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  • 51. Berglin Blohm, M
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Factors associated with prehospital and in-hospital delay time in acute myocardial infarction: a 6-year experience1998Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 243, nr 3, s. 243-250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy. METHODS: During a 6-year period we prospectively computerized pre-hospital and in-hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden. RESULTS: Pre-hospital delay: independent predictors of a prolonged delay were increased age (P = 0.0007), female sex (P = 0.02) and a history of hypertension (P = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age (P = 0.005). In-hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), increased age (P = 0.03) and a history of angina (P = 0.002), hypertension (P = 0.01) and diabetes (P = 0.01). For thrombolytic treated AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), female sex (P = 0.02) and a history of diabetes (P = 0.02). CONCLUSION: Risk factors for both pre-hospital and hospital delay time could in AMI be defined although slightly different. Two factors appeared for both, i.e. increasing age and a history of hypertension.

  • 52. Berglin Blohm, M
    et al.
    Nilsson, G
    Karlsson, T
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    The possibility of influencing components of hospital delay time within emergency departments among patients with ST-elevation in the initial electrocardiogram1998Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 5, nr 3, s. 289-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to describe the possibility of influencing components of hospital delay time within the emergency department (ED) among patients with ST-elevation on the initial electrocardiogram (ECG). Nurses recorded seven patient time points: (1) ED admission; (2) ECG recording; (3) decision by nurse/ED physician; (4) cardiologist ED arrival; (5) decision of coronary care unit (CCU) admission; (6) ED departure; (7) CCU arrival. After special training in ECG, nurses in the ED were subsequently delegated to send patients directly to the CCU if showing ST-elevation on the admission ECG without contacting either the physician in ED or the cardiologist on call (intervention). Delay times between hospital admission and admission to the CCU were evaluated during the 9 months prior to and during the 6 months after the start of this intervention. Fifty patients (66% men) participated in the first study during 3 months (prior to intervention). Patients with suspected or confirmed acute myocardial infarction (AMI) in the ED had a median delay time from ED arrival to CCU arrival of 55.5 minutes (34.5 minutes for patients with confirmed AMI; ST elevation on admission). Time interval from decision to admit to CCU and ED departure was an average of 31% of the total delay. A mean of 21% of total delay occurred between ED decision to cardiologist arrival, and 19% during the time interval from cardiologist ED arrival until decision to CCU admission. Among patients receiving thrombolysis, the median delay time from hospital admission to CCU admission was reduced from 40 minutes during the 9 months prior to start of the intervention (nurses sending patients directly to the CCU) to 22 minutes during the 6 months thereafter (p = 0.02). The largest proportion of hospital delay components for acute coronary syndrome patients occurred between the cardiologist's decision to admit to the CCU and departure from the ED, and the interval following the decision by the nurse or physician to the cardiologist ED arrival. When nurses were delegated to transfer patients with ST-elevation on admission directly to the CCU without contacting a physician, the delay time from ED admission to CCU admission was reduced by nearly 50%.

  • 53. Berglind, L
    et al.
    Karlsson, T
    Hirlekar, G
    Albertsson, P
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ravn-Fischer, A
    Delay and inequality in treatment of the elderly with suspected acute coronary syndrome2014Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, nr 3, s. 946-950Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND/OBJECTIVES: The aim of this study is to determine differences between elderly patients (≥80 years) and younger patients with suspected acute coronary syndrome (ACS) regarding delay times before diagnostic tests and treatments. METHODS: All patients with chest pain who were admitted to a hospital in the Gothenburg area were included consecutively over a 3-month period. They were divided into an elderly group (≥80 years) and a reference group (<80 years). Previous medical history, ECG findings, treatments, diagnostic tests, and delay times were registered. RESULTS: Altogether, 2588 patients were included (478 elderly and 2110 reference). There were no significant differences in delay time to hospital ward admission, to first medical therapy with aspirin, or to investigation with coronary angiography (CA) between the two groups. The elderly patients had a significantly shorter median time from first medical contact to first ECG (12 vs. 14 min, p=0.002) but after adjustment for confounding factors, especially mode of transport, the opposite was found to be the case (p=0.002). Elderly hospitalized patients with ACS were less often investigated with CA (44% vs. 89%, p<0.0001) and received less medical treatment with P2Y12 antagonists and lipid lowering drugs. CONCLUSIONS: Elderly individuals with chest pain could not be shown to have a delay to hospital admission compared to their younger counterparts. Nevertheless, higher age was associated with a longer time to first ECG. The elderly patients received less active therapy, and fear of age-related side effects might explain this difference.

  • 54.
    Bergström, Mattias
    et al.
    Lund University.
    Schmidbauer, Simon
    Lund University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Rawshani, Araz
    University of Gothenburg.
    Friberg, Hans
    Lund University.
    Pulseless electrical activity is associated with improved survival in out-of-hospital cardiac arrest with initial non-shockable rhythm.2018Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 133, s. 147-152, artikel-id S0300-9572(18)31010-4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To describe the prevalence, baseline characteristics and factors associated with survival in out-of-hospital cardiac arrest (OHCA) with initial non-shockable rhythm sub-grouped into pulseless electrical activity (PEA) and asystole as presenting rhythm.

    METHODS: The Swedish Registry of Cardiopulmonary Resuscitation is a prospectively recorded nationwide registry of modified Utstein parameters, including all patients with attempted resuscitation after OHCA. Data between 1990-2016 were analyzed.

    RESULTS: After exclusions, the study population consisted of 48,707 patients presenting with either PEA or asystole. The proportion of PEA increased from 12% to 22% during the study period with a fivefold increase in 30-day survival reaching 4.9%. Survival in asystole showed a modest increase from 0.6% to 1.3%. In the multivariable analysis, PEA was independently associated with survival at 30 days (OR 1.54, 95% CI 1.26-1.88).

    CONCLUSION: Between 1990 and 2016, the proportion of PEA as the first recorded rhythm doubled with a five-fold increase in 30-day survival, while survival among patients with asystole remained at low levels. PEA and asystole should be considered separate entities in clinical decision-making and be reported separately in observational studies and clinical trials.

  • 55. Blohm, M
    et al.
    Hartford, M
    Karlson, BW
    Karlsson, T
    Herlitz, Johan
    [external].
    A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI1994Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, ISSN 0735-6757, Vol. 12, nr 3, s. 315-318Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its pertormance, whereas ambulance use was not affected.

  • 56. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Hartford, M
    Karlson, BW
    Risenfors, M
    Luepker, RV
    Sjölin, M
    Holmberg, S
    Consequences of a media campaign focusing on delay in acute myocardial infarction1992Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, ISSN 0002-914, Vol. 69, nr 4, s. 411-413Artikel i tidskrift (Övrigt vetenskapligt)
  • 57. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Hartford, M
    Karlsson, BW
    Holmberg, S
    Schröder, U
    Larsson, E
    Mediakampanj om råd vid bröstsmärtor har stor genomslagskraft i befolkningen1989Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 86, nr 32-33, s. 2695-2696Artikel i tidskrift (Refereegranskat)
  • 58. Blohm, M
    et al.
    Herlitz, Johan
    [external].
    Schröder, U
    Hartford, M
    Karlsson, BW
    Risenfors, M
    Larsson, E
    Luepker, R
    Wennerblom, B
    Holmberg, S
    Reaction to a media campaign focusing on delay in acute myocardial infarction1991Ingår i: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 20, nr 6, s. 661-666Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A media campaign conducted to reduce delay time and to increase the use of ambulance transport in acute myocardial infarction was performed in an urban area with about half a million inhabitants during 1 year. The main message was that chest pain lasting more than 15 minutes might indicate acute myocardial infarction; dial 90,000 immediately for ambulance transport to the hospital. The target population was the general public. After 6 and 12 months 400 and 610 randomly chosen persons, respectively, were contacted by telephone to evaluate the reaction of the general public to the campaign. Of these, 60% and 71%, respectively, had heard of the campaign, and all parts of the message were spontaneously remembered by 15% and 19%, respectively. The reaction to the campaign was generally positive. Among all patients admitted to the coronary care unit of one of the two city hospitals, 65% were aware of the campaign and 31% of them were of the opinion that they came to the hospital faster because of the campaign. In conclusion, a media campaign aimed at reducing patient delay time in acute myocardial infarction was shown to reach a majority of people in the community and patients with ischemic heart disease. The reaction was positive and about one fifth of interviewed people spontaneously remembered the total message.

  • 59. Blomberg, S
    et al.
    Curelaru, I
    Emanuelsson, H
    Herlitz, Johan
    [external].
    Pontén, J
    Ricksten, S-E
    Thoracic epidural anaesthesia in patients with unstable angina pectoris1989Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 10, nr 5, s. 437-444Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated wth nitroglycerin infusion for gt;24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest < 2 days after infarction. 4.4 ± 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments ( Th1-7) for 98 ± 9min. Heart rate decreased significantly from 70 ± 3 to 64 ± 3 beats min-1 while blood pressure was unaffected by thoracic epidural anaesthesia. In 27 patients (96%) the anaesthesia induced complete analgesia. Nitroglycerin infusion was discontinued definitely within 3 h in 26 patients (93%) and pain was thereafter controlled by means of thoracic epidural anaesthesia as the sole treatment in 23 patients (82%) and as the major treatment in 25 patients (89%). Twenty-one patients (75%) were fully mobilized and stabilized. Treatment with thoracic epidural anaesthesia lasted for 6.0 ± 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 ±0.3 the first day to 0.9 ± 0.3 the fourth day (P>0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died. Exercise stress testing was performed on eight patients three to five days after the start of thoracic epidural anaesthesia. At a comparable workload, ST-segment depression was significantly (P>0.05) less pronounced during anaesthesia ( − 0.6 ± 0.1 mm) compared with control ( − 1.3 ± 0.2mm). The respective heart rate values were 95 ± 7 and 107 ± 7 beats min -1 (P > 0.05), while systolic or diastolic blood pressure did not differ between the two conditions. We conclude that blockade of cardiac sympathetic afferents and efferents by means of thoracic epidural anaesthesia can effectively treat pain and stabilize patients with unstable angina pectoris refractory to medical treatment. Furthermore, thoracic epidural anaesthesia attenuates stress-induced myocardial ischaemia; thus, it may be an efficient supplementary treatment for the control of pain and for stabilizing patients with unstable angina pectoris during diagnostic procedures and prior to coronary surgery or angioplasty.

  • 60. Bohm, K
    et al.
    Rosenqvist, M
    Herlitz, Johan
    [external].
    Hollenberg, J
    Svensson, L
    Survival is similar after standard treatment and chest compression only in out-of-hospital bystander cardiopulmonary resuscitation.2007Ingår i: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 116, nr 25, s. 2908-2912Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We sought to compare the 1-month survival rates among patients after out-of-hospital cardiac arrest who had been given bystander cardiopulmonary resuscitation (CPR) in relation to whether they had received standard CPR with chest compression plus mouth-to-mouth ventilation or chest compression only. METHODS AND RESULTS: All patients with out-of-hospital cardiac arrest who received bystander CPR and who were reported to the Swedish Cardiac Arrest Register between 1990 and 2005 were included. Crew-witnessed cases were excluded. Among 11,275 patients, 73% (n=8209) received standard CPR, and 10% (n=1145) received chest compression only. There was no significant difference in 1-month survival between patients who received standard CPR (1-month survival=7.2%) and those who received chest compression only (1-month survival=6.7%). CONCLUSIONS: Among patients with out-of-hospital cardiac arrest who received bystander CPR, there was no significant difference in 1-month survival between a standard CPR program with chest compression plus mouth-to-mouth ventilation and a simplified version of CPR with chest compression only.

  • 61.
    Bondestam, E
    et al.
    Sahlgrenska.
    Hovgren, K
    Sahlgrenska.
    Gaston Johansson, F
    Sahlgrenska.
    Jern, S
    Sahlgrenska.
    Herlitz, Johan
    [external] Sahlgrenska.
    Holmberg, S
    Sahlgrenska.
    Pain assessment by patient and nurse in the early phase of acute myocardial infarction1987Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 12, nr 6, s. 677-682Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients’ and nurses’ assessments was found (r = 0-76; P < 0-001). However, the nurses under-estimated the patients’ pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients’ and nurses’ assessments of pain, although underestimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.

  • 62. Brandrup-Wognsen, G
    et al.
    Berggren, H
    Caidahl, K
    Karlsson, T
    Herlitz, Johan
    [external].
    Sjöland, H
    Predictors for recurrent chest pain and relationship to myocardial ischaemia during long-term follow-up after coronary artery bypass grafting1997Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 12, nr 2, s. 304-311Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To describe the impact of coronary artery bypass grafting on chest pain during 2 years of follow-up after the operation and to identify predictors of chest pain and its relationship to myocardial ischaemia 2 years after the operation. Methods: Patients were approached with a questionnaire at the time of coronary angiography (1291) and 3 months (1664), 1 year (1638) and 2 years (1613) after coronary artery bypass grafting. Two years after the operation, a computerised 12-lead electrocardiogram was obtained during a standardised bicycle exercise test (618). Results: Prior to surgery, 37% of the patients were unable to perform physical activity compared with 6% after the operation (PB0.0001 for change in degree of limitation). Only 3% had no chest pain at all prior to the operation, while 58% of the patients were free from chest pain 2 years after surgery (PB0.0001). We found no correlation between patients reporting chest pain and signs of ischaemia at exercise test, but there was a highly significant correlation with chest pain during the exercise test (PB0.0001). Independent predictors of chest pain were severity of preoperative angina (PB0.0001), younger age (P 0.0009), previous coronary artery bypass grafting (P 0.003), duration of symptoms (P 0.005), the need for prolonged cardiopulmonary bypass (P 0.04) and the absence of left main stenosis (P 0.04). Conclusion: Independent predictors of chest pain were identified 2 years after coronary artery bypass grafting. There was a dramatic improvement after coronary artery bypass grafting. However, almost half the patients complained of some kind of chest pain even after the operation. This chest pain correlated well with chest pain during the exercise test but not with signs of myocardial ischaemia.

  • 63. Brandrup-Wognsen, G
    et al.
    Berggren, H
    Hartford, M
    Hjalmarson, Å
    Karlsson, T
    Herlitz, Johan
    [external].
    Female sex is associated with increased mortality and morbidity early, but not late, after coronary artery bypass grafting1996Ingår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, nr 9, s. 1426-1431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective To describe mortality and morbidity during a period of 2 years after coronary artery bypass grafting in relation to gender. Design Prospective follow-up study. Setting Two regional cardiothoracic centres which performed all the coronary artery bypass operations in western Sweden at the time. Sub|ects A total of 2129 (1727 (81%) men and 402 (19%) women) consecutive patients undergoing coronary artery bypass surgery between June 1988 and June 1991 without concomitant procedures. Results Females were older and more frequently had a history of hypertension, diabetes mellitus, congestive heart failure, renal dysfunction and obesity. In a multivariate analysis, taking account of age, history of cardiovascular diseases and renal dysfunction, female sex appeared as a significant independent predictor of mortality during the 30 days after coronary artery bypass grafting (/><0-05), but not thereafter. Various postoperative complications including neurological deficit, hydro- and pneumo-thorax, perioperative myocardial damage and the need for assist devices and prolonged reperfusion were more common in females than males. Conclusion Females run an increased risk of early death and the development of postoperative complications after coronary artery bypass surgery as compared with males. Late mortality does not appear to be influenced by gender and the long-term benefit of the coronary artery bypass graft operation is similar in men and women.

  • 64. Brandrup-Wognsen, G
    et al.
    Berggren, H
    Hartford, M
    Karlson, BW
    Karlson, T
    Herlitz, Johan
    [external].
    Mortality and morbidity during a period of two years after coronary artery bypass grafting in relation to age1996Ingår i: Cardiology in the Elderly, ISSN 1058-3661, Vol. 31, s. 289-295Artikel i tidskrift (Refereegranskat)
  • 65. Brandrup-Wognsen, G
    et al.
    Haglid, M
    Karlsson, T
    Berggren, H
    Herlitz, Johan
    [external].
    Mortality during two years after coronary artery bypass grafting in relation to preoperative factors and urgency of operation1995Ingår i: European Journal of Cardio-Thoracic Surgery, ISSN 1010-7940, E-ISSN 1873-734X, Vol. 9, nr 12, s. 685-691Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to describe mortality during the 2-year-period after coronary artery bypass surgery (CABG) in relation to perioperative risk factors and urgency of operation. All the patients in western Sweden were included in whom CABG was performed between June 1988 and June 1991, without concomitant procedures or re-operations. The study was prospective in design. In all, 2000 patients were operated upon and 186 (9.3%) of the operations were acute. There was a significant relationship between the urgency of the operation and mortality. Early mortality was 2.4% in elective operations and 5.4-62.5% in urgent to emergency operations. The 30-day to 2-year mortality was 4.2%. The perioperative risk indicators independently associated with early mortality were neurologic complications, serum-aspartate aminotransferase (S-ASAT) more than 2.0 microkat/l, urgency of operation, the use of circulatory assist devices, re-operation and ventilator time more than 24 h. The risk indicators for mortality after 30 days were pneumothorax, longer intensive care unit (ICU) time, the use of inotropic drugs and neurologic complications. In conclusion, the multivariate analysis reveals the urgency of the operation as a predictor of early mortality after CABG, but no significant association with mortality was found after 30 days. When excluding death within 30 days, three additional independent predictors of mortality were identified.

  • 66. Brandrup-Wognsen, G
    et al.
    Haglid, M
    Karlsson, T
    Berggren, H
    Herlitz, Johan
    [external].
    Preoperative risk indicators of death at an early and late stage after coronary artery bypass grafting1995Ingår i: The thoracic and cardiovascular surgeon, ISSN 0171-6425, E-ISSN 1439-1902, Vol. 43, nr 2, s. 77-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study was to describe mortality during a period of two years after coronary artery bypass surgery (CABG) in relation to preoperative risk factors. Included were all the patients in western Sweden in whom CABG was performed between June 1988 and June 1991, without concomitant procedures or re-operations. The study was prospective in design. In all, 2000 patients with a median age of 64 years were operated upon. Early (within 30 days) mortality was 3.0% and late (30-day-2-year) mortality was 4.2%. Total two-year mortality was 7.1%. For patients undergoing coronary artery bypass grafting, the factors found to be independently predictive of early mortality were female sex, renal dysfunction (creatine clearance < 60ml/min), left main stenosis, number of diseased vessels, previous myocardial infarction, and functional class. We found that a history of congestive heart failure, a history of cerebrovascular disease, diabetes mellitus, renal dysfunction and intermittent claudication were independent risk factors for late mortality. In conclusion, with the exception of renal dysfunction, preoperative risk factors for death within 30 days after CABG differ from risk factors for death between 30 days and two years after CABG.

  • 67. Brandstrom, Y
    et al.
    Brink, E
    Grankvist, G
    Alsen, P
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlson, BW
    Physical Activity Six Months after a Myocardial Infarction2009Ingår i: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 15, nr 3, s. 191-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.

  • 68. Brink, E
    et al.
    Alsén, P
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kjellgren, K
    Cliffordson, C
    General self-efficacy and health-related quality of life after myocardial infarction2012Ingår i: Psychology, Health & Medicine, ISSN 1354-8506, E-ISSN 1465-3966, Vol. 17, nr 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.

  • 69. Brink, E
    et al.
    Brändström, Y
    Cliffordsson, C
    Herlitz, Johan
    [external].
    Karlson, BW
    Illness consequences after myocardial infarction: problems with physical functioning and return to work.2008Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 64, nr 6, s. 587-594Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This paper is a report of a study to explore health problems, physical and mental functioning, and physical activity in working-age patients after myocardial infarction, in order to assess the possible effects of these factors on return to work. BACKGROUND: A diagnosis of myocardial infarction may discourage patients from continuing an active working life. Enabling myocardial infarction patients to return to work has benefits for both individuals and society. METHODS: A convenience sample was recruited of 88 patients, <or=65 years of age, who had suffered a myocardial infarction. Assessments of employment, health-related quality of life and physical activity (footsteps per day) were conducted in 2005-2006, 4-6 months after myocardial infarction. To explore data and compare groups, t-tests were applied. Logistic regression analyses were performed to identify variables that best predicted return to work. RESULTS: Differences were identified between individuals who were employed after myocardial infarction and those who were not. Those not in work scored lower on variables related to the physical dimension of health-related quality of life and on physical activity. Logistic regression revealed that a multivariate model including age, physical dimension of health-related quality of life and footsteps per day predicted return to work in 68% of all cases (R2=0.344). CONCLUSION: Low physical health and low physical activity after myocardial infarction negatively affect returning to work. These findings stress the importance of clinical assessment of myocardial infarction patients' daily physical activity and physical functioning.

  • 70. Brink, E
    et al.
    Cliffordson, E
    Herlitz, Johan
    [external].
    Karlson, BW
    Dimensions of the Somatic Health Complaints Questionnaire (SHCQ) in a sample of myocardial infarction patients.2007Ingår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, nr 1, s. 27-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A short health complaints measure may provide information on the degree of recovery from acute myocardial infarction. The present study therefore evaluated a questionnaire-called the Somatic Health Complaints Questionnaire (SHCQ)-that includes 13 items concerning health problems common in cardiac patients. The sample included 114 patients in total, 37 women and 77 men, who had suffered a first-time myocardial infarction 5months prior to the testing. Confirmatory factor analysis was performed to examine whether the factor structure replicated the hypothesized hierarchical model. The results indicated that SHCQ represents four dimensions: breathlessness, fatigue, pain and unrest. It was also found that SHCQ may be treated as one general concept. It is a brief and easily administered questionnaire and may therefore be a useful tool in secondary prevention work, identifying patients at risk for possible negative consequences of a first-time myocardial infarction.

  • 71. Brorsson, B
    et al.
    Herlitz, Johan
    [external].
    Werkö, L
    Evaluation of patients referred for possible coronary revascularization among patients with and without a history of hypertension1998Ingår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 8, nr 2, s. 151-157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Patients with and without a history of hypertension referred for eventual coronary revascularization were compared on the basis of a national survey including previous history, indications for coronary angiography, use of medication, findings at exercise test and cardioangiography, and long-term prognosis. As part of a national study of the appropriateness of coronary revascularization, data were prospectively collected on patients referred for possible coronary revascularization to 7/8 public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994. The study included 2764 patients of whom 986 (36%) had a history of hypertension. Indications for coronary angiography were similar in patients with and without a history of hypertension. Triple therapy (a combination of beta-blockers, long-acting nitrates and calcium channel-blockers) was more frequently used among patients with hypertension (32.6% as compared with 21.4% among patients without hypertension; p < 0.001). With the exception of ST depression > 6 min after discontinuation of exercise test, which was more frequent among hypertensive patients (30.9% vs 25.7%; p < 0.05), the various indicators of myocardial ischemia were similar in the two groups during exercise. Patients with hypertension had a somewhat lower exercise capacity (mean of 109.6 w) than patients without hypertension (113.7; p < 0.05). The extent of coronary artery disease was more severe among hypertensives (p < 0.001). Overall mortality during the subsequent 21 months was 5.6% for patients with hypertension and 3.1% for patients without hypertension (p < 0.01). This was caused mainly by a difference in cardiovascular mortality (3.9% vs 2.5%; p < 0.05) and cerebrovascular mortality (1.0% vs 0.3%; p < 0.05). Among patients referred for possible coronary revascularization, those with a history of hypertension differed from those without such a history, in that they more frequently had ST depression at exercise test, a lower exercise capacity, more severe coronary artery disease, a higher frequency of triple-therapy use and a higher mortality rate.

  • 72. Brändström, Yvonne
    et al.
    Brink, Eva
    Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg.
    Grankvist, Gunne
    Alsén, Pia
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Karlson, Björn W
    Physical activity six months after a myocardial infarction2009Ingår i: International Journal of Nursing Practice, ISSN 1322-7114, E-ISSN 1440-172X, Vol. 15, nr 3, s. 191-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In the present study, we wished to explore physical activity in middle-aged patients 6 months after a myocardial infarction and to compare the patients' self-reported activity level with pedometric measures of footsteps/day. The sample comprised 89 patients with myocardial infarction, aged <or= 65 years. The self-report question showed that < 40% of the patients were engaged in at least 30 min of physical activity every day. The pedometric physical activity data showed a daily mean number of steps of 6719. The self-report question was correlated with the pedometric registration data. Among myocardial infarction patients, physical activity 6 months after the acute heart attack was insufficient in the majority of patients, both when evaluated with a self-report question and when evaluated with a pedometer. Efforts to increase physical activity after myocardial infarction are warranted.

  • 73. Bylow, Helene
    et al.
    Karlsson, Thomas
    Claesson, Andreas
    Lepp, Margret
    Lindqvist, Jonny
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Self-learning training versus instructor-led training for basic life support: A cluster randomised trial.2019Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 139, s. 122-132, artikel-id S0300-9572(19)30094-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To compare the effectiveness of two basic life support (BLS) training interventions.

    METHODS: This experimental trial enrolled 1301 lay people in BLS training. The participants were cluster randomised to either self-learning training or to traditional instructor-led training. Both groups used the Mini-Anne Kit (Laerdal Medical, Stavanger, Norway) and standardised film instructions. After training, the participants practical skills were measured on a Resusci Anne manikin and an AED trainer with the PC SkillReporting system (Laerdal Medical, Stavanger, Norway). The primary outcome was the total score from the modified Cardiff Test of basic life support with automated external defibrillation (19-70 points), six months after training. The secondary outcomes were total score directly after training and quality of individual variables, self-assessed knowledge, confidence and willingness to act, directly and six months after training.

    RESULTS: For primary outcome six months after training there was no statistically significant difference (p = 0.44) between the total score for the self-learning group (n = 670; median 59, IQR 55-62) compared with the instructor-led group (n = 561; median 59, IQR 55-63). The instructor-led training resulted in a statistically significant higher total score (median 61 versus 59, p < 0.0001), self-assessed knowledge and willingness to act, directly after training (secondary outcomes) compared with the self-learning training.

    CONCLUSIONS: There was no statistically significant difference in practical skills or willingness to act when comparing self-learning training with instructor-led training six months after training in BLS. However, directly after the intervention, practical skills were better when the training was led by an instructor.

  • 74. Bylow, Helene
    et al.
    Karlsson, Thomas
    Claesson, Andreas
    Lepp, Margret
    Lindqvist, Jonny
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Supplementary dataset to self-learning training compared with instructor-led training in basic life support.2019Ingår i: Data in Brief, E-ISSN 2352-3409, Vol. 25, artikel-id 104064Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In this article, we present supplementary data to the article entitled "Self-learning training versus instructor-led training in basic life support: a cluster randomised trial" [1]. In three supplementary files, we present the informed consent of the included participants, the modified instrument to calculate the total score for practical skills called "the Cardiff Test of basic life support and automated external defibrillation" and the questionnaire to obtain background factors, theoretical knowledge, self-assessed knowledge and confidence and willingness to act, distributed directly after training and six months after training. The results of comparisons between "directly after intervention" and "six months after intervention", for each training group separately, are presented in three tables. We also present two tables showing the reasons why the participants were not prepared to perform compressions and/or ventilations in the event of a sudden out-of-hospital cardiac arrest.

  • 75. Bylow, Helene
    et al.
    Karlsson, Thomas
    Lepp, Margret
    Claesson, Andreas
    Lindqvist, Jonny
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial.2019Ingår i: PLoS ONE, E-ISSN 1932-6203, Vol. 14, nr 7, artikel-id e0219341Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED).

    AIM: To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD).

    METHODS: Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes.

    RESULTS: BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004).

    CONCLUSION: A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.

  • 76. Bäck, M
    et al.
    Cider, Å
    Gillström, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Physical activity in relation to cardiac risk markers in secondary prevention of coronary artery disease2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 1, s. 478-483Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The relationship between physical activity and cardiac risk markers in secondary prevention for patients with coronary artery disease (CAD) is uncertain. The aims of the study were therefore to examine the level of physical activity in patients with CAD, and to investigate the association between physical activity and cardiac risk markers. METHODS: In total, 332 patients, mean age, 65 ± 9.1 years, diagnosed with CAD at a university hospital were included in the study 6 months after their cardiac event. Physical activity was measured with a pedometer (steps/day) and two questionnaires. Investigation of cardiac risk markers included serum lipids, oral glucose-tolerance test, twenty-four hour blood pressure and heart rate monitoring, smoking, body-mass index (BMI), waist-hip ratio, and muscle endurance. The study had a cross-sectional design. RESULTS: The patients performed a median of 7,027 steps/day. After adjustment for confounders, statistically significant correlations between steps/day and risk markers were found with regard to; high-density lipoprotein cholesterol (HDL-C) (r=0.19, p<0.001), muscle endurance measures (r ranging from 0.19 to 0.25, p=0.001 or less) triglycerides (r=-0.19, p<0.001), glucose-tolerance (r=-0.23, p<0.001), BMI (r=-0.21, p<0.001), 24-h heart rate recording during night (r=-0.17, p=0.004), and average 24-h heart rate (r=-0.13, p=0.02). CONCLUSIONS: A relatively high level of physical activity was found among patients with CAD. There was a weak, but significant, association between pedometer steps/day and HDL-C, muscle endurance, triglycerides, glucose-tolerance, BMI and 24-h heart rate, indicating potential positive effects of physical activity on these parameters. However, before clinical implications can be formed, more confirmatory data are needed.

  • 77. Bäck, M
    et al.
    Cider, Å
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Jansson, B
    What variables predict participation in exercise-based cardiac rehabilitation in patients with coronary artery disease?2014Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background Despite the well-established positive effects of exercise-based cardiac rehabilitation (CR) participation has been shown to be sub-optimal. A significant association between kinesiophobia (fear of movement) and participation in CR has previously been found. Therefore, the aim of this study was to identify predictors of participation in CR in patients with coronary artery disease (CAD), with a special reference to kinesiophobia. Material and methods In all, 332 patients (75 women; mean age 65±9.1 years) with a diagnosis of CAD were recruited between 2007 and 2009 at Sahlgrenska University Hospital/Sahlgrenska. The patients were tested regarding muscle endurance, level of physical activity, health related quality of life, anxiety, depression and kinesiophobia. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An explorative selection of significant predictors was performed. Results Kinesiophobia (p=.012), waist circumference (p=.023), and a previous history of PCI (p=.037) had direct negative effects on participation in CR, while current incidence of CABG (p<.001), PCI (p=.005) and BMI (p=.008) had positive effects. Compared to patients diagnosed with unstable angina, a diagnosis of myocardial infarction (p=.004) had a positive effect on participation in CR. The following indirect effects on participation in CR were found. Anxiety (p=.001) and previous PCI (p=.025) increased kinesiophobia, while muscle endurance (p=.003), perceptions of general health (p<.001) and physical functioning (p=.009) decreased kinesiophobia. Moreover, men had higher kinesiophobia compared to women (p=.031) and smoking was found to reduce kinesiophobia (p=.004). Conclusion Several important variables with an influence on participation in CR were identified and should be further analysed in relation to clinical practice. A reduction of kinesiophobia can be an efficient way to increase participation in CR and should therefore be given priority in future research.

  • 78. Bäck, M
    et al.
    Jansson, B
    Cider, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, M
    Validation of a questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease.2012Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 4, s. 363-369Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To investigate the validity and reliability of the Tampa Scale for Kinesiophobia Heart (TSK-SV Heart), a brief questionnaire to detect kinesiophobia (fear of movement) in patients with coronary artery disease. Design: Methodological research (cross-sectional study). Subjects: A total of 332 patients, mean age 65 years (standard deviation 9.1) diagnosed with coronary artery disease at a university hospital were included in the study. Methods: The psychometric properties of the TSK-SV Heart were tested. The tests of validity comprised face, content, and construct validity. The reliability tests included composite reliability, internal consistency and stability over time. Results: In terms of reliability, the TSK-SV Heart was found to be stable over time (intra-class correlation coefficient 0.83) and internally consistent (Cronbach's alpha 0.78). Confirmatory factor analysis provided acceptable fit for a hypothesized 4-factor model with inclusion of a method factor. Conclusion: These results provide support for the reliability of the TSK-SV Heart. The questionnaire appears to be valid for use in patients with coronary artery disease. However, some items require further investigation due to low influence on some sub-dimensions of the test. The sub-dimensions of kinesiophobia require future research concerning their implications for the target group.

  • 79. Bäck, Maria
    et al.
    Cider, Åsa
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Physical activity in relation to cardiac risk markers in coronary artery disease2012Konferensbidrag (Refereegranskat)
  • 80. Bäck, Maria
    et al.
    Cider, Åsa
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lundberg, Mari
    Jansson, Bengt
    Kinesiophobia mediates the influences on attendance at exercise-based cardiac rehabilitation in patients with coronary artery disease.2016Ingår i: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 32, nr 8, s. 571-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To identify predictors of attendance at exercise-based cardiac rehabilitation (CR) and to test the hypothesis that kinesiophobia mediates the influence on attendance at CR in patients with coronary artery disease (CAD).

    PATIENTS: In total, 332 patients (75 women; mean age 65 ± 9.1 years) with a diagnosis of CAD were recruited at Sahlgrenska University Hospital, Sweden.

    METHODS: The patients were tested in terms of objective measurements, self-rated psychological measurements, and level of physical activity. A path model with direct and indirect effects via kinesiophobia was used to predict participation in CR. An exploratory selection of significant predictors was made.

    RESULTS: A current incidence of coronary bypass grafting (p < 0.001) and a diagnosis of ST-elevation myocardial infarction (p = 0.004) increased the probability of attendance at CR, while kinesiophobia (p = 0.001) reduced attendance. As a mediator, kinesiophobia was influenced by four predictors and the following indirect effects were found. General health and muscle endurance increased the probability of attendance at CR, while self-rated anxiety and current incidence of heart failure had the opposite effect.

    CONCLUSIONS: This study suggests that kinesiophobia has an influence on and a mediating role in attendance at CR. The results need to be further investigated in relation to clinical practice.

  • 81. Bäck, Maria
    et al.
    Cider, Åsa
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Lundberg, Mari
    Jansson, Bengt
    The impact on kinesiophobia (fear of movement) by clinical variables for patients with coronary artery disease2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 2, s. 391-397Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The impact on kinesiophobia (fear of movement) for patients with coronary artery disease (CAD) is not known. The aims were to describe the occurrence of kinesiophobia in patients with CAD, and to investigate the influence on kinesiophobia by clinical variables. Material and methods: In total, 332 patients, mean age, 65±9.1 years diagnosed with CAD at a university hospital were included in the study. The Tampa Scale for Kinesiophobia Heart (TSK-SV Heart) was used to assess kinesiophobia. Comparisons between high versus low levels of kinesiophobia were measured for each variable. Binary logistic regression analyses were performed with a high level of kinesiophobia (TSK-SV Heart >37) as dependent variable, and with the observed variables as independent. The study had an exploratory, cross-sectional design. Results: A high level of kinesiophobia was found in 20% of the patients. The following variables decreased the odds ratio (OR) for a high level of kinesiophobia: Attending cardiac rehabilitation (yes vs no; -56.7%), level of physical activity (medium vs high; -80.2%), Short Form-36: general health (-4,3%), physical functioning (-1.8%). Two variables increased the OR for a high level of kinesiophobia: heart failure as complication at hospital (yes vs no; 418.7%), anxiety (19.2%). Previous heart failure (yes vs no) was unexpectedly found to reduce kinesiophobia (-88.3%) due to suppression. Conclusions: Several important clinical findings with impact on rehabilitation and prognosis for patients with CAD were found to be associated with a high level of kinesiophobia. Therefore, kinesiophobia needs to be considered in secondary prevention for patients with CAD.

  • 82. Bäck, Maria
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Biochemical markers and blood pressure in relation to physical activity among patients with coronary artery disease2012Konferensbidrag (Refereegranskat)
  • 83.
    Bäck, Maria
    et al.
    Sahlgrenska University Hospital.
    Lundberg, Mari
    Sahlgrenska University Hospital.
    Cider, Åsa
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jansson, Bengt
    University of Gothenburg.
    Relevance of Kinesiophobia in Relation to Changes Over Time Among Patients After an Acute Coronary Artery Disease Event.2017Ingår i: Journal of cardiopulmonary rehabilitation and prevention, ISSN 1932-751XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: To identify levels of kinesiophobia during the first 4 months after an acute episode of coronary artery disease (CAD), while controlling for gender, anxiety, depression, and personality traits.

    METHODS: In all, 106 patients with CAD (25 women), mean age 63.1 ± 11.5 years, were included in the study at the cardiac intensive care unit, Sahlgrenska University Hospital, Sweden. The patients completed questionnaires at 3 time points: in the cardiac intensive care unit (baseline), 2 weeks, and 4 months after baseline. The primary outcome measure was kinesiophobia. Secondary outcome measures were gender, anxiety, depression, harm avoidance, and positive and negative affect. A linear mixed model procedure was used to compare kinesiophobia across time points and gender. Secondary outcome measures were used as covariates.

    RESULTS: Kinesiophobia decreased over time (P = .005) and there was a significant effect of gender (P = .045; higher values for women). The presence of a high level of kinesiophobia was 25.4% at baseline, 19% after 2 weeks, and 21.1% after 4 months. Inclusion of the covariates showed that positive and negative affect and harm avoidance increased model fit. The effects of time and gender remained significant.

    CONCLUSIONS: This study highlights that kinesiophobia decreased over time after an acute CAD episode. Nonetheless, a substantial part of the patients were identified with a high level of kinesiophobia across time, which emphasizes the need for screening and the design of a treatment intervention.

  • 84. Bäck, Maria
    et al.
    Lundberg, Marie
    Cider, Åsa
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jansson, Bengt
    How does kinesiophobia change over time in patients with coronary artery disease2015Ingår i: Abstracts and presentations, 2015, Vol. 101Konferensbidrag (Refereegranskat)
  • 85.
    Bång, A
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Biber, B
    Isaksson, L
    Lindqvist, J
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Evaluation of dispatcher assisted cardiopulmonary resuscitation1999Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 6, nr 3, s. 175-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The outcome of out-of-hospital cardiac arrest (CA) following cardiopulmonary resuscitation (CPR) initiated by dispatcher-provided telephone instructions (T-CPR) in the area of Gothenburg, Sweden was studied. During a period of 27 months, 475 cases categorized by the dispatchers at the Emergency Co-ordination and Dispatch Centre as being suspected CA were offered T-CPR and were included in one of the following groups: (1) T-CPR completed (caller without previous CPR training); (2) T-CPR completed (caller with previous CPR training); (3) T-CPR started, but not completed; (4) T-CPR declined by caller due to previous CPR training; (5) T-CPR declined by caller due to other reasons; or, (6) T-CPR not offered. Of the patients, 473 could be followed up and of them 427 fulfilled the criteria for CA on ambulance arrival. Among the latter cases, 10% were hospitalized alive, 4% could be discharged from hospital, and the distribution among groups was: (1) 7%; (2) 18%; (3) 5%; (4) 11%; (5) 3%; and (6) 1%. The study concludes that although more attention should be paid to the detection of CA patients by the dispatchers, when the dispatchers suspected CA, their accuracy was high. Half of the witnesses accepted the offer of T-CPR and one-third completed T-CPR. More efforts and research are needed, however, to increase the percentages of callers completing CPR. The impact of T-CPR on survival might be limited. Indeed, the comparison of 'resuscitable' patients in whom T-CPR played an important role in supporting bystanders (i.e. groups 1 and 2) with 'resuscitable' patients in whom T-CPR was not performed (i.e. groups 3, 5 and 6) suggests an increase in survival from 6% (groups 3, 5 and 6) to 9% (groups 1 and 2).

  • 86.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, B-O
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, L
    Svensson, L (Redaktör)
    Forskning och utveckling2009Ingår i: Prehospital akutsjukvård, Liber AB , 2009, s. 461-468Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 87.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, S
    Karlsson, T
    Caidahl, K
    Hartford, M
    Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.2008Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 88.
    Bång, A
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustavsson, M
    Larsson, C
    Holmberg, S
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Are patients who are found deeply unconscious, without having suffered a cardiac arrest, always breathing normally?2008Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 89. Bång, A
    et al.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Caidahl, K
    Karlsson, T
    Kihlgren, S
    Hartford, M
    The relative influence of age, previous history and therapeutic strategies prior to hospital admission among ambulance transported patients with ST-elevation myocardial infarction.2009Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 213-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Among 388 patients with ST-elevation and myocardial infarction admitted to hospital with ambulance, we found the following to be independent predictors of the short term (30 days) mortality rate; Age and treatment with aspirin prior to hospital admission. The following were associated with long term (30 days to 5 years) mortality rate; age, a history of diabetes and fast track to CCU.

  • 90. Bång, A
    et al.
    Herlitz, Johan
    [external].
    Holmberg, S
    Possibilities of implementing dispatcher-assisted cardiopulmonary resuscitation in the community2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 44, nr 1, s. 19-26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: By evaluating tape recordings of true cardiac arrest calls, to judge the dispatchers ability to (a) identify cases as suspected cardiac arrest (CA), (b) give the case the right priority, (c) identify CA cases suitable for dispatcher-assisted, telephone-guided cardiopulmonary resuscitation (T-CPR) and (d) accomplish T-CPR. Methods: Evaluation of 99 tape recordings of consecutive cases that had been admitted to the two city hospitals in Göteborg after out-of-hospital CA. Results: In 70% of the interviews, the dispatcher demonstrated impeccable behaviour with short, distinct questions, quickly resulting in a decision on how to handle the case. In 30%, serious criticism could be voiced as the dispatcher displayed very stressful behaviour, or omitted to ask important questions such as whether the patient was conscious and breathing. In 21%, the interviews indicated a clear opportunity to perform T-CPR. In another 10%, there was a possibility of performing T-CPR. Only in 8% was T-CPR actually accomplished. Conclusions: (1) In the majority of the interviews, the quality was very high, while in one-third, serious criticism could be voiced. (2) In our study, only one-third (95% confidence interval, 22–41) of CA cases were suitable for T-CPR, and T-CPR was performed in only 8% of the 99 cases. (3) To optimise the dispatcher ability to identify suspected CA and initiate T-CPR, both medical knowledge and practical training are needed, preferably with protocols for pre-arrival instructions.

  • 91.
    Bång, A
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. [external].
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Martinell, S
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases.2003Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 56, nr 1, s. 25-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: One of the objectives of this study was to assess the emergency medical dispatchers (EMDs) ability for the identification and prioritisation of cardiac arrest (CA) cases, and offering and achievements of dispatcher-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of agonal respiration in cardiac arrest calls and the caller's descriptions of breathing. METHODS: Prospective study evaluating 100 tape recordings of the EMD calls of emergency medical service (EMS)-provided advanced life support- (ALS) cases, of out-of-hospital cardiac arrest. RESULTS: The quality of EMD-performed interviews was highly commended in 63% of cases, but insufficient or unapproved in the remaining 37%. The caller's state of mind was not a major problem for co-operation. Among the 100 cases, 24 were suspected to be unconscious and in respiratory arrest. A further 38 cases were presented as unconscious with abnormal breathing. In only 14 cases dispatcher-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the cases were unconscious patients with abnormal breathing. The incidence of suspected agonal breathing was estimated to be approximately 30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional breathing. CONCLUSIONS: Among suspected cardiac arrest cases, EMDs offer CPR instruction to only a small fraction of callers. A major obstacle was the presentation of agonal breathing. Patients with a combination of unconsciousness and agonal breathing should be offered dispatcher-assisted CPR instruction. This might improve survival in out-of hospital cardiac arrest.

  • 92.
    Bång, A
    et al.
    [external].
    Ortgren, P-O
    Herlitz, Johan
    [external].
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2002Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 2, s. 135-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 93.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Castrén, Maaret
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Suserud, Björn-Ove
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Svensson, Leif
    Forskning och utveckling2009Ingår i: Prehospital akutsjukvård / [ed] Leif Svensson, Stockholm: Liber AB , 2009, s. 461-469Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 94.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, Lars
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Kihlgren, Stefan
    Karlsson, Thomas
    Caidahl, Kenneth
    Hartford, Marianne
    Lower mortality after prehospital recognition and treatment by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction2008Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 129, nr 3, s. 325-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.

  • 95.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Gustavsson, Mikael
    Larsson, Carina
    Holmberg, Stig
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Are patients who are found deeply unconscious without having suffered a cardiac arrest, always breathing normally?2008Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 78, nr 2, s. 116-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate how often an ambulance crew reports abnormal breathing among patients who are found deeply unconscious but without having suffered a cardiac arrest. METHODS: Patients with Glasgow Coma Scale (GCS) 3 (1+1+1) and without cardiac arrest were retrospectively evaluated, via ambulance records, for signs of abnormal breathing. RESULTS: Of 45 patients who fulfilled inclusion criteria, 24 (53%) had signs of abnormal breathing, as reported by the ambulance crew. CONCLUSION: Signs of abnormal breathing among comatose patients with no cardiac arrest appear to be relatively common. This therefore increases the risk of starting cardiopulmonary resuscitation (CPR) in such patients, which is in accordance with the present CPR guidelines for the lay person. Whether this might do harm to such patients is not known.

  • 96.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, L
    Caidahl, K
    Karlsson, T
    Kihlgren, S
    Hartford, M
    The Relative Influence of Age, Previous History and Therapeutic Strategies Prior to Hospital Admission among Ambulance Transported Patients with ST-elevation Myocardial Infarction2009Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 213-214Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Among 388 patients with ST-elevation and myocardial infarction admitted to hospital with ambulance, we found the following to be independent predictors of the short term (30 days) mortality rate; Age and treatment with aspirin prior to hospital admission. The following were associated with long term (30 days to 5 years) mortality rate; age, a history of diabetes and fast track to CCU.

  • 97.
    Bång, Angela
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Grip, Lars
    Caidahl, Kenneth
    Karlsson, Thomas
    Kihlgren, Stefan
    Hartford, Marianne
    The relative influence of age, previous history and therapeutic strategies prior to hospital admission among ambulance transported patients with ST-elevation myocardial infarction2008Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 136, nr 2, s. 213-214Artikel i tidskrift (Refereegranskat)
  • 98. Bång, Angela
    et al.
    Martinell, S
    Herlitz, Johan
    Interaction between emergency medical dispatcher and caller in suspected out-of-hospital cardiac arrest calls with focus on agonal breathing. A review of 100 tape recordings of true cardiac arrest cases2003Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 2003, nr 56, s. 25-34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: One of the objectives of this study was to assess the previous termemergency medical dispatchersnext term (EMDs) ability for the identification and prioritisation of previous termcardiac arrestnext term (CA) previous termcases,next term and offering and achievements of previous termdispatchernext term-assisted bystander cardiopulmonary resuscitation (CPR). The other objective was to give an account of the frequency of previous termagonalnext term respiration in previous termcardiac arrest calls and the caller'snext term descriptions of previous termbreathing.next term Methods: Prospective study evaluating previous term100 tape recordingsnext term of the EMD previous termcalls of emergency medicalnext term service (EMS)-provided advanced life support- (ALS) previous termcases, of out-of-hospital cardiac arrest.next term Results: The quality of EMD-performed interviews was highly commended in 63% of previous termcases,next term but insufficient or unapproved in the remaining 37%. The previous termcaller'snext term state of mind was not previous termanext term major problem for co-operation. Among the previous term100 cases,next term 24 were previous termsuspectednext term to be unconscious and in respiratory previous termarrest. Anext term further 38 previous termcasesnext term were presented as unconscious with abnormal previous termbreathing.next term In only 14 previous termcases dispatchernext term-assisted bystander CPR was offered by the EMD, and in 11 of these it was attempted, and completed in eight. Only four of the previous termcasesnext term were unconscious patients with abnormal previous termbreathing.next term The incidence of previous termsuspected agonal breathingnext term was estimated to be not, vert, similar30% and the descriptions were; difficulty, poorly, gasping, wheezing, impaired, occasional previous termbreathing.next term Conclusions: Among previous termsuspected cardiac arrest cases,next term EMDs offer CPR instruction to only previous termanext term small fraction of previous termcallers. Anext term major obstacle was the presentation of previous termagonal breathing.next term Patients with previous termanext term combination of unconsciousness and previous termagonal breathingnext term should be offered previous termdispatchernext term-assisted CPR instruction. This might improve survival in previous termout-of hospital cardiac arrest.next term

  • 99. Bång, Angela
    et al.
    Ortgren, P-O
    Herlitz, Johan
    Währborg, P
    Dispatcher-assisted telephone CPR: A qualitative study exploring how dispatchers perceive their experiences2000Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 53, nr 1, s. 135-151Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives:To investigate how emergency medical dispatchers (EMDs) perceive their experience of identifying suspected cardiac arrests (CA), and offer and provide instructions in cardiopulmonary resuscitation via telephone (t-CPR). Design: A qualitative method using the phenomenographic design where 10 EMDs were approached for semi-structured interviews. Main outcome measures: Perception in identifying CA, perception in offering t-CPR and perception in providing t-CPR. Results: In this analysis, 12 categories and 31 subcategories emerged. The categories for perception in identifying CA were; to trust the witness's account, to be open-minded and to be organised. The categories for perception in offering t-CPR were: to feel prepared to connect with the witness on a mental level by being organised, flexible and supportive, to obtain a basis for assessments and to be observant for diverse obstacles in a situation. Finally, the categories for perception in providing t-CPR were: to feel engaged, to be supportive of the witness, to feel secure by recognising response-feedback from the witness, to observe external conditions with regard to the locality and technical complications, to be composed and adjust to the needs of the situation, to feel competent or to feel despair. Conclusions: By listening in an open-minded way, a vast amount of information can be collected. Using criteria-based dispatch (CBD) and their own resources, the possibilities and difficulties of the situation are analysed. The EMDs believe that they are being an empathic support, relieving the witness of the burden of responsibility, and connecting with them mentally to enable them to act at the scene. There are EMDs who feel competent and experienced in managing these cases, and other EMDs who feel insecure and despair. The choice between providing t-CPR and answering incoming calls is prioritised differently among EMDs. There is also a broad subjective assessment among EMDs of offering t-CPR, especially to persons over 70 years old whom they consider incapable of performing CPR. The competence of the EMDs in t-CPR is dependent on re-training and a feedback on patient outcome. Witnesses who are negative towards acting constitute a common problem. There are witnesses with physical impediments or psychologically not susceptible to suggestions. The EMD is also dependent on the knowledge and trustworthiness of the witness. Convincing answers from witnesses prompt a more secure feeling in the EMDs, just as lack of knowledge in the witness has a negative effect on the efforts.

  • 100. Caidahl, K
    et al.
    Hartford, M
    Karlsson, T
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Pettersson, K
    de Faire, U
    Frostegård, J
    IGM-phosphorylcholine autoantibodies and outcome in acute coronary syndromes.2013Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, nr 2, s. 464-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Antibodies against proinflammatory phosphorylcholine (anti-PC) seem to be protective and reduce morbidity. We sought to determine whether low levels of immunoglobulin-M (IgM) autoantibodies against PC add prognostic information in acute coronary syndromes (ACS). METHODS: IgM anti-PC titers were measured in serum obtained within 24h of admission from 1185 ACS patients (median age 66 years, 30% women). We evaluated major acute cardiovascular events (MACE) and all-cause mortality short--(6 months), intermediate--(18 months) and long--(72 months) terms. RESULTS: Low anti-PC titers were associated with MACE and all-cause mortality at all follow-up times. After adjusting for clinical variables, plasma troponin-I, proBNP and CRP levels, associations remained at all times with MACE, short and intermediate terms also with all-cause mortality. With anti-PC titers below median, adjusted hazard ratios at 18months were for MACE 1.79 (95% confidence interval [CI]: 1.31 to 2.44; p=0.0002) and for all-cause mortality 2.28 (95% CI: 1.32 to 3.92; p=0.003). Anti-PC and plasma CRP were unrelated and added to risk prediction. CONCLUSIONS: Serum IgM anti-PC titers provide prognostic information above traditional risk factors in ACS. The ease of measurement and potential therapeutic perspective indicate that it may be a valuable novel biomarker in ACS.

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