Endre søk
Begrens søket
45678910 301 - 350 of 833
RefereraExporteraLink til resultatlisten
Permanent link
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf
Treff pr side
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sortering
  • Standard (Relevans)
  • Forfatter A-Ø
  • Forfatter Ø-A
  • Tittel A-Ø
  • Tittel Ø-A
  • Type publikasjon A-Ø
  • Type publikasjon Ø-A
  • Eldste først
  • Nyeste først
  • Skapad (Eldste først)
  • Skapad (Nyeste først)
  • Senast uppdaterad (Eldste først)
  • Senast uppdaterad (Nyeste først)
  • Disputationsdatum (tidligste først)
  • Disputationsdatum (siste først)
  • Standard (Relevans)
  • Forfatter A-Ø
  • Forfatter Ø-A
  • Tittel A-Ø
  • Tittel Ø-A
  • Type publikasjon A-Ø
  • Type publikasjon Ø-A
  • Eldste først
  • Nyeste først
  • Skapad (Eldste først)
  • Skapad (Nyeste først)
  • Senast uppdaterad (Eldste først)
  • Senast uppdaterad (Nyeste først)
  • Disputationsdatum (tidligste først)
  • Disputationsdatum (siste først)
Merk
Maxantalet träffar du kan exportera från sökgränssnittet är 250. Vid större uttag använd dig av utsökningar.
  • 301.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Mortality, place and mode of death and reinfarction during a period of five years after acute myocardial infarction in diabetic and non diabetic patients1996Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, nr 5, s. 423-428Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the prognosis during a 5-year follow-up of 858 consecutive patients with confirmed acute myocardial infarction (AMI), of which 97 (11%) had a history of diabetes mellitus. Diabetic patients had a 5-year mortality of 72% versus 50% for non-diabetic patients (p < 0.001). In a multivariate analysis considering age, sex, diabetes and a history of cardiovascular disease, diabetes was an independent predictor of death (p < 0.001) together with age (p < 0.001), previous AMI (p < 0.001) and a history of congestive heart failure (p < 0.05). Among diabetic patients, 55% developed a reinfarction versus 22% among non-diabetic patients (p < 0.001). Mode and place of death appeared to be similar in diabetic and non-diabetic patients.

  • 302.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Karlson, BW
    Hartford, M
    Is there a gender difference in etiology of chest pain and symptoms associated with AMI1999Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 6, nr 4, s. 311-315Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many previous studies have shown that there is a gender difference in terms of the use of diagnostic procedures and the treatment of patients with chest pain. The mechanisms behind these observations are less well described. This survey describes gender differences in the aetiology of chest pain and symptoms associated with acute myocardial infarction (AMI). Among the patients with symptoms of acute chest pain, in the emergency medical department women less frequently develop an AMI and are less frequently given a diagnosis of ischaemic heart disease. Among patients developing an AMI, women differ from men by less frequently reporting chest pain, more frequently reporting nausea, vomiting, abdominal complaints, fatigue and dyspnoea and less frequently reporting sweating. With regard to the localization of pain in AMI, women differ from men by more frequently reporting pain in the back, neck and jaw. In terms of electrocardiographic changes, women seem to have less marked ST deviations than men. However, we do not believe that these differences between women and men are substantial enough and, as a result, we do not recommend that the initial medical care of patients seeking medical attention with chest pain or other symptoms raising a suspicion of AMI should be differentiated with regard to gender. The differences described here might partly explain the prolonged delay until hospital admission in women suffering from AMI.

  • 303.
    Herlitz, Johan
    et al.
    [external].
    Bång, A
    [external].
    Sjölin, M
    Karlson, BW
    Five-year mortality after acute myocardial infarction in relation to previous history, level of initial care, complications in hospital, and medication at discharge1996Inngår i: Cardiovascular Drugs and Therapy, ISSN 0920-3206, E-ISSN 1573-7241, Vol. 10, nr 4, s. 485-490Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of this study was to describe the prognosis during 5 years of follow-up in a consecutive population of patients discharged from hospital after acute myocardial infarction (AMI) in relation to clinical history, level of initial care, complications during hospitalization, and medication at discharge. All patients admitted to a single hospital from February 15, 1986 to November 9, 1987 due to AMI, regardless of age and whether or not they were treated in the coronary care unit, and who were discharged alive from hospital were included in the study. There were 862 patients with AMI, 740 of whom were discharged alive. Information on medication at discharge was available in 713 patients (96%). In a multivariate analysis taking into account age, sex, history of cardiovascular diseases, whether patients were admitted to coronary care unit or not, complications during hospitalization, and medication at discharge, the following factors appeared to be independent predictors of mortality: age (p < 0.001), history of AMI (p < 0.001), congestive heart failure in hospital (p < 0.001), whether beta-blockers had been prescribed at discharge (p < 0.01), and a history of diabetes (p < 0.01). This study indicates that in consecutive patients surviving the hospital phase of AMI, the development of complications while in hospital and the manner in which medication was prescribed at discharge independently influenced their long-term prognosis, but age was the most important factor in long-term prognosis.

  • 304. Herlitz, Johan
    et al.
    Bång, Angela
    Gunnarsson, J
    Engdahl, J
    Karlsson, BW
    Lindqvist, J
    Waagstein, L
    Factors associated with survival to hospital discharge among patients hospitalized alive after out-of-hospital cardiac arrest and change in outcome over time. Experiences during 20 years in the community of Göteborg2003Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, nr 1, s. 25-30Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 305.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bång, Angela
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Wireklint-Sundström, Birgitta
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, Christer
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Hagiwara, Magnus
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Jonsson, Anders
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Lars
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, nr 42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Sepsis is a life-threatening condition where the risk of death has been reported to be even higher than that associated with the major complications of atherosclerosis, i.e. myocardial infarction and stroke. In all three conditions, early treatment could limit organ dysfunction and thereby improve the prognosis. Aim To describe what has been published in the literature a/ with regard to the association between delay until start of treatment and outcome in sepsis with the emphasis on the pre-hospital phase and b/ to present published data and the opportunity to improve various links in the pre-hospital chain of care in sepsis. Methods A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In overall terms, we found a small number of articles (n=12 of 1,162 unique hits) which addressed the prehospital phase. For each hour of delay until the start of antibiotics, the prognosis appeared to become worse. However, there was no evidence that prehospital treatment improved the prognosis. Studies indicated that about half of the patients with severe sepsis used the emergency medical service (EMS) for transport to hospital. Patients who used the EMS experienced a shorter delay to treatment with antibiotics and the start of early goal-directed therapy (EGDT). Among EMS-transported patients, those in whom the EMS staff already suspected sepsis at the scene had a shorter delay to treatment with antibiotics and the start of EGDT. There are insufficient data on other links in the prehospital chain of care, i.e. patients, bystanders and dispatchers. Conclusion Severe sepsis is a life-threatening condition. Previous studies suggest that, with every hour of delay until the start of antibiotics, the prognosis deteriorates. About half of the patients use the EMS. We need to know more about the present situation with regard to the different links in the prehospital chain of care in sepsis.

  • 306.
    Herlitz, Johan
    et al.
    [external].
    Caidahl, K
    Albertsson, P
    Karlsson, T
    Hartford, M
    Haglid, M
    Lurje, L
    Karlson, BW
    Sjöland, H
    Limitation of physical activity, dyspnea and chest pain prior to and during two years after coronary artery bypass grafting in relation to a history of hypertension1998Inngår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 6, nr 6, s. 349-356Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the limitation of physical activity, the cause of limitation of physical activity and symptoms of dyspnea and chest pain before and 2 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: All patients from western Sweden who underwent CABG between 1988 and 1991 were approached with a questionnaire--prior to, 3 months and 2 years after CABG--evaluating the issues raised above. RESULTS: Of 2121 patients, 37% had a history of hypertension. By 3 months after CABG, physical activity tolerance had improved markedly and in a similar way for both hypertensive (p<0.001) and non-hypertensive patients (p<0.001); this level was sustained for 2 years. Absence of dyspnea increased markedly and similarly among both hypertensive and non-hypertensive patients (p < 0.001) after CABG. The presence of chest pain decreased markedly and similarly among hypertensive (p<0.001) and non-hypertensive patients (p<0.001), both 3 months and 2 years after compared to prior to the operation. CONCLUSION: There was a marked improvement in terms of physical activity and cardiovascular symptoms 3 months and 2 years after CABG as compared with the situation prior to the operation. A previous history of hypertension did not seem to affect these results.

  • 307.
    Herlitz, Johan
    et al.
    [external].
    Caidahl, K
    Wiklund, I
    Sjöland, H
    Karlson, BW
    Karlsson, T
    Haglid, M
    Hartford, M
    Impact of a history of diabetes on the improvement on symptoms and Quality of Life during five years after coronary artery bypass grafting2000Inngår i: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 14, nr 6, s. 314-321Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To describe the impact of a history of diabetes mellitus on the improvement of symptoms and various aspects of quality of life (QoL) during 5 years after coronary artery bypass grafting (CABG). Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. QoL was estimated with three different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP) and Psychological General Well-Being (PGWB) index. 876 patients participated in the evaluation, of whom 87 (10%) had a history of diabetes. Symptoms of dyspnea and chest pain improved both in diabetic and non-diabetic patients. Diabetic patients scored worse than non-diabetic patients both prior to and 5 years after CABG, but without any major difference in improvement between the two groups with all three measures of QoL. PAS tended to improve more in non-diabetic than in diabetic patients, whereas improvement in NHP and PGWB was similar regardless of a history of diabetes. Diabetic patients differ from non-diabetic patients having an inferior QoL both prior to and 5 years after CABG. Both diabetic and non-diabetic patients improve in symptoms and QoL after the operation. In some aspects improvement tended to be less marked in the diabetic patients but on the whole improvement was similar compared to non-diabetic patients.

  • 308.
    Herlitz, Johan
    et al.
    [external].
    Caidahl, K
    Wiklund, I
    Sjöland, H
    Karlson, BW
    Karlsson, T
    Haglid, M
    Hartford, M
    Impact of a history of hypertension on symptoms and Quality of Life prior to and at five years after coronary artery bypass grafting2000Inngår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 9, nr 1, s. 52-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe symptoms and other aspects of health-related quality of life (QoL) prior to and 5 years after coronary artery bypass grafting (CABG) in relation to a history of hypertension. METHODS: Patients who underwent CABG in western Sweden were approached prior to surgery and 5 years after the operation. Health-related QoL was estimated with the Physical Activity Score, the Nottingham Health Profile and the Psychological General Well-Being Index. RESULTS: In patients with a history of hypertension (n = 740) the 5-year mortality was 16.9% versus 12.4% among patients with no history (n = 1257; p = 0.004). Of 1717 patients available for the survey, 876 (51%) responded both prior to and 5 years after CABG. Of these, 36% had a history of hypertension. Compared with the situation prior to surgery there was an improvement in both hypertensive and non-hypertensive patients in terms of physical activity, symptoms of dyspnea and chest pain and other estimates of health-related QoL. However, physical activity and dyspnea improved less in hypertensive than in non-hypertensive patients. CONCLUSION: Five years after CABG, a marked and significant improvement in terms of symptoms and other aspects of health-related QoL was observed among both hypertensive and non-hypertensive patients. However, improvement in physical activity was less marked in patients with a history of hypertension. Overall, a history of hypertension seemed to have a minor impact on improved well-being 5 years after coronary surgery. However, because of the limited response rate the results may not be applicable in a non-selected CABG population.

  • 309.
    Herlitz, Johan
    et al.
    [external].
    Castren, M
    Friberg, H
    Nolan, J
    Skrifvars, M
    Sunde, K
    Steen, P-A
    Post resuscitation care: what are the therapeutic alternatives and what do we know?2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 69, nr 1, s. 15-22Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A large proportion of deaths in the Western World are caused by ischaemic heart disease. Among these patients a majority die outside hospital due to sudden cardiac death. The prognosis among these patients is in general, poor. However, a significant proportion are admitted to a hospital ward alive. The proportion of patients who survive the hospital phase of an out of hospital cardiac arrest varies considerably. Several treatment strategies are applicable during the post resuscitation care phase, but the level of evidence is weak for most of them. Four treatments are recommended for selected patients based on relatively good clinical evidence: therapeutic hypothermia, beta-blockers, coronary artery bypass grafting, and an implantable cardioverter defibrillator. The patient's cerebral function might influence implementation of the latter two alternatives. There is some evidence for revascularisation treatment in patients with suspected myocardial infarction. On pathophysiological grounds, an early coronary angiogram is a reasonable alternative. Further randomised clinical trials of other post resuscitation therapies are essential.

  • 310.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Hartford, M
    Karlson, BW
    Karlsson, T
    Impact of early thrombolysis on chest pain score reflecting myocardial ischemia in relation to various markers of ischemic damage1993Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 41, nr 2, s. 123-131Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We randomized 352 patients with pain suggestive of acute myocardial infarction who were seen less than 3 h after onset of symptoms to either tissue plasminogen activator or placebo. The impact of treatment on chest pain score was assessed during the first 24 h and related to limitation of final myocardial damage as assessed by various indirect markers. The most marked effect of tissue plasminogen activator was observed in the chest pain score being reduced by 43% in the tissue plasminogen activator group as compared with placebo. Limitation of infarct size with tissue plasminogen activator reached the following percentage values when various methods were used: maximum serum lactate dehydrogenase I activity, 32%; vectorcardiography (QRS vector difference), 20%; electrocardiography (Palmeri score), 20%; ejection fraction, 9%. We conclude that early thrombolysis in acute myocardial infarction reduces the severity of chest pain by nearly 50%. The effect on chest pain is much more marked as compared with the effect on various markers of the final ischemic damage.

  • 311.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Hartford, M
    Karlsson, T
    Risenfors, M
    Karlsson, BW
    Luepker, R
    Holmberg, S
    Swedberg, K
    Hjalmarson, Å
    Mortality and morbidity 1 year after early thrombolysis in suspected AMI: results from the TEAHAT Study1991Inngår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 734, nr suppl 1, s. 43-51Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We randomized 352 patients with suspected acute myocardial infarction (AMI) to treatment with rt-PA (n = 177) or placebo (n = 175). Patients were eligible if evaluated within 2 h and 45 min from onset of chest pain, and if aged less than 75 years. There were no ECG criteria for inclusion. A mobile coronary-care unit with a cardiologist present was used to initiate treatment at home in 29% of cases. During 1 year of follow-up the mortality in patients treated with rt-PA was 10.2%, as compared with 14.3% in patients the initial ECG, the mortality during the first year was 8% in the rt-PA group vs. 18% in the placebo group (P less than 0.05). Among patients without ST-elevation the mortality was 9% for the rt-PA group vs. 12% for the placebo group (NS). Requirement for rehospitalization, symptoms of angina pectoris and congestive heart failure, time of return to work and requirement for various medications did not differ significantly between the two groups, regardless of the initial ECG pattern.

  • 312.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlson, BW
    Karlsson, T
    Prognosis after acute myocardial infarction continues to improve in the reperfusion era in the community of Göteborg2002Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 144, nr 1, s. 89-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The objective of this study was to compare the prognosis of nonselected patients who had an acute myocardial infarction (AMI) during 2 time periods in the thrombolytic era and to describe coronary heart disease (CHD) mortality rates in the community of Göteborg during 1990 to 1995. METHODS: Patients aged <75 years who were hospitalized in the community of Göteborg for AMI during 1990 to 1991 (period 1) and 1995 to 1996 (period 2) were compared in terms of history, treatment for AMI, and outcome. Information on CHD mortality rates in the community of Göteborg was gathered from the National Registry of Deaths. RESULTS: The numbers of patients in the 2 cohorts were 926 and 861, respectively. The incidence rate for AMI per 100,000 inhabitants and year was 200 for period 1 and 183 during period 2. During period 2, there was an increased use of percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, angiotensin-converting enzyme inhibitors, heparin, and intravenous nitroglycerin. On the other hand, there was a decreased use of thrombolytic agents, diuretic agents, digitalis, long-acting nitrates, calcium-channel blockers, and lidocaine. The hospital case-fatality rates were 9.4% during period 1 and 6.0% during period 2 (P =.01). The adjusted risk ratio for period 2 versus period 1 was 0.65, with 95% confidence limits of 0.45 to 0.94. The mortality rate over a period of 3 years was 26.5% during period 1 and 17.8% during period 2 (P <.0001). The adjusted risk ratio for period 2 versus period 1 was 0.67, with 95% confidence limits of 0.54 to 0.82. Among inhabitants aged 30 to 74 years in the community of Göteborg, the CHD mortality rate decreased in 1995 as compared with 1990 (age-adjusted odds ratio 0.79, 95% confidence limits 0.68 to 0.92). CONCLUSIONS: For consecutive patients aged <75 years who were hospitalized for AMI in the community of Göteborg, we found that in the thrombolytic era, major changes in medical and nonmedical treatment still took place associated with a continuing decrease in mortality rates during 3 years of follow-up. A similar reduction of CHD mortality rates was seen in the same age group within the community of Göteborg.

  • 313.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlson, BW
    Lindqvist, J
    Sandén, W
    Svensson, H
    Sjölin, M
    Wedel, H
    Similar risk reduction of death of extended-release metoprolol once daily and immediate release metoprolol twice daily during 5 years after myocardial infarction1999Inngår i: Cardiovascular Drugs and Therapy, ISSN 0920-3206, E-ISSN 1573-7241, Vol. 13, nr 2, s. 127-135Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The pooled results from five placebo-controlled postinfarction studies with metoprolol have shown a significant reduction in total mortality. All five studies used immediate-release metoprolol twice daily. An extended-release formulation of metoprolol for once-daily use has since been developed. The aim of the present study was to compare the two different forms of metoprolol with regard to the risk reduction of death for 5 years postinfarction and to analyze whether treatment with the beta-blocker metoprolol is associated with a reduced mortality after the introduction of modern therapies such as thrombolysis, aspirin, and ACE inhibitors. All patients discharged after an acute myocardial infarction (AMI) from Sahlgrenska University Hospital (SU) during 1986-1987 (n = 740, Period I) and during 1990-1991 (n = 1446, Period II) from both SU and Ostra Hospital, Göteborg, Sweden, were included in the study. During Period I, 56% were prescribed immediate-release metoprolol compared with 61% prescribed extended-release metoprolol during Period II. Immediate-release metoprolol was not available for outpatient use during Period II. In a multivariate analysis, all variables significantly associated with either increased or decreased postinfarction mortality during Periods I and II (univariate analysis of patient characteristics, medical history, complications during the AMI medication at discharge) studied were with Cox's proportional hazards model. Treatment with immediate-release metoprolol was significantly associated with reduced mortality over 5 years during Period I (relative risk reduction for total mortality, -34%, P = 0.003; 95% CI for RR, 0.51-0.87), and treatment with extended-release metoprolol was significantly associated with reduced mortality during Period II (-34%, P < 0.0001; 95% CI for RR, 0.53-0.82). Thrombolysis and the use of aspirin and ACE inhibitors were more frequently used during Period II. The results showed that postinfarction treatment with extended-release metoprolol given once daily was associated with a similar risk reduction of death over 5 years as immediate-release metoprolol given twice daily. The data, furthermore, indicate that the beta-blocker metoprolol is associated with a reduced risk of death after the introduction of modern therapy such as thrombolysis, aspirin, and ACE inhibitors.

  • 314.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlson, BW
    Lindqvist, J
    Wedel, H
    Long term mortality after acute myocardial infarction in relation to prescribed dosages of a beta-blocker at hospital discharge2001Inngår i: Cardiovascular Drugs and Therapy, ISSN 0920-3206, E-ISSN 1573-7241, Vol. 14, nr 6, s. 589-595Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    his study was designed to describe the 5-year mortality rate in relation to the dose of metoprolol prescribed at hospital discharge after hospitalisation for acute myocardial infarction (AMI). All patients discharged alive after being hospitalized for AMI at Sahlgrenska Hospital (covering half of the community of Göteborg, with 500,000 inhabitants) during 1986–1987 (period I) and all patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital and östra Hospital (covering the whole area of the community of Göteborg) in 1990–1991 (period II) were included. Overall mortality was retrospectively evaluated over 5 years of follow-up. In all there were 2161 patients who were discharged after AMI. Seventy-three percent of these patients were prescribed a beta-blocker and 59% were prescribed metoprolol. Of the patients prescribed metoprolol, 34% were on 200 mg, 46% on 100 mg, and 20% on 50 mg or less. Information on 5-year mortality was available for 2142 of the 2161 patients (99.1%). The 5-year mortality was 24% among patients prescribed 200 mg, 33% among patients prescribed 100 mg, and 43% among patients prescribed 50 mg (P < 0.0001).="" patients="" prescribed="" another="" beta-blocker="" had="" a="" 5-year="" mortality="" of="" 39%,="" and="" patients="" prescribed="" no="" beta-blocker="" at="" all="" had="" a="" 5-year="" mortality="" of="" 61%.="" when="" correcting="" for="" dissimilarities="" at="" baseline,="" patients="" who="" were="" prescribed="">le100 mg had an adjusted risk ratio for death of 0.79 (95% confidence limit 0.64–0.96; P = 0.021) as compared with patients not prescribed a beta blocker. The corresponding figure for patients prescribed >100 mg was 0.63 (95% confidence limit 0.48–0.84; P = 0.001). Both patients prescribed high and low doses of metoprolol after AMI appeared to benefit from treatment. There was a trend indicating more benefit when larger doses were prescribed.

  • 315.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlsson, T
    Långtidsprognos vid hjärtinfarkt sämre än väntat2008Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, nr 17, s. 1289-1294Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    I en representativ population patienter som sjukhusvårdats i Göteborgs kommun med slutdiagnos akut hjärtinfarkt (medelålder 75 år) var långtidsprognosen mer alarmerande än vad som tidigare rapporterats i litteraturen. Under det första året efter symtomdebut hade 30 procent avlidit, och under de första 3 åren hade 45 procent avlidit. Endast 60 procent av patienterna behandlades på hjärtinfarktavdelning. Högriskgrupper var de patienter som aldrig behandlades på hjärtinfarktavdelning och de patienter där det inte förelåg någon misstanke om hjärtinfarkt vid ankomst till sjukhus.

  • 316.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Dellborg, M
    Karlsson, T
    Evander, MH
    Hartford, M
    Perers, E
    Caidahl, K
    Treatment and Outcome in Acute Myocardial Infarction in a Community in Relation to Gender2009Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 135, nr 3, s. 315-22Artikkel i tidsskrift (Fagfellevurdert)
  • 317.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlsson, T
    Haglid Evander, M
    Berger, A
    Luepker, R
    Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions2008Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 128, nr 3, s. 342-349Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To describe the characteristics and outcome of patients with acute myocardial infarction (AMI) in a community, with particular emphasis on those who never reached a Coronary Care Unit (CCU) and those in whom the primary diagnosis was something other than a heart attack. Methods Patients hospitalised in the city of Göteborg, Sweden, and discharged (dead or alive) with a diagnosis of AMI. Results Among 1423 patient admissions the mean overall age was 75 years (81 years and 79 years in the two subsets). Among all patients, 33% had a history of heart failure and 20% had a history of cerebrovascular disease. The figures were even higher in the two subsets which were evaluated. In overall terms, an invasive strategy (coronary angiography) was used in 32% (in 5% and 9% in the two subsets respectively). The overall one-year and three-year mortality rate was 30% and 44% respectively. The three-year mortality rate among patients not admitted to a CCU was 65% and, among patients with no suspicion of a heart attack on admission, it was 68%. Conclusion Even in the 21st century, patients with AMI who reach hospital alive run a high risk of death and nearly half are dead within the first three years. In overall terms, patients are characterised by high age and high co-morbidity. Among patients who do not reach a CCU and among patients with no suspicion of AMI on admission, approximately two thirds are dead within the subsequent three years.

  • 318.
    Herlitz, Johan
    et al.
    [external].
    Dellborg, M
    Karlsson, T
    Haglid Evander, M
    Hartford, M
    Perers, E
    Caidahl, K
    Treatment and outcome in acute myocardial infarction in a community in relation to gender.2009Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 153, nr 3, s. 315-322Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe treatment and outcome in all patients in a community with acute myocardial infarction (AMI) in relation to gender. METHODS: All patients discharged from hospital between 2001 and 2002 in Göteborg, Sweden, with a diagnosis of AMI underwent a survey to find possible gender differences. All p-values are age adjusted. RESULTS: Among 1423 admissions, women comprised 41% and were older than men (mean 79 versus mean 72 years). Women were admitted to a coronary care unit less frequently than men (49% versus 67%; p=0.005). Women underwent coronary angiography less frequently (21% versus 40%; p=0.02). Percutaneous coronary intervention (PCI) was performed in 10% of the women and 18% of the men (p=0.36). Coronary artery bypass grafting (CABG) was performed in 2% of the women and in 9% of the men (p<0.0001). Female gender was associated with a lower risk of reinfarction during first year after hospital discharge (12% versus 16%; p=0.003). The cumulative three-year mortality was 49% in women and 41% in men. However, when adjusting for age, admittance to CCU, coronary angiography and coronary revascularisation, risk of death during 3 years was lower in women than men (odds ratio 0.72; 95% confidence interval 0.60-0.85; p=0.0001). CONCLUSION: In the community of Göteborg women (mean age 79 years) with AMI are prioritised differently than men (mean age 72 years), prior to admission to a CCU. This results in a less invasive strategy in women, particularly with regard to CABG. When adjusting for difference in age, admittance to CCU and coronary revascularisation female gender was associated with a low risk of death during the subsequent 3 years.

  • 319.
    Herlitz, Johan
    et al.
    [external].
    Edwardsson, N
    Holmberg, S
    Rydén, L
    Waagstein, F
    Waldenström, A
    Swedberg, K
    Hjalmarson, Å
    Göteborg Metoprolol Trial: effects on arrhythmias1984Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 53, nr 13, s. 27-31Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During the initial hospitalization, ventricular fibrillation (VF) developed in 6 metoprolol-treated patients (0.9%) vs 17 placebo-treated patients (2.4%) after inclusion in the study (p = 0.035). There were 6 episodes of VF in the metoprolol group compared with 41 episodes in the placebo group (p less than 0.001). During the same period, 14 metoprolol-treated patients had treated ventricular tachycardia vs 26 placebo-treated patients (p = 0.076). Similar favorable results were found when the incidence of severe ventricular arrhythmias during the first rehospitalization within the 3-month double-blind treatment period was analyzed.

  • 320.
    Herlitz, Johan
    et al.
    [external].
    Eek, M
    Engdahl, J
    Holmberg, M
    Holmberg, S
    Factors at resuscitation and outcome among patients suffering from out of hospital cardiac arrest in relation to age.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 3, s. 309-317Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe various factors at resuscitation and outcome among patients suffering from out-of-hospital cardiac arrest in relation to age. PATIENTS: All patients included in the Swedish Cardiac Arrest Registry during the period 1990-1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS: All patients reached by the ambulance crew and in whom resuscitative efforts were attempted. Crew witnessed cases were excluded. Only patients aged over 18 years were included. Patients were divided into three age groups: less than 65 years (n=7810), 65-75 years (n=7261) and over 75 years (n=8390). RESULTS: The proportion of cases with a cardiac aetiology increased with increasing age (P<0.0001). The proportion of witnessed cases increased with increasing age among those with a non-cardiac aetiology (P<0.0001) and decreased with increasing age among cases with a cardiac aetiology (P=0.02). The proportion of patients exposed to bystander CPR decreased with increasing age (P<0.0001). The proportion of patients found in ventricular fibrillation (VF) decreased with increasing age among patients with a cardiac aetiology (P<0.0001) but was not related to age in those with a non-cardiac aetiology. The proportion of patients being alive after 1 month in the three age groups (youngest first) were: 4.5, 3.2 and 2.5% (P<0.0001). The corresponding figures for patients with a cardiac aetiology found in VF were: 10.7, 7.6 and 6.6% (P<0.0001). After multiple regression analysis controlling for other factors increasing age was still associated with decreased survival to 1 month (odds ratio 0.85; 95% confidence limits 0.80-0.91). CONCLUSION: Among patients suffering from out-of-hospital cardiac arrest various factors at resuscitation, including initial rhythm, aetiology and bystander CPR, are strongly related to age. The chance of survival diminishes with increasing age. When correcting for the dissimilarities in terms of factors at resuscitation, age is still significantly associated with survival, being lower among the elderly.

  • 321.
    Herlitz, Johan
    et al.
    [external].
    Eek, M
    Holmberg, M
    Engdahl, J
    Holmberg, S
    Characteristics and outcome among patients having out of hospital cardiac arrest at home compared with elsewhere.2002Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 88, nr 6, s. 579-582Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the characteristics and outcome of patients who have a cardiac arrest at home compared with elsewhere out of hospital. PATIENTS: Subjects were patients included in the Swedish cardiac arrest registry between 1990 and 1999. The registry covers about 60% of all ambulance organisations in Sweden. METHODS: The study sample comprised patients reached by the ambulance crew and in whom resuscitation was attempted out of hospital. There was no age limit. Crew witnessed cases were excluded. The patients were divided into two groups: cardiac arrest at home and cardiac arrest elsewhere. RESULTS: Among a study population of 24 630 patients the event took place at home in 16 150 (65.5%). Those in whom the arrest took place at home differed from the remainder in that they were older, were more often women, less often had a witnessed cardiac arrest, were less often exposed to bystander cardiopulmonary resuscitation (CPR), were less often found in ventricular fibrillation, and had a longer interval between collapse and call for ambulance, arrival of ambulance, start of CPR, and first defibrillation. Of patients in whom the arrest took place at home, 11.3% were admitted to hospital alive, v 19.4% in the elsewhere group (p < 0.0001); corresponding figures for survival after one month were 1.7% v 6.2% (p < 0.0001). The adjusted odds ratio for survival after one month (at home v not at home; considering age, sex, initial arrhythmia, bystander CPR, aetiology, and whether the arrest was witnessed) was 0.40 (95% confidence interval 0.33 to 0.49; p < 0.0001). CONCLUSIONS: Sixty five per cent of out of hospital cardiac arrests in Sweden occur at home. The patients differed greatly from those with out of hospital cardiac arrests elsewhere, and fewer than 2% were alive after one month. Having an arrest at home was a strong independent predictor of adverse outcome. Further research is needed to identify the reasons for this.

  • 322.
    Herlitz, Johan
    et al.
    [external].
    Eek, M
    Holmberg, M
    Holmberg, S
    Diurnal, weekly and seasonal rhythm of out of hospital cardiac arrest in Sweden2002Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 54, nr 2, s. 133-138Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the diurnal, weekly and seasonal rhythm among patients suffering from out of hospital cardiac arrest in Sweden. METHODS: All patients in Sweden between 1990 and 1999 participating in a National Registry covering 65% of all patients suffering from out of hospital cardiac arrest where cardiopulmonary resuscitation (CPR) was attempted. Only patients with a cardiac arrest of a cardiac aetiology and aged > 18 years were included in the survey. RESULTS: 10,868 patients fulfilled inclusion criteria. In terms of the diurnal rhythm, there was a progressive increase in the development of cardiac arrest from 06:00 h, reaching a peak at about 10:00 h. Thereafter, there was a progressive decline until 05:00 h. The diurnal rhythm was more marked among patients aged > 65 years and among patients in whom the arrest occurred outside home. There was a weekly rhythm with an increased incidence of cardiac arrest on Mondays. This was particularly evident among patients aged < 66 years and among men. A cardiac arrest occurred most frequently in January and December. This was particularly observed in the large cities. CONCLUSION: We found that out of hospital cardiac arrest of a cardiac etiology has a diurnal, weekly and seasonal rhythm occurring most frequently in the morning hours, on Mondays and in December and January. Age, sex and place of arrest influence these rhythms.

  • 323.
    Herlitz, Johan
    et al.
    [external].
    Ejdebäck, J
    Swedberg, K
    Waagstein, F
    Hjalmarson, Å
    Göteborg Metoprolol Trial: electrocardiographically estimated infarct size1984Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 53, nr 13, s. 22-26Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 236 patients with anterior myocardial infarction (MI), infarct size was estimated by analyzing the R- and Q-wave amplitude in 24 precordial leads 4 days after randomization. In 254 patients with inferior MI, the final R- and Q-wave amplitude was evaluated in leads II, III and aVF. Electrocardiographic signs of a smaller MI were observed in anterior MI in the metoprolol group compared with the placebo group when treatment was started 12 hours or less after the onset of pain, but no difference was found when treatment was started later. There was no sign of an effect of metoprolol in inferior MI. An immediate reduction in ST-segment elevation was observed after metoprolol treatment regardless of infarct localization or delay between the onset of pain and treatment.

  • 324.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Axelsson, Å
    Bång, A
    Wennerblom, B
    Waagstein, L
    Dellborg, M
    Holmberg, S
    Continuation of CPR on admission to Emergency Department after out-of-hospital cardiac arrest. Occurence, characteristics and outcome1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, nr 3, s. 223-231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the occurrence, characteristics and outcome among patients with out-of-hospital cardiac arrest who required continuation of cardiopulmonary resuscitation (CPR) on admission to the emergency department. PATIENTS: all patients in the municipality of Göteborg who suffered out-of-hospital cardiac arrest, were reached by the emergency medical service (EMS) system and in whom CPR was initiated. Period for inclusion in study: 1 Oct. 1980-31 Dec. 1992. RESULTS: of 334 out-of-hospital cardiac arrests, 2,319 (68%) were receiving on-going CPR at the time of admission to hospital. Of these, 137 patients (6%) were hospitalized alive and 28 (1.2%) could be discharged from hospital. Of these patients, 39% had a cerebral performance categories (CPC) score of 1 (no cerebral deficiency), 18% had a CPC score of 2 (moderate cerebral deficiency), 36% had a CPC score of 3 (severe cerebral deficiency) and 7% had a CPC score of 4 (coma) at discharge. Among patients discharged. 76% were alive after 1 year. CONCLUSION: among consecutive patients with out-of-hospital cardiac arrest, CPR was ongoing in 68% of them on admission to hospital. Among these patients, 6% were hospitalized alive and 1.2% were discharged from hospital. Thus, among patients with ongoing CPR on admission to hospital, survivors can be found but they are few in numbers and extensive cerebral damage is frequently present.

  • 325.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Hartford, M
    Karlson, BW
    Karlsson, T
    Grip, L
    Characteristics and outcome of patients with ST-elevation infarction in relation to whether they received thrombolysis or underwent acute coronary angiography: are we selecting the right patients for coronary angiography?2003Inngår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 26, nr 2, s. 78-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: During the last decade, there has been an on-going debate with regard to whether percutaneous coronary intervention (PCI) or thrombolysis should be preferred in patients with ST-elevation acute myocardial infarction (AMI). Some studies clearly advocate PCI, while others do not. HYPOTHESIS: The study aimed to describe the characteristics and to evaluate outcome of patients with suspected ST-elevation or left bundle-branch block infarction in relation to whether they received thrombolysis or had an acute coronary angiography aiming at angioplasty. METHODS: The study included all patients admitted to Sahlgrenska University Hospital in Göteborg, Sweden, with suspected acute myocardial infarction who, during 1995-1999, had ST-elevation or left bundle-branch block on admission electrocardiogram (ECG) requiring either thrombolysis or acute coronary angiography. A retrospective evaluation with a follow-up of 1 year after the intervention was made. RESULTS: In all, 413 patients had thrombolytic treatment and 400 had acute coronary angiography. The patients who received thrombolysis were older (mean age 70.3 vs. 64.1 years). Mortality during 1 year of follow-up was 20.9% in the thrombolysis group and 16.6% in the angiography group (p = 0.12). Among patients in whom acute coronary angiography was performed, only 85% underwent acute percutaneous coronary intervention (PCI). There was a mortality of 12.1 vs. 41.7% among those who did not undergo acute PCI. Development of reinfarction, stroke, and requirement of rehospitalization was similar regardless of type of initial intervention. The thrombolysis group more frequently required new coronary angiography (36.9 vs. 20.6%; p<0.0001) and new PCI (17.8 vs. 11.9%; p = 0.01). Despite this, after 1 year symptoms of angina pectoris were observed in 27% of patients in the thrombolysis group and in only 14% of those in the angiography group (p = 0.0002). CONCLUSION: In a Swedish university hospital with a high volume of coronary angioplasty procedures, we found no significant difference in mortality between patients who had thrombolysis and those who underwent acute coronary angiography. However, requirement of revascularization and symptoms of angina pectoris 1 year later was considerably less frequent in those who had undergone acute coronary angiography. However, distribution of baseline characteristics was skewed and efforts should be focused on the selection of patients for the different reperfusion strategies.

  • 326.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, D
    Predictors of early and late survival after out of hospital cardiac arrest in which asystole was the first recorded arrhythmia on scene1994Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 28, nr 1, s. 27-36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A large proportion of patients who suffer out-of-hospital cardiac arrest have asystole as the initial recorded arrhythmia. Since they have a poor prognosis, less attention has been paid to this group of patients. Aim: To describe a consecutive population of patients with out-of-hospital cardiac arrest with asystole as the first recorded arrhythmia and to try to define indicators for an increased chance of survival in this population. Setting: The community of Gothenburg. Patients: All patients who suffered out-of-hospital cardiac arrest during 1981 to 1992 and were reached by our emergency medical service (EMS) system and where cardiopulmonary resuscitation (CPR) was attempted. Results: In all there were 3434 cardiac arrests of which 1222 (35%) showed asystole as the first recorded arrhythmia. They differed from patients with ventricular fibrillation by being younger, including more women and having a longer interval between collapse and arrival of the first ambulance. In all 90 patients (7%) were hospitalized alive and 20 (2%) could be discharged from hospital. Independent predictors for an increased chance of survival were: (a) a short interval between the collapse and arrival of the first ambulance (P < 0.001) and the time the collapse occurred (P < 0.05). Initial treatment given in some cases with adrenaline, atropine and tribonate were not associated with an increased survival. Conclusions: Of all the patients with out-of-hospital cardiac arrest, 35% were found in asystole. Of these, 7% were hospitalized alive and 2% could be discharged from hospital. Efforts should be made to improve still further the interval between collapse and arrival of the first ambulance.

  • 327.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?1995Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 3, s. 195-201Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role of treatment with adrenaline in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with adrenaline prior to hospital admission. PATIENTS AND TREATMENT: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1981 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1360 patients were found in ventricular fibrillation and detailed information was available in 1203 cases (88%). Adrenaline was given in 417 cases (35%). Among patients with sustained ventricular fibrillation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalized alive more frequently (P < 0.01). However, the rate of discharge from hospital did not differ significantly between the 2 groups. Among patients who converted to asystole or electromechanical dissociation, those who received adrenaline experienced the return of spontaneous circulation more frequently (P < 0.001) and were hospitalised alive more frequently (P < 0.001). However, the rate of discharge from hospital did not differ significantly between the 2 groups. CONCLUSIONS: On the basis of 2 treatment regimens during a 12-year survey, we explored the usefulness of adrenaline in out-of-hospital ventricular fibrillation. Both patients with sustained ventricular fibrillation and those who converted to asystole or electromechanical dissociation had an initially more favourable outcome if treated with adrenaline. However, the final outcome was not significantly affected. This study does not confirm the hypothesis that adrenaline increases survival among patients with out-of-hospital cardiac arrest who are found in ventricular fibrillation.

  • 328.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital1994Inngår i: British Heart Journal, ISSN 0007-0769, Vol. 72, nr 5, s. 408-412Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE--To describe the proportion of patients who were discharged from hospital after witnessed cardiac arrest outside hospital in relation to whether a bystander initiated cardiopulmonary resuscitation. PATIENTS--All patients with witnessed cardiac arrest outside hospital before arrival of the ambulance and in whom cardiopulmonary resuscitation was attempted by the emergency medical service in Gothenburg during 1980-92. RESULTS--Cardiopulmonary resuscitation was initiated by a bystander in 18% (303) of 1,660 cases. In this group 69% had ventricular fibrillation at first recording compared with 51% in the remaining patients (P < 0.001). Among patients in whom cardiopulmonary resuscitation had been initiated by a bystander 25% were discharged alive versus 8% of the remaining patients (P < 0.001). Independent predictors of survival were in order of significance: initial arrhythmia (P < 0.001), interval between collapse and arrival of first ambulance (P < 0.001), cardiopulmonary resuscitation initiated by a bystander (P < 0.001), and age (P < 0.01). Among patients who were admitted to hospital alive 30% of patients in whom cardiopulmonary resuscitation had been initiated by a bystander compared with 58% of remaining patients (P < 0.001) had brain damage and died in hospital. Corresponding figures for death in association with myocardial damage were 18% and 29% respectively (P < 0.01). CONCLUSIONS--Cardiopulmonary resuscitation initiated by a bystander maintains ventricular fibrillation and triples the chance of surviving a cardiac arrest outside hospital. Furthermore, it seems to protect against death in association with brain damage as well as with myocardial damage.

  • 329.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Prognosis among survivors of prehospital cardiac arrest1995Inngår i: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 25, nr 1, s. 58-63Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY OBJECTIVE: To describe the prognosis in consecutive patients discharged from hospital after prehospital cardiac arrest. PATIENTS: All patients in the community of Göteborg who were discharged from hospital after out-of-hospital cardiac arrest between 1981 and 1991. RESULTS: Two hundred forty-three patients were discharged from hospital during the observation period, of whom 80% initially experienced ventricular fibrillation. Among patients discharged, 21% died during the first year; after 10 years, 82% had died. Age, sex, previous history of cardiovascular disease, circumstances at the time of cardiac arrest, complications during hospitalization, and discharge medications were assessed as predictors of 1-year mortality. Independent predictors of death during follow-up were history of myocardial infarction (P < .001), no prescription of beta-blockers at discharge (P < .01), age (P < .05), and cerebral performance category (CPC) at discharge (P < .05). CONCLUSION: Among patients who survived out-of-hospital cardiac arrest, one of five died during the first year and one of five survived 10 years after discharge. Prognosis was associated with a history of myocardial infarction, prescription of beta-blockers at discharge, age, and CPC at discharge.

  • 330.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Risk indicators for, and symptoms associated with, death among patients hospitalized after out-of-hospital cardiac arrest1994Inngår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 5, nr 5, s. 407-414Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: An increasing proportion of patients who have an out-of-hospital cardiac arrest are initially successfully resuscitated and thus hospitalized. AIMS: To define risk indicators for, and to describe the mode of, in-hospital death among patients hospitalized after an out-of-hospital cardiac arrest. SETTING: Göteborg, Sweden. PATIENTS: All patients hospitalized after out-of-hospital cardiac arrest between 1980 and 1992. RESULTS: A total of 707 out of 3434 patients were hospitalized after out-of-hospital cardiac arrest, of whom 278 (39%) were discharged alive. Independent risk indicators for in-hospital death were: type of initial arrhythmia on the scene, age, interval between cardiac arrest and arrival of first ambulance, bystander-initiated cardiopulmonary resuscitation and history of diabetes mellitus. Of the patients who died in hospital, 88% had brain damage and 43% myocardial damage. CONCLUSION: Risk indicators for hospital death can be defined. The majority of in-hospital deaths were associated with brain damage.

  • 331.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival among patients with out of hospital cardiac arrest found in electromechanical dissociation1995Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 29, nr 2, s. 97-106Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest are found in electromechanical dissociation at the time the Emergency Medical Service (EMS) arrives. Since they have a poor prognosis, less attention has been paid to them. AIM: To describe a consecutive population of patients with out-of-hospital cardiac arrest found in electromechanical dissociation and to try to define indicators for an increased chance of survival in this patient population. SETTING: The municipality of Göteborg. PATIENTS: All the patients who suffered an out-of-hospital cardiac arrest between 1981-1992 and were reached by our EMS system and in whom cardiopulmonary resuscitation (CPR) was attempted. RESULTS: In all, there were 3434 patients with cardiac arrest of whom 748 (22%) were found in electromechanical dissociation. They differed from patients found in ventricular fibrillation as there were more women, a higher frequency of cardiac arrest during the night, a lower frequency of witnessed cardiac arrest and consequently a lower frequency of bystander-initiated CPR. In all, 96 patients (13%) were hospitalized alive and only 16(2%) could be discharged from hospital. In a multivariate analysis relating to age, sex, time of cardiac arrest, interval between collapse and the arrival of the first ambulance, bystander-initiated CPR and treatment with adrenaline, atropine and tribonate, no independent predictor of survival was found. CONCLUSION: Of all the patients with out-of hospital cardiac arrest in whom CPR was attempted by our EMS, 22% were found in electromechanical dissociation. Of these, 13% were hospitalized alive and 2% could be discharged from the hospital. No independent predictor of an increased chance of survival was found.

  • 332.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    Holmberg, S
    Survival in patients found to have ventricular fibrillation after cardiac arrest witnessed outside hospital1994Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 15, nr 12, s. 1628-1633Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Since 1980 an Emergency Medical Service (EMS) system with a two-tier ambulance service has been operating in Goteborg. During this 12-year period, all cardiac arrests outside hospital have been monitored. Cardiopulmonary resuscitation (CPR) training for the general public began in 1985 and, by the end of 1992, 125 000 persons had been trained. The aim of this study was to define the factors associated with an increased chance of survival after cardiac arrest witnessed out-of-hospital and secondary to ventricular fibrillation. The study group comprises all patients with cardiac arrest witnessed outside hospital in Goteborg between 1980 and 1992, in whom CPR was initiated by our EMS and ventricular fibrillation observed at the first ECG recording. In a multivariate analysis of age, sex, time of collapse, interval between collapse and first defibrillation, bystander-initiated CPR, the following factors were associated with an increased chance of being discharged from hospital: (1) Short interval between collapse and first defibrillation (P < 0.001); (2) Bystander-initiated CPR (P < 0.001); and (3) Age (P < 0.05). Among patients with an out-of-hospital cardiac arrest who were found by the EMS personnel to have ventricular fibrillation, the predictors of survival were: interval between collapse and defibrillation, bystander-initiated CPR and age.

  • 333.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    [external].
    Holmberg, S
    Type of arrhythmia at EMS arrival scene in out of hospital cardiac arrest in relation to interval from collapse and whether a bystander initiated CPR1996Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 14, nr 2, s. 119-123Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Outcome after cardiac arrest is strongly related to whether the patient has ventricular fibrillation at the time the emergency medical service (EMS) arrives on the scene. The occurrence of various arrhythmias at the time of EMS arrival among patients with out-of-hospital cardiac arrest was studied in relation to the interval from collapse and whether cardiopulmonary resuscitation (CPR) was initiated by a bystander. The patients studied were all those with out-of-hospital cardiac arrest in Goteborg, Sweden, between 1980 and 1992 in whom CPR was attempted by the arriving EMS and for whom the interval between collapse and the arrival of EMS was known. In all, information on the time of collapse and the arrival of EMS was available for 1,737 patients. Among patients for whom EMS arrived within 4 minutes of collapse, 53% were found in ventricular fibrillation/tachycardia. There was a successive decline in occurrence of such arrhythmias with time. However, when the interval exceeded 20 minutes, ventricular fibrillation/tachycardia was still observed in 27% of cases. Bystander CPR increased the occurrence of such arrhythmias regardless of the interval between collapse and EMS arrival.

  • 334.
    Herlitz, Johan
    et al.
    [external].
    Ekström, L
    Wennerblom, B
    Axelsson, Å
    Bång, A
    [external].
    Lindqvist, J
    Persson, N-G
    Holmberg, S
    Lidocaine in out-of-hospital ventricular fibrillation. Does it improve the survival?1997Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, nr 3, s. 199-205Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: A large proportion of cardiac arrests outside hospital are caused by ventricular fibrillation. Although it is frequently used, the exact role for treatment with lidocaine in these patients remains to be determined. AIM: To describe the proportion of patients with witnessed out-of-hospital cardiac arrest found in ventricular fibrillation who survived and were discharged from hospital in relation to whether they were treated with lidocaine prior to hospital admission. Patients and treatment: All the patients with out-of-hospital cardiac arrest found in ventricular fibrillation in Göteborg between 1980 and 1992 in whom cardiopulmonary resuscitation (CPR) was initiated by our emergency medical service (EMS). During the observation period, some of the EMS staff were authorized to give medication and some were not. RESULTS: In all, 1,360 patients were found in ventricular fibrillation, with detailed information being available in 1,212 cases (89%). Lidocaine was given in 405 of these cases (33%). Among patients with sustained ventricular fibrillation, those who received lidocaine had a return of spontaneous circulation (ROSC) more frequently (P < 0.001) and were hospitalized alive more frequently (38% vs. 18%, P < 0.01). However, the rate of discharge from hospital did not significantly differ between the two groups. Among patients who were converted to a pulse-generating rhythm, those who received lidocaine on that indication were more frequently alive than those who did not receive such treatment (94% vs. 84%; P < 0.05). However, the rate of discharge did not significantly differ between the two groups. CONCLUSION: In a retrospective analysis comparing patients who received lidocaine with those who did not in sustained ventricular fibrillation and after conversion to a pulse-generating rhythm, such treatment was associated with a higher rate at ROSC and hospitalization but was not associated with an increased rate of discharge from hospital.

  • 335.
    Herlitz, Johan
    et al.
    [external].
    Elmfeldt, D
    Hjalmarson, Å
    Holmberg, S
    Málek, I
    Nyberg, G
    Rydén, L
    Swedberg, K
    Vedin, A
    Waagstein, F
    Waldenström, A
    Waldenström, J
    Wedel, H
    Wilhelmsen, L
    Wilhelmsson, C
    Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction1983Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 51, nr 8, s. 1282-1288Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In a double-blind randomized trial, 1,395 patients with suspected acute myocardial infarction (MI) were investigated to evaluate the possibility of limiting indirect signs of the size and severity of acute MI with the beta1-selective adrenoceptor antagonist metoprolol. Metoprolol (15 mg) was given intravenously and followed by oral administration for 3 months (200 mg daily). Placebo was given in the same way. The size of the MI was estimated by heat-stable lactate dehydrogenase (LD[EC 1.1.1.27]) analyses and precordial electrocardiographic mapping. Lower maximal enzyme activities compared with placebo were seen in the metoprolol group (11.1 ± 0.5 μkat · liter−1)when the patient was treated within 12 hours of the onset of pain (13.3 ± 0.6 μkat · liter−1; n = 936; p = 0.009). When treatment was started later than 12 hours, no difference was found between the 2 groups. Enzyme analyses were performed in all but 20 patients (n = 1,375). Precordial mapping with 24 chest electrodes was performed in patients with anterior wall MI. The final total R-wave amplitude was higher and the final total Q-wave amplitude lower in the metoprolol group than in the placebo group. Patients treated with metoprolol ≤12 hours also showed a decreased need for furosemide, a shortened hospital stay, and a significantly reduced 1-year mortality compared with the placebo group, whereas no difference was observed among patients treated later on. After 3 months, however, there was a similar reduction in mortality among patients in whom therapy was started 12 hours and >12 hours after the onset of pain. The results support the hypothesis that intravenous metoprolol followed by oral treatment early in the course of suspected myocardial infarction can limit infarct size and improve longterm prognosis.

  • 336.
    Herlitz, Johan
    et al.
    [external].
    Elmfeldt, D
    Holmberg, S
    Málek, I
    Nyberg, G
    Pennert, K
    Rydén, L
    Swedberg, K
    Vedin, A
    Waagstein, F
    Waldenström, A
    Waldenström, J
    Wedel, H
    Wilhelmsen, L
    Wilhelmsson, C
    Hjalmarson, Å
    Göteborg Metoprolol Trial: mortality and causes of death1984Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 53, nr 13, s. 9-14Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    During the 3-month blind treatment period there were 40 deaths in the metoprolol group compared with 62 deaths in the placebo group (p = 0.024). During the first year (after 3 months the 2 groups were treated similarly) there were 64 deaths in the metoprolol group vs 93 in the placebo group (p = 0.017) and during 2 years 92 patients died in the metoprolol group vs 120 in the placebo group (p = 0.043). The relative incidence of different causes of death did not differ significantly between the 2 treatment groups, indicating that metoprolol reduced all causes of death to the same extent as its effect on overall mortality.

  • 337.
    Herlitz, Johan
    et al.
    [external].
    Emanuelsson, H
    Hjalmarson, Å
    Holmberg, S
    Waagstein, F
    Waldenström, A
    Waldenström, J
    Hemodynamic and clinical findings after combined therapy with metoprolol and nifedipine in acute myocardial infarction1984Inngår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 7, nr 8, s. 425-432Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In a double-blind trial, 30 patients with suspected acute myocardial infarction with onset of symptoms within the previous 24 h were randomized to treatment with 10 mg nifedipine/placebo orally 4 times a day during hospitalization. All patients were given 15 mg metoprolol intravenously 20 min after the initial administration of nifedipine/placebo, and thereafter, 50 mg 4 times a day. The combined therapy resulted only in moderate changes in systolic blood pressure and heart rate compared with metoprolol alone. Three of the 15 patients in the nifedipine group versus 2 of the 15 in the placebo group were withdrawn because of hypotension and/or bradycardia. None was withdrawn because of congestive heart failure or A-V block. It is concluded that the combination of nifedipine and metoprolol seems to be a relatively well-tolerated combination in acute myocardial infarction.

  • 338.
    Herlitz, Johan
    et al.
    [external].
    Emanuelsson, H
    Swedberg, K
    Vedin, A
    Waldenström, A
    Waldenström, J
    Hjalmarson, Å
    Göteborg Metoprolol Trial: enzyme-estimated infarct size1984Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 53, nr 13, s. 15-21Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In 1,375 patients serum activity of heat-stable lactate dehydrogenase (LD; E.C.1.1.1.27.) was analyzed every twelfth hour for 48 to 108 hours. The mean maximum LD activity was 11.1 +/- 0.4 mu kat X 1(-1) in the metoprolol group vs 12.4 +/- 0.5 mu kat X 1(-1) in the placebo group (p = 0.054). In patients in whom treatment was started 12 hours or less after the onset of pain, a 17% reduction in LD activity was observed (p = 0.009) and similar results were found in patients randomized 8 hours or less. Groups in which the effect after metoprolol treatment was more pronounced were those with an initially higher heart rate and also those with anterior myocardial infarction.

  • 339.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden.2005Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 64, nr 1, s. 37-40Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden. METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants). RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1). CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.

  • 340.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    A short delay from out of hospital cardiac arrest to call for ambulance increases survival2003Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 24, nr 19, s. 1750-1755Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe the relative impact on survival of the delay from estimated time of collapse to call for an ambulance among patients who suffer from a bystander witnessed out of hospital cardiac arrest of a cardiac aetiology. METHODS: A majority of all ambulance organizations in Sweden (covering 85% of Sweden inhabitants) participate in a National survey of out of hospital cardiac arrest. RESULTS: In all there were 9340 patients with a bystander witnessed cardiac arrest of a cardiac aetiology in whom cardiopulmonary resuscitation (CPR) was attempted participating in this survey. Survival at one month among patients with a delay between estimated time of collapse and call for ambulance of < or =4 min (median) was 6.9% versus 2.8% among patients with a median of >4 min (P<0.0001). When adjusting for age, sex, initial rhythm, estimated interval between collapse and start of CPR, place of arrest and the interval between call for ambulance and arrival of the rescue team, the odds ratio for survival was 0.70 (0.95% CI. 0.58-0.84) per unit increase of the natural logarithm of delay in minutes between collapse and call. CONCLUSION: Among patients with a bystander witnessed out of hospital cardiac arrest of a cardiac aetiology increased delay from estimated time of collapse to call for an ambulance decreased the chance of survival.

  • 341.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Can we define patients with no chance of survival after out-of-hospital cardiac arrest?2004Inngår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 90, nr 10, s. 1114-1118Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. PATIENTS: Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. SETTING: Various ambulance organisations in Sweden. DESIGN: Prospective observational study. RESULTS: Among the 16,712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. CONCLUSION: Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.

  • 342.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden2005Inngår i: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 16, nr 1, s. 51-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. Methods This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. Results In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P=0.025) and an increase of females from 29 to 32% (P=0.0001). There was a change in witnessed status (P<0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P<0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P<0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P<0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P=0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). Conclusions Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.

  • 343.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, KA
    Holmberg, S
    Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden2004Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 60, nr 3, s. 283-290Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. Patients: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. Methods: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. Results: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P < 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P < 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P < 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. Conclusion: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.

  • 344.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Young, M
    Ängquist, K-A
    Holmberg, S
    Is female sex associated with increased survival after out-of-hospital cardiac arrest?2004Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 60, nr 2, s. 197-203Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To evaluate survival after out-of-hospital cardiac arrest in relation to sex. METHODS: All patients with out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1990 and 2000 in whom cardiopulmonary resuscitation (CPR) was attempted and who did not have a crew witnessed arrest were included. The registry covers 85% of the inhabitants of Sweden (approximately 8 million inhabitants). P-values were adjusted to differences in age. Survival was defined as patients being hospitalised alive and being alive one month after cardiac arrest. In all, 23,797 patients participated in the survey of which 27.9% were women. RESULTS: Among women 16.4% were hospitalised alive versus 13.2% among men ( P<0.001). After one month 3.0% among women were alive versus 3.4% among men (NS). In a multivariate analysis considering differences in age and various factors at resuscitation female sex was an independent predictor for patients being hospitalised alive (odds ratio 1.66; 95% confidence limits 1.49-1.84) and for being alive after one month (odds ratio 1.27; 95% confidence limits 1.03-1.56). Women differed from men as they were older ( P<0.001 ), had a lower prevalence of witnessed cardiac arrest ( P=0.01), a lower occurrence of bystander CPR (P<0.001), a lower occurrence of ventricular fibrillation as initial arrhythmia (P<0.001) and a lower occurrence of cardiac disease judged to be the cause of cardiac arrest ( P<0.0001 ). On the other hand they had a cardiac arrest at home more frequently ( P<0.001 ). CONCLUSION: Among patients suffering out-of-hospital cardiac arrest in Sweden which was not crew witnessed and in whom resuscitation efforts were attempted, female sex was associated with an increased survival.

  • 345.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Ängquist, K-A
    Silfverstolpe, J
    Holmberg, S
    Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest.2006Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 73, nr 3, s. 404-409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To explore the rate of survival to hospital discharge among patients who were brought to hospital alive after an out-of-hospital cardiac arrest in different hospitals in Sweden. PATIENTS AND METHODS: All patients who had suffered an out-of-hospital cardiac arrest which was not witnessed by the ambulance crew, in whom cardiopulmonary resuscitation (CPR) was started and who had a palpable pulse on admission to hospital were evaluated for inclusion. Each participating ambulance organisation and its corresponding hospital(s) required at least 50 patients fulfilling these criteria. RESULTS: Three thousand eight hundred and fifty three patients who were brought to hospital by 21 different ambulance organisations fulfilled the inclusion criteria. The number of patients rescued by each ambulance organisation varied between 55 and 900. The survival rate, defined as alive 1 month after cardiac arrest, varied from 14% to 42%. When correcting for dissimilarities in characteristics and factors of the resuscitation, the adjusted odds ratio for survival to 1 month among patients brought to hospital alive in the three ambulance organisations with the highest survival versus the three with the lowest survival was 2.63 (95% CI: 1.77-3.88). CONCLUSION: There is a marked variability between hospitals in the rate of 1-month survival among patients who were alive on hospital admission after an out-of-hospital cardiac arrest. One possible contributory factor is the standard of post-resuscitation care.

  • 346.
    Herlitz, Johan
    et al.
    [external].
    Engdahl, J
    Svensson, L
    Ängquist, KA
    Young, M
    Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden.2005Inngår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 149, nr 1, s. 61-66Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in Sweden. PATIENTS AND METHODS: All patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom cardiopulmonary resuscitation (CPR) was attempted and who were registered in the Swedish Cardiac Arrest Registry. This registry covers about 85% of the Swedish population and has been running since 1990. RESULTS: In all, 33,453 patients, 71% of whom had a cardiac etiology, were included in the survey. The following were independent predictors for an increased chance of survival in order of magnitude: (1) patients found in ventricular fibrillation (odds ratio [OR] 5.3, 95% confidence limits [CL] 4.2-6.8), (2) the interval between call for and arrival of the ambulance less than or equal to the median (OR 3.6, 95% CL 2.9-4.6), (3) cardiac arrest occurred outside the home (OR 2.2, 95% CL 1.9-2.7), (4) cardiac arrest was witnessed (OR 2.0, 95% CL 1.6-2.7), (5) bystanders performing CPR before the arrival of the ambulance (OR 2.0, 95% CL 1.7-2.4), and (6) age less than or equal to the median (OR 1.6, 95% CL 1.4-2.0). When none of these factors were present, survival to 1 m was 0.4%; when all factors were present, survival was 23.8%. CONCLUSION: Among patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom CPR was attempted, 6 factors for an increased chance of survival could be defined. These include (1) initial rhythm, (2) delay to arrival of the rescue team, (3) place of arrest, (4) witnessed status, (5) bystander CPR, and (6) age.

  • 347.
    Herlitz, Johan
    et al.
    [external].
    Fredriksson, M
    Engdahl, J
    Nineteen years' experience of out-of-hospital cardiac arrest in Gothenburg--reported in Utstein style.2003Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 58, nr 1, s. 37-47Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the outcome in the Utstein style for out of hospital cardiac arrest in Gothenburg, over a period of 19 years. METHODS: All consecutive cases of cardiac arrest between 1980 and 1999 in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up for 1 year. RESULTS: In all, there were 5270 attempts. 3871 (73%) of which were regarded as being of a cardiac aetiology. In these cases, information on witnessed status was missing in 782 cases (20%). Of the remaining 3089 cases, 2066 (67%) were bystander witnessed, 791 (26%) were unwitnessed and 232 (8%) crew witnessed. The median interval between a call for the ambulance and the arrival of the first ambulance was 5 min. Thirteen percent of the bystander-witnessed cases were discharged from hospital. Of the unwitnessed cases, only 2% were discharged from hospital, whereas 22% of the crew-witnessed cases were discharged. Of the patients with a bystander-witnessed cardiac arrest of a cardiac aetiology found in ventricular fibrillation (VF), 20% were discharged from hospital. CONCLUSION: In this large Utstein style study of out of hospital cardiac arrest stretching over almost 19 years, we report high survival rates both for patients suffering a bystander-witnessed cardiac arrest, and for the subgroup suffering a bystander-witnessed cardiac arrest with VF as the first recorded rhythm. These high survival rates can in part be explained by the short time intervals from calls being received by the emergency dispatch centre (EDC) to the arrival of the emergency medical service at the scene.

  • 348.
    Herlitz, Johan
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustavsson, Mikael
    Larsson, Carina
    Fria en sjuk eller fälla en frisk2007Inngår i: Samverkan 112, ISSN 1650-7487, nr 2, s. 56-57Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 349.
    Herlitz, Johan
    et al.
    [external].
    Haglid, M
    Albertsson, P
    Westberg, S
    Karlson, BW
    Hartford, M
    Lurje, L
    Caidahl, K
    Short- and long term prognosis after coronary artery bypass grafting in relation to smoking habits1997Inngår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 88, nr 6, s. 492-497Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We describe the 2- and 5-year prognoses following coronary artery bypass grafting (CABG) in relation to smoking habits among consecutive patients being operated on in western Sweden during a 3-year period. Among the 2,121 patients, 10.2% admitted smoking at coronary angiography as compared with 7.5% 2 years after CABG (NS). Among smokers, the mortality during the subsequent 2 years was 8.9% as compared with 6.5% for exsmokers and 7.3% for never smokers (NS). During the 5-year follow-up, smokers had a mortality of 18.8% as compared with 13.6% for exsmokers and 12.5% for never smokers (p = 0.03). When correcting for dissimilarities in previous history, smoking was a strongly significant independent (p < 0.0001) predictor of 5-year mortality.

  • 350.
    Herlitz, Johan
    et al.
    [external].
    Haglid, M
    Hartford, M
    Karlson, BW
    Karlsson, T
    Lindelöw, B
    Caidahl, K
    Physical activity, dyspnea and chest pain prior to and after coronary artery bypass grafting in relation to a history of diabetes1998Inngår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 21, nr 10, s. 1603-1611Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe the limitation of physical activity and symptoms of chest pain and dyspnea before and after coronary artery bypass grafting (CABG) in relation to a history of diabetes. RESEARCH DESIGN AND METHODS: All patients in western Sweden in whom CABG was performed between 1988 and 1991 were asked to complete a questionnaire before 3 months and 2 years after the operation. The questionnaire evaluated limitation of physical activity and symptoms of chest pain and dyspnea. RESULTS: In all, 2,121 patients participated in the evaluation, of whom 13% had a history of diabetes. The overall 2-year mortality was 14% among patients with a history of diabetes and 6% among patients without such a history (P < 0.001). The proportion of patients with a limitation of physical activity caused by chest pain decreased from 76% before CABG to 19% 2 years after in diabetic patients (P < 0.001) and from 79 to 17% in nondiabetic patients (P < 0.001). The proportion of diabetic patients without dyspnea increased from 13% before to 31% 2 years after CABG (P < 0.001). The corresponding figures for nondiabetic patients were 12 and 43% (P < 0.001). Symptoms of angina pectoris were reported in 94% of diabetic patients before CABG versus 35% after 2 years (P < 0.001). Corresponding figures for nondiabetic patients were 93 and 29% (P < 0.001). Aggregate data confirmed differences between diabetic and nondiabetic patients, with more symptoms in the diabetic patients, particularly with regard to dyspnea. CONCLUSIONS: Mortality during 2 years of follow up was more than twice as high in diabetic than in nondiabetic patients. Limitation of physical activity, dyspnea, and angina pectoris improved markedly and similarly in diabetic and nondiabetic patients after CABG. Whereas limitation of physical activity and dyspnea was more frequent in diabetic than in nondiabetic patients, the occurrence of angina pectoris was more similar in the two groups.

45678910 301 - 350 of 833
RefereraExporteraLink til resultatlisten
Permanent link
Referera
Referensformat
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Annet format
Fler format
Språk
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Annet språk
Fler språk
Utmatningsformat
  • html
  • text
  • asciidoc
  • rtf