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  • 51.
    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 AMI1999In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 6, no 4, p. 311-315Article in journal (Refereed)
    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.

  • 52.
    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 discharge1996In: Cardiovascular Drugs and Therapy, ISSN 0920-3206, E-ISSN 1573-7241, Vol. 10, no 4, p. 485-490Article in journal (Refereed)
    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.

  • 53. 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 Göteborg2003In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, no 1, p. 25-30Article in journal (Refereed)
    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.

  • 54.
    Herlitz, Johan
    et al.
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Wireklint-Sundström, Birgitta
    University of Borås, School of Health Science.
    Axelsson, Christer
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Hagiwara, Magnus
    University of Borås, School of Health Science.
    Jonsson, Anders
    University of Borås, School of Health Science.
    Lundberg, Lars
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Ljungström, Lars
    Suspicion and treatment of severe sepsis. An overview of the prehospital chain of care.2012In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 20, no 42Article in journal (Refereed)
    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.

  • 55.
    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 CPR1996In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 14, no 2, p. 119-123Article in journal (Refereed)
    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.

  • 56.
    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?1997In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 33, no 3, p. 199-205Article in journal (Refereed)
    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.

  • 57.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Lindqvist, J
    Characteristics and outcome for patients with acute chest pain in relation to whether or not they were transported by ambulance2000In: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 7, no 3, p. 195-200Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the characteristics and long-term outcome for patients suffering from acute chest pain in relation to whether or not they were transported to hospital by ambulance. All patients with acute chest pain who were admitted over a 21-month period to the emergency department at Sahlgrenska Hospital in Göteborg with symptoms of acute chest pain were included in the study. Consecutive patients were prospectively registered and followed with regard to mortality and morbidity over 5 years. In all, 4270 patients took part in the evaluation, of whom 1445 (34%) were transported by ambulance. Patients transported by ambulance were older (p < 0.0001) and had a higher prevalence of previous myocardial infarction, angina pectoris, hypertension, diabetes mellitus, and congestive heart failure (p < 0.0001 for all) than the others. They more frequently developed acute myocardial infarction (28% vs. 11%; p < 0.0001) and there was a final diagnosis of either confirmed or possible myocardial infarction/ischaemia in 69% compared with 38% for patients not transported by ambulance (p < 0.0001). The 5-year mortality among ambulance-transported patients was 41% vs. 16% among those who were not (p < 0.0001). When correcting for dissimilarities at baseline including final diagnosis the adjusted risk ratio for death among ambulance transported patients was 1.44 (95% confidence limit 1.26-1.65). However, we did not correct for severe non-cardiac diseases. It is concluded that among patients admitted to the emergency department with acute chest pain, those transported by ambulance had a much higher mortality during the subsequent 5 years than those who were not transported by ambulance. This was not entirely explained by observed differences at baseline. This information should be considered when ambulance organizations are being constructed.

  • 58.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Sjölin, M
    Mortality and risk indicators for death during five years after acute myocardial infarction among patients with and without ST-elevation on admission electrocardiogram1998In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 89, no 1, p. 33-39Article in journal (Refereed)
    Abstract [en]

    We related observations in the electrocardiogram (ECG) on admission to hospital among consecutive patients hospitalized in one single hospital with acute myocardial infarction (AMI) and related the prognosis during the following 5 years to these observations. Results: Of 863 patients, 63% had ECG signs of myocardial ischemia, but only 41% had ST elevation on ED admission. Patients with ST elevation had a 5-year mortality of 44% as compared with 58% in patients without ST elevation (p < 0.001). Patients with the highest mortality were those with a pathologic ECG including signs of previous AMI, bundle branch block and pacemaker ECG, but with no ECG sign of acute ischemia. Patients with the lowest mortality were those with a nonpathologic ECG on admission. Conclusion: Among consecutive patients hospitalized with AMI, less than half had ST elevation on admission to hospital. These patients had a lower mortality during 5 years of follow-up than patients without ST elevation.

  • 59.
    Herlitz, Johan
    et al.
    [external].
    Karlson, BW
    Bång, A
    [external].
    Sjölin, M
    Survival, mode of death, reinfarction and use of medication during a period of 5 years ater acute myocardial infarction in different age groups1996In: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 87, no 6, p. 529-536Article in journal (Refereed)
    Abstract [en]

    We describe the prognosis during 5 years of follow-up among consecutive patients hospitalized in a single hospital due to acute myocardial infarction in various age groups. When considering various aspects of clinical history, age was the strongest independent predictor of total 5-year mortality and of 5-year mortality after discharge from hospital. The overall 5-year mortality was: age < 65, 23%; age 65-75, 49%; age > 75, 79% (p < 0.001). The relationship between age and death appeared to be similar regardless of the development of Q waves, infarct size and infarct site. Among patients who died, younger patients more frequently died a sudden death associated with ventricular fibrillation, whereas the elderly more frequently died in association with congestive heart failure.

  • 60.
    Herlitz, Johan
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Ravi-Fischer, Annica
    Svensson, Leif
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Circulation: Bröstsmärtor2016In: Prehospital Akutsjukvård / [ed] Björn-Ove Suserud och Lars Lundberg, Liber, 2016, 2, p. 308-321Chapter in book (Other academic)
  • 61.
    Herlitz, Johan
    et al.
    [external].
    Rundqvist, S
    Bång, A
    [external].
    Aune, S
    Ekström, L
    Lindqvist, J
    Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?2001In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 49, no 1, p. 15-23Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital Göteborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06-2.62; P=0.028).

  • 62.
    Herlitz, Johan
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Berglund, A
    Svensson, L
    Blomstrand, C
    Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities2010In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 18, no 48, p. 13-Article in journal (Refereed)
    Abstract [en]

    Background: The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method: A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results: In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women). With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion: Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

  • 63.
    Herlitz, Johan
    et al.
    University of Borås, School of Health Science.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Omerovic, E
    Is pre-hospital treatment of chest pain optimal in acute coronary syndrome? Both relief of pain and anxiety are needed2011In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 149, no 2, p. 147-151Article in journal (Refereed)
    Abstract [en]

    Background Many patients who suffer from acute chest pain are transported by ambulance. It is not known how often treatment prior to hospital admission is optimal and how optimal pain-relieving treatment is defined. It is often difficult to delineate pain from anxiety. Aim To describe various aspects of chest pain in the pre-hospital setting with the emphasis on a) treatment and b) presumed acute coronary syndrome. Methods In the literature search, we used PubMed and the appropriate key words. We included randomised clinical trials and observational studies. Results Four types of drug appear to be preferred: 1) narcotic analgesics, 2) nitrates, 3) beta-blockers and 4) benzodiazepines. Among narcotic analgesics, morphine has been associated with the relief of pain at the expense of side-effects. Alfentanil was reported to produce more rapid pain relief. Nitrates have been associated with the relief of pain with few side-effects. Beta-blockers have been reported to increase the relief of pain when added to morphine. The combination of beta-blockers and morphine has been reported to be as effective as beta-blockers alone in pain relief, but this combination therapy was associated with more side-effects. Experience from anxiety-relieving drugs such as benzodiazepines is limited. It is not known how these 4 drugs should be combined. The results indicate that various pain-relieving treatments might modify the disease. Conclusion Our knowledge of the optimal treatment of chest pain and associated anxiety in the pre-hospital setting is insufficient. Recommendations from existing guidelines are limited. Large randomised clinical trials are warranted.

  • 64. Hollenberg, J
    et al.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lindqvist, J
    Herlitz, Johan
    [external].
    Nordlander, R
    Svensson, L
    Rosenqvist, M
    Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time?2005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 257, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING: All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS: All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P <0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Goteborg (P=0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Goteborg. CONCLUSION: Survival was almost three times higher in Goteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Goteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Goteborg as one possible explanation.

  • 65. Hollenberg, J
    et al.
    Bång, Angela
    Lindqvist, J
    Herlitz, Johan
    Norlander, R
    Svensson, L
    Rosenqvist, M
    Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time2005In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 257, no 3, p. 247-254Article in journal (Refereed)
    Abstract [en]

    Background.  Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. Setting.  All patients suffering an OHCA in Stockholm and Göteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. Results.  All together, 969 OHCA in Stockholm and 398 in Göteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Göteborg (P < 0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Göteborg (P = 0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Göteborg. Conclusion.  Survival was almost three times higher in Göteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Göteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Göteborg as one possible explanation.

  • 66. Lingsarve, Johan
    et al.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Claesson, Andreas
    Wireklint Sundström, Birgitta
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Abelsson, Anna
    Svensson, Anders
    Wallin, Kim
    Kågström, Christer
    Rantala, Andreas
    Wihlborg, Jonas
    Ek, Bo
    Styrwoldt, Eva
    Bremer, Anders
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Kompetens i ambulansen ger en säker akutsjukvård2015In: Dagens Medicin, ISSN 1104-7488Article in journal (Other (popular science, discussion, etc.))
  • 67. Martinell, L
    et al.
    Larsson, M
    Bång, A
    University of Borås, School of Health Science.
    Karlsson, T
    Lindqvist, J
    Thorén, A-B
    Herlitz, Johan
    University of Borås, School of Health Science.
    Survival in out-of-hospital cardiac arrest before and after use of advanced postresuscitation care: a survey focusing on incidence, patient characteristics, survival, and estimated cerebral function after postresuscitation care.2010In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, no 5, p. 543-551Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia. METHODS: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Göteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared. RESULTS: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011). For all patients, 1-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in 1-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >or=3) decreased from 28% to 6% (P = .0006) among all patients. CONCLUSION: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm.

  • 68. Martinell, Louise
    et al.
    Larsson, Malena
    Bång, Angela
    University of Borås, School of Health Science.
    Lindqvist, Jonny
    Thorén, Ann-Britt
    Herlitz, Johan
    University of Borås, School of Health Science.
    Karlsson, Thomas
    Survival in Out of Hospital Cardiac Arrest Before and After Use of Advanced Post Resuscitation Care2010In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, no 5, p. 543-551Article in journal (Refereed)
    Abstract [en]

    Background: Knowledge of the epidemiology of postresuscitation care is insufficient. We describe the epidemiology of postresuscitation care in a community from a 26-year perspective, focusing on incidence, patient characteristics, survival, and estimated cerebral function in relation to intensified postresuscitation care and initial arrhythmia. Methods: The study included patients with out-of-hospital cardiac arrest (OHCA) who were brought alive to a hospital ward in Goteborg, Sweden, between 1980 and 2006. Two periods (1980-2002 and 2003-2006) were compared. Results: In all, 1603 patients were included. For age, sex, and history, no significant differences between the 2 periods were seen. There was a significant multiple increase in bystander cardiopulmonary resuscitation, the use of coronary angiography, coronary revascularization, and therapeutic hypothermia. The number of patients found in ventricular fibrillation (VF) decreased (P = .011).For all patients, I-year survival did not change significantly (27% vs 32%; P = .14). Among patients found in VF, an increase in I-year survival was found (37% vs 57%; P < .0001), whereas no significant change was seen in nonshockable rhythm (10% vs 7%; P = .38). Survivors to discharge displaying low cerebral function (ie, cerebral performance categories score >= 3) decreased from 28% to 6% (P = .0006) among all patients. Conclusion: After the introduction of a more intensified postresuscitation care, there was no overall improvement in survival but signs of an improved cerebral function among survivors. There was a marked increase in survival among patients found in a shockable rhythm but not among those found in a nonshockable rhythm. (C) 2010 Elsevier Inc. All rights reserved.

  • 69. Perers, E
    et al.
    Abrahamsson, P
    Bång, A
    [external].
    Engdahl, J
    Karlson, BW
    Lindqvist, J
    Waagstein, L
    Herlitz, Johan
    [external].
    Outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex1999In: Coronary Artery Disease, ISSN 0954-6928, E-ISSN 1473-5830, Vol. 10, no 7, p. 509-514Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe characteristics and outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex. PATIENTS: All patients in the community of Göteborg who between 1980 and 1996 suffered out-of-hospital cardiac arrest and were hospitalized alive. METHODS: We calculated age-adjusted P values. RESULTS: In all 1038 patients were hospitalized alive of whom 29% were women. Women differed from men by being older and there being lower prevalences of previous acute myocardial infarction (AMI) and smoking and a higher prevalence of bronchial asthma among them. They had less commonly received cardio-pulmonary resuscitation (CPR) from bystanders (16 versus 25% of cases; P = 0.002) and were less commonly found to be in ventricular fibrillation when the ambulance crew arrived (55 versus 73% of cases; P < 0.0001). They were less commonly judged to have a cardiac etiology behind the arrest (87 versus 92% of cases; P = 0.016). Of women 31.3% could be discharged alive from hospital, compared with 41.8% of men (P = 0.001). While they were in hospital, women were less commonly subjected to exercise tests, coronary angiography, and coronary artery bypass grafting. CONCLUSION: Among patients who suffered out-of-hospital cardiac arrest and were hospitalized alive, women had less commonly received CPR from bystanders, were less commonly found in ventricular fibrillation, less commonly underwent coronary angiography and coronary artery bypass grafting and had a lower survival rate than did men.

  • 70. Rawshani, A
    et al.
    Larsson, A
    Gelang, C
    Lindqvist, J
    Gellerstedt, M
    Bång, A
    University of Borås, School of Health Science.
    Herlitz, J
    University of Borås, School of Health Science.
    Characteristics and outcome among patients who dial for the EMS due to chest pain2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, no 3, p. 859-865Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age. METHODS: All patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≤50, 51-64 and ≥65 years. RESULTS: In all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group. CONCLUSION: Men and the elderly were given a disproportionately low priority by the EMS.

  • 71.
    Rawshani, Araz
    et al.
    Sahlgrenska University Hospital.
    Rawshani, Nina
    Sahlgrenska University Hospital.
    Gelang, Carita
    Sahlgrenska University Hospital.
    Andersson, Jan-Otto
    Sahlgrenska University Hospital.
    Larsson, Anna
    University of Gothenburg.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Gellerstedt, Martin
    University West.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education.2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, p. 43-48, article id S0167-5273(16)32916-3Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30days.

    METHODS: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC. Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest).

    RESULTS: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival.

    CONCLUSIONS: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value.

    KEY MESSAGES: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency - as judged by the ability to identify life-threatening cases among patients with chest pain - varies according to the dispatcher's educational level and the time of day. What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life-threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time. How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

  • 72. Rawshani, Nina
    et al.
    Rawshani, Araz
    Gelang, Carita
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Andersson, Jan-Otto
    Gellerstedt, Martin
    Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, p. 223-225Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

    METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

    RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

    CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

  • 73. Svensson, Leif
    et al.
    Herlitz, Johan
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Bremer, Anders
    University of Borås, School of Health Science.
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Cirkulation, Bröstsmärtor2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 264-278Chapter in book (Other academic)
  • 74. Wibring, Kristoffer
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Christensson, Lennart
    Lingman, Markus
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients - A systematic review.2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 219, p. 373-379Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chest pain is a common symptom among patients contacting the emergency medical services (EMS). Risk stratification of these patients is warranted before arrival in hospital, regarding likelihood of an acute life-threatening condition (LTC).

    AIM: To identify factors associated with an increased risk of acute LTC among patients who call the EMS due to non-traumatic chest pain.

    METHODS: Several databases were searched for relevant articles. Identified articles were quality-assessed using the Scottish Intercollegiate Guidelines Network checklists. Extracted data was analysed using a semi-quantitative synthesis evaluating the level of evidence of each identified factor.

    RESULTS: In total, 10 of 1245 identified studies were included. These studies provided strong evidence for an increased risk of an acute LTC with increasing age, male gender, elevated heart rate, low systolic blood pressure and ST elevation or ST depression on a 12-lead ECG. The level of evidence regarding the history of myocardial infarction, angina pectoris or presence of a Q wave or a Left Bundle Branch Block on the ECG was moderate. The evidence was inconclusive regarding dyspnoea, cold sweat/paleness, nausea/vomiting, history of chronic heart failure, smoking, Right Bundle Branch Block or T-inversions on the ECG.

    CONCLUSIONS: Factors reflecting age, gender, myocardial ischemia and a compromised cardiovascular system predicted an increased risk of an acute life-threatening condition in the prehospital setting in cases of acute chest pain. These factors may form the basis for prehospital risk stratification in acute chest pain.

  • 75. Wibring, Kristoffer
    et al.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lingman, Markus
    Bång, Angela
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Symptom description in patients with chest pain-A qualitative analysis of emergency medical calls involving high-risk conditions.2019In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 28, no 15-16, p. 2844-2857Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore the symptoms descriptions and situational information provided by patients during ongoing chest pain events caused by a high-risk condition.

    BACKGROUND: Chest pain is a common symptom in patients contacting emergency dispatch centres. Only 15% of these patients are later classified as suffering from a high-risk condition. Prehospital personnel are largely dependent on symptom characteristics when trying to identify these patients.

    DESIGN: Qualitative descriptive.

    METHODS: Manifest content analysis of 56 emergency medical calls involving patients with chest pain was carried out. A stratified purposive sampling was used to obtain calls concerning patients with high-risk conditions. These calls were then listened to and transcribed. Thereafter, meaning units were identified and coded and finally categorised. Consolidated criteria for reporting qualitative studies guidelines have been applied.

    RESULTS: A wide range of situational information and symptoms descriptions was found. Pain and affected breathing were dominating aspects, but other situational information and several other symptoms were also reported. The situational information and these symptoms were classified into seven categories: Pain narrative, Affected breathing, Bodily reactions, Time, Bodily whereabouts, Fear and concern and Situation management. The seven categories consisted of 17 subcategories.

    CONCLUSIONS: Patients with chest pain caused by a high-risk condition present a wide range of symptoms which are described in a variety of ways. They describe different kinds of chest pain accompanied by pain from other parts of the body. Breathing difficulties and bodily reactions such as muscle weakness are also reported. The variety of symptoms and the absence of a typical symptomatology make risk stratification on the basis of symptoms alone difficult.

    RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of an open mind when assessing patients with chest pain and the requirement of a decision support tool in order to improve risk stratification in these patients.

  • 76.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Bång, Angela
    University of Borås, School of Health Science.
    Karlsson, Thomas
    Winge, Karin
    Lundberg, Camilla
    Herlitz, Johan
    University of Borås, School of Health Science.
    Anxiolytics in patients suffering a suspected acute coronary syndrome: Multi-centre randomised controlled trial in Emergency Medical Service2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, no 4, p. 3580-3587Article in journal (Refereed)
    Abstract [en]

    Background: The prehospital treatment of pain and discomfort among patients who suffer from acute coronary syndrome (ACS) needs a treatment strategy which combines relief of pain with relief of anxiety. Aim: The aim of the present study was to evaluate the impact on pain and anxiety of the combination of an anxiolytic and an analgesic as compared with an analgesic alone in the prehospital setting of suspected ACS. Methods: A multi-centre randomised controlled trial compared the combination of Midazolam (Mi) + Morphine (Mo) and Mo alone. All measures took part: Prior to randomisation, 15 min thereafter and on admission to a hospital. Inclusion criteria were: 1) pain raising suspicion of ACS and 2) pain score ≥4. Primary endpoint: Pain score after 15 min. Results: In all, 890 patients were randomised to Mi + Mo and 873 to Mo alone. Pain was reduced from a median of 6 to 4 and finally to 3 in both groups. The mean dose of Mo was 5.3 mg in Mi + Mo and 6.0 mg in Mo alone (p b 0.0001). Anxiety was reported in 66% in Mi + Mo and in 64% in Mo alone at randomisation (NS); 15 min thereafter in 31% and 39% (p = 0.002) and finally in 12% and 26% respectively (p b 0.0001). On admission to a hospital nausea or vomiting was reported in 9% in Mi + Mo and in 13% in Mo alone (p = 0.003). Drowsiness differed; 15% and 14% were drowsy in Mi + Mo versus 2% and 3% in Mo alone respectively (p b 0.001). Conclusion: Despite the fact that the combination of anxiolytics and analgesics as compared with analgesics alone reduced anxiety and the requirement of Morphine in the prehospital setting of acute coronary syndrome, this strategy did not reduce patients' estimation of pain (primary endpoint). More effective pain relief among these patients is warranted.

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