventricular ejection fraction < 0.40. Compared with non-diabetic patients, those with diabetes more frequently died in hospital, died a cardiac death, or had death associated with the development of acute myocardial infarction and with symptoms of congestive heart failure. Among survivors, diabetic patients tended to have more angina pectoris 5 years after CABG than did those without diabetes. CONCLUSION: During a period of 5 years after CABG, diabetic patients had a mortality twice that of non-diabetic patients. The increased risk included death in hospital, cardiac death and death associated with development of acute myocardial infarction and with symptoms of congestive heart failure.

  • 281. Herlitz, Johan
    et al.
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, risk indicators for death and mode of death in younger and elderly patients during 5 years coronary artery bypass graft.2000Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 23, nr 6, s. 421-426Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The number of elderly patients who may be candidates for coronary artery bypass graft (CABG) for severe coronary artery disease has increased. Cardiac surgery in the elderly is a high-risk procedure because many of these patients have concomitant systemic disease and other disabilities. HYPOTHESIS: The study was undertaken to evaluate mortality, risk indicators for death, and mode of death in younger and elderly patients during 5 years after CABG. METHODS: The study included all patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. In all, 2,000 patients, of whom 953 (48%) were > or = 65 years, were divided into two age groups (< 65 years and > or = 65 years). RESULTS: Compared with the younger patients, the elderly had a relative risk of death of 2.3 (95% confidence interval 1.8-3.0). The increased risk of death in the elderly was significantly more marked in men, in patients with more severe angina pectoris, and in patients without a history of cerebrovascular diseases. The mode and place of death appeared similar regardless of age; neither was there marked difference in symptoms of angina pectoris among survivors 5 years after CABG. CONCLUSION: Compared with patients < 65 years, the elderly have more than twice as high a risk of death during the subsequent 5 years, and this risk is higher in men, in patients with severe symptoms of angina pectoris, and in those with no history of cerebrovascular disease.

  • 282.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, risk indicators for death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in men and women2000Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, nr 4, s. 500-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe mortality, risk indicators of death, mode of death and symptoms of angina pectoris during 5 years after coronary artery bypass grafting in women and men. SAMPLE: All patients in western Sweden who underwent coronary artery bypass grafting without concomitant valve surgery and without previously performed coronary artery bypass grafting between June 1988 and June 1991. RESULTS: In all, 2000 patients participated in the evaluation, 381 (19%) of whom were women. Compared to men, who had a 5-year mortality of 13.3%, women had a relative risk of death of 1.4 (95% CI 1.0-1.8; P = 0.03). Renal dysfunction interacted significantly (P = 0.048) with gender, in that the differences were more marked in patients without renal dysfunction. When adjusting for differences at baseline, the relative risk of death amongst women was 1.0 (95% CL 0.7-1.3). Compared to men, women had an increased risk of in-hospital death and death associated with stroke. However, amongst the patients who died, the place and mode of death appeared to be similar in women and men. Amongst survivors after 5 years, women had more symptoms of angina pectoris than men. CONCLUSION: During 5 years after coronary artery bypass grafting, women had an increased mortality compared to men; renal dysfunction seemed to interact with female gender regarding mortality. Women had a higher risk of in-hospital death and death associated with stroke. However, the adjusted relative risk of death during 5 years was equal in women and men. Amongst survivors, women suffered more from angina pectoris than men.

  • 283.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlson, BW
    Sjöland, H
    Karlsson, T
    Caidahl, K
    Hartford, M
    Haglid, M
    Mortality, risk indicators mode and place of death and symptoms of angina pectoris in the five years after coronary artery bypass grafting in patients with and without a history of hypertension1999Ingår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, nr 4, s. 200-206Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe mortality, risk indicators for death, place and mode of death, and symptoms of angina pectoris among survivors in the 5 years after coronary artery bypass grafting (CABG) in patients with and without a history of hypertension. METHODS: All patients in western Sweden who underwent CABG without concomitant valve surgery and without previously performed CABG between June 1988 and June 1991. RESULTS: A total of 1997 patients were included in the analysis, 740 (37%) of whom had a history of hypertension. Patients with no history had a 5-year mortality of 12.4%. The corresponding relative risk for hypertensives was 1.4 (95% CI 1.1-1.8). Risk factors for death appeared similar in patients with and without a history of hypertension. Patients with hypertension had an increased risk of death in hospital and an increased risk of a non-cardiac death. Among survivors after 5 years, patients with a history of hypertension tended to have a higher prevalence of symptoms equivalent to angina pectoris. CONCLUSIONS: Patients with a history of hypertension have an increased risk of death in the 5 years after CABG. Risk factors for death appear similar in patients with and without a history of hypertension. Patients with hypertension have a particularly increased risk of death in hospital and of death judged as non-cardiac.

  • 284.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, G
    Karlsson, T
    Karlson, BW
    Haglid, M
    Sjöland, H
    Predictors of death and other cardiac events within two years after coronary artery bypass grafting1998Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 90, nr 2, s. 110-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    RESULTS: In 1,841 patients who underwent coronary artery bypass grafting (CABG) we evaluated risk indicators for death and other cardiac events during 2 years of follow-up. Independent predictors of death were: a history of congestive heart failure, diabetes mellitus and renal dysfunction prior to CABG. Independent predictors of death, acute myocardial infarction (AMI), CABG or percutaneous transluminal coronary angioplasty (PTCA) were: a small body surface area, a history of congestive heart failure, diabetes mellitus and smoking prior to CABG. Independent predictors of death, AMI, CABG, PTCA or rehospitalization for a cardiac reason were: angina functional class, previous AMI, a history of congestive heart failure and renal dysfunction prior to CABG. CONCLUSION: When using various definitions of a cardiac event after CABG, various risk indicators for death or such an event can be found. Our data suggest that anamnestic information prior to CABG indicating a depressed myocardial function or severe myocardial ischemia are more important predictors of outcome than the information gained from cardioangiography.

  • 285.
    Herlitz, Johan
    et al.
    [external].
    Brandrup-Wognsen, H
    Haglid, M
    Hartford, M
    Emanuelsson, H
    Karlson, BW
    Karlsson, T
    Hjalmarson, Å
    Mortality and morbidity during a period of 2 years after coronary artery bypass surgery in patients with and without a history of hypertension1996Ingår i: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 14, nr 3, s. 309-314Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. PATIENTS: All patients in western Sweden in whom CABG was undertaken between June 1988 and June 1991 and in whom simultaneous valve surgery was not performed were included in the study. DESIGN: A prospective 2-year follow-up study. RESULTS: Patients with a history of hypertension (n = 777) differed from patients without such a history (n = 1348) in that the proportion of women was higher, they were older and more frequently had a history of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication and obesity, and the number of smokers and patients with previous CABG was lower. They were also more likely to develop post-operative cerebrovascular complications and signs of myocardia damage. Patients with hypertension tended to have increased mortality during the first 30 days after CABG and the late mortality (between day 30 and 2 years) was significantly higher than in non-hypertensive participants. Whereas the development of myocardial infarction was similar in both groups, the hypertensive study participants more frequently developed stroke during 2 years of follow-up. In a multivariate analysis including age, sex, history of different cardiovascular diseases, smoking, ejection fraction, and the occurrence of three-vessel disease, hypertension did not emerge as an independent predictor of death in the early or late phase or during a total of 2 years of follow-up. CONCLUSION: Among CABG patients, those with a history of hypertension have a different pattern of risk factors. They have a higher mean age, include a higher proportion of women and have a higher prevalence of congestive heart failure, diabetes mellitus, renal dysfunction, cerebro-vascular disease, intermittent claudication, and obesity. They also have an increased frequency of immediate post-operative complications and an increased 2-year mortality, even if a history of hypertension was not an independent predictor of death during 2 years of follow-up.

  • 286.
    Herlitz, Johan
    et al.
    [external].
    Brorsson, B
    Werkö, L
    Factors associated with the use of various medications among patients with severe coronary artery disease. SECOR/SBU Project Group.1999Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 245, nr 2, s. 143-153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim. To describe variations by age, sex, symptom severity and hospital region in the use of various medications amongst patients with stable angina pectoris who are candidates for coronary revascularization. Patients. Patients (n = 2030) with chronic stable angina pectoris participating in a national survey evaluating the appropriateness of the use of percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG). Methods. As part of a national study of the appropriateness of coronary revascularization, data were prospectively collected on patients referred for consideration of coronary revascularization to seven of the eight public Swedish heart centres that performed approximately 92% of all bypass operations in Sweden in 1994. Results. Amongst all patients 76% were treated with beta blockers, 41% with calcium antagonists and 71% with long-acting nitrates and 70% were treated with at least two of these three drugs. Eighty-two per cent of the patients used aspirin and 14% lipid-lowering drugs. According to logistic regression analysis, with medication as the dependent variable and independent variables of age, sex, angina functional class, findings at exercise test, history of various diseases and region in Sweden where the investigation took place, the most consistent factor explaining the use of various medications was found to be geographical region. A previous history of acute myocardial infarction (AMI) was also associated with the use of all drugs and age was associated with all with the exception of beta blockers. Sex was not an independent factor explaining the use of any of the drugs. Conclusion. In a national survey including patients with stable angina pectoris who are potential candidates for coronary revascularization, the most important predictor for the use of various medications was the geographical region in which the investigation took place.

  • 287.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Bröstkompressioner lämpligare behandling för teleinstruktion än HLR2001Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, nr 4, s. 4458-4461Artikel i tidskrift (Refereegranskat)
  • 288.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Alsén, B
    Aune, S
    Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to the interval between collapse and start of CPR2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 1, s. 21-27Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe survival after in-hospital cardiac arrest in relation to the interval between collapse and start of cardiopulmonary resuscitation (CPR). PATIENTS: All patients suffering in-hospital cardiac arrest in Sahlgrenska University Hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the interval between collapse and start of CPR was known. METHODS: Prospective recording of various factors at resuscitation including the interval between collapse and start of CPR. Retrospective evaluation via medical records of patients' previous history, clinical situation prior to cardiac arrest and final outcome. RESULTS: Survival to discharge was 33% among the 344 patients in whom CPR was started within the first minute as compared with 14% among the 88 patients in whom CPR started more than 1 min after collapse (P=0.008). The corresponding figures for patients found in ventricular fibrillation was 50 versus 32% (NS); for patients found in pulseless electrical activity 9 versus 3% (NS) and for patients found in asystole 19 versus 0% (NS). Correcting for dissimililarties in the previous history and factors at resuscitation, the adjusted odds ratio and 95% confidence limits for being discharged from hospital when CPR was started within 1 min compared with a later start was 3.06 with 95% confidence limits of 1.59-6.31. CONCLUSION: Among patients with in-hospital cardiac arrest in whom the interval between collapse and start of CPR was known, we found that in 80% of the cases CPR was started within the first minute after collapse. Among these patients, survival to discharge was twice that of patients in whom CPR was started later. These results highlight the importance of immediate CPR after in-hospital cardiac arrest.

  • 289.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Alsén, B
    Aune, S
    Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 127-133Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS: Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.

  • 290.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lundström, G
    Holmberg, S
    Characteristics and outcome among patients suffering in hospital cardiac arrest in monitored and non monitored areas2001Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 48, nr 2, s. 125-135Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering in-hospital cardiac arrest in relation to whether the arrest took place in a ward with monitoring facilities. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4-year period in Sahlgrenska Hospital, Göteborg, Sweden and in whom resuscitative efforts were attempted, were prospectively recorded and described in terms of characteristics and outcome. RESULTS: Among 557 patients, 292 (53%) had a cardiac arrest in wards with monitoring facilities. Those in a monitored location more frequently had a confirmed or possible acute myocardial infarction (AMI) as judged to be the cause of arrest (P < 0.0001), and the arrest was witnessed more frequently (96 vs. 79%; P < 0.0001). Ventricular fibrillation/tachycardia was observed more often as initial arrhythmia in monitored wards (56 vs. 44%; P = 0.006). The median interval between collapse and first defibrillation was 1 min in monitored wards and 5 min in non-monitored wards (P < 0.0001). Among patients with arrest in monitored wards 43.2% were discharged alive compared with 31.1% of patients in non-monitored wards (P = 0.004). Cerebral performance category (CPC-score) at discharge was somewhat better among survivors in monitored wards. CONCLUSION: In a Swedish University Hospital 47% of in-hospital cardiac arrests in which resuscitation was attempted took place in wards without monitoring facilities. These patients differed markedly from those having arrest in wards with monitoring facilities in terms of characteristics, interval to defibrillation and outcome. A shortening of the interval between collapse and defibrillation in these patients might increase survival even further.

  • 291.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lundström, G
    Holmberg, S
    Holmberg, M
    Lindqvist, J
    A comparison between patients suffering in-hospital and out-of-hospital cardiac arrest in terms of treatment and outcome2000Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 248, nr 1, s. 53-60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To compare treatment and outcome amongst patients suffering in-hospital and out-of-hospital cardiac arrest in the same community. PATIENTS: All patients suffering in-hospital cardiac arrest in Sahlgrenska University Hospital covering half the catchment area of the community of Göteborg (500 000 inhabitants) and all patients suffering out-of-hospital cardiac arrest in the community of Göteborg. Criteria for inclusion were that resuscitation efforts should have been attempted. TIME OF SURVEY: From 1 November 1994 to 1 November 1997. METHODS: Data were recorded both prospectively and retrospectively. RESULTS: In total, 422 patients suffered in-hospital cardiac arrest and 778 patients suffered out-of-hospital cardiac arrest. Patients with in-hospital cardiac arrest included more women and were more frequently found in ventricular fibrillation. The median interval between collapse and defibrillation was 2 min in in-hospital cardiac arrest compared with 7 min in out-of-hospital cardiac arrest (< 0.001). The proportion of patients being discharged from hospital was 37.5% after in-hospital cardiac arrest, compared with 8.7% after out-of-hospital cardiac arrest (P < 0.001). Corresponding figures for patients found in ventricular fibrillation were 56.9 vs. 19.7% (P < 0.001) and for patients found in asystole 25.2 vs. 1.8% (P < 0.001). CONCLUSION: In a survey evaluating patients with in-hospital and out-of-hospital cardiac arrest in whom resuscitation efforts were attempted, we found that the former group had a survival rate more than four times higher than the latter. Possible strong contributing factors to this observation are: (i) shorter time interval to start of treatment, and (ii) a prepared selection for resuscitation efforts.

  • 292.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Axelsson, Å
    Graves, JR
    Lindqvist, J
    Experience with use of automated external defibrillators in out of hospital cardiac arrest1998Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 37, nr 1, s. 3-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the sequences of arrhythmias, number of shocks delivered and the number of failures in a consecutive series of patients with out-of-hospital cardiac arrest attended by our emergency medical service (EMS) and in whom cardio-pulmonary resuscitation (CPR) was initiated and in whom automated external defibrillators (AEDs) were used. PATIENTS: All patients with out-of-hospital cardiac arrest attended by the EMS and in whom AEDs were used. Time for inclusion in the study: January 1st, 1987 to December 31st, 1992. RESULTS: In all there were 1781 out of hospital cardiac arrests during the study period. Among them AEDs were used in 383 cases (22%). The total number of interpreted rhythms delivered in these patients was 2719. Among all rhythm sequences coarse ventricular fibrillation (VF) was found on 375 occasions (14%); fine VF on 107 occasions (4%) and ventricular tachycardia (VT) on 12 occasions (0.4%). In ten cases with coarse VF (nine patients) the AED did not advise a shock (2.7%). In five of those nine patients a human error was interpreted as the explanation and in four there was a possible technical error. In these four patients defibrillation was delayed by 33-43 s, respectively. Among the 2225 rhythm sequences not judged as VF/VT the AED advised a shock on one occasion (0.04%). CONCLUSION: Among patients with coarse VF AED gave inaccurate instructions in 2.7%. However, the majority of the failures were judged to be caused by human errors.

  • 293.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Ekström, L
    Ågård, A
    Holmberg, M
    Lundström, G
    Holmberg, S
    Förbättrad överlevnad efter hjärtstopp på sjukhus2000Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, nr 30-31, s. 3363-3368Artikel i tidskrift (Refereegranskat)
  • 294.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Gellerstedt, M
    Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?2006Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 13, nr 5, s. 290-294Artikel i tidskrift (Refereegranskat)
    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.

  • 295.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Gunnarsson, J
    Engdahl, J
    Karlson, BW
    Lindqvist, J
    Waagstein, L
    Factors associated with survival to hospital discharge among patients hospitalized alive after out-of-hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg2003Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, nr 1, s. 25-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. Patients: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. Methods: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). Setting: Community of Göteborg, Sweden. Results: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). Conclusion: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.

  • 296.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Hartford, M
    Karlson, BW
    Influence of gender on survival, mode of death, reinfarction, use of medication, and aspects of well being during a period of five years after onset of acute myocardial infarction1996Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 19, nr 7, s. 555-561Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND HYPOTHESIS: This study was undertaken to describe prognosis during a period of 5 years after an acute myocardial infarction (AMI) in relation to gender. METHODS: All patients studied were hospitalized in a single hospital during a period of 21 months due to AMI, regardless of age and whether they were admitted to the coronary care unit or another ward. A total of 862 AMI patients [581 (67%) men and 281 (33%) women] were prospectively evaluated. Males were younger and less frequently had a history of congestive heart failure and hypertension. RESULTS: The overall 5-year mortality rate was 48% among men compared with 61% among women (p < 0.001). However, in a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, female gender was not independently associated with death. Revascularization in terms of coronary artery bypass grafting and percutaneous transluminal angioplasty did not differ significantly between men and women. The rate of reinfarction was 34% among men and 38% among women (p > 0.2). CONCLUSION: During 5 years of follow-up in a consecutive series of 862 AMI patients, women had a worse prognosis than men, with a mortality of 61% compared with 48% (p < 0.001). However, after controlling for a number of potentially confounding prognostic factors, female gender was not independently associated with mortality.

  • 297.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Holmberg, M
    Axelsson, Å
    Lindqvist, J
    Holmberg, S
    Rhythm changes during resuscitation from ventricular fibrillation in relation to delay until defibrillation, number of shocks delivered and survival1997Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 34, nr 1, s. 17-22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe rhythm changes during the initial phase of resuscitation from ventricular fibrillation in relation to the interval between collapse and defibrillation, to survival and to bystander-initiated cardiopulmonary resuscitation (CPR). PATIENTS: All patients who suffered out-of-hospital cardiac arrest between 1980 and 1992, who were reached by the emergency medical service system (EMS), in whom resuscitation attempts were initiated and who were found in ventricular fibrillation. RESULTS: In all, 1216 patients were included in the study. Among patients who converted to a pulse-generating rhythm after the first defibrillation (n = 119) were 56% discharged from hospital as compared with 6% among patients who converted to asystole. The corresponding figures after the third defibrillation were 49% and 2%, respectively, and after the fifth defibrillation 28% and 7%, respectively. Among patients in whom the first defibrillation took place less than 5 min after collapse, 28% directly converted to a pulse-generating rhythm as compared with 3% when the first defibrillation took place 12 min or more after collapse. CONCLUSION: Among patients who suffer out-of-hospital cardiac arrest and are found in ventricular fibrillation, there is a strong relationship between survival and initial rhythm changes after defibrillation. These rhythm changes are directly related to the interval between collapse and the first defibrillation.

  • 298.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    Isaksson, L
    Karlsson, T
    Ambulance despatchers´ estimation of intensity of pain and presence of associated symptoms in relation to outcome among patients who call for an ambulance because of acute chest pain1995Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 16, nr 12, s. 1789-1794Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: A large number of patients who call for an ambulance because of acute chest pain have an acute ischaemic event, but some do not. AIM. To relate the ambulance despatcher's estimated severity of pain and presence of associated symptoms, in patients who call for an ambulance because of acute chest pain, to whether they develop acute myocardial infarction (AMI) and to the risk of early death. PATIENTS: All those with acute chest pain who contacted the despatch centre in Göteborg over a 2-month period. RESULTS: In all, 503 patients fulfilled the inclusion criteria. Patients judged as having severe chest pain (68%) developed AMI during the first 3 days in hospital on 26% of occasions as compared with 13% among patients judged as having only vague chest pain (P = 0.0004). The difference was less marked among the elderly and women. The presence of any of the following associated symptoms, dyspnoea, nausea, vertigo, cold sweat or syncope, tended to be associated with a higher infarction rate (24%) than if none of these symptoms was present (17%, P = 0.06). Mortality during the pre-hospital and the hospital phase was not associated with the estimated severity of pain or the presence of associated symptoms. CONCLUSIONS: The despatcher's estimation of the severity of pain and the presence of associated symptoms appears to be associated with the development of AMI but not with early mortality.

  • 299.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Isaksson, L
    Karlsson, T
    Outcome for patients who call for an ambulance for chest pain in relation to dispatcher's initial suspicion of acute myocardial infarction1995Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 2, nr 2, s. 75-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The very early handling of patients with suspected acute myocardial infarction (AMI) is of critical importance to the outcome. The aim of this study was to relate the dispatcher's initial suspicion of AMI, among patients who call for an ambulance due to chest pain, to the subsequent diagnosis and outcome. All patients who called for an ambulance in Gothenburg due to acute chest pain during a 2-month period were included in the study. In all, 503 patients fulfilled the inclusion criteria, and information on the dispatcher's initial suspicion of AMI was available in 484 patients. There was at least a strong suspicion of AMI in 36%, a moderate suspicion of AMI in 34% and only a vague or no suspicion in 30%. Among patients with at least a strong suspicion of AMI, 29% subsequently developed infarcation, compared with 18% among patients with a moderate suspicion of AMI and 15% among patients with only a vague or no suspicion (p < 0.001). However, the priority level was similar in patients with and without a life-threatening condition, and the mortality rate remained similar in patients with a strong suspicion and those without a strong suspicion of AMI. Thus, among patients who called for an ambulance due to acute chest pain there was a direct relationship between the dispatcher's suspicion of AMI and the subsequent diagnosis, but the mortality rate was similar in the different groups.

  • 300.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Five-year prognosis after AMI in relation to a history of hypertension1996Ingår i: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 9, nr 1, s. 70-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study described the prognosis during 5 years of follow-up after acute myocardial infarction (AMI) for patients with a history of hypertension. All patients, regardless of age and whether or not they were admitted to the coronary care unit, were hospitalized in a single hospital due to AMI during a period of 21 months. Overall, 290 (34%) of the 862 AMI patients had a history of hypertension. Hypertensive patients had an overall 5-year mortality rate of 58% v 49% among nonhypertensive patients (P < .05). In a multivariate analysis considering age, gender, and a previous history of cardiovascular diseases, a history of hypertension was not an independent predictor of either the total mortality or mortality after discharge from hospital. The mode of death and the place of death appeared to be similar in hypertensive and nonhypertensive patients. Reinfarction developed in 43% of hypertensive patients versus 31% of nonhypertensive patients (P < .01) and a history of hypertension was an independent predictor of reinfarction (P < .05). In consecutive patients admitted to a single hospital due to AMI, a history of hypertension did not appear as an independent predictor of mortality, but it did appear as an independent predictor of reinfarction during 5 years of follow-up.

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