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  • 651. Karlson, BW
    et al.
    Sjöland, H
    Währborg, P
    Lindqvist, J
    Herlitz, Johan
    [external].
    Patients discharged from emergency care after acute myocardial infarction was ruled out: early follow-up in relation to gender1997Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 4, nr 2, s. 72-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this research was to describe men and women who were discharged from the emergency department after having an initial suspicion of acute myocardial infarction ruled out in terms of patient characteristics, symptom reevaluation, electrocardiogram and exercise stress test. Consecutive patients below the age of 65 years who came to the emergency department of Sahlgrenska Hospital with acute chest pain or other symptoms raising suspicion of acute myocardial infarction for whom the suspicion was ruled out either directly in the emergency department or less than 1 day after hospital admission were included in the study. Four hundred and eighty-four patients participated, of whom 295 (61%) were men. Men had a higher prevalence of ischaemic heart disease. The cause of pain was judged similarly at reevaluation compared with in the emergency department in 53% of the cases. Only in 4.6% of the cases were the symptoms judged to be caused by myocardial ischaemia on both occasions. At the initial visit 36.0% of the patients were judged to have uncertain cause of the symptoms. This proportion was lowered to 26.4% at reevaluation. The exercise electrocardiogram at reevaluation revealed clinical and electrocardiographic signs indicating definite myocardial ischaemia in 2.6% of the cases. Early follow-up of patients discharged from the emergency department after acute myocardial infarction was ruled out revealed that a low proportion showed signs of myocardial ischaemia. In about half of the cases the judgement differed from that being made in the emergency department.

  • 652. Karlson, BW
    et al.
    Sjölin, M
    Herlitz, Johan
    [external].
    Clinical factors associated with pain in acute myocardial infarction1993Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 83, nr 1-2, s. 107-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In an unselected population of 921 consecutive patients with acute myocardial infarction admitted to one single hospital, regardless of age and whether they were admitted to the coronary care unit or not, we describe the course of pain during hospitalization. Patients with a history of angina pectoris, patients with a particularly long delay time, and patients not transported by ambulance had the longest duration of pain.

  • 653. Karlson, BW
    et al.
    Sjölin, M
    Lindqvist, J
    Caidahl, K
    Herlitz, Johan
    [external].
    Ten year mortality rate in relation to observation at a bicycle exercise test in patients with suspected or confirmed ischemic event but with no or only minor myocardial damage2001Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 141, nr 6, s. 977-984Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim Our purpose was to describe symptoms and electrocardiographic findings at a bicycle exercise test 4 weeks after hospitalization for a suspected or confirmed acute ischemic event but either no or only minor myocardial necrosis and its relationship to long-term prognosis and subsequent revascularization. Methods In all patients a symptom-limited bicycle exercise test was performed 4 weeks after discharge from the hospital. The total mortality rate over 10 years was registered. Results In all, 770 patients participated in the evaluation. The median age was 63 years, and 34% were women. The most frequent reason for stopping the exercise test was fatigue (69%) followed by dyspnea (33%) and angina pectoris (15%). Angina pectoris was observed in 24% of the patients. ST-segment depression ≥1 mm was observed in 50% and ST-segment depression ≥2 mm was observed in 15% of the patients. The 10-year mortality rate in patients with ST-segment depression ≥2 mm was 24.7%, in patients with ST-segment depression 1.0 to 1.9 mm 33.5%, and in patients with ST-segment depression <1 mm 26.9% (not significant [NS]). Patients with symptoms of angina pectoris had a 10-year mortality rate of 29.4% compared with 27.9% among patients without such symptoms (NS). Patients who had either a drop in systolic blood pressure or failure to raise systolic blood pressure (13%) had a 10-year mortality rate of 36.2% compared with 27.2% among patients without such signs (NS). However, there was a significant association between maximum exercise capacity (in watts) and mortality (P < .0001): 53.8% in the lowest quartile (30-70 W) and 10.2% in the highest (>120 w). When clinical history was considered simultaneously, a low exercise capacity remained as a strong independent predictor of death together with age and a history of either acute myocardial infarction, smoking, or diabetes mellitus. Mechanical revascularization during the subsequent 5 years interacted only with angina pectoris and prognosis; thus patients who had angina during the exercise test had a worse prognosis than those without if they were not being revascularized. Conclusion Among patients hospitalized with a suspected or confirmed acute ischemic event but either no or only minor myocardial necrosis, we found the maximum working capacity at a symptom-limited bicycle exercise test to be independently associated with the long-term prognosis but not other signs of myocardial ischemia. Further predictors for long-term prognosis were age, a history of acute myocardial infarction, current smoking, and diabetes mellitus. Mechanical revascularization during the subsequent 5 years interacted with the influence of symptoms of angina during test and prognosis.

  • 654. Karlson, BW
    et al.
    Strömbom, U
    Ekvall, H-E
    Herlitz, Johan
    [external].
    Prognosis in diabetics in whom the initial suspicion of acute myocardial infarction was not confirmed1993Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 16, nr 7, s. 559-564Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    For 2,058 consecutive patients hospitalized for suspected acute myocardial infarction (AMI) but in whom AMI was later ruled out, we describe the prognosis with particular emphasis on diabetics. In all, a previous history of diabetes mellitus occurred in 290 (14%) of the patients. Compared with nondiabetics, they had a longer delay time between onset of symptoms and arrival in hospital. During 1 year of follow-up, their mortality rate was 28% compared with 14% for nondiabetics (p < 0.001), and their reinfarction rate was 20% compared with 10% for nondiabetics. More diabetics died in association with a fatal myocardial infarction and more frequently had ventricular fibrillation preceding death. With the exception of re-infarction, no clear difference in terms of morbidity was observed between the two groups. We conclude that the prognosis in diabetics in whom AMI is ruled out is poor, with between one-quarter and one-third not surviving 1 year.

  • 655. Karlson, BW
    et al.
    Wiklund, I
    Bengtsson, A
    Herlitz, Johan
    [external].
    Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain1994Ingår i: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 105, nr 5, s. 1442-1447Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out. AIM: To describe the outcome of such patients during 1 year of follow-up in terms of mortality, development of AMI, and especially severity of symptoms 1 year after discharge. METHODS: All patients who during 21 months were admitted to the medical emergency department at Sahlgrenska Hospital, Göteborg, Sweden, due to chest pain, and who could be directly sent home, were prospectively followed up for 1 year. Their outcome was compared with patients who had chest pain and were hospitalized for AMI during the same time. RESULTS: Patients with chest pain directly sent home (n = 2,102) had a median age of 52 years (age range, 16 to 96 years), and 54 percent were men. The mortality during 1 year was 3 percent, and 3 percent developed AMI. As compared with patients with AMI, those who were directly sent home less frequently reported various cardiovascular symptoms, with the exception for chest pain at rest and palpitations. On the other hand, various emotional and psychosomatic symptoms were more frequently reported by patients who were directly sent home than by patients with AMI. CONCLUSION: Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.

  • 656. Karlson, BW
    et al.
    Wiklund, I
    Bengtsson, A
    Herlitz, Johan
    [external].
    Prognosis, severity of symptoms, and aspects of well-being among patients in whom myocardial infarction was ruled out1994Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 17, nr 8, s. 427-431Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a high proportion of patients hospitalized due to suspected acute myocardial infarction (AMI) the diagnosis cannot be confirmed. The majority of these patients have ischemic heart disease and are at risk for subsequent cardiac events. The aim of this study was to describe the severity of symptoms and various aspects of well-being 1 year after hospitalization due to suspected AMI in surviving patients in whom the diagnosis was not confirmed, and to relate the observations to those found among survivors of a confirmed AMI. All patients admitted to Sahlgrenska Hospital, Göteborg, due to suspected AMI and who were alive after 1 year were asked to answer a questionnaire including questions regarding cardiovascular, psychiatric, and psychological symptoms. Patients in whom AMI was not confirmed reported more cardiovascular symptoms, for example, chest pain (p <0.001), dyspnea (p <0.01), palpitations (p <0.001), and fatigue (p <0.01) when compared with patients who suffered confirmed AMI. The majority of psychosomatic and psychological parameters evaluated were also more frequently reported by these patients and their quality of life seems to be worse compared with survivors of AMI.

  • 657. Karlson, BW
    et al.
    Wiklund, O
    Hallgren, P
    Sjölin, M
    Lindqvist, J
    Herlitz, Johan
    [external].
    Ten year mortality among patients with a very small or non-confirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischemia2000Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, nr 4, s. 449-456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract. Karlson BW, Wiklund O, Hallgren P, SjoÈlin M, Lindqvist J, Herlitz J (Sahlgrenska University Hospital, GoÈteborg, Sweden). Ten-year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 2000; 247: 449±456. Aim. To evaluate the long-term prognosis amongst patients with a very small or unconfirmed acute myocardial infarction (AMI) in relation to clinical history, metabolic screening and signs of myocardial ischaemia at exercise test. Methods. Patients with a very small or unconfirmed AMI, aged , 76 years, were selected and given a clinical evaluation, metabolic screening and checked for ischaemia at an exercise test 4 weeks after admittance. The 10-year mortality was related to age, sex, clinical history, body weight, serum (S) cholesterol, S-triglycerides, S-gammaglutamyltranspeptidase (GT), S-glucose and various indices of myocardial ischaemia at exercise test. Results. In all, 714 patients participated in the evaluation. The median age was 63 years and 33% werewomen. The overall 10-year mortality was 33%. In univariate analysis, the following factors appeared as risk indicators for death: age (P , 0.0001), a history of previous AMI (P , 0.0001), angina pectoris (P , 0.001), diabetes mellitus (P , 0.0001), congestive heart failure (P , 0.0001), smoking (P = 0.030), S-triglycerides (P , 0.0001), S-gamma GT (P , 0.0001) and Sglucose (P , 0.0001). In multivariate analysis, the following remained as independent risk indicators for death: age (P , 0.0001), S-gamma GT (P , 0.0001), previous AMI (P , 0.0001), smoking (P , 0.0001) and Sglucose (P = 0.010). Conclusion. Amongst patients with a very small or a unconfirmed AMI, factors reflecting their clinical history, including age, a history of AMI and current smoking, as well as factors reflecting their metabolic status, including S-gamma GT and S-glucose, were important predictors for the long-term outcome.

  • 658. Karlson, BW
    et al.
    Währborg, P
    Sjöland, H
    Lindqvist, J
    Herlitz, Johan
    [external].
    Impact of a chest pain clinic on recurrency of symptoms and readmission among patients early discharged from hospital for acute myocardial infarction ruled out1998Ingår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 5, nr 1, s. 29-35Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper evaluates the impact of an early revisit including symptom evaluation and an exercise electrocardiogram on recurrency of symptoms and readmissions during 1 year of follow-up among patients coming to hospital with chest pain or an initial suspicion of acute myocardial infarction (AMI) but in whom the suspicion was quickly ruled out. Patients below the age of 65 admitted to the emergency department (ED) at Sahlgrenska Hospital due to chest pain or other symptoms raising a suspicion of AMI who were either directly discharged from the ED or discharged within 1 day after having AMI ruled out. Patients were allocated to two groups: (1) patients being re-evaluated in a chest pain clinic less than a week after discharge from hospital (intervention group) and (2) patients handled routinely with no formalized follow-up (control group). The intervention group (n=484) and the control group (n=374) were comparable at baseline. During 1 year of follow-up, patients in the intervention group had a lower rate of readmissions to the ED than patients in the control group (17.4% versus 24.9%, p < 0.05) and a lower rate of rehospitalizations (15.9% versus 23.3%, p < 0.05). The proportion of patients being on sick leave at any time during the follow-up did not differ and neither did the recurrency of symptoms. The introduction of a chest pain clinic for patients early discharged from hospital after having AMI ruled out indicated beneficiency in terms of a lower rate of readmissions to the ED and a lower requirement of rehospitalizations. However, a methodological weakness in the randomization procedure suggest carefulness in interpretation.

  • 659. Karlsson, B W
    et al.
    Dellborg, M
    Gullestad, L
    Åberg, L
    Sugg, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    A pharmacokinetic and pharmacodynamic comparison of immediate-release metoprolol and extended-release metoprolol CR/XL in patients with suspected acute myocardial infarction: a randomized, open-label study2014Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 127, nr 2, s. 73-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous metoprolol studies in myocardial infarction patients were performed with immediate-release (IR) metoprolol. This study aims to evaluate if extended-release metoprolol CR/XL once daily gives a similar β-blockade over 24 h compared to multiple dosing of metoprolol IR. METHODS: After 2 days of routine metoprolol treatment, 27 patients with suspected acute myocardial infarction were randomized to open-label treatment with metoprolol IR (50 mg four times daily or 100 mg twice daily) or metoprolol CR/XL 200 mg once daily for 3 days. RESULTS: Metoprolol CR/XL 200 mg once daily gave more pronounced suppression of peak heart rate, with lower peak and less variation in peak to trough plasma levels. There were no differences in AUC between the CR/XL and IR formulations, although the trough plasma metoprolol levels were comparable for metoprolol CR/XL 200 mg once daily and metoprolol IR 50 mg four times daily, but lower for metoprolol IR 100 mg twice daily. Both treatments were well tolerated. CONCLUSIONS: Metoprolol CR/XL 200 mg once daily showed lower peak and less variation in peak to trough plasma levels compared to multiple dosing of metoprolol IR with the same AUC. This was accompanied by a more uniform β-blockade over time, which was reflected by heart rate, and a more pronounced suppression of peak heart rate with similar tolerability. This suggests metoprolol CR/XL may be used as an alternative to metoprolol IR in patients with myocardial infarction.

  • 660. Karlsson, BW
    et al.
    Dellborg, M
    Gullestad, L
    Åberg, J
    Sugg, J
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    A Pharmacokinetic and Pharmacodynamic Comparison of Immediate-Release Metoprolol and Extended-Release Metoprolol CR/XL in Patients with Suspected Acute Myocardial Infarction: A Randomized, Open-Label Study2014Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 127, nr 2, s. 73-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous metoprolol studies in myocardial infarction patients were performed with immediate-release (IR) metoprolol. This study aims to evaluate if extended-release metoprolol CR/XL once daily gives a similar β-blockade over 24 h compared to multiple dosing of metoprolol IR. Methods: After 2 days of routine metoprolol treatment, 27 patients with suspected acute myocardial infarction were randomized to open-label treatment with metoprolol IR (50 mg four times daily or 100 mg twice daily) or metoprolol CR/XL 200 mg once daily for 3 days. Results: Metoprolol CR/XL 200 mg once daily gave more pronounced suppression of peak heart rate, with lower peak and less variation in peak to trough plasma levels. There were no differences in AUC between the CR/XL and IR formulations, although the trough plasma metoprolol levels were comparable for metoprolol CR/XL 200 mg once daily and metoprolol IR 50 mg four times daily, but lower for metoprolol IR 100 mg twice daily. Both treatments were well tolerated. Conclusions: Metoprolol CR/XL 200 mg once daily showed lower peak and less variation in peak to trough plasma levels compared to multiple dosing of metoprolol IR with the same AUC. This was accompanied by a more uniform β-blockade over time, which was reflected by heart rate, and a more pronounced suppression of peak heart rate with similar tolerability. This suggests metoprolol CR/XL may be used as an alternative to metoprolol IR in patients with myocardial infarction.

  • 661. Karlsson, BW
    et al.
    Emanuelsson, H
    Herlitz, Johan
    [external].
    Nilsson, J-E
    Olsson, G
    Evaluation of the antianginal effect of nifedipine: influence of formulation dependent pharmacokinetics1991Ingår i: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 40, nr 5, s. 501-506Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Nifedipine capsules t.d.s. and an extended release formulation of nifedipine, nifedipine-ER tablets, given once daily in corresponding daily doses, have been compared with placebo in a double-blind, three-way cross-over study in 24 patients with stable angina pectoris. The objective was to study the influence on the antianginal effect of the different pharmacokinetics of several preparations of nifedipine. All patients received concomitant treatment with beta-adrenoceptor blockers. Antianginal efficacy was assessed by a dynamic exercise test at the end of the dosage intervals, i.e. 8 and 24 h after nifedipine capsules and nifedipine-ER, respectively, as well as 6 h after dosing. Six h after dosing the time of onset of chest pain and total exercise time were longer and total work was significantly higher during both nifedipine-ER (plasma concentration 260 nmol/l) and placebo treatment than after nifedipine capsules (plasma concentration 78 nmol/l). Time to 1 mm ST depression was longer during nifedipine-ER than during nifedipine capsule treatment. No significant difference was seen between nifedipine-ER and placebo. At the end of the dosage interval (24 and 8 h after nifedipine-ER and nifedipine capsules, respectively), no significant difference was found between nifedipine-ER (plasma concentration 75 nmol/l) and the other two treatments. However, placebo was superior to nifedipine capsules (plasma concentration 58 nmol/l) both in the time to onset of chest pain and total exercise time. The lack of effect at the end of the dosage interval was probably due to the subtherapeutic plasma nifedipine level.

  • 662. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Edvardsson, N
    Emanuelsson, H
    Sjölin, M
    Hjalmarson, Å
    Eligibility for intravenous thrombolysis in suspected acute myocardinal infarction1990Ingår i: Circulation, ISSN 0569-6704, Vol. 82, nr 4, s. 1140-1146Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Based on the registration of all the 7,157 patients admitted during a 21-month period to the emergency ward of a single hospital in an urban area with chest pain or other symptoms suggestive of acute myocardial infarction, we studied eligibility for intravenous thrombolysis in suspected acute myocardial infarction. We have limited the present analysis to those 1,715 patients with a strong suspicion of myocardial infarction, and for these patients, we have calculated the percentages eligible for thrombolysis when various electrocardiographic and delay time criteria are applied, but we have not considered contraindications to thrombolysis. We have also calculated the proportions of all infarctions in this group that would thereby receive the treatment, and the proportions of patients treated that would develop a confirmed infarction. Using the criteria ST elevation on the initial electrocardiogram and arrival in hospital within 6 hours from onset of symptoms, 18% of patients would have been given early intravenous thrombolysis, 37% of confirmed infarctions would have been treated, and 91% of all treated patients would have developed a confirmed infarction; with a delay time criterion of 12 hours, these percentages would have been 209%, 41%, and 91%, respectively; with a criterion of 24 hours, they would have been 22%, 45%, and 90%, respectively. By not considering the initial electrocardiogram and applying only the criterion of delay time, these percentages would have been 70%, 72%, and 45%, respectively, for a delay time of 6 hours; 83%, 84%, and 45%, respectively, for a delay time of 12 hours; and 91%, 92%, and 44%, respectively, for a delay time of 24 hours. We have also calculated these percentages for two further electrocardiographic criteria, namely, electrocardiogram showing acute ischemia and any form of pathology. We conclude that the percentage of patients with a strong suspicion of myocardial infarction eligible for intravenous thrombolysis varies considerably depending on the electrocardiographic and delay time criteria used. If the delay time is limited to 6 hours and the electrocardiogram is required to show ST elevation, then 37% of patients developing myocardial infarction would receive thrombolytic treatment.

  • 663. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Edvardsson, N
    Olsson, SB
    Profylaktisk behandling mot recidiv efter elregulariseringen av kroniskt förmaksflimmer1989Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 86, nr 38, s. 3147-3153Artikel i tidskrift (Refereegranskat)
  • 664. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Edvardsson, N
    Olsson, SB
    Prophylactic treatment after electroconversion of atrial fibrillation1990Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 13, nr 4, s. 279-286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Atrial fibrillation is a common arrhythmia. Sinus rhythm can often be restored by electroconversion, but the relapse rate is high. Various antiarrhythmic drugs have been used to maintain sinus rhythm after electroconversion. This article reviews the experience with these drugs and suggests a treatment strategy.

  • 665. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Emanuelsson, H
    Edvardsson, N
    Wiklund, O
    Richter, A
    Hjalmarson, Å
    One-year mortality rate after disharge from hospital in relation to whether or not a confirmed myocardial infarction was developed1991Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 32, nr 3, s. 381-388Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Consecutive patients admitted to our hospital with suspected acute myocardial infarction during 21 months were prospectively evaluated. One-year mortality after discharge from hospital was related to whether or not an infarction developed (infarct versus non-infarct patients). Of patients discharged alive after developing an infarct, there was a mortality of 17% (n = 777) versus 12% (n = 1830) (P < 0.001) for all patients not developing infarction. In a high risk group (any of the following: age ≥ 75 years, previous history of myocardial infarction, diabetes mellitus or congestive heart failure) patients developing infarction had a mortality of 24% (n = 457) versus 17% (n = 1221) for those who did not (P < 0.001). In a low risk group (none of the high risk criteria), the corresponding mortality was 8% (n = 316) for patients suffering infarction and 3% (n = 603) for those not having infarction (P < 0.001). The difference in mortality between patients with and without infarction was most marked in women (21% vs 11%; P < 0.01) and in hypertensives (25% vs 12%; P < 0.001), but less marked in men (16% vs 13%; NS) and in patients without hypertension (13% vs 12%; NS). Among patients not suffering infarction, mortality was particularly high in those with previous congestive heart failure (23%) and diabetes mellitus (21%).

  • 666. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Emanuelsson, H
    Hjalmarson, Å
    Patienter med avskriven infarkt misstanke: hur är prognosen?1986Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 83, s. 4191-4193Artikel i tidskrift (Refereegranskat)
  • 667. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Emanuelsson, H
    Karlsson, T
    Hjalmarson, Å
    The prognosis of patients suspected of having acute myocardial infarction subsequent to its exclusion as the diagnosis1990Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 26, nr 3, s. 251-257Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This review of the literature concerns the prognosis of patients suspected of having myocardial infarction subsequent to its exclusion as the diagnosis. Several investigations show a surprisingly bad prognosis for patients in this category, almost comparable to that of patients with a confirmed infarction. When the results of the different studies are pooled, however, there is a significant difference between those patients with true infarction, and those in whom infarction was excluded, in terms of overall mortality (12% and 7%; P < 0.0001) and the development of subsequent non-fatal infarction (11% and 6%; P < 0.05) when the results are analysed for a period of follow-up of one year. The difference was significant even when both fatal and non-fatal infarctions were taken into account over the one-year period of follow-up (13% and 8%; P < 0.0001). The analysis shows that electrocardiographic ST-T changes are a risk factor for coronary events, but the results are conflicting for other possible risk factors. The selection of patients varies between the different studies, which probably contributes to the different results reported. Prospective studies with well defined groups of patients large enough to permit analysis of subgroupings will be needed to resolve the outstanding questions.

  • 668. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Liljeqvist, J-Å
    Pettersson, P
    Hallgren, P
    Strömbom, U
    Hjalmarson, Å
    Prognosis in suspected acute myocardial infarction in relation to delay time between onset of symptoms and arrival in hospital1991Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 78, nr 2, s. 131-137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    During a 21-month period, the prognosis in all patients admitted to a hospital ward from the emergency room with suspected acute myocardial infarction (AMI) was prospectively recorded and related to the time between onset of symptoms and arrival in hospital. They were classified as early arrivers (less than or equal to 2 h), intermediate arrivers (2-8 h) and late arrivers (greater than 8 h). Among patients developing a confirmed AMI (n = 909) the 1-year mortality rate was 26.0% in early arrivers, 28.1% in intermediate arrivers and 32.6% in late arrivers. The corresponding figures for patients in whom AMI was ruled out (n = 2,035) were 15.2, 15.1 and 17.6%, respectively. In AMI patients, various morbidity aspects during hospitalization and 1 year of follow-up appeared mainly independent of delay time, whereas among those in whom AMI was ruled out congestive heart failure during hospitalization was most common in early arrivers. We conclude that patients with suspected AMI who do not arrive early in hospital have a high 1-year mortality rate regardless of whether they develop AMI or not. Whether their prognosis can be improved by shortening of delay time remains to be clarified.

  • 669. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Pettersson, P
    Ekvall, H-E
    Hjalmarson, Å
    Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction1991Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 230, nr 3, s. 251-258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    All 7157 patients (55% men) admitted to the emergency room with chest pain or other symptoms indicative of acute myocardial infarction during a period of 21 months were registered consecutively. Chest pain was reported by 93% of the patients. On the basis of history, clinical examination, and electrocardiogram in the emergency room, all patients were prospectively classified in one of four categories: (i) obvious infarction (4% of all patients): (ii) strongly suspected infarction (20%): (iii) vague suspicion of infarction (35%); and (iv) no suspected infarction (41%). In patients with no suspected infarction (n = 2910), musculoskeletal (26%), obscure (21%) and psychogenic origins (16%) of the symptoms occurred most frequently. We conclude that few of the patients had an obvious infarction on admission, and that a musculoskeletal origin of the symptoms occurred most frequently in patients with no suspected infarction.

  • 670. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Richter, A
    Hjalmarson, Å
    Prognosis in acute myocardial infarction in relation to development of Q-waves1991Ingår i: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 14, nr 11, s. 875-880Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In a totally nonselected group of patients with acute myocardial infarction (AMI) (n = 921) admitted from the emergency department to the coronary care unit or other hospital ward, the occurrence of non-Q-wave AMI and the prognosis in these patients was determined and compared with those in whom Q waves were developed. Fifty-two percent had AMI without new Q waves. Patients with a non-Q-wave AMI differed from patients with Q-wave AMI, more frequently having a previous history of AMI (p less than 0.001), angina pectoris (p less than 0.01), diabetes mellitus (p less than 0.05), congestive heart failure (p less than 0.001), and a higher mean age (p less than 0.001), whereas smoking was more common in Q-wave AMI. Patients with non-Q-wave AMI had a 1-year mortality of 31% compared with 26% in Q-wave AMI (p greater than 0.2) and a reinfarction rate of 20% compared with 12% for Q-wave AMI (p less than 0.01). Among patients aged less than 75 years without a previous history of AMI, congestive heart failure, and diabetes mellitus, the 1-year mortality rate was 16% for patients with Q waves versus 15% for those without Q waves (NS). Appearance of Q waves was not independently associated with death. We conclude that in a nonselected group of patients with AMI the occurrence of a non-Q-wave AMI is much higher than previously reported. The prognosis in AMI during one year of follow-up is not associated with development of Q waves.

  • 671. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Richter, Johan
    Sjölin, M
    Hjalmarson, Å
    Prognosis in patients with ST-T wave chamges but no rise in serum enzyme activity as compared with non Q-wave infarction1991Ingår i: Cardiology, ISSN 0008-6312, E-ISSN 1421-9751, Vol. 79, nr 4, s. 271-279Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We evaluated the prognosis for 419 patients admitted to hospital due to suspected acute myocardial infarction (AMI) who developed ST-T changes, but no rise in serum enzyme activity, and compared it to that of 508 patients developing non-Q-wave AMIs. We conclude that these patients have a high 1-year mortality (13%), although significantly lower than in patients with non-Q-wave AMIs (31%). The mortality is higher in patients with only ST depression (n = 86; 22%) than in patients with only T-wave inversion (n = 264; 8%).

  • 672. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Sjölin, M
    Ekvall, H-E
    Persson, NG
    Lindqvist, J
    Hjalmarson, Å
    Clinical factors associated with delay time in suspected acute myocardial infarction1990Ingår i: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 120, nr 5, s. 1213-1215Artikel i tidskrift (Refereegranskat)
  • 673. Karlsson, BW
    et al.
    Herlitz, Johan
    [external].
    Wiklund, O
    Richter, A
    Hjalmarson, Å
    Early prediction of acute myocardial infarction from clinical history, examination and electrocardiogram in the emergency room1991Ingår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 68, nr 2, s. 171-175Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The possibility of early prediction of acute myocardial infarction (AMI) was assessed in 7,157 consecutive patients coming to our emergency room during a 21-month period with chest pain or other symptoms suggestive of AMI. Of these patients 921 developed an AMI during the first 3 days in the hospital. Of the 4,690 patients admitted to hospital, 1,576 (34%) had a normal admission electrocardiogram, and 90 of these (6%) developed AMI. Of 1,964 patients with an abnormal electrocardiogram without signs of acute ischemia (42% of those admitted), 268 (14%) developed AMI, and 563 (51%) of 1,109 patients with acute ischemia on the electrocardiogram (24%) developed AMI. All patients were prospectively classified in the emergency room on the basis of history, clinical examination and electrocardiogram into 1 of 4 categories, according to the initial degree of suspicion of AMI. Of 279 admitted patients judged to have an obvious AMI (6% of the 4,690), 245 (88%) actually developed AMI; of 1,426 with a strong suspicion of AMI (30%), 478 (34%) developed one; of 2,519 with a vague suspicion of AMI (54%), 192 (8%) developed one; and of 466 with no suspicion of AMI (10%), 6 (1%) developed one. Thus, only a low percentage of the patients with a normal initial electrocardiogram or a vague initial suspicion of AMI developed a confirmed AMI.

  • 674.
    Kauppi, Wivica
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jiménez-Herrera, Maria F.
    Nursing Department, Universitat Rovira i Virgili (URV), Tarragona, Spain.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patients' lived experiences of breathlessness prior to prehospital care – A phenomenological study2022Ingår i: Nursing Open, E-ISSN 2054-1058, Vol. 9, nr 4, s. 2179-2189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Abstract Aims and objectives The study aimed to describe how breathlessness is experienced by patients prior to prehospital care. Design A qualitative phenomenological design. Methods Lifeworld interviews were conducted with 14 participants. The analysis was carried out within the descriptive phenomenological framework. Results The essential meaning of the breathlessness phenomenon is described as an existential fear in terms of losing control over one?s body and dying, which involves a battle to try to regain control. This is further described by four constituents: being in an unknown body, striving to handle the situation, the ambiguity of having loved ones close and reaching the utmost border. Conclusions Patients describe a battling for survival. It is at the extreme limit of endurance that patients finally choose to call the emergency number. It is a challenge for the ambulance clinician (AC) to support these patients in the most optimal fashion.

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  • 675.
    Kauppi, Wivica
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Emergency Medical Service (EMS), Sahlgrenska University Hospital, Gothenburg, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jiménez‐Herrera, Maria
    Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden; Nursing Department, Universitat Rovira i Virgili (URV), Tarragona, Spain.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Lived experiences of being cared for by ambulance clinicians when experiencing breathlessness—A phenomenological study2023Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Breathlessness is a serious and distressing symptom and a common reason why patients require prehospital care by ambulance clinicians. However, little is known about how patients experience this care when they are in a state of breathlessness.

     

    Aim

    The aim of this study is to describe the lived experiences of being cared for by ambulance clinicians when experiencing breathlessness.

     

    Methods

    Fourteen lifeworld interviews were conducted with patients who experienced breathlessness and were cared for by ambulance clinicians. The interviews were analysed using a qualitative phenomenological approach.

     

    Findings

    The essential meaning of being cared for by ambulance clinicians when experiencing breathlessness is described in two ways: existential humanising care, in which the experience is that of being embraced by a genuine presence or existential dehumanising care, in which feeling exposed to an objectifying presence is the main experience. This meaning has four constituents: surrendering to and trusting in the care that will come; being exposed to an objectifying presence is violating; being embraced by a genuine presence is relieving; and knowing is dwelling.

     

    Conclusion

    The findings reveal that the ability of ambulance clinicians to provide existential humanising and trustful care, which is the foundation of professional judgement, was essential in how patients responded to and handled the overall situation when breathlessness.

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  • 676.
    Kauppi, Wivica
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Karlsson, Thomas
    Biostatistics, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Magnusson, Carl
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by prehospital emergency nurses- a retrospective observational study2020Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, nr 89, s. 1-12Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet thesepatients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death.

    Methods: A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the southwestern part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for uniquepatients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed usingmultiple logistic regression and multiple imputations.

    Results: Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic bloodpressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death.

    Conclusions: Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death.

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    Pre-hospital predictors of an adverse outcome
  • 677.
    Kauppi, Wivica
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Palmér, Lina
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study2020Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 20, nr 1, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN).

    Methods: This retrospective observational study included patients aged >16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the south-western part of Sweden by PENs during January and December, 2017. Of 7,260 assignments (9% of all primary missions), 6,354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis.

    Results: The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 hours after symptom onset.

    Conclusions:  Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.

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  • 678.
    Kiguchi, Tekeyuki
    et al.
    Kyoto University Health Service, Kyoto, Japan..
    Okubo, Masashi
    Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA..
    Nishiyama, Chika
    Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan..
    Maconochie, Ian
    Department of Emergency Medicine, Division of Medicine, Imperial College London, London, UK..
    Ong, Marcus Eng Hock
    Health Services & Systems Research, Duke-NUS Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore..
    Kern, Karl B
    Division of Cardiology, University of Arizona, Sarver Heart Center, Tucson, AZ, USA..
    Wyckoff, Myra H
    Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA..
    McNally, Bryan
    Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA..
    Christensen, Erika F
    Center for Prehospital and Emergency Research, Aalborg University and Aalborg University Hospital, Aalborg, Denmark..
    Tjelmeland, Ingvild
    Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Division of Prehospital Services, Oslo University Hospital, Oslo, Norway..
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. University of Borås, Sahlgrenska University Hospital, Göteborg, Sweden..
    Perkins, Gavin D
    Warwick Medical School and University Hospitals Birmingham NHS Foundation Trust, UK..
    Booth, Scott
    Warwick Medical School, University of Warwick, Coventry, UK..
    Finn, Judith
    School of Nursing, Midwifery and Paramedicine, Curtin University, WA, Australia; University of Western Australia, WA, Australia; Department of Epidemiology and Preventive Medicine, Monash University, VIC, Australia..
    Shahidah, Nur
    Department of Emergency Medicine, Singapore General Hospital, Singapore..
    Shin, Sang Do
    Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea..
    Bobrow, Bentley J
    Department of EMS, McGovern Medical School at UT Health, Houston, TX, USA..
    Morrison, Laurie J
    Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada..
    Salo, Ari
    Emergency Medical Services, Department of Emergency Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland..
    Baldi, Enrico
    Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy..
    Burkart, Roman
    Fondazione Ticino Cuore, Lugano, Switzerland..
    Lin, Chih-Hao
    Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan..
    Jouven, Xavier
    Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France..
    Soar, Jasmeet
    Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, UK..
    Nolan, Jerry P
    Warwick Medical School, University of Warwick, Coventry and Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK..
    Iwami, Taku
    Kyoto University Health Service, Kyoto, Japan..
    Out-of-hospital cardiac arrest across the World: First report from the International Liaison Committee on Resuscitation (ILCOR).2020Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 152, s. 39-49, artikel-id S0300-9572(20)30129-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Since development of the Utstein style recommendations for the uniform reporting of cardiac arrest, increasing numbers of national and regional out-of-hospital cardiac arrest (OHCA) registries have been established worldwide. The International Liaison Committee on Resuscitation (ILCOR) created the Research and Registries Working Group and aimed to systematically report data collected from these registries.

    METHODS: We conducted two surveys of voluntarily participating national and regional registries. The first survey aimed to identify which core elements of the current Utstein style for OHCA were collected by each registry. The second survey collected descriptive summary data from each registry. We chose the data collected for the second survey based on the availability of core elements identified by the first survey.

    RESULTS: Seven national and four regional registries were included in the first survey and nine national and seven regional registries in the second survey. The estimated annual incidence of emergency medical services (EMS)-treated OHCA was 30.0-97.1 individuals per 100,000 population. The combined data showed the median age varied from 64 to 79 years and more than half were male in all 16 registries. The provision of bystander cardiopulmonary resuscitation (CPR) and bystander automated external defibrillator (AED) use was 19.1-79.0% in all registries and 2.0-37.4% among 11 registries, respectively. Survival to hospital discharge or 30-day survival after EMS-treated OHCA was 3.1-20.4% across all registries. Favorable neurological outcome at hospital discharge or 30 days after EMS-treated OHCA was 2.8-18.2%. Survival to hospital discharge or 30-day survival after bystander-witnessed shockable OHCA ranged from 11.7% to 47.4% and favorable neurological outcome from 9.9% to 33.3%.

    CONCLUSION: This report from ILCOR describes data on systems of care and outcomes following OHCA from nine national and seven regional registries across the world. We found variation in reported survival outcomes and other core elements of the current Utstein style recommendations for OHCA across nations and regions.

  • 679. Källerstedt, ML
    et al.
    Berglund, A
    Thoren, AB
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enlund, M
    Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital health care professionals2011Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, nr 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR.

  • 680. Källestedt, ML
    et al.
    Berglund, A
    Enlund, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    In-hospital cardiac arrest characteristics and outcome after defibrillator implementation and education: from 1 single hospital in Sweden.2012Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 30, nr 9, s. 1712-1718Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Survival after in-hospital cardiac arrest (CA) has been reported to be surprisingly low without any major improvement during the last decade. AIMS: The aim of this study is to evaluate the clinical impact (delay to defibrillation and survival after CA) of an intervention within 1 single hospital (Västerås, Sweden), including (1) a systematic education of all health care professionals in cardiopulmonary resuscitation and (2) the implementation of 18 automated external defibrillators. METHODS: Information was retrieved from the Swedish National Register of Cardiopulmonary Resuscitation. The differences between the 2 calendar periods were evaluated by χ(2) and Fisher exact tests. Logistic regression was used to control for potential confounders. RESULTS: In total, there were 73 in-hospital CAs before (12 months) and 133 after (18 months) the intervention. The overall delay to defibrillation was not reduced after the intervention, and the proportion of survivors to hospital discharge was 26% before and 32% after the intervention (P =.51). Cerebral function, however, was improved after the intervention (as judged by the cerebral performance categories score; P < .001). Thus, the proportion of survivors among all CA patients discharged with a cerebral performance scale score of 1 or 2 (good or acceptable cerebral function) increased from 20% to 32%. CONCLUSION: An intervention within 1 single hospital (systematic training of all health care professionals in cardiopulmonary resuscitation and implementation of automated external defibrillators) did not reduce treatment delay or increase overall survival. Our results, however, suggest indirect signs of an improved cerebral function among survivors.

  • 681. Källestedt, ML
    et al.
    Berglund, A
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Leppert, J
    Enlund, M
    The impact of CPR and AED training on healthcare professionals' self-perceived attitudes to performing resuscitation.2012Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 20, nr 26Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Healthcare professionals have shown concern about performing mouth-to-mouth ventilation due to the risks to themselves with the procedure. However, little is known about healthcare professionals' fears and attitudes to start CPR and the impact of training. Objective To examine whether there were any changes in the attitudes among healthcare professionals to performing CPR from before to after training. Methods Healthcare professionals from two Swedish hospitals were asked to answer a questionnaire before and after training. The questions were relating to physical and mental discomfort and attitudes to CPR. Statistical analysis used was generalized McNemar's test. Results Overall, there was significant improvement in 10 of 11 items, reflecting various aspects of attitudes to CPR. All groups of health care professionals (physicians, nurses, assistant nurses, and "others" = physiotherapists, occupational therapists, social welfare officers, psychologists, biomedical analysts) felt more secure in CPR knowledge after education. In other aspects, such as anxiety prior to a possible cardiac arrest, only nurses and assistant nurses improved. The concern about being infected, when performing mouth to mouth ventilation, was reduced with the most marked reduction in physicians (75%; P < 0.001). Conclusion In this hospital-based setting, we found a positive outcome of education and training in CPR concerning healthcare professionals' attitudes to perform CPR. They felt more secure in their knowledge of cardiopulmonary resuscitation. In some aspects of attitudes to resuscitation nurses and assistant nurses appeared to be the groups that were most markedly influenced. The concern of being infected by a disease was low.

  • 682. Källestedt, ML
    et al.
    Berglund, A
    Thorén, AB
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    Enlund, M
    Occupational affiliation does not influence practical skills in cardiopulmonary resuscitation for in-hospital healthcare professionals2011Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 19, nr 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background D-CPR (Defibrillator Cardiopulmonary Resuscitation) is a technique for optimal basic life support during cardiopulmonary resuscitation (CPR). Guidelines recommend that healthcare professionals can perform CPR with competence. How CPR training and provision is organized varies between hospitals, and it is our impression that in Sweden this has generally improved during the last 15-20 years. However, some hospitals still do not have any AED (Automated External Defibrillators). The aim was to investigate potential differences in practical skills between different healthcare professions before and after training in D-CPR. Methods Seventy-four healthcare professionals were video recorded and evaluated for adherence to a modified Cardiff Score. A Laerdal Resusci Anne manikin in connection to PC Skill reporting System was used to evaluate CPR quality. A simulated CPR situation was accomplished during a 5-10 min scenario of ventricular fibrillation. Paired and unpaired statistical methods were used to examine differences within and between occupations with respect to the intervention. Results There were no differences in skills among the different healthcare professions, except for compressions per minute. In total, the number of compression per minute and depth improved for all groups (P < 0.001). In total, 41% of the participants used AED before and 96% of the participants used AED after the intervention (P < 0.001). Before intervention, it took a median time of 120 seconds until the AED was used; after the intervention, it took 82 seconds. Conclusion Nearly all healthcare professionals learned to use the AED. There were no differences in CPR skill performances among the different healthcare professionals.

  • 683. Källestedt, ML
    et al.
    Leppert, J
    Enlund, M
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Development of a reliable questionnaire in resuscitation knowledge2008Ingår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 26, nr 6, s. 723-728Artikel i tidskrift (Refereegranskat)
  • 684. Källestedt, M-L
    et al.
    Rosenblad, A
    Leppert, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Enlund, M
    Hospital employees’ theoretical knowledge on what to do in an in-hospital cardiac arrest2010Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 18, nr 43, s. 43-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

  • 685.
    Langenskiöld, M
    et al.
    The Sahlgrenska Academy, Gothenburg University.
    Smidfelt, K
    The Sahlgrenska Academy, Gothenburg University.
    Karlsson, A
    The Sahlgrenska Academy, Gothenburg University.
    Bohm, C
    The Sahlgrenska Academy, Gothenburg University.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nordanstig, J
    The Sahlgrenska Academy, Gothenburg University.
    Weak Links in the Early Chain of Care of Acute Lower Limb Ischaemia in Terms of Recognition and Emergency Management.2017Ingår i: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, nr 2, s. 235-240, artikel-id S1078-5884(17)30268-XArtikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Acute lower limb ischaemia (ALLI) is a potentially fatal, limb threatening medical emergency. Early treatment is essential for a good outcome. The aim was to describe the early chain of care in ALLI focusing on lead times and emergency management in order to identify weak links for improvement.

    METHODS: This was a retrospective, descriptive case study. This study analysed the medical records of all patients with a main discharge diagnosis of ALLI between January 2009 and December 2014. Predetermined emergency care data on lead times, diagnosis recognition, presenting symptoms, emergency care treatment and outcome were collected for patients who were transported by the Emergency Medical Service (EMS) and those who were not.

    RESULTS: In total, 552 medical records were audited of which 195 patients fulfilled the inclusion criteria and were analysed. Among them were 117 (60%) transported by the EMS. The median time from symptom onset to revascularisation was 23 (interquartile range [IQR] 10-55; EMS transported) and 93 (IQR 42-152, not EMS transported) hours (p < .01). The time from symptom onset to arrival in hospital was 5 (IQR 2-26; EMS transported) and 48 (IQR 6-108; not EMS transported) hours. After arrival in hospital, the median time to first doctor evaluation was 51 (IQR 28-90; EMS transported) and 80 (IQR 44-169; not EMS transported) minutes, p = .01. Low molecular weight heparin (LMWH) was given to 72% of patients in the emergency department (ED) and a multivariate analysis showed that the use of LMWH was associated with a more favourable outcome.

    CONCLUSIONS: Both the time spent in the ED and the time from the onset of symptoms to revascularisation were considerably longer than optimal. Time delays in the early treatment chain can mainly be attributed to "patient delay" and a considerable time spent in hospital before revascularisation. The use of LMWH as an integral part of ED management was associated with a better outcome.

  • 686. Langhelle, A
    et al.
    Nolan, J
    Herlitz, Johan
    [external].
    Castren, M
    Wenzel, V
    Soreide, E
    Engdahl, J
    Steen, PA
    Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 3, s. 271-283Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this report is to establish recommendations for reviewing, reporting, and conducting research during the post-resuscitation period in hospital. It defines data that are needed for research and more specialised registries and therefore supplements the recently updated Utstein template for resuscitation registries. The updated Utstein template and the out-of-hospital "Chain of Survival" describe factors of importance for successful resuscitation up until return of spontaneous circulation (ROSC). Several factors in the in-hospital phase after ROSC are also likely to affect the ultimate outcome of the patient. Large differences in survival to hospital discharge for patients admitted alive are reported between hospitals. Therapeutic hypothermia has been demonstrated to improve the outcome, and other factors such as blood glucose, haemodynamics, ventilatory support, etc., might also influence the result. No generally accepted, scientifically based protocol exists for the post-resuscitation period in hospital, other than general brain-oriented intensive care. There is little published information on this in-hospital phase. This statement is the result of a scientific consensus development process started as a symposium by a task force at the Utstein Abbey, Norway, in September 2003. Suggested data are defined as core and supplementary and include the following categories: pre-arrest co-morbidity and functional status, cause of death, patients' quality of life, in-hospital system factors, investigations and treatment, and physiological data at various time points during the first three days after admission. It is hoped that the publication of these recommendations will encourage research into the in-hospital post-resuscitation phase, which we propose should be included in the chain-of-survival as a fifth ring. Following these recommendations should enable better understanding of the impact of different in-hospital treatment strategies on outcome.

  • 687.
    Larsson, Glenn
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden; PICTA, Prehospital Innovation Arena, Lindholmen Science Park, Gothenburg, Sweden.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. PreHospen.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Klementsson, Håkan
    Register Centre South, Karlskrona, Sweden.
    Troëng, Thomas
    Register Centre South, Karlskrona, Sweden.
    Magnusson, Carl
    Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Epidemiology of patients assessed for trauma by Swedish ambulance services: a retrospective registry study2024Ingår i: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 24, nr 1, artikel-id 11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    There is a lack of knowledge regarding the epidemiology of severe trauma assessed by Swedish emergency medical services (EMS).

    Aim

    To investigate the prevalence of trauma in Sweden assessed by EMS from a national perspective and describe patient demography, aetiology, trauma type, prehospital triage and clinical outcomes.

    Methods

    Data from two national quality registries, the Swedish Ambulance Registry and the Swedish Trauma Registry (SweTrau) were collected from January 1 to December 31, 2019. Inclusion criteria were an Emergency Symptoms and Signs code equivalent to trauma in the Swedish Ambulance Registry and criteria fulfilled for SweTrau inclusion. Exclusion criteria were patients < 18 years old, those not transported to a hospital and those without a personal identification number.

    Results

    In total, 53,120 patients with trauma were included (14% of primary EMS missions involving a personal identification number). Of those, 2,278 (4.3%) patients (median age: 45 years; 32% women) were reported in SweTrau to have severe or potentially severe trauma (penetrating: 7%, blunt: 93%). In terms of including all causes of trauma, the code for ‘trauma alert activation’ was most frequent (55%). The most frequent injury mechanism was an injury caused by a car (34%). Most (89%) cases were assigned Priority 1 (life-threatening condition) at the dispatch centre. 62% were regarded as potentially life threatening upon EMS arrival, whereas 29% were assessed as non-life-threatening. Overall, 25% of the patients had new injury severity scores > 15. 12% required invasive treatment, 11% were discharged with severe disability and the 30-day mortality rate was 3.6%.

    Conclusion

    In this cross-sectional study, 14% of the primary EMS missions for one year were caused by trauma. However, only a small proportion of these cases are severe injuries, and the risk of severe disabilities and death appears to be limited. The most frequent aetiology of a severe trauma is injury caused by a car, and most severe traumas are blunt. Severe traumas are given the highest priority at the dispatch centre in the vast majority of cases, but nearly one-third of these cases are considered a low priority by the EMS nurse. The latter leaves room for improvement.

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  • 688.
    Larsson, Glenn
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Magnusson, Carl
    Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study2023Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 31, nr 1, artikel-id 33Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Globally, injuries are a major health problem, and in Sweden, injuries are the second most common reason for ambulance dispatch. However, there is a knowledge gap regarding the epidemiology of injuries requiring assessment by emergency medical services (EMS) in Sweden. The aim of the present study was to describe the prehospital population with injuries that have been assessed and treated by EMS.

    Methods

    A randomly selected retrospective sample was collected from 1 January through 31 December 2019 in a region in southwestern Sweden. Data were collected from ambulance and hospital medical records.

    Results

    Among 153,724 primary assignments, 26,697 (17.4%) were caused by injuries. The study cohort consisted of 5,235 patients, of whom 50.5% were men, and the median age was 63 years. The most common cause of injury was low-energy fall (51.4%), and this was the cause in 77.8% of those aged > 63 years and in 26.7% of those aged ≤ 63 years. The injury mechanism was a motor vehicle in 8.0%, a motorcycle in 2.1% and a bicycle in 4.0%. The most common trauma location was the residential area (55.5% overall; 77.9% in the elderly and 34.0% in the younger group). In the prehospital setting, the most frequent clinical sign was a wound (33.2%), a closed fracture were seen in 18.9% and an open fracture in 1.0%. Pain was reported in 74.9% and 42.9% reported severe pain. Medication was given to 42.4% of patients before arrival in the hospital. The most frequent triage colour according to the RETTS was orange (46.7%), whereas only 4.4% were triaged red. Among all patients, 83.6% were transported to the hospital, and 27.8% received fracture treatment after hospital admission. The overall 30-day mortality rate was 3.4%.

    Conclusion

    Among EMS assignments in southwestern Sweden, 17% were caused by injury equally distributed between women and men. More than half of these cases were caused by low-energy falls, and the most common trauma location was a residential area. The majority of the victims had pain upon arrival of the EMS, and a large proportion appeared to have severe pain.

     

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  • 689.
    Larsson, Glenn
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Hansson, Peter
    NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden.
    Olsson, Emelie
    NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study2022Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 22, nr 1, artikel-id 92Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of ‘optimal level of care‘, some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective.

    Aim

    This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians.

    Methods

    This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study.

    Results

    Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy.

    Conclusion

    Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.

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  • 690. Larsson, M
    et al.
    Thorén, A-B
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap. [external].
    A history of diabetes is associated with an adverse outcome among patients admitted to hospital alive after an out-of-hospital cardiac arrest.2005Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 66, nr 3, s. 303-307Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Factors of importance for the outcome among patients who are admitted to hospital alive after an out-of-hospital cardiac arrest are not well described in the literature. The importance of a history of diabetes for the outcome among these patients has not been reported in detail previously. This survey aims to describe the outcome among patients who were admitted to hospital after an out-of-hospital cardiac arrest in relation to whether they had a history of diabetes. METHODS: All patients who were admitted to hospital alive after an out-of-hospital cardiac arrest in the two city hospitals in the Municipality of Göteborg between 1980 and 2002 were included in the survey. RESULTS: In all, 1377 patients fulfilled the inclusion criteria and 187 (14%) of them had a history of diabetes. Patients with diabetes differed from those without diabetes by having a previous history of myocardial infarction, angina pectoris, hypertension and heart failure more frequently. Furthermore, they were older, with a mean age of 70 years versus 66 years for patients without diabetes. Among patients with diabetes, 25% were discharged alive, as compared with 37% of patients without diabetes (p=0.002). When adjusting for differences at baseline, the adjusted odds ratio for diabetic patients being discharged alive (versus no diabetes) was 0.57 (95% confidence interval, 0.39-0.80). CONCLUSION: Among patients admitted to hospital after an out-of-hospital cardiac arrest, 14% had a history of diabetes. These patients had a lower survival rate compared with those without diabetes, even after correcting for dissimilarities at baseline. It remains to be determined whether an early metabolic intervention in these patients will improve survival.

  • 691. Libungan, B
    et al.
    Karlsson, T
    Hirleikar, G
    Albertsson, P
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Ravn-Fischer, A
    Delay and inequality in Treatment of the very elderly with Suspected Acute Coronary Syndrome2014Konferensbidrag (Refereegranskat)
  • 692. Libungan, B
    et al.
    Stensdotter, L
    Hjalmarson, A
    From Attebring, M
    Lindqvist, J
    Herlitz, Johan
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bäck, M
    Secondary prevention in coronary artery disease. Achieved goals and possibilities for improvements2012Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 161, nr 1, s. 18-24Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim To describe presence of risk indicators of recurrence 6 months after hospitalisation due to coronary artery disease at a university clinic. Methods The presence of risk indicators, including tobacco use, lipid levels, blood pressure and glucometabolic status, including 24-hour blood pressure monitoring and an oral glucose-tolerance test, was analysed. Results Of 1465 patients who were screened, 402 took part in the survey (50% previous myocardial infarction and 50% angina pectoris). Mean age was 64 years (range 40–85 years) and 23% were women. Present medications were: lipid lowering drugs (statins; 94%), beta-blockers (85%), aspirin or warfarin (100%) and ACE-inhibitors or angiotensin II blockers (66%). Values above target levels recommended in guidelines were: a) low density lipoprotein (LDL) in 40%; b) mean blood pressure (day or night) in 38% and c) smoking in 13%. Of all patients, 66% had at least one risk factor (LDL or blood pressure above target levels or current smoking). An abnormal glucose-tolerance test was found in 59% of patients without known diabetes. If no history of diabetes, 85% had either LDL or blood pressure above target levels, current smoking or an abnormal glucose-tolerance test. However, with treatment intensification to patients with elevated risk factors 56% reached target levels for blood pressure and 79% reached target levels for LDL. Conclusion Six months after hospitalisation due to coronary artery disease, despite the high use of medication aimed at prophylaxis against recurrence, the majority were either above target levels for LDL or blood pressure or continued to smoke.

  • 693.
    Libungan, Berglind
    et al.
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    Sahlgrenska Academy at University of Gothenburg.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy.2015Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 10Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.

    HYPOTHESIS: There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.

    METHODS: A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).

    RESULTS: Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.

    CONCLUSION: Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.

  • 694. Libungan, Berglind
    et al.
    Karlsson, Thomas
    Albertsson, Per
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Elderly patients with myocardial infarction selected for conservative or invasive treatment strategy.2015Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 10, s. 321-327Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There are limited data on patients aged >75 years with myocardial infarction (MI), especially those who are treated conservatively.

    HYPOTHESIS: There are important differences in the clinical characteristics and outcome between elderly MI patients selected for invasive or conservative treatment strategy.

    METHODS: A total of 1,413 elderly patients (>75 years old) admitted to Sahlgrenska University Hospital, Gothenburg, Sweden with a final diagnosis of acute MI in 2001 or 2007, were divided into two groups, those who underwent a conservative treatment strategy (conservative group [CG], n=1,169) and those who underwent coronary angiography and were revascularized if indicated (invasive group [IG], n=244).

    RESULTS: Other than higher age in the CG, there were no significant differences in traditional risk factors such as hypertension, diabetes, and smoking in the two groups. A higher proportion of patients in the CG had a history of heart failure and cerebrovascular disease. The hazard ratio (with 95% confidence interval), adjusted for potential confounders, for 5 year mortality in the IG in relation to the CG was 0.49 (0.39, 0.62), P<0.0001. Overall, in the elderly with MI, the proportion who underwent an invasive treatment strategy doubled from 12% in 2001 to 24% in 2007, despite a slightly higher mean age.

    CONCLUSION: Elderly patients with MI in the CG (no coronary angiography), were generally older and a higher proportion had chronic diseases such as congestive heart failure and cerebrovascular disease than those in the IG. Our data suggest that the invasive treatment strategy is associated with better outcome. However, randomized trials will be needed to determine whether revascularization procedures are beneficial in elderly patients with MI, in terms of less symptoms, better outcome, and improved quality of life.

  • 695.
    Libungan, Berglind
    et al.
    Sahlgrenska University Hospital.
    Lindqvist, Jonny
    Sahlgrenska University Hospital.
    Strömsöe, Anneli
    University of Dalarna.
    Nordberg, Per
    Karolinska Institutet.
    Hollenberg, Jacob
    Karolinska Institutet.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Karlsson, Thomas
    Sahlgrenska Academy at University of Gothenburg.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study.2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA).

    AIM: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    METHODS: OHCA patients ≥ 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and ≥ 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    RESULTS: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    CONCLUSIONS: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age.

  • 696. Libungan, Berglind
    et al.
    Lindqvist, Jonny
    Strömsöe, Anneli
    Nordberg, Per
    Hollenberg, Jacob
    Albertsson, Per
    Karlsson, Thomas
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Out-of-hospital cardiac arrest in the elderly: A large-scale population-based study.2015Ingår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, nr September 2015, s. 28-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA).

    AIM: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    METHODS: OHCA patients ≥ 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and ≥ 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    RESULTS: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    CONCLUSIONS: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age.

  • 697.
    Lindahl, B
    et al.
    From the, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Ljung, L.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Alfredsson, J.
    Department of Cardiology, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Sciences, Linköping University Linköping, Linköping, Sweden.
    Erlinge, D.
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Kellerth, T.
    Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Omerovic, E.
    Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ravn-Fischer, A.
    Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sparv, D.
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Yndigegn, T.
    Department of Clinical Sciences, Cardiology, Lund University, Lund, Sweden.
    Svensson, P.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Östlund, O.
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Jernberg, T.
    Department of Clinical Sciences, Cardiology, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    James, S. K.
    From the, Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
    Hofmann, R.
    Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
    Investigators, for the DETO2X-SWEDEHEART
    Poor long-term prognosis in patients admitted with strong suspicion of acute myocardial infarction but discharged with another diagnosis2021Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Characteristics and prognosis of patients admitted with strong suspicion of myocardial infarction (MI) but discharged without an MI diagnosis are not well-described. Objectives: To compare background characteristics and cardiovascular outcomes in patients discharged with or without MI diagnosis. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial compared 6629 patients with strong suspicion of MI randomized to oxygen or ambient air. The main composite end-point of this subgroup analysis was the incidence of all-cause death, rehospitalization with MI, heart failure (HF) or stroke during a follow-up of 2.1 years (median; range: 1–3.7 years) irrespective of randomized treatment. Results: 1619 (24%) received a non-MI discharge diagnosis, and 5010 patients (76%) were diagnosed with MI. Groups were similar in age, but non-MI patients were more commonly female and had more comorbidities. At thirty days, the incidence of the composite end-point was 2.8% (45 of 1619) in non-MI patients, compared to 5.0% (250 of 5010) in MI patients with lower incidences in all individual end-points. However, for the long-term follow-up, the incidence of the composite end-point increased in the non-MI patients to 17.7% (286 of 1619) as compared to 16.0% (804 of 5010) in MI patients, mainly driven by a higher incidence of all-cause death, stroke and HF. Conclusions: Patients admitted with a strong suspicion of MI but discharged with another diagnosis had more favourable outcomes in the short-term perspective, but from one year onwards, cardiovascular outcomes and death deteriorated to a worse long-term prognosis. © 2021 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine

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  • 698. Lindvall, B
    et al.
    Brorsson, B
    Herlitz, Johan
    [external].
    Albertsson, P
    Werkö, L
    Comparison of diabetic and non diabetic patients referred for coronary angiography1999Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 70, nr 1, s. 33-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To evaluate whether diabetic patients differ from non-diabetic patients when referred for coronary angiography regarding previous history, indication for and findings at coronary angiography, use of medication, exercise test results and mortality. METHODS: Data were prospectively collected on patients referred for consideration of coronary revascularization to seven of the eight public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994. RESULTS: 2762 patients were included of whom 406 (15%) had a history of diabetes mellitus. There was no difference in age or sex in the two groups. Chronic stable angina was the most common indication (73% in both groups) and only 3% were admitted due to silent ischemia. Diabetic patients had more severe symptoms (Canadian Cardiovascular Society III-IV) than non-diabetic patients (66% vs. 58%, p<0.01). They more frequently used ACE-inhibitors (33% vs. 19%, p<0.0001) and calcium channel blockers (47% vs. 40%, p<0.01) and more often had a diagnosis of arterial hypertension than non-diabetic patients (50% vs. 33%, p<0.0001). Diabetic patients more often had depressed myocardial function (EF<35%); 12% and 8%, respectively (p<0.01), and more extensive coronary artery disease (left main/3-VD; 48% vs. 37%, p<0.001). The mortality during the subsequent 21 months was 7.9% among diabetic patients and 3.6% among non-diabetic patients (p<0.001). CONCLUSION: Among patients being referred for coronary angiography in Sweden, 15% were patients with a history of diabetes. They differed from patients without such a history by more often having severe symptoms and a higher prevalence of left main/triple vessel disease. Coronary angiography may thus be underused in diabetic patients with chest pain.

  • 699. Lindén, T
    et al.
    Taddei-Peters, W
    Wilhelmsen, L
    Herlitz, Johan
    [external].
    Karlsson, T
    Ullström, C
    Wiklund, O
    Serum lipids, lipoprotein(a) an apo(a) isoforms in patients with established coronary artery disease and their relation to disease and prognosis after coronary by-pass surgery1998Ingår i: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 137, nr 1, s. 175-186Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Consecutive patients (n=964) undergoing coronary angiography were studied and compared with a random population sample regarding serum lipids and lipoproteins with focus on lipoprotein(a) (Lp(a)) levels and apo(a) isoforms. The patients were also followed for 5 years after the angiography, and the progostic value of serum lipoproteins were analyzed. The patients were divided in two groups: Group 1 (n=814) consisted of patients with angina pectoris and at least one coronary artery with 50% stenosis and group 2 (n=150) patients with none of the coronary arteries significantly obstructed (<50%). As controls a random population sample was selected (n=197). Blood samples were collected before coronary angiography for determination of serum lipids, Lp(a) and isoforms of apo(a). When group 1 and group 2 patients were compared, group 1 was found to have higher serum cholesterol, triglycerides, apoB and Lp(a) as well as lower HDL and apoAI. When group 1 was compared with the random sample, after correction for age and sex, similar differences were observed, except that the difference in Lp(a) was not significant. The high Lp(a) levels among patients was found to be primarily due to the female patients, where the difference compared to both group 2 and controls was highly significant (P=0.007 and P=0.001, respectively). There was a significant difference in the apo(a) isoform distribution between group 1 patients and control subjects (P=0.0003), with a higher frequency of low molecular weight isoforms among patients. This was also significant for the male subgroup (P=0.001). Lp(a), LDL, total cholesterol, triglycerides, apoB, HDL and apoAI were significantly related to the number of major coronary arteries with >50% stenosis. Mortality during follow-up was,in a univariate analysis, significantly correlated to several factors related to the degree of heart disease and to LDL (P=0.02) and apoB (P<0.01). Increased mortality was, however, related to low levels of apoB and LDL. For cardiac mortality no significant correlation to lipoprotein variables were found. In conclusion established lipoprotein risk factors were more frequent among patient with angina pectoris and verified coronary stenosis. Furthermore high Lp(a) levels and a high frequency of low molecular weight isoforms of apo(a) were found in coronary patients. Higher Lp(a) levels were observed both for female and male patients, the differences were, however, significant only for the female patients. None of the lipoprotein variables could predict coronary death during the follow-up period.

  • 700. Lingman, M
    et al.
    Albertsson, P
    Herlitz, Johan
    [external].
    Bergfeldt, L
    Lagerqvist, B
    The impact of hypertension and diabetes on outcome in patients undergoing percutaneous coronary intervention2011Ingår i: American Journal of Medicine, ISSN 0002-9343, E-ISSN 1555-7162, Vol. 124, nr 3, s. 265-275Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Information relating the outcome of percutaneous coronary intervention to diabetes mellitus or hypertension is limited. The study objective was to describe the outcome in patients undergoing percutaneous coronary intervention in relation to diabetes and hypertension. Methods Data were extracted from 5 national registers: the Swedish Coronary Angiography and Angioplasty Register (all percutaneous coronary interventions), the Prescribed Drug Registry (all prescribed pharmaceuticals purchased in Swedish pharmacies), the Swedish Hospital Discharge Register (data on myocardial infarction, revascularization, stroke, and congestive heart failure from in-hospital and specialist health care), and the National Population Register and Cause of Death Register (data on death). We included all “first percutaneous coronary interventions” between January 1, 2006, and December 31, 2008 (n=44,268; followed an average of 1.9 [± 0.9] years). Results Mortality was 6.4% and highest in patients with diabetes plus hypertension. Hypertension per se did not increase mortality or the risk for repeat intervention, but carried a 10% increased risk for subsequent myocardial infarction, increasing to a 4-fold increase when combined with diabetes. Stroke occurred in 2%; the importance of hypertension was evident in nondiabetic patients, but even stronger in diabetic patients. Congestive heart failure caused hospital admission in 8%, with a negative influence from hypertension with and without diabetes. Conclusion After percutaneous coronary intervention and with modern pharmacotherapy, diabetes had a negative effect on the outcome, especially when combined with hypertension. Hypertension per se was not associated with increased mortality but with an increased risk for myocardial infarction, stroke, and congestive heart failure, probably related to widespread coronary artery disease. Improved diabetes care might improve the prognosis.

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