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  • 1.
    Besirevic, Vedran
    Växjö University, Faculty of Mathematics/Science/Technology, School of Technology and Design.
    Linder båtkoncept 20102007Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Projektet behandlar produktutveckling av Linders befintliga

    båtmodell Sportsman 400 med avseende på interiörutformningen

    som ska svara mot den framtida båtägarens krav och behov.

    Den framtida båtägaren består av två olika typer av individer

    som kan beskrivas som ”den äventyrliga individualisten”

    och ”den sociala traditionalisten”, som var och en har

    olika uppfattningar kring begreppet komfort.

  • 2.
    Bremer, Anders
    et al.
    University of Borås.
    Axelsson, Åsa B.
    University of Gothenburg.
    Vårdvetenskaplig analys: erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, 345-349 p.Chapter in book (Other academic)
  • 3. Broström, Anders
    et al.
    Sunnergren, Ola
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköpings universitet.
    Johansson, Peter
    Ulander, Martin
    Riegel, Barbara
    Svanborg, Eva
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients.2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, 107-113 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA.

    DESIGN: Cross-sectional.

    SETTING: Four primary care health centres in Sweden.

    PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP >140/90).

    MAIN OUTCOME MEASURES: Occurrence of OSA as measured by the apnoea hypopnoea index (AHI).

    RESULTS: Mild (AHI 5-14.9/h) and moderate/severe (AHI > 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI > 30 kg/m2) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI > 30 kg/m2, snoring, witnessed apnoeas, and sleep duration >8 hours were determinants of obstructive sleep apnoea.

    CONCLUSION: Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 4. Burell, G
    et al.
    Carlsson, R
    Hambraeus, K
    Johansson, P
    Lisspers, J
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Efter perkutan koronar intervention (PCI): en enkät bland 1073 patienter2012In: XIV Svenska Kardiovaskulära Vårmötet, 2012Conference paper (Refereed)
  • 5.
    Carlsson, Jörg
    et al.
    Kalmar County Hospital.
    Danielsson, Tom
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    A two-peaked increase of serum myosin heavy chain-α after full distance triathlon demonstrates heart muscle cell death2017Conference paper (Refereed)
    Abstract [en]

    Background: There is an ongoing debate about the significance of cardiac troponin T (cTnT) elevation after strenuous exercise: heart muscle cell death versus physiologic mechanism of release through an intact cell membrane. While cTnT is a small molecule (37 kDa), cardiac specific myosin heavy chain-alpha (MHC-α) is much larger (224 kDa) and an increase after exercise could hardly be explained by passage through an intact cardiac cell membrane. PURPOSE: To measure MHC-α, and other biomarkers (C-reactive protein (CRP); cTnT, creatine kinase (CK), myoglobin (MG), creatinine (C), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) before and after a full distance Ironman in order to answer the question of heart muscle cell death versus physiologic changes. 

    Methods: In 52 non-elite athletes (14 female, 38 male; age 41.1 ± 9.7, range 24-70 years; all completed the race) biomarkers were measured by standard laboratory methods 7 days before, directly after, and day 1, 4 and 6 after the race. MHC-α was measured with a commercially available ELISA with no cross reactivity with other myosins. 

    Results: The course of MHC-α concentration [µg/L] was 1.33 ± 0.53 (before), 2.57 ± 0.78 (directly after), 1.51 ± 0.53 (day 1), 2.74 ± 0.55 (day 4) and 1.83 ± 0.76 (day 6). Other biomarkers showed a one-peaked increase with maximal values either directly after the race or at day 1: cTnT 76 ± 80 ng/L (12-440; reference <15), NT-proBNP 776 ± 684 ng/L (92-4700; ref. < 300), CK 68 ± 55 µkat/L (5-280; ref. < 1.9), MG 2088 ± 2350 µg/L (130-17000; ref.< 72), and creatinine 100 ± 20 µmol/L (74-161; ref. < 100), CRP 49 ± 23 mg/L (15-119; ref.< 5). There was a significant correlation between MHC-α and NT-proBNP (R=0.48; p<0.001) but neither between MHC-α and cTnT (R=0.13; p=0.36) nor MHC-α and myoglobin (R=0.18; p=0.2). 

    Conclusion: An Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT was in the range of myocardial infarction in 100% of women and 97% of men. This is to our best knowledge the first investigation of MHC-α after strenuous exercise and its two-peaked increase most likely represents first release from the cytosolic pool and later from cell necrosis including the contractile apparatus. However, many questions remain, not at least why MHC-α baseline levels are as high as 1.33 ± 0.53 µg/L. 

  • 6.
    Carlsson, Jörg
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ragnarsson, Thony
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Danielsson, Tom
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Increase of biomarkers after the Kalmar Ironman in male and female non-elite triathletes2016Conference paper (Refereed)
    Abstract [en]

    Strenuous and prolonged exercise like marathon, ultra running and triathlon can lead to changes in biomarkers of cardiac, muscle and kidney functional damage.

    We present the data of 29 (15 male, 14 female) non-elite participants of the Kalmar Ironman 2015 3.8 km swimming, 180 km cycling, 42 km running). Pre-race electrocardiograms and echocardiograms showed a high frequency of abnormalities. Post race elevations of troponin T, creatine kinase, myoglobin, N-terminal pro b-type natriuretic peptide, aspartataminotransferas, creatinine and leucocytes returned to normal in almost all cases within 5-8 days. In 100% of male and 93% of female participants’ troponin T increase was compatible with the diagnosis of minor myocardial infarction. Some results are shown in the table (* denotes level of significance between male and female results).

                                               Before race         Directly after race        5-8 days after race

    CK [µkat/L]                                      

    male                                                 3.7 ± 2.1**       48,1 ± 44.1                4.5 ± 4.0

    female                                   1.5 ± 0.7          30.5 ± 41.5                3.1 ± 3.6

    Myoglobin [µg/L

    male                                      58.3 ± 35.9        2449 ± 1923             51.3 ± 38.5

    female                                    30.6 ± 11.0         1134 ± 756*             50.4 ± 67.7

    Creatinine [µmol/L]

    male                                       87.4 ± 11.4         119.9 ± 23.4           85.1 ± 12.1

    female                                     73.0 ± 13.4         84.1 ± 14.1***        69.6 ± 6.3

    p-NT-proBNP [ng/L]

    male                                        60.1 ± 25.2          658.7 ± 354.9        61.9 ± 22.7

    female                                      95.5 ± 69.5          907.9 ± 433.1        76.9 ± 26.9

    Troponin T [ng/L]

    male                                         8.5 ± 4.3             68.1 ± 41.1           7.4 ± 4.4

    female                                       7.1 ± 4.9             54.3 ± 49.5           5.8 ± 1.7

    The results will be discussed in the light of the current literature and the so far unanswered question about the long-term significance of repetitive organ damage due to strenuous exercise. Long-term follow-up of these athletes is needed.

  • 7.
    Carlsson, Jörg
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital; Justus-Liebig Universität Giessen, Germany.
    Ragnarsson, Thony
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Danielsson, Tom
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Johansson, Therése
    Kalmar County Hospital.
    Schreyer, Hendrik
    Kalmar County Hospital.
    Breyne, Antonia
    Justus-Liebig Universität Giessen, Germany.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Hjärtmarkörer ökar efter intensiv motion - oklar klinisk betydelse: Data från förstudie av Kalmar IronWoman-studien visar på troponin T-värden som vid hjärtinfarkt2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, no 31-33, D3CRArticle in journal (Refereed)
    Abstract [en]

    Biochemical changes after strenuous exercise - data from the Kalmar Ironman

    Strenuous and prolonged exercise like marathon, ultra running and triathlon can lead to changes in biomarkers of cardiac, muscle and kidney functional damage. We present the data of 30 (15 men, 15 women) participants of the Kalmar Ironman 2015. Pre-race electrocardiograms and echocardiograms showed a high frequency of abnormalities. Post race elevations of troponin T, creatine kinase, myoglobin, N-terminal prohormone of brain natriuretic peptide, and creatinine returned to normal in almost all cases within 5-8 days. In all but one participant the troponin T pattern was compatible with the diagnosis of myocardial infarction. It is an up-to-date unanswered question whether the increase of troponin represents myocardial damage or just is a benign consequence of an intermittent change of the permeability of myocardial cell membranes.

  • 8.
    Claesson, Andreas
    et al.
    Karolinska Institute.
    Herlitz, Johan
    University of Borås.
    Svensson, Leif
    Karolinska Institute.
    Ottosson, Linn
    Sahlgrenska University Hospital.
    Bergfeldt, Lennart
    Sahlgrenska University Hospital.
    Engdahl, Johan
    Karolinska Institute ; Danderyd Hospital.
    Ericson, Caroline
    Sahlgrenska University Hospital.
    Sandén, Petra
    Sahlgrenska University Hospital.
    Axelsson, Christer
    University of Borås.
    Bremer, Anders
    University of Borås.
    Defibrillation before EMS arrival in western Sweden2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, 1043-1048 p., S0735-6757(17)30117-1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.

    METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.

    RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).

    CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.

  • 9. Dallongeville, Jean
    et al.
    Banegas, José R
    Tubach, Florence
    Guallar, Eliseo
    Borghi, Claudio
    De Backer, Guy
    Halcox, Julian P J
    Massó-González, Elvira L
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Sazova, Ogün
    Steg, Philippe Gabriel
    Artalejo, Fernando Rodriguez
    Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study.2012In: European journal of preventive cardiology, ISSN 2047-4881, Vol. 19, no 3, 541-550 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the practices of physicians in 12 European countries in the primary prevention of cardiovascular disease (CVD).

    METHODS: In 2009, 806 physicians from 12 European countries answered a questionnaire, delivered electronically or by post, regarding their assessment of patients with cardiovascular risk factors, and their use of risk calculation tools and clinical practice guidelines (ClinicalTrials.gov number: NCT00882336). Approximately 60 physicians per country were selected (participation rate varied between 3.1% in Sweden and 22.8% in Turkey).

    RESULTS: Among participating physicians, 85.2% reported using at least one clinical guideline for CVD prevention. The most popular were the ESC guidelines (55.1%). Reasons for not using guidelines included: the wide choice available (47.1%), time constraints (33.3%), lack of awareness of guidelines (27.5%), and perception that guidelines are unrealistic (23.5%). Among all physicians, 68.5% reported using global risk calculation tools. Written charts were the preferred method (69.4%) and the most commonly used was the SCORE equation (35.4%). Reasons for not using equations included time constraints (59.8%), not being convinced of their usefulness (21.7%) and lack of awareness (19.7%). Most physicians (70.8%) believed that global risk-equations have limitations; 89.8% that equations overlook important risk factors, and 66.5% that they could not be used in elderly patients. Only 46.4% of physicians stated that their local healthcare framework was sufficient for primary prevention of CVD, while 67.2% stated that it was sufficient for secondary prevention of CVD.

    CONCLUSIONS: A high proportion of physicians reported using clinical guidelines for primary CVD prevention. However, time constraints, lack of perceived usefulness and inadequate knowledge were common reasons for not using CVD prevention guidelines or global CVD risk assessment tools.

  • 10. De Backer, G.
    et al.
    Catapano, A. L.
    Chapman, J.
    Graham, I.
    Reiner, Z.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wiklund, O.
    Guidelines on CVD prevention: Confusing or complementary?2013In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 226, no 1, 299-300 p.Article in journal (Other academic)
  • 11. De Backer, Guy
    et al.
    Catapano, Alberico L
    Chapman, John
    Graham, Ian
    Reiner, Zeljko
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wiklund, Olov
    Guidelines on CVD prevention: confusing or complementary?2013In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 20, no 1, 6-8 p.Article in journal (Other academic)
  • 12.
    Eriksson, Thomas
    et al.
    Graz University of Technology, Austria ; Royal Institute of Technology (KTH).
    Kroon, Martin
    Royal Institute of Technology (KTH).
    Holzapfel, Gerhard A.
    Graz University of Technology, Austria ; Royal Institute of Technology (KTH).
    Influence of medial collagen organization and in-situ axial stretch on saccular cerebral aneurysm growth2009In: Journal of Biomechanical Engineering, ISSN 0148-0731, E-ISSN 1528-8951, Vol. 131, no 10, 101010Article in journal (Refereed)
    Abstract [en]

    A model for saccular cerebral aneurysm growth, proposed by Kroon and Holzapfel (2007, "A Model for Saccular Cerebral Aneurysm Growth in a Human Middle Cerebral Artery," J. Theor. Biol., 247, pp. 775-787; 2008, "Modeling of Saccular Aneurysm Growth in a Human Middle Cerebral Artery," ASME J. Biomech. Eng., 130, p. 051012), is further investigated. A human middle cerebral artery is modeled as a two-layer cylinder where the layers correspond to the media and the adventitia. The immediate loss of media in the location of the aneurysm is taken to be responsible for the initiation of the aneurysm growth. The aneurysmis regarded as a development of the adventitia, which is composed of several distinct layers of collagen fibers perfectly aligned in specified directions. The collagen fibers are the only load-bearing constituent in the aneurysm wall; their production and degradation depend on the stretch of the wall and are responsible for the aneurysm growth. The anisotropy of the surrounding media was modeled using the strain-energy function proposed by Holzapfel et al. (2000, "A New Constitutive Framework for Arterial Wall Mechanics and a Comparative Study of Material Models," J. Elast., 61, pp. 1-48), which is valid for an elastic material with two families of fibers. It was shown that the inclusion of fibers in the media reduced the maximum principal Cauchy stress and the maximum shear stress in the aneurysm wall. The thickness increase in the aneurysm wall due to material growth was also decreased. Varying the fiber angle in the media from a circumferential direction to a deviation of 10 deg from the circumferential direction did, however, only show a little effect. Altering the axial in situ stretch of the artery had a much larger effect in terms of the steady-state shape of the aneurysm and the resulting stresses in the aneurysm wall. The peak values of the maximum principal stress and the thickness increase both became significantly higher for larger axial stretches.

  • 13.
    Fröbert, Ole
    et al.
    Örebro University Hospital.
    Scherstén, Fredrik
    Skåne University Hospital.
    James, Stefan K.
    Uppsala University.
    Carlsson, Jörg
    Kalmar County Hospital.
    Lagerqvist, Bo
    Uppsala University.
    Long-term safety and efficacy of drug-eluting and bare metal stents in saphenous vein grafts2012In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 164, no 1, 87-93 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Long-term safety and efficacy data of drug-eluting stents (DESs) in saphenous vein grafts (SVGs) are lacking. This study sought to compare the clinical outcomes of DES versus bare metal stents (BMS) in SVGs.

    METHODS: We studied all stent implantations in SVGs in Sweden during 74 months between 2005 and 2011 registered in the Swedish Coronary Angiography and Angioplasty Registry. We evaluated outcome in patients who received DES compared with those who received BMS after adjustments for differences in clinical, vessel, and lesion characteristics.

    RESULTS: Mean follow-up time was 3 years and 4 months. A total of 4,576 stents, implanted at 3,063 procedures, were included in the analysis of which 2,499 stents (54.6 %) were BMS and 2,077 (45.4%) were DES. The outcome analysis was based on 190 stent thromboses, 898 restenoses, and 523 deaths. The incidence of stent thrombosis did not differ between groups. When adjusted for baseline characteristics, including a propensity score for receiving DES, the incidence of restenosis was significantly lower with DES as compared with BMS (risk ratio 0.83, 95% CI 0.70-0.97, P = .019). There was a difference in mortality in the crude analysis between DES and BMS, and after multivariable adjustment, this difference remained statistically significant (risk ratio 0.80, CI 0.65-0.99, P = .038).

    CONCLUSIONS: The use of DES compared with BMS in SVGs was associated with a significantly lower adjusted incidence of restenosis and death in this large, national, all-encompassing propensity adjusted observational study.

  • 14.
    Good, Elin
    et al.
    Linköping University.
    Länne, Toste
    Linköping University.
    Wilhelm, Elisabeth
    Linköping University.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Jaarsma, Tiny
    Linköping University.
    De Muinck, Ebo
    Linköping University.
    High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management2016In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 13, 1453-1460 p.Article in journal (Refereed)
    Abstract [en]

    Background Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Design Cross-sectional retrospective study. Methods Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). Results A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. Conclusions The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.

  • 15.
    Gotberg, M.
    et al.
    Lund University.
    Christiansen, E. H.
    Aarhus Univ Hosp, Denmark.
    Gudmundsdottir, I. J.
    Reykjavik Univ Hosp, Iceland.
    Sandhall, L.
    Helsingborg Hosp.
    Danielewicz, M.
    Karlstad Hosp.
    Jakobsen, L.
    Aarhus Univ Hosp, Denmark.
    Olsson, S. -E
    Ohagen, P.
    Uppsala University.
    Olsson, H.
    Karlstad Hosp.
    Omerovic, E.
    Sahlgrenska Univ.
    Calais, F.
    Örebro University.
    Lindroos, P.
    St Göran Hosp.
    Maeng, M.
    Aarhus Univ Hosp, Denmark.
    Todt, T.
    Lund Univ, Skåne Univ Hosp.
    Venetsanos, D.
    Linköping University.
    James, S. K.
    Uppsala University.
    Karegren, A.
    Västmanland Hosp Västerås.
    Nilsson, M.
    Lund Univ, Skåne Univ Hosp.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Hauer, D.
    Linköping University.
    Jensen, J.
    Karolinska Institutet ; Capio St Görans Sjukhus ; Sundsvall Hosp.
    Karlsson, A. -C
    Panayi, G.
    Linköping University.
    Erlinge, D.
    Lund University, Skåne Univ Hosp.
    Frobert, O.
    Örebro University.
    Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI2017In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 376, no 19, 1813-1823 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODS We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTS A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P = 0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P = 0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONS Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months.

  • 16.
    Halcox, Julian P.
    et al.
    Swansea Univ, UK.
    Banegas, Jose R.
    Univ Autonoma Madrid, Spain ; CIBER Epidemiol & Publ Hlth CIBERESP, Spain.
    Roy, Carine
    Hop Bichat Claude Bernard, France.
    Dallongeville, Jean
    Univ Lille Nord France, France.
    De Backer, Guy
    Univ Ghent, Belgium.
    Guallar, Eliseo
    Johns Hopkins Bloomberg Sch Publ Hlth, USA.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hajage, David
    Hop Bichat Claude Bernard, France.
    Henriksson, Karin M.
    Uppsala University.
    Borghi, Claudio
    Univ Bologna, Italy.
    Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study2017In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 17, 160Article in journal (Refereed)
    Abstract [en]

    Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol. Methods: This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Results: Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. Conclusions: A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated.

  • 17.
    Hambraeus, Kristina
    et al.
    Uppsala Univ / Falun Cent Hosp.
    Held, Claes
    Uppsala Univ.
    Johansson, Per
    Sahlgrens Univ Hosp.
    Svennberg, Lars
    Gävle Cent Hosp.
    Cider, Åsa
    Gothenburg Univ, Sahlgrenska Acad.
    James, Stefan
    Uppsala Univ.
    Lagerqvist, Bo
    Uppsala Univ.
    Friberg, Örjan
    Univ Örebro.
    Nilsson, Johan
    Lund Univ / Skåne Univ Hosp / Umeå Univ.
    From Attebring, Mona
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Harnek, Jan
    Lund Univ.
    Jernberg, Tomas
    Karolinska Inst.
    SWEDEHEART Annual Report 20122014In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, 1-129 p.Article in journal (Refereed)
    Abstract [en]

    The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) supports continuous monitoring and improvement of care for coronary artery disease, catheter-based and surgical coronary interventions, secondary prevention as well as catheter based and surgical valve intervention, by providing extensive data on base-line, diagnostic, procedural and outcome variables. Design. This national quality registry collects information from all Swedish hospitals treating patients with acute coronary artery disease and all patients undergoing coronary angiography, catheter-based interventions or heart surgery. Combination with other national mandatory official registries enables complete follow-up of all individuals regarding myocardial infarction, new interventional procedures, death and all-cause hospitalizations. The registry is governed by an independent steering committee and funded by the Swedish National Health care provider. The software is developed by Uppsala Clinical Research Center. Results. The SWEDEHEART Quality Index reflects overall quality of care for coronary artery disease including secondary prevention. In comparison with 2011, an improvement of the index occurred in 2012 overall. There was however, still a wide range in performance between individual centers, emphasizing the need for continuous monitoring of quality of care at a national as well as on a center level.

  • 18. Hellström, M
    et al.
    Hellström, L
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Resting heart rate: a cardiovascular risk predictor for healthy middle aged men.2012In: EuroPrevent, Dublin 2012, 2012Conference paper (Refereed)
  • 19.
    Herlitz, Johan
    et al.
    University of Borås ; Västra Götalandsregionen.
    Ravn-Fischer, Annica
    Sahlgrenska universitetssjukhuset.
    Svensson, Leif
    Karolinska institutetet.
    Bremer, Anders
    University of Borås.
    Bång, Angela
    University of Borås.
    Circulation: Bröstsmärtor2016In: Prehospital Akutsjukvård, Liber, 2016, 2, 308-321 p.Chapter in book (Other academic)
  • 20.
    Hollenberg, Jacob
    et al.
    Södersjukhuset ; Karolinska institutet.
    Engdahl, Johan
    Hallands sjukhus.
    Axelsson, Åsa B.
    University of Gothenburg.
    Bremer, Anders
    University of Borås.
    Hjärtstopp2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Liber, 2009, 1, 295-304 p.Chapter in book (Other academic)
  • 21.
    Holmgren, Christina M.
    et al.
    University of Gothenburg ; County Hospital Ryhov.
    Abdon, Nils J.
    Hudiksvall Hospital.
    Bergfeldt, Lennart B.
    University of Gothenburg.
    Edvardsson, Nils G.
    University of Gothenburg.
    Herlitz, Johan D.
    University of Borås ; Sahlgrenska University Hospital.
    Karlsson, Thomas
    University of Gothenburg.
    Svensson, Leif G.
    Karolinska Institutet.
    Åstrand, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Changes in Medication Preceding Out-of-hospital Cardiac Arrest Where Resuscitation Was Attempted2014In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, no 6, 497-503 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. Methods: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. Results: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 +/- 16 years vs. 54 +/- 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded ;rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. Conclusions: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.

  • 22.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital ; Linköping University.
    Bremer, Anders
    University of Borås ; Kalmar County Hospital.
    Herlitz, Johan
    University of Borås.
    Axelsson, Åsa B.
    University of Gothenburg.
    Cronberg, Tobias
    Lund University.
    Djärv, Therese
    Karolinska Institutet ; Karolinska University Hospital.
    Kristofferzon, Marja-Leena
    University of Gävle ; Uppsala University.
    Larsson, Ing-Marie
    Uppsala University.
    Lilja, Gisela
    Lund University .
    Sunnerhagen, Katharina S.
    University of Gothenburg.
    Wallin, Ewa
    Uppsala University.
    Ågren, Susanna
    Linköping University ; County Council of Östergötland.
    Åkerman, Eva
    Skåne University Hospital ; Karolinska Institutet.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal University College ; Kalmar County Hospital.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to gender2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 114, 27-33 p.Article in journal (Refereed)
    Abstract [en]

    AIM: To describe health status and psychological distress among in-hospital cardiac arrest (IHCA) survivors in relation to gender.

    METHODS: This national register study consists of data from follow-up registration of IHCA survivors 3-6 months post cardiac arrest (CA) in Sweden. A questionnaire was sent to the survivors, including measurements of health status (EQ-5D-5L) and psychological distress (HADS).

    RESULTS: Between 2013 and 2015, 594 IHCA survivors were included in the study. The median values for EQ-5D-5L index and EQ VAS among survivors were 0.78 (q1-q3=0.67-0.86) and 70 (q1-q3=50-80) respectively. The values were significantly lower (p&lt;0.001) in women compared to men. In addition, women reported more problems than men in all dimensions of EQ-5D-5L, except self-care. A majority of the respondents reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (p&lt;0.001) and symptoms of depression (p&lt;0.001) compared to men. Gender was significantly associated with poorer health status and more psychological distress. No interaction effects for gender and age were found.

    CONCLUSIONS: Although the majority of survivors reported acceptable health status and no psychological distress, a substantial proportion reported severe problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. Health care professionals should make efforts to identify health problems among survivors and offer individualised support when needed.

  • 23.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Bremer, Anders
    University of Borås.
    Herlitz, Johan
    University of Borås.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health status and psychological distress among in-hospital cardiac arrest survivors in relation to sex2016In: Presented at EuroHeart, Dubrovnik, Croatia, June 14-15, 2015, 2016, Vol. 134Conference paper (Refereed)
    Abstract [en]

    Introduction: Previous studies have demonstrated differences in characteristics and outcome between men and women in cardiac arrest (CA) populations. However, most studies have focused only on survival outcome. Knowledge about patient reported health and psychological distress among CA survivors is sparse, in particular among those suffering in-hospital cardiac arrest (IHCA). The aim was to describe health status and psychological distress among IHCA survivors in relation to sex. Methods: This national register study presents follow-up data of IHCA survivors from 64% of the eligible hospitals in Sweden. A questionnaire was sent to the survivors, 3-6 months post CA, including measures of health status (EQ-5D) and psychological distress (HADS). Results: Between 2013 and 2015, 594 IHCA survivors were included. Women reported more problems in all dimensions of EQ-5D, except for Self-care. They also had worse health status (EQ-index) (0.75 vs 0.79, p&lt;0.001). The median value for EQ-VAS was 70 (q1-q3=50-80), significantly lower for women compared to men (65 vs 75, p&lt;0.001). A majority reported no problems with anxiety (85.4%) and/or symptoms of depression (87.0%). Women reported significantly more problems with anxiety (median 3 vs 2, p&lt;0.001) and symptoms of depression (median 3 vs 2, p&lt;0.001) compared to men. Being women was significantly associated with lower health status and more psychological distress in the regression models. No interaction effects for sex and age were found. Conclusions: Although the majority of the survivors reported acceptable health status and no psychological distress, a substantial group reported serious problems. Women reported worse health status and more psychological distress compared to men. Therefore, a higher proportion of women may be in need of support. All IHCA survivors should be screened for health problems during the post cardiac arrest follow-up, and offered support when needed.

  • 24.
    Israelsson, Johan
    et al.
    Kalmar County Hospital.
    Bremer, Anders
    University of Borås.
    Herlitz, Johan
    University of Borås.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Health-related quality of life among in-hospital cardiacarrest survivors2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 1 suppl, 174Article in journal (Refereed)
    Abstract [en]

    Purpose: A cardiac arrest can cause brain injury with cognitive dysfunctions, emotional reactions and negative effects on activities in daily life. However, most research has focused on survival and the knowledge about health-related quality of life (HRQoL) among survivors is limited. In addition, almost all studies are performed in an out-of-hospital context. The aim of the current study was therefore to describe HRQoL among in-hospital cardiac arrest (IHCA) survivors.

    Methods: This study has a cross-sectional design. In collaboration with the Swedish national register for cardiopulmonary resuscitation, data was collected 3-6 months after resuscitation by using a questionnaire including EuroQol-5 dimension (EQ-5D), the Hospital Anxiety and Depression Scale (HADS) and single questions on activities in daily life and mental/intellectual recovery. In addition, the Cerebral Performance Category (CPC) was scored.

    Results: In total, 286 IHCA survivors with a mean age of 67±12 were included. A majority of the survivors were men (65%), had a cerebral function of CPC 1 (88%) and had no need of assistance from other people in daily life (70%). A large proportion of the survivors had not made a complete mental and/or intellectual recovery (34%), causing problems in daily life for 65% of them. Pain was the dimension in EQ-5D where most survivors reported problems of some degree (64%). Problems within the dimensions anxiety/depression and mobility were reported by more than half of the survivors (53% vs. 51%). In the dimensions personal care and activities in daily life problems were reported by less than half of the survivors (24% vs. 49%). The individual variations of present health measured by the EQ-VAS were substantial (range 0-100), with a mean value of 67±22. Symptoms of anxiety and depression (measured by HADS) were reported by 15% and 16% respectively.

    Conclusions: Although the majority of the IHCA survivors reported satisfactory HRQoL, the results indicate major individual differences, with a substantial group reporting serious problems. Our findings stress the importance of assessing HRQoL among IHCA survivors and the need of follow-up and structured post cardiac arrest care.

  • 25. Johansson, P
    et al.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Auditing cardiac rehabilitation: a task for a patients’ organisation2009In: EuroPRevent Congress May 2009, 2009, Vol. 16, no 1, S115- p.Conference paper (Refereed)
  • 26.
    Johansson Östbring, Malin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eriksson, T.
    Lund Univ.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patient-centered medication review in coronary heart disease: impact on beliefs about medicines2014In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, S15-S15 p.Article in journal (Other academic)
  • 27.
    Kroon, Martin
    et al.
    Royal Institute of Technology.
    Holzapfel, Gerhard
    Royal Institute of Technology ; Graz University of Technology, Austria.
    A new constitutive model for multi-layered collagenous tissues2008In: Journal of Biomechanics, ISSN 0021-9290, E-ISSN 1873-2380, Vol. 41, no 12, 2766-2771 p.Article in journal (Refereed)
    Abstract [en]

    Collagenous tissues such as the aneurysmal wall or the aorta are multi-layered structures with the mean fibre alignments distinguishing one layer from another. A constitutive representation of the multiple collagen layers is not yet developed, and hence the aim of the present study. The proposed model is based on the constitutive theory of finite elasticity and is characterized by an anisotropic strain-energy function which takes the material structure into account. The passive tissue behaviour is modelled and the related mechanical response is assumed to be dominated by elastin and collagen. While elastin is modelled by the neo-Hookean material the constitutive response of collagen is assumed to be transversely isotropic for each individual layer and based on an exponential function. The proposed constitutive function is polyconvex which ensures material stability. The model has five independent material parameters, each of which has a clear physical interpretation: the initial stiffnesses of the collagen fabric in the two principal directions, the shear modulus pertaining to the non-collagenous matrix material, a parameter describing the level of nonlinearity of the collagen fabric, and the angle between the principal directions of the collagen fabric and the reference coordinate system. An extension-inflation test of the adventitia of a human femoral artery is simulated by means of the finite element method and an error function is minimized by adjusting the material parameters yielding a good agreement between the model and the experimental data.

  • 28.
    Kroon, Martin
    et al.
    Royal Institute of Technology .
    Holzapfel, Gerhard
    Royal Institute of Technology ; Graz University of Technology, Austria.
    Modelling of saccular aneurysm growth in a human middle cerebral artery2008In: Journal of Biomechanical Engineering, ISSN 0148-0731, E-ISSN 1528-8951, Vol. 130, no 5, 051012Article in journal (Refereed)
    Abstract [en]

    Saccular aneurysm growth in a human middle cerebral artery is modeled. The aneurysm growth model was presented in a companion paper by Kroon and Holzapfel ("A Model for Saccular Cerebral Aneurysm Growth by Collagen Fibre Remodelling," J. Theor. Biol., in press) and was assessed there for axisymmetric growth. The aneurysm growth model is now evaluated for a more realistic setting. The middle cerebral artery is modeled as a two-layered cylinder, where the layers correspond to the media and the adventitia. An instant loss of the media in a region of the artery wall initiates the growth of the saccular aneurysm. The aneurysm wall is assumed to be a development of the adventitia of the original healthy artery, and collagen is assumed to be the only load-bearing constituent in the adventitia and in the aneurysm wall. The collagen is organized in a number of distinct layers where fibers in a specific layer are perfectly aligned in a certain fiber direction. The production of new collagen is taken to depend on the stretching of the aneurysm wall, and the continuous remodeling of the collagen fibers is responsible for the aneurysm growth. The general behavior of the growth model is investigated and also the influence of the structural organization of the collagen fabric. The analysis underlines the fact that the material behavior of aneurysmal tissue cannot be expected to be isotropic. The model predictions agree well with clinical and experimental results, for example, in terms of aneurysm size and shape, wall stress levels, and wall thickness.

  • 29.
    Kroon, Martin
    et al.
    Royal Institute of Technology (KTH).
    Holzapfel, Gerhard A.
    Royal Institute of Technology (KTH) ; Graz University of Technology, Austria.
    A theoretical model for fibroblast-controlled growth of saccular cerebral aneurysms2009In: Journal of Theoretical Biology, ISSN 0022-5193, E-ISSN 1095-8541, Vol. 257, no 1, 73-83 p.Article in journal (Refereed)
    Abstract [en]

    A new theoretical model for the growth of saccular cerebral aneurysms is proposed by extending the recent constitutive framework of Kroon and Holzapfel [2007a. A model for saccular cerebral aneurysm growth by collagen fibre remodelling. J. Theor. Biol. 247, 775–787]. The continuous turnover of collagen is taken to be the driving mechanism in aneurysmal growth. The collagen production rate depends on the magnitude of the cyclic deformation of fibroblasts, caused by the pulsating blood pressure during the cardiac cycle. The volume density of fibroblasts in the aneurysmal tissue is taken to be constant throughout the growth process. The growth model is assessed by considering the inflation of an axisymmetric membranous piece of aneurysmal tissue, with material characteristics representative of a cerebral aneurysm. The diastolic and systolic states of the aneurysm are computed, together with its load-free state. It turns out that the value of collagen pre-stretch, that determines growth speed and stability of the aneurysm, is of pivotal importance. The model is able to predict aneurysms with typical berry-like shapes observed clinically, and the predicted wall stresses correlate well with the experimentally obtained ultimate stresses of this type of tissue. The model predicts that aneurysms should fail when reaching a size of about 1.2–3.6 mm, which is smaller than what has been clinically observed. With some refinements, the model may, however, be used to predict future growth of diagnosed aneurysms.

  • 30.
    Kroon, Martin
    et al.
    Royal Institute of Technology (KTH).
    Holzapfel, Gerhard A.
    Royal Institute of Technology (KTH) ; Graz University of Technology, Austria.
    Elastic properties of anisotropic vascular membranes examined by inverse analysis2009In: Computer Methods in Applied Mechanics and Engineering, ISSN 0045-7825, E-ISSN 1879-2138, Vol. 198, no 45-46, 3622-3632 p.Article in journal (Refereed)
    Abstract [en]

    An inverse method for estimating the distributions of the nonlinear elastic properties of inhomogeneous and anisotropic vascular membranes such as cerebral aneurysms is proposed. The material description of the membrane is based on a versatile structural model able to represent multiple collagen layers and the passive response of the vascular wall. Each individual layer is assumed to behave transversely isotropic following exponential stiffening with increasing loading. The model includes four parameters to be explainable physically: two initial stiffnesses of the collagen fabric, a parameter related to the nonlinearity of the collagen fabric, angle between the principal directions of the collagen fabric and a reference coordinate system. For this finite deformation problem a finite element framework for membranous structures considering pressure boundary loading is outlined, i.e. the principle of virtual work, its linearisation and the related spatial discretisation. The estimation procedure consists of the following three steps: (i) in vivo or in vitro approaches record the mechanical responses of membranous structures whose properties are to be determined; (ii) define a corresponding finite element model; (iii) minimise an error function (regarding the unknown parameters) that quantifies the deviation of the numerical prediction from the recorded data. To achieve a robust parameter estimation, an element partition method is employed. The outcome of the procedure is affected by the number of nodes defined on the membrane surface and the number of load steps. In a numerical example, the proposed procedure is assessed by reestablishing given reference distributions in a reference membrane. The deviations of the estimated material parameter distributions from the related reference fields are within just a few percent. In most of the investigated cases the standard deviation for the resulting maximum principal stress was even below 1%, which is accurate enough for rupture risk assessment of vascular membranes.

  • 31.
    Lagerqvist, Bo
    et al.
    Uppsala Univ.
    Frobert, Ole
    Örebro Univ Hosp.
    Olivecrona, Göran K.
    Lund Univ.
    Gudnason, Thorarinn
    Landspitali Univ Hosp.
    Maeng, Michael
    Aarhus Univ Hosp.
    Alstrom, Patrik
    Karolinska Inst.
    Andersson, Jonas
    Umeå Univ Hosp.
    Calais, Fredrik
    Örebro Univ Hosp.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Collste, Olov
    Karolinska Inst.
    Gotberg, Matthias
    Lund Univ.
    Hardhammar, Peter
    Ioanes, Dan
    Kallryd, Anders
    Linder, Rickard
    Karolinska Inst.
    Lundin, Anders
    Odenstedt, Jacob
    Omerovic, Elmir
    Puskar, Verner
    Todt, Tim
    Zelleroth, Eva
    Ostlund, Ollie
    James, Stefan K.
    Outcomes 1 Year after Thrombus Aspiration for Myocardial Infarction2014In: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, Vol. 371, no 12, 1111-1120 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND Routine intracoronary thrombus aspiration before primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) has not been proved to reduce short-term mortality. We evaluated clinical outcomes at 1 year after thrombus aspiration. METHODS We randomly assigned 7244 patients with STEMI to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone, in a registry-based, randomized clinical trial. The primary end point of all-cause mortality at 30 days has been reported previously. Death from any cause at 1 year was a prespecified secondary end point of the trial. RESULTS No patients were lost to follow-up. Death from any cause occurred in 5.3% of the patients (191 of 3621 patients) in the thrombus-aspiration group, as compared with 5.6% (202 of 3623) in the PCI-only group (hazard ratio, 0.94; 95% confidence interval [CI], 0.78 to 1.15; P = 0.57). Rehospitalization for myocardial infarction at 1 year occurred in 2.7% and 2.7% of the patients, respectively (hazard ratio, 0.97; 95% CI, 0.73 to 1.28; P = 0.81), and stent thrombosis in 0.7% and 0.9%, respectively (hazard ratio, 0.84; 95% CI, 0.50 to 1.40; P = 0.51). The composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis occurred in 8.0% and 8.5% of the patients, respectively (hazard ratio, 0.94; 95% CI, 0.80 to 1.11; P = 0.48). The results were consistent across all the major subgroups, including grade of thrombus burden and coronary flow before PCI. CONCLUSIONS Routine thrombus aspiration before PCI in patients with STEMI did not reduce the rate of death from any cause or the composite of death from any cause, rehospitalization for myocardial infarction, or stent thrombosis at 1 year.

  • 32.
    Lindberg, Michael
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Identifiering av mutationer i typ B3 coxsackievirusets arvsmassa, vilka förändrar virusets vävnadstropism: Av betydelse för myokarditdiagnostik?1993Conference paper (Refereed)
  • 33. Mancia, Giuseppe
    et al.
    Fagard, Robert
    Narkiewicz, Krzysztof
    Redon, Josep
    Zanchetti, Alberto
    Böhm, Michael
    Christiaens, Thierry
    Cifkova, Renata
    De Backer, Guy
    Dominiczak, Anna
    Galderisi, Maurizio
    Grobbee, Diederick E
    Jaarsma, Tiny
    Kirchhof, Paulus
    Kjeldsen, Sverre E
    Laurent, Stéphane
    Manolis, Athanasios J
    Nilsson, Peter M
    Ruilope, Luis Miguel
    Schmieder, Roland E
    Sirnes, Per Anton
    Sleight, Peter
    Viigimaa, Margus
    Waeber, Bernard
    Zannad, Faiez
    Redon, Josep
    Dominiczak, Anna
    Narkiewicz, Krzysztof
    Nilsson, Peter M
    Burnier, Michel
    Viigimaa, Margus
    Ambrosioni, Ettore
    Caufield, Mark
    Coca, Antonio
    Olsen, Michael Hecht
    Schmieder, Roland E
    Tsioufis, Costas
    van de Borne, Philippe
    Zamorano, Jose Luis
    Achenbach, Stephan
    Baumgartner, Helmut
    Bax, Jeroen J
    Bueno, Héctor
    Dean, Veronica
    Deaton, Christi
    Erol, Cetin
    Fagard, Robert
    Ferrari, Roberto
    Hasdai, David
    Hoes, Arno W
    Kirchhof, Paulus
    Knuuti, Juhani
    Kolh, Philippe
    Lancellotti, Patrizio
    Linhart, Ales
    Nihoyannopoulos, Petros
    Piepoli, Massimo F
    Ponikowski, Piotr
    Sirnes, Per Anton
    Tamargo, Juan Luis
    Tendera, Michal
    Torbicki, Adam
    Wijns, William
    Windecker, Stephan
    Clement, Denis L
    Coca, Antonio
    Gillebert, Thierry C
    Tendera, Michal
    Rosei, Enrico Agabiti
    Ambrosioni, Ettore
    Anker, Stefan D
    Bauersachs, Johann
    Hitij, Jana Brguljan
    Caulfield, Mark
    De Buyzere, Marc
    De Geest, Sabina
    Derumeaux, Geneviève Anne
    Erdine, Serap
    Farsang, Csaba
    Funck-Brentano, Christian
    Gerc, Vjekoslav
    Germano, Giuseppe
    Gielen, Stephan
    Haller, Herman
    Hoes, Arno W
    Jordan, Jens
    Kahan, Thomas
    Komajda, Michel
    Lovic, Dragan
    Mahrholdt, Heiko
    Olsen, Michael Hecht
    Ostergren, Jan
    Parati, Gianfranco
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Polonia, Jorge
    Popescu, Bogdan A
    Reiner, Zeljko
    Rydén, Lars
    Sirenko, Yuriy
    Stanton, Alice
    Struijker-Boudier, Harry
    Tsioufis, Costas
    van de Borne, Philippe
    Vlachopoulos, Charalambos
    Volpe, Massimo
    Wood, David A
    2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 28, 2159-2219 p.Article in journal (Refereed)
  • 34.
    Munkhaugen, John
    et al.
    Drammen Hospital, Norway.
    Sverre, Elise
    Drammen Hospital, Norway ; University of Oslo, Norway.
    Otterstad, Jan E.
    Vestfold Hospital, Norway.
    Peersen, Kari
    Vestfold Hospital, Norway ; University of Oslo, Norway.
    Gjertsen, Erik
    Drammen Hospital, Norway.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Gullestad, Lars
    University of Oslo, Norway.
    Moum, Torbjørn
    University of Oslo, Norway.
    Dammen, Toril
    University of Oslo, Norway.
    Husebye, Einar
    Drammen Hospital, Norway.
    Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, 981-989 p.Article in journal (Refereed)
    Abstract [en]

    Objective Understanding the determinants of low-density lipoprotein cholesterol (LDL-C) control constitutes the basis of modelling interventions for optimal lipid control and prognosis. We aim to identify medical and psychosocial (study) factors associated with unfavourable LDL-C control in coronary patients. Methods A cross-sectional explorative study used logistic and linear regression analysis to investigate the association between study factors and LDL-C in 1095 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records, a comprehensive self-report questionnaire, clinical examination and blood samples after 2-36 months follow-up. Results Fifty-seven per cent did not reach the LDL-C target of 1.8 mmol/l at follow-up. Low socioeconomic status and psychosocial factors were not associated with failure to reach the LDL-C target. Statin specific side-effects (odds ratio 3.23), low statin adherence (odds ratio 3.07), coronary artery by-pass graft operation as index treatment (odds ratio 1.95), ≥ 1 coronary event prior to the index event (odds ratio 1.81), female gender (odds ratio 1.80), moderate- or low-intensity statin therapy (odds ratio 1.62) and eating fish < 3 times/week (odds ratio 1.56) were statistically significantly associated with failure to reach the LDL-C target, in adjusted analyses. Only side-effects (standardized β 0.180), low statin adherence (β 0.209) and moderate- or low-intensity statin therapy (β 0.228) were associated with LDL-C in continuous analyses. Conclusions Statin specific side-effects, low statin adherence and moderate- or low-intensity statin therapy were the major factors associated with unfavourable LDL-C control. Interventions to improve LDL-C should ensure adherence and prescription of sufficiently potent statins, and address side-effects appropriately. © European Society of Cardiology 2017.

  • 35.
    Munkhaugen, John
    et al.
    Drammen Hosp, Norway.
    Sverre, Elise
    Drammen Hosp, Norway.
    Peersen, Kari
    Vestfold Hosp, Norway.
    Gjertsen, Erik
    Drammen Hosp, Norway.
    Gullestad, Lars
    Oslo Univ Hosp, Norway.
    Moum, Torbjorn
    Univ Oslo, Norway.
    Otterstad, Jan Erik
    Vestfold Hosp, Norway.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Husebye, Einar
    Drammen Hosp, Norway.
    Dammen, Toril
    Univ Oslo, Norway.
    The role of medical and psychosocial factors for unfavourable coronary risk factor control2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, 1-8 p.Article in journal (Refereed)
    Abstract [en]

    Objectives. This project aims to identify socio-demographic, medical and psychosocial factors (study factors) associated with coronary risk control and prognosis, and to test their impact in a representative sample of coronary heart disease (CHD) patients. Design. The first phase includes a cross-sectional study designed to explore the association between the study factors and coronary risk factor control in CHD patients. Data from hospital records, a questionnaire, clinical examination and blood samples were collected. The independent effects of study factors on subsequent coronary events will be explored prospectively by controlling for baseline coronary risk factors. In the second phase, we will test the effect of tailored interventions to modify the study factors associated with unfavourable risk profile in phase I. Results. In all 1366 patients (21% women), aged 18-80 years with a coronary event on average 17 (2-38) months prior to study participation were identified (83% participation rate). Of the 239 patients who refused participation, 229 patients consented to analysis of hospital record data (non- participants). Conclusions. If the study variables contribute to CHD risk factors and prognosis, the present project may be important for the development of prevention programs by tailoring these to the patients perceived needs and behaviour profiles.

  • 36.
    Namazi Esfahani, Neda
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Lived experience of patient with diabetes after Cronary Artery Bypass Graft- A case study2012Independent thesis Advanced level (degree of Master (Two Years)), 80 credits / 120 HE creditsStudent thesis
  • 37.
    Nordström, Erik Blennow
    et al.
    Lund University.
    Lilja, Gisela
    Lund University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital.
    Friberg, Hans
    Lund University.
    Nielsen, Niklas
    Lund University.
    Vestberg, Susanna
    Lund University.
    Cronberg, Tobias
    Lund University.
    Validity of the IQCODE-CA: An informant questionnaire on cognitive decline modified for a cardiac arrest population2017In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 118, 8-14 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To examine the psychometric properties of a modified version of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), for a cardiac arrest population (IQCODE-CA). Methods: The IQCODE-CA, a 26-item observer-reported questionnaire, was completed by informants, defined as relatives or close friends, of 268 out-of-hospital cardiac arrest (OHCA) survivors who participated in the Target Temperature Management trial in a scheduled follow-up 180 +/- 14 days after OHCA. Survivors completed the Mini Mental State Examination (MMSE), the Rivermead Behavioural Memory Test (RBMT) and the Hospital Anxiety and Depression Scale (HADS). An exploratory factor analysis was performed. Associations between IQCODE-CA results and demographic variables along with other instruments were calculated. Area under the curve (AUC) ratios were evaluated to examine discrimination. Results: The IQCODE-CA measured one factor, global cognitive decline, with high internal consistency (ordinal alpha = 0.95). Age, gender or education did not influence the IQCODE-CA score. Associations with performance-based measures of global cognitive function as well as anxiety and depression ranged from small to moderate (rs = -0.29 to 0.38). AUC ratios ranged from fair to good (0.72-0.81). According to the MMSE and RBMT, the optimal cut-off score to identify cognitive decline on the IQCODE-CA was 3.04. Using this value, 53% of the survivors were under the cut-off. Conclusions: The IQCODE-CA identified a large amount of survivors with possible cognitive problems, making it useful when screening for cognitive decline post-CA. Due to lower AUC ratios than desired, additional performance-based measures should be used to improve the overall screening methodology. (C) 2017 Elsevier B.V. All rights reserved.

  • 38.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nya europeiska riktlinjer för kardiovaskulär prevention2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 34, 1463-1463 p.Article in journal (Other academic)
    Abstract [sv]

    2012 års europeiska riktlinjer för kardiovaskulär prevention i klinisk praxis utgår från några nyckelfrågor: Vad är kardiovaskulär prevention, varför behövs den och för vem, hur och var bör den erbjudas?

    Riktlinjedokumentet är kortare och rekommendationerna för vården är tydligare än tidigare riktlinjer.

    Fyra nivåer av kardiovaskulär risk definieras, och riktade preventiva råd ges för varje riskgrupp.

    Sverige är numera ett lågriskland för hjärt–kärlsjukdom.

  • 39.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Risk factors in childhood and youth2015In: Prevention of cardiovascular diseases: from current evidence to clinical practice / [ed] Jadelson P. Andrade, Fausto J. Pinto & Donna K. Arnett, Springer, 2015, 1, 101-108 p.Chapter in book (Other academic)
    Abstract [en]

    In recent decades a shift in the epidemiology of cardiovascular diseases (CVD) from high to middle and low income countries has been observed. CVD mortality is declining in the high income regions but it still remains a major cause of premature death and presently >80 % of all CVD mortality occurs in the remaining part of the world. As atherosclerotic disease is a chronic disorder developing early in life and progressing over decades before symptoms occur factors that influence its onset should be sought as early as in childhood.

  • 40.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Burell, G
    Carlsson, R
    Hambraeus, K
    Johansson, P
    Lisspers, J
    Cardiac rehabilitation after acute coronary intervention: the patients view2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 1suppl, S61- p.Article in journal (Refereed)
  • 41.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Burell, Gunilla
    Uppsala University.
    Carlsson, Roland
    PCI-Centrum.
    Hambraeus, Kristina
    Falu hospital.
    Johansson, Pelle
    Riksförbundet HjärtLung.
    Lisspers, Jan
    Mid Sweden University.
    Allvarliga brister i rådgivning till koronarsjuka patienter efter ballongvidgning: patienter undervärderar levnadsvanors betydelse, visar enkätstudie2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 42Article in journal (Refereed)
    Abstract [en]

    In a questionnaire 1073 patients from 29 randomly selected Swedish hospitals who had undergone percutaneous coronary intervention (PCI) were asked what they considered to be the cause of their coronary disease, how they experienced the information given by the medical staff and in which way had they adopted a heart-healthy lifestyle. The main outcomes were; A majority attributed the cause of the disease to non-modifiable factors, i.e. age and heredity. Merely one in four patients had perceived the information in a correct way: they still carried the coronary disease and needed to adapt their lifestyle. Half of the patient population had increased their physical activity and likewise merely half had changed their food habits. Half of the tobacco users had quit after PCI. Thus the results of this study shows that there is ample space for improving the present care of post-PCI patients.

  • 42.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    De Backer, Guy
    Gohlke, Helmut
    Graham, Ian
    Reiner, Zeljko
    Verschuren, W. M. Monique
    Albus, Christian
    Benlian, Pascale
    Boysen, Gudrun
    Cifkova, Renata
    Deaton, Christi
    Ebrahim, Shah
    Fisher, Miles
    Germano, Giuseppe
    Hobbs, Richard
    Hoes, Arno
    Karadeniz, Sehnaz
    Mezzani, Alessandro
    Prescott, Eva
    Ryden, Lars
    Scherer, Martin
    Syvanne, Mikko
    Reimer, Wilma J. M. Scholte Op
    Vrints, Christiaan
    Wood, David
    Luis Zamorano, Jose
    Zannad, Faiez
    European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 4, 585-667 p.Article in journal (Refereed)
  • 43.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hambraeus, Kristina
    Falun Hospital.
    Burell, Gunilla
    Uppsala University.
    Carlsson, Roland
    Swedish PCI AB.
    Johansson, Pelle
    Heart and Lung Patients Association.
    Lisspers, Jan
    Mid Sweden University.
    Study of patient information after percutaneous coronary intervention (SPICI): should prevention programmes become more effective?2015In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 10, no 11, e1-e7 p.Article in journal (Refereed)
    Abstract [en]

    Aims: This cross-sectional observational study was designed to evaluate the uptake and outcome of patient education after percutaneous coronary intervention (PCI).

    Methods and results: A questionnaire containing 41 items was handed out to consecutive patients from randomly selected Swedish hospitals after PCI. Questions concerned the patient's attribution of the cause of the cardiac event, perception of the information provided by physicians and nurses, and a self-assessment of changes in lifestyle post PCI regarding tobacco, physical activity, food habits and stress. Replies were obtained from 1,073 patients (reply rate 67%). Non-modifiable risk factors (age, heredity) were attributed a higher rate as the cause of disease compared to modifiable factors (smoking, physical activity, food habits). Most patients (67%) perceived they were cured, and 38% perceived from the given information that there was no need to change their habits. A mere 27% reported that they still had cardiovascular disease and needed behavioural change. After PCI, 16% continued to use tobacco; half of these were offered smoking cessation support. In spite of an 80% referral rate to cardiac rehabilitation, one out of two patients did not enrol. Fewer than half were regularly physically active. Nutritional counselling was provided to 71%, but only 40% changed food habits. Stress management programmes were rarely provided.

    Conclusions: Current preventive practice scarcely meets the challenge posed by the progress in modern invasive cardiology. The Study of Patient Information after percutaneous Coronary Intervention (SPICI) motivates an in-depth revision and adaptation of cardiac rehabilitation programmes in order to improve patient understanding of the disease, and to support greater compliance with a cardioprotective lifestyle.

  • 44.
    Rodríguez-Artalejo, Fernando
    et al.
    Universidad Autónoma de Madrid, Spain ; AstraZeneca Europe, -.
    Guallar, Eliseo
    Johns Hopkins Bloomberg School of Public Health, USA ; National Center for Cardiovascular Research (CNIC), Spain.
    Borghi, Claudio
    University of Bologna, Italy.
    Dallongeville, Jean
    Institut Pasteur de Lille, France.
    De Backer, Guy
    University of Gent, France.
    Halcox, Julian P
    Cardiff University, Wales.
    Hernández-Vecino, Ramón
    AstraZeneca Farmacéutica Spain, Spain.
    Jiménez, Francisco J
    AstraZeneca Farmacéutica Spain, Spain.
    Massó-González, Elvira L
    AstraZeneca Farmacéutica Spain, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Steg, Philippe G.
    Assistance Publique-Hôpitaux de Paris and Université, France.
    Banegas, José R
    Universidad Autónoma de Madrid, Spain.
    EURIKA Investigators,
    Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA)2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, 382Article in journal (Refereed)
    Abstract [en]

    The EURIKA study aims to assess the status of primary prevention of cardiovascular disease (CVD) acrossEurope. Specifically, it will determine the degree of control of cardiovascular risk factors in current clinical practice in relation to the European guidelines on cardiovascular prevention. It will also assess physicians' knowledge and attitudes about CVD prevention as well as the barriers impeding effective risk factor management in clinical practice.

  • 45. Rydén, Lars
    et al.
    Grant, Peter J
    Anker, Stefan D
    Berne, Christian
    Cosentino, Francesco
    Danchin, Nicolas
    Deaton, Christi
    Escaned, Javier
    Hammes, Hans-Peter
    Huikuri, Heikki
    Marre, Michel
    Marx, Nikolaus
    Mellbin, Linda
    Ostergren, Jan
    Patrono, Carlo
    Seferovic, Petar
    Uva, Miguel Sousa
    Taskinen, Marja-Riita
    Tendera, Michal
    Tuomilehto, Jaakko
    Valensi, Paul
    Zamorano, Jose Luis
    Zamorano, Jose Luis
    Achenbach, Stephan
    Baumgartner, Helmut
    Bax, Jeroen J
    Bueno, Héctor
    Dean, Veronica
    Deaton, Christi
    Erol, Cetin
    Fagard, Robert
    Ferrari, Roberto
    Hasdai, David
    Hoes, Arno W
    Kirchhof, Paulus
    Knuuti, Juhani
    Kolh, Philippe
    Lancellotti, Patrizio
    Linhart, Ales
    Nihoyannopoulos, Petros
    Piepoli, Massimo F
    Ponikowski, Piotr
    Sirnes, Per Anton
    Tamargo, Juan Luis
    Tendera, Michal
    Torbicki, Adam
    Wijns, William
    Windecker, Stephan
    De Backer, Guy
    Sirnes, Per Anton
    Ezquerra, Eduardo Alegria
    Avogaro, Angelo
    Badimon, Lina
    Baranova, Elena
    Baumgartner, Helmut
    Betteridge, John
    Ceriello, Antonio
    Fagard, Robert
    Funck-Brentano, Christian
    Gulba, Dietrich C
    Hasdai, David
    Hoes, Arno W
    Kjekshus, John K
    Knuuti, Juhani
    Kolh, Philippe
    Lev, Eli
    Mueller, Christian
    Neyses, Ludwig
    Nilsson, Peter M
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Ponikowski, Piotr
    Reiner, Zeljko
    Sattar, Naveed
    Schächinger, Volker
    Scheen, André
    Schirmer, Henrik
    Strömberg, Anna
    Sudzhaeva, Svetlana
    Tamargo, Juan Luis
    Viigimaa, Margus
    Vlachopoulos, Charalambos
    Xuereb, Robert G
    ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 39, 3035-3087 p.Article in journal (Refereed)
    Abstract [en]

    This is the second iteration of the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) joining forces to write guidelines on the management of diabetes mellitus (DM), pre-diabetes, and cardiovascular disease (CVD), designed to assist clinicians and other healthcare workers to make evidence-based management decisions. The growing awareness of the strong biological relationship between DM and CVD rightly prompted these two large organizations to collaborate to generate guidelines relevant to their joint interests, the first of which were published in 2007. Some assert that too many guidelines are being produced but, in this burgeoning field, five years in the development of both basic and clinical science is a long time and major trials have reported in this period, making it necessary to update the previous Guidelines.

  • 46.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Linköping University ; Kalmar County Hospital.
    von Wangenheim, Burkard
    Kalmar County Hospital.
    Carlsson, Jörg
    Kalmar County Hospital.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Quality of chest compressions by healthcare professionals using real-time audiovisual feedback during in-hospital cardiopulmonary resuscitation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 5, 453-457 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: A high quality of chest compressions, e.g. sufficient depth (5-6 cm) and rate (100-120 per min), has been associated with survival. The patient's underlay affects chest compression depth. Depth and rate can be assessed by feedback systems to guide rescuers during cardiopulmonary resuscitation. Aim: The purpose of this study was to describe the quality of chest compressions by healthcare professionals using real-time audiovisual feedback during in-hospital cardiopulmonary resuscitation. Method: An observational descriptive study was performed including 63 cardiac arrest events with a resuscitation attempt. Data files were recorded by Zoll AED Pro, and reviewed by RescueNet Code Review software. The events were analysed according to depth, rate, quality of chest compressions and underlay. Results: Across events, 12.7% (median) of the compressions had a depth of 5-6 cm. Compression depth of >6 cm was measured in 70.1% (median). The underlay could be identified from the electronic patient records in 54 events. The median compression depth was 4.5 cm (floor) and 6.7 cm (mattress). Across events, 57.5% (median) of the compressions were performed with a median frequency of 100-120 compressions/min and the most common problem was a compression rate of <100 (median=22.3%). Conclusions: Chest compression quality was poor according to the feedback system. However, the distribution of compression depth with regard to underlay points towards overestimation of depth when treating patients on a mattress. Audiovisual feedback devices ought to be further developed. Healthcare professionals need to be aware of the strengths and weaknesses of their devices.

  • 47.
    Shahini, Negar
    et al.
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Michelsen, Annika E
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Nilsson, Per H.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Ekholt, Karin
    University of Oslo, Norway.
    Gullestad, Lars
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Broch, Kaspar
    Oslo University Hospital, Rikshospitalet, Norway.
    Dahl, Christen P
    Oslo University Hospital, Rikshospitalet, Norway.
    Aukrust, Pål
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Ueland, Thor
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Mollnes, Tom Eirik
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway; Norwegian University of Science and Technology, Norway ; Nordland Hospital, Bodø, Norway ; University of Tromsø, Norway.
    Yndestad, Arne
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    Louwe, Mieke C
    Oslo University Hospital, Rikshospitalet, Norway ; University of Oslo, Norway.
    The alternative complement pathway is dysregulated in patients with chronic heart failure.2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, 1-10 p., 42532Article in journal (Refereed)
    Abstract [en]

    The complement system, an important arm of the innate immune system, is activated in heart failure (HF). We hypothesized that HF patients are characterized by an imbalance of alternative amplification loop components; including properdin and complement factor D and the alternative pathway inhibitor factor H. These components and the activation product, terminal complement complex (TCC), were measured in plasma from 188 HF patients and 67 age- and sex- matched healthy controls by enzyme immunoassay. Our main findings were: (i) Compared to controls, patients with HF had significantly increased levels of factor D and TCC, and decreased levels of properdin, particularly patients with advanced clinical disorder (i.e., NYHA functional class IV), (ii) Levels of factor D and properdin in HF patients were correlated with measures of systemic inflammation (i.e., C-reactive protein), neurohormonal deterioration (i.e., Nt-proBNP), cardiac function, and deteriorated diastolic function, (iii) Low levels of factor H and properdin were associated with adverse outcome in univariate analysis and for factor H, this was also seen in an adjusted model. Our results indicate that dysregulation of circulating components of the alternative pathway explain the increased degree of complement activation and is related to disease severity in HF patients.

  • 48.
    Van Guelpen, B.
    et al.
    Umeå University.
    Hultdin, J.
    Umeå University.
    Johansson, I.
    Umeå University.
    Witthöft, Cornelia M.
    Swedish University of Agricultural Sciences.
    Weinehall, L.
    Umeå University ; National Public Health Institute.
    Eliasson, M.
    Umeå University ; Sunderby Hospital.
    Hallmans, G.
    Umeå University.
    Palmqvist, R.
    Umeå University.
    Jansson, J.-H.
    Umeå University ; Skellefteå Hospital.
    Winkvist, A.
    University of Gothenburg.
    Plasma folate and total homocysteine levels are associated with the risk of myocardial infarction, independently of each other and of renal function2009In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 266, no 2, 182-195 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the relationship between plasma folate, vitamin B12 and total homocysteine concentrations, dietary intake of folate and vitamins B12, B6 and B2, and the risk of first acute myocardial infarction (MI).

    DESIGN: Nested case-referent study with up to 13 years of follow-up.

    SETTING: The population-based Northern Sweden Health and Disease Study, with 73 879 participants at the time of case ascertainment.

    SUBJECTS: A total of 571 MI cases (406 men) and 1569 matched referents. Of the cases, 530 had plasma samples available, and 247 had dietary B-vitamin intake data.

    RESULTS: Plasma concentrations of folate were inversely associated, and total homocysteine positively associated, with the risk of MI, independently of each other and of a number of established and novel cardiovascular risk factors, including renal function [multivariate odds ratio for highest vs. lowest quintile of folate 0.52 (95% CI 0.31-0.84), P for trend = 0.036, and homocysteine 1.92 (95% CI 1.20-3.09), P for trend = 0.006]. For plasma vitamin B12 concentrations, and vitamin B12, B6 and B2 intake, no clear risk relationship was apparent. Though not statistically significant, the results for folate intake were consistent with those for plasma concentrations.

    CONCLUSIONS: In this large prospective study of a population without mandatory folic acid fortification, both folate and homocysteine were strongly associated with the risk of myocardial infarction, independently of each other and of renal function. Although randomized trials of folic acid supplementation are needed to determine causality, our findings highlight the potential importance of folate, or sources of folate, in incident cardiovascular disease.

  • 49.
    Velders, Matthijs A.
    et al.
    Uppsala University ; Leiden University Medical Center, The Netherlands.
    James, Stefan K.
    Uppsala University.
    Libungan, Berglind
    Sahlgrenska University Hospital.
    Sarno, Giovanna
    Uppsala University.
    Fröbert, Ole
    Örebro University Hospital.
    Carlsson, Jörg
    Kalmar County Hospital.
    Schalij, Martin J.
    Leiden University Medical Center, The Netherlands.
    Albertsson, Per
    Sahlgrenska University Hospital.
    Lagerqvist, Bo
    Uppsala University.
    Prognosis of elderly patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention in 2001 to 2011: a report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR) registry2014In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 167, no 5, 666-673 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Elderly patients constitute a growing part of the population presenting with ST-elevation myocardial infarction (STEMI). The use of primary percutaneous coronary intervention (PCI) in this high-risk population remains poorly investigated.

    METHODS: Using the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we identified consecutive patients with STEMI 80 years or older undergoing primary PCI during a 10-year period. Temporal trends in care and 1-year prognosis were investigated, and long-term outcome was compared with a reference group of patients with STEMI aged 70 to 79 years. Relative survival was calculated by dividing the observed survival rate with the expected survival rate of the general population. Adjusted end points were calculated using Cox regression.

    RESULTS: In total, 4,876 elderly patients with STEMI were included. During the study period, average age and presence of comorbidity increased, as well as the use of antithrombotic therapy. Procedural success remained constant. One-year mortality was exclusively reduced between the most recent vs the earliest cohort, whereas the risk of reinfarction, heart failure, stroke, and bleeding remained similar. The risk of death was higher for elderly patients early after PCI, after which the prognosis was slightly better compared with the general population. Long-term risk of adverse events increased markedly with age.

    CONCLUSIONS: The prognosis of patients older than 80 years treated with primary PCI for STEMI was relatively unchanged during the 10-year inclusion period, despite changes in patient characteristics and treatment. Advanced age increased the risk of adverse events, but survivors of the early phase after PCI had a slightly improved prognosis compared with the general population.

  • 50.
    Vellone, Ercole
    et al.
    Tor Vergata University, Rome, Italy.
    Jaarsma, Tiny
    University of Linköping.
    Strömberg, Anna
    University of Linköping.
    Fida, Roberta
    Sapienza University, Italy.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. University of Linköping.
    Rocco, Gennaro
    Center of Excellence for Nursing Scholarship, Italy.
    Cocchieri, Antonello
    Tor Vergata University, Italy.
    Alvaro, Rosaria
    Tor Vergata University, Italy.
    The European Heart Failure Self-care Behaviour Scale: new insights into factorial structure, reliability, precision and scoring procedure.2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 1, 97-102 p., S0738-3991(13)00367-4Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate a new factorial structure of the European Heart Failure Self-care Behaviour Scale 9-item version (EHFScBS-9), and to test its reliability, floor and ceiling effect, and precision. To propose a new 0-100 score with a higher score meaning better self-care.

    METHODS: A sample of 1192 Heart Failure (HF) patients (mean age 72 years, 58% male) was enrolled. Psychometric properties of the EHFScBS-9 were tested with confirmative factor analysis, factor score determinacy, determining the floor and ceiling effect, and evaluating the precision with the standard error of measurement (SEM) and the smallest real difference (SRD).

    RESULTS: We identified three well-fitting factors: consulting behaviour, autonomy-based adherence, and provider-based adherence (comparative fit index=0.96). Reliability ranged from 0.77 to 0.95. The EHFScBS-9 showed no floor and ceiling effect except for the provider-based adherence which had an expected ceiling effect. The SEM and the SRD indicated good precision of the EHFScBS-9.

    CONCLUSION: The new factorial structure of the EHFScBS-9 showed supportive psychometric properties.

    PRACTICE IMPLICATIONS: The EHFScBS-9 can be used to compute a total and specific scores for each identified factor. This may allow more detailed assessment and tailored interventions to improve self-care. The new score makes interpretation of the EHFScBS-9 easier.

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