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  • 1.
    Al-Dury, Nooraldeen
    et al.
    University of Gothenburg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping university, Sweden.
    Strömsöe, Anneli
    School of Health, Care and Social Welfare, Västerås, Sweden.
    Aune, Solveig
    Sahlgrenska University Hospital, Sweden.
    Agerström, Jens
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Ravn-Fischer, Annica
    University of Gothenburg, Sweden;Sahlgrenska University Hospital, Sweden.
    Herlitz, Johan
    University of Gothenburg, Sweden;Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest: A nationwide study with the emphasis on gender and age.2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 12, p. 1839-1844Article in journal (Refereed)
    Abstract [en]

    AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.

    METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.

    RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.

    CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.

  • 2.
    Andreae, Christina
    et al.
    Linköping University, Sweden;Uppsala University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Evangelista, Lorraine
    Univ Calif Irvine, USA.
    Strömberg, Anna
    Linköping University, Sweden;Univ Calif Irvine, USA.
    The relationship between physical activity and appetite in patients with heart failure: A prospective observational study2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 5, p. 410-417Article in journal (Refereed)
    Abstract [en]

    Introduction: Physical activity and appetite are important components for maintaining health. Yet, the association between physical activity and appetite in heart failure (HF) populations is not completely understood. The aim of the present study was to investigate the relationship between physical activity, functional capacity, and appetite in patients with HF. Methods: This was a prospective observational study. In total, 186 patients diagnosed with HF, New York Heart Association (NYHA) class II-IV (mean age 70.7, 30% female), were included. Physical activity was measured using a multi-sensor actigraph for seven days and with a self-reported numeric rating scale. Physical capacity was measured by the six-minute walk test. Appetite was measured using the Council on Nutrition Appetite Questionnaire. Data were collected at inclusion and after 18 months. A series of linear regression analyses, adjusted for age, NYHA class, and B-type natriuretic peptide were conducted. Results: At baseline, higher levels of physical activity and functional capacity were significantly associated with a higher level of appetite in the unadjusted models. In the adjusted models, number of steps (p = 0.019) and the six-minute walk test (p = 0.007) remained significant. At the 18-month follow-up, all physical activity variables and functional capacity were significantly associated with appetite in the unadjusted regression models. In the adjusted models, number of steps (p = 0.001) and metabolic equivalent daily averages (p = 0.040) remained significant. Conclusion: A higher level of physical activity measured by number of steps/day was associated with better self-reported appetite, both at baseline and the 18-month follow-up. Further research is needed to establish causality and explore the intertwined relationship between activity and appetite in patients with HF.

  • 3.
    Badimon, Lina
    et al.
    Hosp Santa Creu & Sant Pau, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    ESC Advocacy works!: Promoting cardiovascular health through public policy2019In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 40, no 14, p. 1097-1098Article in journal (Other academic)
  • 4.
    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.

  • 5.
    Borghi, Claudio
    et al.
    Univ Bologna, Italy.
    Rodriguez-Artalejo, Fernando
    Univ Autonoma Madrid, Spain;Inst Salud Carlos III, Spain;IMDEA, Spain;CEI UAM CSIC, Spain.
    De Backer, Guy
    Univ Ghent, Belgium.
    Dallongeville, Jean
    Univ Lille Nord France, France.
    Medina, Jesus
    AstraZeneca, Spain.
    Nuevo, Javier
    AstraZeneca, Spain.
    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.
    Banegas, Jose R.
    Univ Autonoma Madrid, Spain;Inst Salud Carlos III, Spain.
    Tubach, Florence
    Hop La Pitie Salpetriere, France;INSERM, France;Sorbonne Univ, France.
    Roy, Carine
    Hop Bichat Claude Bernard, France.
    Halcox, Julian P.
    Swansea Univ, UK.
    Serum uric acid levels are associated with cardiovascular risk score: A post hoc analysis of the EURIKA study2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 253, p. 167-173Article in journal (Refereed)
    Abstract [en]

    Background: Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk. Methods: This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients had at least one CV risk factor but no clinical CV disease. Ten-year risk of CV death was estimated using SCORE-HDL and SCORE algorithms, categorized as low (<1%), intermediate (1% to <5%), high (>5% to <10%) or very high (>10%). Results: Mean serum sUA levels increased significantly with increasing CV death risk category in the overall population and in subgroups stratified by diuretics use or renal function (all P < 0.0001). Multivariate ordinal logistic regression analyses, adjusted for factors significantly associated with CV death risk in univariate analyses (study country, body mass index, number of CV risk factors and comorbidities, use of lipid lowering therapies, antihypertensives and antidiabetics), showed a significant association between sUA levels and SCORE-HDL category in the overall population (OR: 1.39 [95% CI: 1.34-1.44]) and all subgroups (using diuretics: 1.32 [1.24-1.40]; not using diuretics: 1.46 [1.39-1.53]; estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m(2): 1.30 [1.22-1.38]; eGFR >= 60 ml/min/1.73 m(2): 1.44 [1.38-1.51]; all P < 0.0001). Similar results were obtained when using SCORE. Conclusions: Higher sUA levels are associated with progressively higher 10-year CV death risk score in patients with at least one CV risk factor but no CV disease. (c) 2017 Elsevier B.V. All rights reserved.

  • 6.
    Bremer, Anders
    et al.
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Vårdvetenskaplig analys: erfarenheter vid prehospitala hjärtstopp2016In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Lars Lundberg, Stockholm: Liber, 2016, 2, p. 345-349Chapter in book (Other academic)
  • 7.
    Bremer, Anders
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Dahné, Tova
    Uppsala University, Sweden;Linköping University, Sweden.
    Stureson, Lovisa
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Council, Sweden.
    Thylén, Ingela
    Linköping University, Sweden.
    Lived experiences of surviving in‐hospital cardiac arrest2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 1, p. 156-164Article in journal (Refereed)
    Abstract [en]

    Background

    Out‐of‐hospital cardiac arrest survivors suffer from psychological distress and cognitive impairments. They experience existential insecurity and vulnerability and are striving to return to a life in which well‐being and the meaning of life have partly changed. However, research highlighting the experiences of in‐hospital cardiac arrest survivors is lacking. This means that evidence for postresuscitation care has largely been extrapolated from studies on out‐of‐hospital cardiac arrest survivors, without considering potential group differences. Studies investigating survivors’ experiences of an in‐hospital cardiac arrest are therefore needed.

    Aim

    To illuminate meanings of people's lived experiences of surviving an in‐hospital cardiac arrest.

    Design

    An explorative, phenomenological hermeneutic method to illuminate meanings of lived experiences.

    Method

    Participants were identified through the Swedish national register of cardiopulmonary resuscitation and recruited from two hospitals. A purposive sample of eight participants, 53–99 years old, who survived an in‐hospital cardiac arrest 1–3 years earlier, was interviewed.

    Findings

    The survivors were striving to live in everyday life and striving for security. The struggle to reach a new identity meant an existence between restlessness and a peace of mind, searching for emotional well‐being and bodily abilities. The search for existential wholeness meant a quest for understanding and explanation of the fragmented cardiac arrest event and its existential consequences. The transition from hospital to home meant a transition from care and protection to uncertainty and vulnerability with feelings of abandonment, which called for a search for security and belonging, away from isolation and loneliness.

    Conclusion

    Surviving an in‐hospital cardiac arrest can be further understood by means of the concept of hospital‐to‐home transition. Following hospital discharge, patients felt vulnerable and abandoned when pending between denial and acceptance of the ‘new’ life. Hence, the healthcare system should play a significant role when it comes to facilitate cardiac arrest survivors’ security during hospital‐to‐home transition.

  • 8. 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, p. 107-113Article 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.

  • 9. 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)
  • 10.
    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 death2017In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 106, no Suppl 1, article id P1159Article in journal (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. 

  • 11.
    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.
    Two-peaked increase of serum myosin heavy chain-α after Ironman demonstrates heart muscle cell death2017In: Medicine & Science in Sports & Exercise, ISSN 0195-9131, E-ISSN 1530-0315, Vol. 47, no 5 Supplement 1, p. 186-, article id 734Article in journal (Other academic)
  • 12.
    Carlsson, Jörg
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Danielsson, Tom
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Schreyer, Hendrik
    Kalmar County Hospital.
    Echocardiographic Findings and Cardiac Biomarkers in Non-Elite Triathletes – Data from the Kalmar Ironwoman Study2018Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: There is an ongoing debate about the impact of endurance exercise on cardiovascular health. Not at least data on cardiac biomarker changes (e.g. troponin T (cTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and cardiac specific myosin heavy chain-alpha (MHC-α) have raised questions about exercise related cardiac injury. 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 a full Ironman distance triathlon (Swim 3.9 km, Bike 180 km, Run 42.2 km) . In 19 of these athletes (9 female, 10 male) echocardiography with 30 different standard measurements was performed before and directly after the race. RESULTS: Only MHC-α [µg/L] showed a two-peaked increase directly after (2.57 ± 0.78) and on day 4 (2.74 ± 0.55). 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). No significant echocardiographic changes were recorded. E.g. left ventricular end diastolic diameter (49.0 ± 4.7 mm before, 47.7 ± 5.0 mm after the race, right ventricular end diastolic diameter (34.3 ± 4.3 mm before, 33.3 ± 5.7 mm after the race), right atrial area (17.5 ± 2.9 cm2 before, 17.7 ± 3.6 cm2 after the race) and left atrial area (18.8 ± 3.7 cm2 before, 17.8 ± 2.2 cm2 after the race) did not show any significant acute changes. CONCLUSION: While an Ironman leads to remarkable disturbances in biomarkers as e.g. cTnT after the race was in the range of myocardial infarction in 100% of women and 97% of men, these alterations were not correlated to any acute echocardiographic changes in heart size or function. However, the significance of biochemical evidence of cardiac injury on long-term heart function and cardiovascular health remains unclear.

  • 13.
    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.

  • 14.
    Carlsson, Jörg
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden;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, Sweden.
    Schreyer, Hendrik
    Kalmar County Hospital, Sweden.
    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, article id 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.

  • 15.
    Claesson, Andreas
    et al.
    Karolinska Institutet, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Svensson, Leif
    Karolinska Institutet, Sweden.
    Ottosson, Linn
    Sahlgrenska University Hospital, Sweden.
    Bergfeldt, Lennart
    Sahlgrenska University Hospital, Sweden.
    Engdahl, Johan
    Karolinska Institutet, Sweden;Danderyd Hospital, Sweden.
    Ericson, Caroline
    Sahlgrenska University Hospital, Sweden.
    Sandén, Petra
    Sahlgrenska University Hospital, Sweden.
    Axelsson, Christer
    University of Borås, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Defibrillation before EMS arrival in western Sweden2017In: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 35, no 8, p. 1043-1048, article id 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.

  • 16. 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, p. 541-550Article 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.

  • 17.
    Danielsson, Tom
    et al.
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Schreyer, Hendrik
    Kalmar County Hospital, Sweden.
    Woksepp, Hanna
    Kalmar County Hospital, Sweden.
    Johansson, Therese
    Kalmar County Hospital, Sweden.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Månsson, Alf
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Carlsson, Jörg
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Two-peaked increase of serum myosin heavy chain-α after triathlon suggests heart muscle cell death2019In: BMJ Open Sport & Exercise Medicine, ISSN 2055-7647, Vol. 5, article id e000486Article in journal (Refereed)
    Abstract [en]

    Objective It has been suggested that the mechanism behind cardiac troponin elevation after strenuous exercise is passage through a cell membrane with changed permeability rather than myocardial cell death. We hypothesised that an increase of cardiac specific myosin heavy chain-alpha (MHC-α; 224 kDa compared with cardiac troponin T’s (cTnT) 37 kDa) could hardly be explained by passage through a cell membrane.

    Methods Blood samples were collected from 56 athletes (15 female, age 42.5±9.7, range 24–70 years) before, directly after and on days 1–8 after an Ironman. Biomarkers (C reactive protein (CRP), cTnT, creatinekinase (CK), MHC-α, myoglobin (MG), creatinine (C) and N-terminal prohormone of brain natriuretic peptide (NTproBNP) were measured.

    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 (130–17 000; ref.<72) and creatinine 100±20 μmol/L (74–161; ref.<100), CRP 49±23 mg/L(15–119; ref.<5).

    Conclusion MHC-α exhibited a two-peaked increase which could represent a first release from the cytosolic pool and later from cell necrosis. This is the first investigation of MHC-α plasma concentration afterexercise.

  • 18. 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, p. 299-300Article in journal (Other academic)
  • 19. 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, p. 6-8Article in journal (Other academic)
  • 20.
    Djarv, T.
    et al.
    Karolinska University Hospital, Sweden;Karolinska Institutet, Sweden.
    Axelsson, C.
    University of Borås, Sweden.
    Herlitz, J.
    Karolinska Institutet, Sweden;University of Borås, Sweden.
    Stromsoe, A.
    Mälardalen University, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Claesson, A.
    Karolinska Institutet, Sweden;University of Borås, Sweden.
    Traumatic cardiac arrest in Sweden 1990-2016: a population-based national cohort study2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, article id 30Article in journal (Refereed)
    Abstract [en]

    Background: Trauma is a main cause of death among young adults worldwide. Patients experiencing a traumatic cardiac arrest (TCA) certainly have a poor prognosis but population-based studies are sparse. Primarily to describe characteristics and 30-day survival following a TCA as compared with a medical out-of-hospital cardiac arrest (medical CA). Methods: A cohort study based on data from the nationwide, prospective population-based Swedish Registry for Cardiopulmonary Resuscitation (SRCR), a medical cardiac arrest registry, between 1990 and 2016. The definition of a TCA in the SRCR is a patient who is unresponsive with apnoea where cardiopulmonary resuscitation and/or defibrillation have been initiated and in whom the Emergency Medical Services (EMS, mainly a nurse-based system) reported trauma as the aetiology. Outcome was overall 30-day survival. Descriptive statistics as well as multivariable logistic regression models were used. Results: In all, between 1990 and 2016, 1774 (2.4%) cases had a TCA and 72,547 had a medical CA. Overall 30-day survival gradually increased over the years, and was 3.7% for TCAs compared to 8.2% following a medical CA (p < 0.01). Among TCAs, factors associated with a higher 30-day survival were bystander witnessed and having a shockable initial rhythm (adjusted OR 2.67, 95% C.I. 1.15-6.22 and OR 8.94 95% C.I. 4.27-18.69, respectively). Discussion: Association in registry-based studies do not imply causality but TCA had short time intervals in the chain of survival as well as high rates of bystander-CPR. C onclusion: In a medical CA registry like ours, prevalence of TCAs is low and survival is poor. Registries like ours might not capture the true incidence. However, many individuals do survive and resuscitation in TCAs should not be seen futile.

  • 21.
    Djärv, Therese
    et al.
    Karolinska Institutet, Sweden.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    University of Gothenburg, Sweden.
    Israelsson, Johan
    Kalmar County Hospital, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Rawshani, Araz
    University of Gothenburg, Sweden.
    Årestedt, Kristofer
    Region Kalmar County, Sweden.
    Health related quality of life after surviving an out-of-hospital compared to an in-hospital cardiac arrest: a national population-based Swedish cohort study2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 142, no s1, p. e27-e27Article in journal (Refereed)
  • 22.
    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, article id 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.

  • 23.
    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, p. 87-93Article 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.

  • 24.
    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, p. 1453-1460Article 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.

  • 25.
    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, p. 1813-1823Article 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.

  • 26.
    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, article id 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.

  • 27.
    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, p. 1-129Article 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.

  • 28.
    Hedberg, Berith
    et al.
    Jönköping University;Region Jönköpings län.
    Malm, Dan
    Jönköping University;Ryhov County Hospital.
    Karlsson, Jan-Erik
    Jönköping University;Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Broström, Anders
    Jönköping University;Linköping University.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    AIM: The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    METHODS: A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale-Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    RESULTS: Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    CONCLUSION: Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 29. 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)
  • 30.
    Herlitz, Johan
    et al.
    University of Borås, Sweden;Västra Götalandsregionen, Sweden.
    Ravn-Fischer, Annica
    Sahlgrenska universitetssjukhuset, Sweden.
    Svensson, Leif
    Karolinska institutetet, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Bång, Angela
    University of Borås, Sweden.
    Circulation: Bröstsmärtor2016In: Prehospital Akutsjukvård, Liber, 2016, 2, p. 308-321Chapter in book (Other academic)
  • 31.
    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, p. 295-304Chapter in book (Other academic)
  • 32.
    Holmberg, Mats
    et al.
    Sörmland County Council, Sweden;Mälardalen University, Sweden;University of Borås, Sweden.
    Andersson, Henrik
    University of Borås, Sweden.
    Winge, Karin
    South Älvsborgs Hospital, Sweden.
    Lundberg, Camilla
    South Älvsborgs Hospital, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Wireklint Sundström, Birgitta
    University of Borås, Sweden.
    Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome2018In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 18, p. 1-10, article id 216Article in journal (Refereed)
    Abstract [en]

    Background: To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital. 

    Methods: Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain 4 on the visual analogue scale. 

    Results: All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results. 

    Conclusion: The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.

  • 33.
    Holmgren, Christina M.
    et al.
    University of Gothenburg, Sweden;County Hospital Ryhov, Sweden.
    Abdon, Nils J.
    Hudiksvall Hospital, Sweden.
    Bergfeldt, Lennart B.
    University of Gothenburg, Sweden.
    Edvardsson, Nils G.
    University of Gothenburg, Sweden.
    Herlitz, Johan D.
    University of Borås, Sweden;Sahlgrenska University Hospital, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Svensson, Leif G.
    Karolinska Institutet, Sweden.
    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, p. 497-503Article 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.

  • 34.
    Instenes, Irene
    et al.
    Haukeland Hosp, Norway.
    Fridlund, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Haukeland Hosp, Norway.
    Amofah, Hege A.
    Haukeland Hosp, Norway.
    Ranhoff, Anette H.
    Univ Bergen, Norway.
    Eide, Leslie S. P.
    Western Norway Univ Appl Sci, Norway.
    Norekval, Tone M.
    Haukeland Hosp, Norway;Univ Bergen, Norway;Western Norway Univ Appl Sci, Norway.
    'I hope you get normal again': an explorative study on how delirious octogenarian patients experience their interactions with healthcare professionals and relatives after aortic valve therapy2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 3, p. 224-233Article in journal (Refereed)
    Abstract [en]

    Background: Delirium affects nearly half of octogenarian patients after aortic valve replacement, resulting in impaired cognition, reduced awareness and hallucinations. Although healthcare professionals and relatives are often present during episodes, the nature of interactions with them is scarcely studied, and little is known about their long-term experiences. Purpose: The purpose of this study was to explore and describe how octogenarian patients with post-aortic valve replacement delirium experience interactions with healthcare professionals and relatives within the first year and four years later. Method: An explorative design with qualitative content analysis was used. Delirium was assessed for five consecutive days after aortic valve replacement using the Confusion Assessment Method. Delirious patients (n=10) were interviewed 6-12 months post-discharge and four years later (n=5). We used an inductive approach to identify themes in transcribed interviews. Findings: An overarching theme emerged: 'Healthcare professionals' and relatives' responses made a considerable impact on the delirium experience postoperatively and in a long-term'. Three sub-themes described the patients' experiences: 'the need for close supportive care', 'disrespectful behaviour created a barrier' and 'insensitive comments made lasting impressions'. Having healthcare professionals and relatives nearby made the patients feel secure, while lack of attention elevated patients' emotional distress. Four years later, patients clearly recalled negative comments and unsupportive actions in their delirious state. Conclusions: Healthcare professionals and relatives have an essential role in the aortic valve replacement recovery process. Inconsiderate behaviour directed at older patients in delirium elevates distress and has long-term implications. Supportive care focused on maintaining the patients' dignity and integrity is vital.

  • 35.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Bremer, Anders
    University of Borås, Sweden;Kalmar County Hospital, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    Axelsson, Åsa B.
    University of Gothenburg, Sweden.
    Cronberg, Tobias
    Lund University, Sweden.
    Djärv, Therese
    Karolinska Institutet, Sweden;Karolinska University Hospital, Sweden.
    Kristofferzon, Marja-Leena
    University of Gävle, Sweden;Uppsala University, Sweden.
    Larsson, Ing-Marie
    Uppsala University, Sweden.
    Lilja, Gisela
    Lund University, Sweden.
    Sunnerhagen, Katharina S.
    University of Gothenburg, Sweden.
    Wallin, Ewa
    Uppsala University, Sweden.
    Ågren, Susanna
    Linköping University, Sweden;County Council of Östergötland, Sweden.
    Åkerman, Eva
    Skåne University Hospital, Sweden;Karolinska Institutet, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Ersta Sköndal Bräcke University College, Sweden;Kalmar County Hospital, Sweden.
    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, p. 27-33Article 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.

  • 36.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy.
    Bremer, Anders
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    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.

  • 37.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Sweden.
    Bremer, Anders
    University of Borås, Sweden.
    Herlitz, Johan
    University of Borås, Sweden.
    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, article id 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.

  • 38.
    Israelsson, Johan
    et al.
    Linnaeus University, Faculty of Technology, Kalmar Maritime Academy. Kalmar County Hospital, Sweden;Linköping University, Sweden.
    Persson, Carina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Strömberg, Anna
    Linköping University, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Region Kalmar County, Sweden.
    Dyadic effects of type D personality and perceived control on health-related quality of life in cardiac arrest survivors and their spouses using the actor–partner interdependence model2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: There is a lack of knowledge about factors associated with health-related quality of life in cardiac arrest survivors and their spouses. In addition, survivors and spouses are likely to affect each other’s health-related quality of life.

    Aims: The aim was to investigate if a distressed personality and perceived control among cardiac arrest survivors and their spouses were associated with their own and their partner’s health-related quality of life.

    Methods: This dyadic cross-sectional study used the actor–partner interdependence model to analyse associations between a distressed personality (type D personality), perceived control (control attitudes scale), and health-related quality of life (EQ index and EQ visual analogue scale).

    Results: In total, 126 dyads were included in the study. Type D personality and perceived control in cardiac arrest survivors were associated with their own health-related quality of life. In their spouses, a significant association was found for type D personality but not for perceived control. In addition, type D personality and perceived control in survivors were associated with health-related quality of life in their spouses.

    Conclusions: Type D personality and perceived control are factors that might be considered during post cardiac arrest, because of the associations with health-related quality of life in survivors and spouses. More research is needed to test psychosocial interventions in the cardiac arrest population in order to improve health-related quality of life.

  • 39.
    Israelsson, Johan
    et al.
    Kalmar County Hospital, Sweden.
    von Wangenheim, Burkard
    Kalmar County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Semark, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Schildmeijer, Kristina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Carlsson, Jörg
    Kalmar County Hospital, Sweden.
    Sensitivity and specificity of two different automated external defibrillators used in-hospital and out-of-hospital2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Supplement 1, p. 23-23, article id AS041Article in journal (Other academic)
    Abstract [en]

    Purpose: To investigate the performance of two different types of automated external defibrillators (AED) in out-of-hospital and in-hospital cardiac pulmonary resuscitation (CPR). Performance criteria in terms of sensitivity and specificity have been established but real life data are sparse.

    Materials and methods: Three investigators reviewed 2938 rhythm analyses performed by AED in 240 consecutive patients (38.3% women) suffering cardiac arrest between January 2011 and March 2015. The mean age was 70.1 ± 17.0 (3 months–104 years). Two different AED were used (AED A n = 105, AED B n = 135) in-hospital (n = 91) and out-of-hospital (n = 149).

    Results: Among 194 shockable rhythms, 17 (8.8%) were not recognized by AED A, while AED B recognized 100% (n = 135) of shockable episodes (p < 0.001). In AED A, 8 (47.1%) of these episodes were judged to be algorithm errors while 9 (52.9%) were caused by external artifacts. Among 1039 non-shockable rhythms, AED A recommended shock in 11 (1.0%), while AED B recommended shock in 63 (4.1%) of 1523 episodes (p < 0.001). In AED A, 2 (18.2%) of these episodes were judged to be algorithm errors (AED B, n = 40, 63.5%) while 9 (81.8%) were caused by external artifacts (AED B, n = 23, 36.5%). Fine ventricular fibrillation was analyzed as a separate category since guidelines do not recommend shock in these cases. AED A advised shock in 24 (80%) of 30 episodes, while AED B advised shock in 8 (47%) of 17 episodes (p < 0.027).

    Conclusions: Significant differences in performance could be detected between two different AED. A higher sensitivity of AED B was associated with a lower specificity while a higher specificity of AED A was associated with a lower sensitivity. Caregivers should be aware of the specific shortcomings of the device they are using. AED manufacturers should try to improve the algorithms in order to minimize the gap between sensitivity and specificity.

  • 40. 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, p. S115-Conference paper (Refereed)
  • 41.
    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, p. S15-S15Article in journal (Other academic)
  • 42.
    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, p. 2766-2771Article 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.

  • 43.
    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, article id 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.

  • 44.
    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, p. 73-83Article 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.

  • 45.
    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, p. 3622-3632Article 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.

  • 46.
    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, p. 1111-1120Article 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.

  • 47.
    Liljeroos, Maria
    et al.
    Linköping University;Uppsala University.
    Strömberg, Anna
    Linköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University;Kalmar County Council.
    Chung, Misook L.
    Univ Kentucky, USA.
    Mediation effect of depressive symptoms in the relationship between perceived control and wellbeing in patients with heart failure and their partners2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 527-534Article in journal (Refereed)
    Abstract [en]

    Background: As treatment has improved, patients with heart failure live longer, and the care mostly takes place at home with partners providing the main assistance. Perceived control over heart failure is important in managing self-care activities to maintain health in patients and their family. Depressive symptoms are associated with impaired health status in patients with heart failure and their family. However, there is limited knowledge about how depressive symptoms affect the relationship between health status and perceived control over heart failure in patients with heart failure and their cohabiting partners. Aim: The aim of this study was to examine whether the relationship between perceived control and health status (i.e. mental and physical) was mediated by depressive symptoms in patients with heart failure and their partners. Methods: In this secondary data analysis, we included 132 heart failure patients and 132 partners who completed measures of depressive symptoms (the Beck depression inventory II), perceived control (the control attitude scale), and physical and mental health status (the short form-36) instruments. The mediation effect of depression was examined using a series of multiple regression in patients and their family caregivers separately. Results: We found a mediator effect of depressive symptoms in the relationship between perceived control and mental health status in both patients and partners. The relationship between perceived control and physical health status was mediated by depressive symptoms in the patients, not in the partners. Conclusion: Efforts to improve self-care management and maintenance by targeting perceived control may be more effective if depressive symptoms are also effectively managed.

  • 48.
    Lin, Chung-Ying
    et al.
    Hong Kong Univ Sci & Technol, Peoples Republic of China.
    Pakpour, Amir H.
    Qazvin Univ Med Sci, Iran;Jönköping University.
    Brostrom, Anders
    Jönköping University.
    Fridlund, Bengt
    Jönköping University.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköping University.
    Strömberg, Anna
    Linköping University.
    Jaarsma, Tiny
    Linköping University;ACU, Mary MacKillop Inst Hlth Res, Australia.
    Martensson, Jan
    Jönköping University.
    Psychometric Properties of the 9-item European Heart Failure Self-care Behavior Scale Using Confirmatory Factor Analysis and Rasch Analysis Among Iranian Patients2018In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Background: The 9-item European Heart Failure Self-Care Behavior scale (EHFScB-9) is a self-reported questionnaire commonly used to capture the self-care behavior of people with heart failure (HF). Objective: The aim of this study was to investigate the EHFScB-9's factorial structure and categorical functioning of the response scale and differential item functioning (DIF) across subpopulations in Iran. Methods: Patients with HF (n = 380; 60.5% male; mean [SD] age, 61.7 [9.1] years) participated in this study. The median (interquartile range) of the duration of their HF was 6.0 (2.4-8.8) months. Most of the participants were in New York Heart Association classification II (NYHA II, 61.8%); few of them had left ventricular ejection fraction assessment (11.3%). All participants completed the EHFScB-9. Confirmatory factor analysis was used to test the factorial structure of the EHFScB-9; Rasch analysis was used to analyze categorical functioning and DIF items across 2 characteristics (gender and NYHA). Results: The 2-factor structure ("adherence to regimen" and "consulting behavior") of the EHFSCB-9 was confirmed, and the unidimensionality of each factor was found. Categorical functioning was supported for all items. No items displayed substantial DIF across gender (DIF contrast, -0.25-0.31). Except for item 3 ("Contact doctor or nurse if legstfeet are swollen"; DIF contrast, -0.69), no items displayed substantial DIF across NYHA classes (DIF contrast, -0.40 to 0.47). Conclusions: Despite the DIF displayed in 1 item across the NYHA classes, the EHFScB-9 demonstrated sound psychometric properties in patients with HF.

  • 49.
    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)
  • 50.
    Lindow, Thomas
    et al.
    Region Kronoberg, Sweden;Lund University, Sweden.
    Kron, Josefine
    Region Kronoberg, Sweden.
    Thulesius, Hans
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kronoberg, Sweden.
    Ljungström, Erik
    Region Skåne, Sweden.
    Pahlm, Olle
    Lund University, Sweden.
    Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 37, no 4, p. 426-433Article in journal (Refereed)
    Abstract [en]

    Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis. Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter. Setting: Primary health care in Region Kronoberg, Sweden. Subjects: All adult patients who had an ECG recorded between January 2016 and June 2016 with a computer statement including the words 'atrial fibrillation' or 'atrial flutter'. Main outcome measures: Number of incorrect computer interpretations of atrial fibrillation or atrial flutter; rate of correction by the interpreting primary care physician; consequences of misdiagnosis of atrial fibrillation or atrial flutter. Results: Among 988 ECGs with a computer diagnosis of atrial fibrillation or atrial flutter, 89 (9.0%) were incorrect, among which 36 were not corrected by the interpreting physician. In 12 cases, misdiagnosed atrial fibrillation/flutter led to inappropriate treatment with anticoagulant therapy. A larger proportion of atrial flutters, 27 out of 80 (34%), than atrial fibrillations, 62 out of 908 (7%), were incorrectly diagnosed by the computer. Conclusions: Among ECGs with a computer-based diagnosis of atrial fibrillation or atrial flutter, the diagnosis was incorrect in almost 10%. In almost half of the cases, the misdiagnosis was not corrected by the overreading primary-care physician. Twelve patients received inappropriate anticoagulant treatment as a result of misdiagnosis.

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