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  • 1. Agewall, Stefan
    et al.
    Rydén, Lars
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rosengren, Annika
    Boman, Kurt
    Hellénius, Mai-Lis
    Ros, Inger
    Efterlyses: politik mot hjärtinfarkt2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 13-14, p. 664-664Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Medicinen kommer inte så mycket längre när det gäller att minska dödligheten i hjärt–kärlsjukdomar. Framtidens utmaning ligger i att förhindra att människor alls insjuknar i hjärtinfarkt. Författarna efterlyser politiska åtgärder som gör de hälsosamma valen billiga och attraktiva.

  • 2. Banegas, José R
    et al.
    López-García, Esther
    Dallongeville, Jean
    Guallar, Eliseo
    Halcox, Julian P
    Borghi, Claudio
    Massó-González, Elvira L
    Sazova, Ogün
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Steg, Philippe Gabriel
    De Backer, Guy
    Rodríguez-Artalejo, Fernando
    Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. The EURIKA study.2013In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 166, no 1, p. 210-214Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. METHODS: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥50years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥2 additional major cardiovascular risk factors). RESULTS: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol<70mg/dl, non-HDL-cholesterol<100mg/dl, and apolipoprotein B<80mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol<100mg/dl, non-HDL-cholesterol<130mg/dl, and apolipoprotein B<90mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. CONCLUSION: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.

  • 3. Bax, Jeroen J
    et al.
    Casadei, Barbara
    Di Mario, Carlo
    Fagard, Robert
    Filippatos, Gerasimos
    Fox, Keith A
    Metra, Marco
    Nihoyannopoulos, Petros
    Perk, Joep
    University of Kalmar, School of Human Sciences.
    Rademakers, Frank
    Rosenhek, Raphael
    Vardas, Panos E
    Pinto, Fausto J
    Ferrari, Roberto
    Highlights of the 2009 scientific sessions of the European Society of Cardiology (Open Access)2009In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 54, no 25, p. 2447-2458Article in journal (Refereed)
  • 4.
    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.

  • 5.
    Borghi, Claudio
    et al.
    University of Bologna, Italy.
    Rodriguez-Artalejo, Fernando
    Univ Autonoma Madrid IdiPaz, Spain ; Inst Salud Carlos III, Spain.
    De Backer, Guy
    Univ Ghent, Belgium.
    Dallongeville, Jean
    Univ Lille Nord France, France.
    Medina, Jesús
    AstraZeneca Farmaceut Spain, Spain.
    Guallar, Eliseo
    Johns Hopkins Bloomberg Sch Publ Hlth, USA ; Johns Hopkins Bloomberg Sch Publ Hlth, USA.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Banegas, José R.
    Univ Autonoma Madrid IdiPaz, Spain ; Inst Salud Carlos III, Spain.
    Tubach, Florence
    Hop Bichat Claude Bernard, France ; ECEVE, France ; Univ Paris Diderot, France.
    Roy, Carine
    Hop Bichat Claude Bernard, France ; ECEVE, France ; Hop Bichat Claude Bernard, France.
    Halcox, Julian P.
    Swansea Univ, UK.
    The association between blood pressure and lipid levels in Europe: European study on cardiovascular risk prevention and management in usual daily practice2016In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 34, no 11, p. 2155-2163Article in journal (Refereed)
    Abstract [en]

    Objectives:Several studies have suggested a positive association between serum lipid levels and blood pressure (BP). This study investigated this association in a large population from 12 European countries.Methods:Data were taken from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (ClinicalTrials.gov identifier: NCT00882336). Associations between BP and lipid levels in patients free from cardiovascular disease and with at least one major cardiovascular disease risk factor (N=7641) were assessed using linear regression analyses.Results:Overall, 72.8 and 64.8% of patients had hypertension and dyslipidaemia, respectively; 47.0% had both conditions. Regression coefficients (95% confidence interval) for the associations of LDL cholesterol, non-HDL cholesterol, total cholesterol and apolipoprotein B levels with SBP, adjusted for age, sex and BMI, were 0.93mmHg/mmol per l (0.54-1.31), 1.07mmHg/mmol per l (0.73-1.40), 1.02mmHg/mmol per l (0.69-1.35) and 4.94mmHg/g per l (3.43-6.46), respectively. The corresponding values (95% confidence interval) for the associations with DBP were 0.96mmHg/mmol per l (0.73-1.19), 0.95mmHg/mmol per l (0.75-1.15), 0.87mmHg/mmol per l (0.67-1.07) and 4.33mmHg/g per l (3.42-5.23), respectively. Most of these associations remained significant whether patients were treated with statins or not.Conclusion:Small but statistically significant associations between lipid levels and BP were observed in a large, multinational European population. Further research is warranted to assess the causality of this association and its implications on the management of patients with both hypertension and dyslipidaemia.

  • 6.
    Borghi, Claudio
    et al.
    Univ Bologna, Italy.
    Tubach, Florence
    Hop Bichat Claude Bernard, France ; Univ Paris Diderot, France.
    De Backer, Guy
    Univ Ghent, Belgium.
    Dallongeville, Jean
    Univ Lille Nord France, France.
    Guallar, Eliseo
    Johns Hopkins Bloomberg Sch Publ Hlth, USA ; Natl Ctr Cardiovasc Res, Spain.
    Medina, Jesus
    AstraZeneca, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Roy, Carine
    Hop Bichat Claude Bernard, France.
    Banegas, Jose R.
    Univ Autonoma Madrid IdiPaz, Spain ; CIBER Epidemiol & Publ Hlth CIBERESP, Spain.
    Rodriguez-Artalejo, Fernando
    Univ Autonoma Madrid IdiPaz, Spain ; CIBER Epidemiol & Publ Hlth CIBERESP, Spain.
    Halcox, Julian P.
    Swansea Univ, UK.
    Lack of control of hypertension in primary cardiovascular disease prevention in Europe: Results from the EURIKA study2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 218, p. 83-88Article in journal (Refereed)
    Abstract [en]

    Background: The prevalence of and factors associated with uncontrolled hypertension and apparent resistant hypertension were assessed in the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; NCT00882336). Methods: EURIKA was a cross-sectional observational study including patients being treated for the primary prevention of cardiovascular disease in 12 European countries. Patients were assessed if they were being treated for hypertension (N = 5220). Blood pressure control was defined according to European guidelines, with sensitivity analysis taking account of patients' age and diabetes status. Associated factors were assessed using multivariate analysis. Results: In the primary analysis, a total of 2691 patients (51.6%) had uncontrolled hypertension. Factors significantly associated with an increased risk of having uncontrolled hypertension included female sex (odds ratio [OR]: 2.29; 95% confidence interval [CI]: 1.93-2.73), body mass index (BMI; OR per kg/m(2): 1.03; 95% CI: 1.01-1.04), and geographic location. A total of 749 patients (14.3%) had apparent resistant hypertension. Factors significantly associated with an increased risk of having apparent resistant hypertension included BMI (OR per kg/m(2): 1.06; 95% CI: 1.04-1.08), diabetes (OR: 1.28; 95% CI: 1.06-1.53), use of statins (OR: 1.36; 95% CI: 1.15-1.62), serum uric acid levels (OR: 1.16; 95% CI: 1.09-1.23), and geographic location. Similar results were seen in sensitivity analyses. Conclusions: Over 50% of patients treated for hypertension continued to have uncontrolled blood pressure and 14.3% had apparent resistant hypertension. Positive associations were seen with other cardiovascular risk factors. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 7. 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)
  • 8. Carlsson, R.
    et al.
    Burell, G.
    Hambraeus, K.
    Johansson, P.
    Lisspers, J.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    The challenge of lifestyle counselling after percutaneous coronary intervention2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, p. 560-560Article in journal (Other academic)
  • 9. Dallongeville, Jean
    et al.
    Banegas, José R
    Tubach, Florence
    Guallar, Eliseo
    Borghi, Claudio
    De Backer, Guy
    Halcox, Julian P J
    Massó-González, Elvira L
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Sazova, Ogün
    Steg, Philippe Gabriel
    Artalejo, Fernando Rodriguez
    Survey of physicians' practices in the control of cardiovascular risk factors: the EURIKA study.2012In: European journal of preventive cardiology, ISSN 2047-4881, Vol. 19, no 3, 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.

  • 10. De Backer, G.
    et al.
    Catapano, A. L.
    Chapman, J.
    Graham, I.
    Reiner, Z.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wiklund, O.
    Guidelines on CVD prevention: Confusing or complementary?2013In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 226, no 1, p. 299-300Article in journal (Other academic)
  • 11. De Backer, Guy
    et al.
    Catapano, Alberico L
    Chapman, John
    Graham, Ian
    Reiner, Zeljko
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Wiklund, Olov
    Guidelines on CVD prevention: confusing or complementary?2013In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 20, no 1, p. 6-8Article in journal (Other academic)
  • 12.
    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.

  • 13.
    Guallar, Eliseo
    et al.
    Johns Hopkins Bloomberg School of Public Health, USA ; Johns Hopkins School of Medicine, USA ; Johns Hopkins Medical Institutions, USA ; National Center for Cardiovascular Research (CNIC), Spain.
    Banegas, José R.
    Universidad Autónoma de Madrid, Spain ; Instituto de Salud Carlos III, Spain.
    Blasco-Colmenares, Elena
    Johns Hopkins Bloomberg School of Public Health, USA.
    Jimenez, Javier F
    AstraZeneca Europe, -.
    Dalongeville, Jean
    Institut Pasteur de Lille, France.
    Halcox, Julian P
    Cardiff University, Walws.
    Borghi, Claudio
    University of Bologna, Italy.
    Massó-González, Elvira L
    AstraZeneca Farmacéutica Spain, Spain.
    Tafalla, Mónica
    AstraZeneca Farmacéutica Spain, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    De Backer, Guy
    University of Gent, Belgium.
    Steg, Phiilippe G
    Assistance Publique-Hôpitaux de Paris, France ; Paris Diderot University, France.
    Rodriquez-Artalejo, Fernando
    Universidad Autónoma de Madrid, Spain ; CIBER of Epidemiology and Public Health, Spain.
    Excess risk attributable to traditional cardiovascular risk factors in clinical practice settings across Europe: The EURIKA Study2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 18, no 11, article id 704Article in journal (Refereed)
    Abstract [en]

    Background

    Physicians involved in primary prevention are key players in CVD risk control strategies, but the expected reduction in CVD risk that would be obtained if all patients attending primary care had their risk factors controlled according to current guidelines is unknown. The objective of this study was to estimate the excess risk attributable, firstly, to the presence of CVD risk factors and, secondly, to the lack of control of these risk factors in primary prevention care across Europe.

    Methods

    Cross-sectional study using data from the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA), which involved primary care and outpatient clinics involved in primary prevention from 12 European countries between May 2009 and January 2010. We enrolled 7,434 patients over 50 years old with at least one cardiovascular risk factor but without CVD and calculated their 10-year risk of CVD death according to the SCORE equation, modified to take diabetes risk into account.

    Results

    The average 10-year risk of CVD death in study participants (N = 7,434) was 8.2%. Hypertension, hyperlipidemia, smoking, and diabetes were responsible for 32.7 (95% confidence interval 32.0-33.4), 15.1 (14.8-15.4), 10.4 (9.9-11.0), and 16.4% (15.6-17.2) of CVD risk, respectively. The four risk factors accounted for 57.7% (57.0-58.4) of CVD risk, representing a 10-year excess risk of CVD death of 5.66% (5.47-5.85). Lack of control of hypertension, hyperlipidemia, smoking, and diabetes were responsible for 8.8 (8.3-9.3), 10.6 (10.3-10.9), 10.4 (9.9-11.0), and 3.1% (2.8-3.4) of CVD risk, respectively. Lack of control of the four risk factors accounted for 29.2% (28.5-29.8) of CVD risk, representing a 10-year excess risk of CVD death of 3.12% (2.97-3.27).

    Conclusions

    Lack of control of CVD risk factors was responsible for almost 30% of the risk of CVD death among patients participating in the EURIKA Study.

  • 14. Halcox, J.
    et al.
    Banegas, J. R.
    Dallongeville, J.
    Backer, G. D.
    Guallar, E.
    Masso-Gonzalez, E. L.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Rodriguez Artalejo, F.
    Steg, P. G.
    Tubach, F.
    Borghi, C.
    PREVALENCE OF ELEVATED C-REACTIVE PROTEIN LEVELS IN A PRIMARY CVD PREVENTION POPULATION IN EUROPE: THE EURIKA STUDY2011In: Atherosclerosis Supplements, ISSN 1567-5688, E-ISSN 1878-5050, Vol. 12, no 1, p. 103-103Article in journal (Other academic)
  • 15. Halcox, J. P. J.
    et al.
    Tubach, F.
    Banegas, J. R.
    Borghi, C.
    Dallongeville, J.
    De Backer, G.
    Guallar, E.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Steg, P. G.
    Rodriguez-Artalejo, F.
    Reclassification of cardiovascular risk in Europe: application of the updated Systematic COronary Risk Evaluation (SCORE) algorithm incorporating high-density lipoprotein levels2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no S1, p. 1060-1060Article in journal (Other academic)
  • 16. Halcox, J. P. J.
    et al.
    Tubach, F.
    Banegas, J. R.
    Borghi, C.
    Dallongeville, J.
    De Backer, G.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Steg, P. G.
    Rodriguez-Artalejo, F.
    Guallar, E.
    Use of lipid lowering therapy in primary care across Europe: results from the European study on cardiovascular risk prevention in daily practice (eurika)2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no S1, p. 810-810Article in journal (Other academic)
  • 17.
    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.

  • 18.
    Halcox, Julian P. J.
    et al.
    Cardiff University, Wales ; Swansea University College of Medicine, UK.
    Roy, Carine
    Assistance Publique - Hôpitaux de Paris, France.
    Tubach, Florence
    Assistance Publique - Hôpitaux de Paris, France ; Paris Diderot University, France.
    Banegas, Jose R.
    Universidad Autónoma de Madrid, Spain ; Biomedical Research Networking Center for Epidemiology and Public Health (CIBERESP), Spain.
    Dallongeville, Jean
    Institut Pasteur de Lille, France.
    De Backer, Guy
    University of Ghent, Belgium.
    Guallar, Eliseo
    Johns Hopkins Bloomberg School of Public Health, USA ; National Center for Cardiovascular Research, Spain.
    Sazova, Oguen
    AstraZeneca Global Medical Affairs, -.
    Medina, Jesus
    AstraZeneca Farmaceutica Holding Spain, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Steg, Philippe Gabriel
    Paris Diderot University, France ; Hôpital Bichat-Claude Bernard, France.
    Rodriguez-Artalejo, Fernando
    Universidad Autónoma de Madrid, Spain.
    Borghi, Claudio
    University of Bologna, Italy.
    C-reactive protein levels in patients at cardiovascular risk: EURIKA study2014In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 14, article id 25Article in journal (Refereed)
    Abstract [en]

    Background: Elevated C-reactive protein (CRP) levels are associated with high cardiovascular risk, and might identify patients who could benefit from more carefully adapted risk factor management. We have assessed the prevalence of elevated CRP levels in patients with one or more traditional cardiovascular risk factors. Methods: Data were analysed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials. gov Identifier: NCT00882336), which included patients (aged = 50 years) from 12 European countries with at least one traditional cardiovascular risk factor but no history of cardiovascular disease. Analysis was also carried out on the subset of patients without diabetes mellitus who were not receiving statin therapy. Results: In the overall population, CRP levels were positively correlated with body mass index and glycated haemoglobin levels, and were negatively correlated with high- density lipoprotein cholesterol levels. CRP levels were also higher in women, those at higher traditionally estimated cardiovascular risk and those with greater numbers of metabolic syndrome markers. Among patients without diabetes mellitus who were not receiving statin therapy, approximately 30% had CRP levels >= 3 mg/ L, and approximately 50% had CRP levels = 2 mg/ L, including those at intermediate levels of traditionally estimated cardiovascular risk. Conclusions: CRP levels are elevated in a large proportion of patients with at least one cardiovascular risk factor, without diabetes mellitus who are not receiving statin therapy, suggesting a higher level of cardiovascular risk than predicted according to conventional risk estimation systems.

  • 19.
    Halcox, Julian P.
    et al.
    Swansea University College of Medicine, UK.
    Tubach, Florence
    INSERM, France ; Paris Diderot University, France.
    Lopez-Garcia, Esther
    Universidad Autónoma de Madrid, Spain ; CIBERESP, Spain.
    De Backer, Guy
    University of Ghent, Belgium.
    Borghi, Claudio
    University of Bologna, Italy.
    Dallongeville, Jean
    Université Lille-Nord de France, France.
    Guallar, Eliseo
    Johns Hopkins Bloomberg School of Public Health, USA ; National Center for Cardiovascular Research, Spain.
    Medina, Jesús
    AstraZeneca Farmacéutica Spain, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sazova, Oguen
    AstraZeneca Global Medical Affairs, UK.
    Sweet, Stephen
    Oxford PharmaGenesis Ltd, UK.
    Roy, Carine
    INSERM, France ; Hôpital Bichat-Claude Bernard, France.
    Banegas, José R.
    Universidad Autónoma de Madrid, Spain ; CIBERESP, Spain.
    Rodriguez-Artalejo, Fernando
    Universidad Autónoma de Madrid, Spain ; CIBERESP, Spain.
    Low Rates of Both Lipid-Lowering Therapy Use and Achievement of Low-Density Lipoprotein Cholesterol Targets in Individuals at High-Risk for Cardiovascular Disease across Europe2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 2, article id e0115270Article in journal (Refereed)
    Abstract [en]

    Aims To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe. Methods and Results Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients' 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE >= 5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE >= 10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels (>= 2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as >= 1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72% and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin >= 40 mg/day or rosuvastatin >= 20 mg/day). Among very-high-risk patients, this figure was 8.4%. Conclusions There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe.

  • 20. Hambraeus, K.
    et al.
    Burell, G.
    Johansson, P.
    Karlsson, R.
    Lisspers, J.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Cardiac rehabilitation: demands from elderly patients after percutaneous coronary intervention2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no S1, p. 450-450Article in journal (Other academic)
  • 21. Hamm, Christian W
    et al.
    Bassand, Jean-Pierre
    Agewall, Stefan
    Bax, Jeroen
    Boersma, Eric
    Bueno, Hector
    Caso, Pio
    Dudek, Dariusz
    Gielen, Stephan
    Huber, Kurt
    Ohman, Magnus
    Petrie, Mark C
    Sonntag, Frank
    Uva, Miguel Sousa
    Storey, Robert F
    Wijns, William
    Zahger, Doron
    Bax, Jeroen J
    Auricchio, Angelo
    Baumgartner, Helmut
    Ceconi, Claudio
    Dean, Veronica
    Deaton, Christi
    Fagard, Robert
    Funck-Brentano, Christian
    Hasdai, David
    Hoes, Arno
    Knuuti, Juhani
    Kolh, Philippe
    McDonagh, Theresa
    Moulin, Cyril
    Poldermans, Don
    Popescu, Bogdan A
    Reiner, Zeljko
    Sechtem, Udo
    Sirnes, Per Anton
    Torbicki, Adam
    Vahanian, Alec
    Windecker, Stephan
    Windecker, Stephan
    Achenbach, Stephan
    Badimon, Lina
    Bertrand, Michel
    Bøtker, Hans Erik
    Collet, Jean-Philippe
    Crea, Filippo
    Danchin, Nicolas
    Falk, Erling
    Goudevenos, John
    Gulba, Dietrich
    Hambrecht, Rainer
    Herrmann, Joerg
    Kastrati, Adnan
    Kjeldsen, Keld
    Kristensen, Steen Dalby
    Lancellotti, Patrizio
    Mehilli, Julinda
    Merkely, Béla
    Montalescot, Gilles
    Neumann, Franz-Josef
    Neyses, Ludwig
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Roffi, Marco
    Romeo, Francesco
    Ruda, Mikhail
    Swahn, Eva
    Valgimigli, Marco
    Vrints, Christiaan Jm
    Widimsky, Petr
    ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).2011In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 32, no 23, p. 2999-3054Article in journal (Refereed)
  • 22. 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)
  • 23. 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)
  • 24.
    Karjalainen, Tina
    et al.
    Umeå University.
    Adiels, Martin
    University of Gothenburg.
    Björck, Lena
    University of Gothenburg.
    Cooney, Marie-Therese
    St. Vincent's University Hospital, Ireland.
    Graham, Ian
    Trinity College Dublin, Ireland.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rosengren, Annika
    University of Gothenburg.
    Söderberg, Stefan
    Umeå University.
    Eliasson, Mats
    Umeå University.
    An evaluation of the performance of SCORE Sweden 2015 in estimating cardiovascular risk: The Northern Sweden MONICA Study 1999-20142017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 1, p. 103-110Article in journal (Refereed)
    Abstract [en]

    Background Risk prediction models for cardiovascular death are important for providing advice on lifestyle and in decision-making regarding primary preventive drug treatment. The latest Swedish version of the Systematic COronary Risk Evaluation (SCORE 2015) has yet not been tested in the population. Objective The objective of this study was to estimate the prevalence of high and very high risk of fatal cardiovascular disease (CVD) of the current population according to 2015 SCORE Sweden and to evaluate the predictive accuracy of the 2003 Swedish version of SCORE (2003 SCORE Sweden) and 2015 SCORE Sweden in a population with declining CVD mortality. Methods We estimated the high and very high risk group for cardiovascular death for individuals 40-65 years of age in the 2014 Northern Sweden MONICA population survey excluding subjects with known diabetes or previous CVD (n=813). Using the 1999 MONICA survey (n=3347) followed up for 10 years for CVD mortality, we assessed the calibration of both 2003 and 2015 SCORE Sweden. Results In 2014 2.6% of the population was considered at high or very high risk for fatal CVD, 95% were men and 76% were in the age group 60-65 years. Including subjects with a single markedly elevated risk factor, known diabetes or CVD, 12% of the population was at high or very high risk. During 10 years of follow-up of the 1999 cohort, 34 CVD deaths (24 men and 10 women) occurred. The 2003 SCORE overestimated the risk of death from CVD (ratio predicted/observed 2.3, P<0.001) whereas the 2015 SCORE slightly overestimated the number of deaths (predicted/observed 1.3, P=0.12). The 2015 SCORE predicted more accurately than the 2003 SCORE the number of deaths in the different risk and age categories. Conclusion The 2015 SCORE Sweden more adequately than 2003 SCORE Sweden predicts the number of deaths. In 2014, the proportion of high-risk individuals is small in northern Sweden. The main use of 2015 SCORE Sweden would therefore be as an educational tool between the physician and people without diabetes or CVD in a consultation regarding cardiovascular risk.

  • 25.
    Lidell, Evy
    et al.
    Halmstad Univ, Sweden.
    Hofer, Stefan
    Med Univ Innsbruck, Austria.
    Saner, Hugo
    Univ Bern, Switzerland.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hildingh, Cathrine
    Halmstad Univ, Sweden.
    Oldridge, Neil
    Univ Wisconsin, USA.
    Health-related quality of life in European women following myocardial infarction: A cross-sectional study2015In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 14, no 4, p. 326-333Article in journal (Refereed)
    Abstract [en]

    Background: Coronary heart disease is a major contributor to women's health problems. Design: Self-perceived social support, well-being and health-related quality of life (HRQL) were documented in the cross-sectional HeartQoL survey of European women one and six months after a myocardial infarction. Methods: European women were recruited in 18 European countries and grouped into four geographical regions (Southern Europe, Northern Europe, Western Europe and Eastern Europe). Continuous socio-demographic variables and categorical variables were compared by age and region with ANOVA and (2), respectively; multiple regression models were used to identify predictors of social support, well-being and HRQL. Results: Women living in the Eastern European region rated social support, well-being and HRQL significantly lower than women in the other regions. Older women had lower physical HRQL scores than younger women. Eastern European women rated social support, well-being and HRQL significantly lower than women in the other regions. Prediction of the dependent variables (social support, well-being and HRQL) by socio-demographic factors varied by total group, in the older age group, and by region; body mass index and managerial responsibility were the most consistent significant predictors.

  • 26. Ljunggren, S
    et al.
    Karlsson, H
    Mörtstedt, H
    Hellström, L
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Besler, C
    Landmesser, U
    von Eckardstein, A
    Lindahl, M
    Changes in human lipoprotein composition in patients with acute coronary syndrome2011In: European Atherosclerosis Society, Gothenburg June 2011, 2011Conference paper (Refereed)
  • 27. Mancia, Giuseppe
    et al.
    Fagard, Robert
    Narkiewicz, Krzysztof
    Redon, Josep
    Zanchetti, Alberto
    Böhm, Michael
    Christiaens, Thierry
    Cifkova, Renata
    De Backer, Guy
    Dominiczak, Anna
    Galderisi, Maurizio
    Grobbee, Diederick E
    Jaarsma, Tiny
    Kirchhof, Paulus
    Kjeldsen, Sverre E
    Laurent, Stéphane
    Manolis, Athanasios J
    Nilsson, Peter M
    Ruilope, Luis Miguel
    Schmieder, Roland E
    Sirnes, Per Anton
    Sleight, Peter
    Viigimaa, Margus
    Waeber, Bernard
    Zannad, Faiez
    Redon, Josep
    Dominiczak, Anna
    Narkiewicz, Krzysztof
    Nilsson, Peter M
    Burnier, Michel
    Viigimaa, Margus
    Ambrosioni, Ettore
    Caufield, Mark
    Coca, Antonio
    Olsen, Michael Hecht
    Schmieder, Roland E
    Tsioufis, Costas
    van de Borne, Philippe
    Zamorano, Jose Luis
    Achenbach, Stephan
    Baumgartner, Helmut
    Bax, Jeroen J
    Bueno, Héctor
    Dean, Veronica
    Deaton, Christi
    Erol, Cetin
    Fagard, Robert
    Ferrari, Roberto
    Hasdai, David
    Hoes, Arno W
    Kirchhof, Paulus
    Knuuti, Juhani
    Kolh, Philippe
    Lancellotti, Patrizio
    Linhart, Ales
    Nihoyannopoulos, Petros
    Piepoli, Massimo F
    Ponikowski, Piotr
    Sirnes, Per Anton
    Tamargo, Juan Luis
    Tendera, Michal
    Torbicki, Adam
    Wijns, William
    Windecker, Stephan
    Clement, Denis L
    Coca, Antonio
    Gillebert, Thierry C
    Tendera, Michal
    Rosei, Enrico Agabiti
    Ambrosioni, Ettore
    Anker, Stefan D
    Bauersachs, Johann
    Hitij, Jana Brguljan
    Caulfield, Mark
    De Buyzere, Marc
    De Geest, Sabina
    Derumeaux, Geneviève Anne
    Erdine, Serap
    Farsang, Csaba
    Funck-Brentano, Christian
    Gerc, Vjekoslav
    Germano, Giuseppe
    Gielen, Stephan
    Haller, Herman
    Hoes, Arno W
    Jordan, Jens
    Kahan, Thomas
    Komajda, Michel
    Lovic, Dragan
    Mahrholdt, Heiko
    Olsen, Michael Hecht
    Ostergren, Jan
    Parati, Gianfranco
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Polonia, Jorge
    Popescu, Bogdan A
    Reiner, Zeljko
    Rydén, Lars
    Sirenko, Yuriy
    Stanton, Alice
    Struijker-Boudier, Harry
    Tsioufis, Costas
    van de Borne, Philippe
    Vlachopoulos, Charalambos
    Volpe, Massimo
    Wood, David A
    2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).2013In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 34, no 28, p. 2159-2219Article in journal (Refereed)
  • 28.
    Munkhaugen, John
    et al.
    Drammen Hospital, Norway.
    Sverre, Elise
    Drammen Hospital, Norway ; University of Oslo, Norway.
    Otterstad, Jan E.
    Vestfold Hospital, Norway.
    Peersen, Kari
    Vestfold Hospital, Norway ; University of Oslo, Norway.
    Gjertsen, Erik
    Drammen Hospital, Norway.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Gullestad, Lars
    University of Oslo, Norway.
    Moum, Torbjørn
    University of Oslo, Norway.
    Dammen, Toril
    University of Oslo, Norway.
    Husebye, Einar
    Drammen Hospital, Norway.
    Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 9, p. 981-989Article in journal (Refereed)
    Abstract [en]

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

  • 29.
    Munkhaugen, John
    et al.
    Drammen Hosp, Norway.
    Sverre, Elise
    Drammen Hosp, Norway.
    Peersen, Kari
    Vestfold Hosp, Norway.
    Gjertsen, Erik
    Drammen Hosp, Norway.
    Gullestad, Lars
    Oslo Univ Hosp, Norway.
    Moum, Torbjorn
    Univ Oslo, Norway.
    Otterstad, Jan Erik
    Vestfold Hosp, Norway.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Husebye, Einar
    Drammen Hosp, Norway.
    Dammen, Toril
    Univ Oslo, Norway.
    The role of medical and psychosocial factors for unfavourable coronary risk factor control2016In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 50, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

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

  • 30.
    Peersen, Kari
    et al.
    Hosp Vestfold, Norway ; Univ Oslo, Norway.
    Munkhaugen, John
    Drammen Hosp, Norway.
    Gullestad, Lars
    Univ Oslo, Norway ; Natl Hosp Norway, Norway.
    Liodden, Toril
    Hosp Vestfold, Norway.
    Moum, Torbjorn
    Univ Oslo, Norway.
    Dammen, Toril
    Univ Oslo, Norway.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Otterstad, Jan E.
    Hosp Vestfold, Norway.
    The role of cardiac rehabilitation in secondary prevention after coronary events2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 13, p. 1360-1368Article in journal (Refereed)
    Abstract [en]

    Background Coronary risk factor control in Europe is suboptimal and there are large variations in the nature of cardiac rehabilitation (CR) programmes offered to coronary heart disease patients. We aim to explore characteristics and risk factor control in patients recruited from two neighbouring hospitals offering CR with different content. Methods In a cross-sectional study, 1127 Norwegian patients hospitalized with acute myocardial infarction and/or a revascularization procedure attended a clinical visit and completed a questionnaire at 2-36 months' follow-up. The hospital of Vestfold provides comprehensive CR, while the hospital of Drammen provides mainly exercise-based CR. Results At follow-up, patients in Vestfold performed more physical activity (p=0.02), were less obese (p=0.02) and reported better medication adherence (p=0.02) than patients in Drammen. The perceived need for information and follow-up was higher in Drammen than Vestfold (p<0.001). The CR participation rate in Vestfold was 75% compared with 18% in Drammen. CR participation in Vestfold was associated with higher prevalence of smoking cessation (p=0.001), lower low-density lipoprotein cholesterol (p=0.01) and better medication adherence (p=0.02) compared with non-CR, in adjusted analyses. No differences in diet, body weight, or blood pressure control were found between CR and non-CR. Conclusions Vestfold, with comprehensive CR, had a higher participation rate and more risk factors on target than Drammen. Participation in CR in Vestfold was associated with higher levels of smoking cessation and medication adherence, and lower low-density lipoprotein cholesterol, but overall risk factor control is still deficient, underlining the need for improved understanding of barriers to optimal risk factor control.

  • 31.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Hjärt-kärlsjukdom i Europa, inte bara en framgångssaga2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 47, p. 2143-Article in journal (Other academic)
  • 32.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nya europeiska riktlinjer för kardiovaskulär prevention2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 34, p. 1463-1463Article in journal (Other academic)
    Abstract [sv]

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

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

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

    Sverige är numera ett lågriskland för hjärt–kärlsjukdom.

  • 33.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    PERSPECTIVE The power of disease prevention2013In: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 493, no 7434, p. S6-S6Article in journal (Other academic)
  • 34.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Riktlinjer för primär hjärt-kärlprevention efterlevs inte i klinisk praxis. EURIKA-studien visar brister i Europa2012In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, no 23, p. 1164-1166Article in journal (Refereed)
    Abstract [sv]

    för primär kardiovaskulär prevention tillämpades i tolv länder för öppenvårdspatienter >50 år med åtminstone en riskfaktor för kardiovaskulär sjukdom.

    Studien visar att gapet mellan riktlinjer och praxis förblir för stort.

    Av hypertoniker uppnådde 39 procent målnivån för blodtrycket, och av patienter med hyperlipidemi uppnådde 41 procent målnivån för totalkolesterol och LDL-kolesterol.

    Endast 37 procent av diabetikerna (typ 2-diabetes) var välreglerade.

    Information om livsstil var bristfällig; mindre än 40 procent av rökarna deltog i ett rökavvänjningsprogram.

    I Sverige fanns ett lägre antal välinställda hypertoniker och diabetiker än genomsnittet för de övriga länderna.

  • 35.
    Perk, Joep
    Department of Internal Medicine, Oskarshamn District Hospital, 572 28 Oskarshamn, Sweden.
    Risk factor management, a practical guide2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no Supplement 2, p. S24-S28Article in journal (Refereed)
  • 36.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Risk factors in childhood and youth2015In: Prevention of cardiovascular diseases: from current evidence to clinical practice / [ed] Jadelson P. Andrade, Fausto J. Pinto & Donna K. Arnett, Springer, 2015, 1, p. 101-108Chapter in book (Other academic)
    Abstract [en]

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

  • 37.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    The 2016 version of the European Guidelines on Cardiovascular Prevention2017In: European Heart Journal - Cardiovascular Pharmacotherapy, ISSN 2055-6837, E-ISSN 2055-6845, Vol. 3, no 1, p. 9-10Article in journal (Other academic)
  • 38.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Burell, G
    Carlsson, R
    Hambraeus, K
    Johansson, P
    Lisspers, J
    Cardiac rehabilitation after acute coronary intervention: the patients view2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 1suppl, p. S61-Article in journal (Refereed)
  • 39.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Burell, G.
    Hambraeus, K.
    Johansson, P.
    Karlsson, R.
    Lisspers, J.
    Harvesting the benefits of a cardioprotective lifestyle after coronary angioplasty2012In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no S1, p. 446-446Article in journal (Other academic)
  • 40.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Burell, Gunilla
    Uppsala University.
    Carlsson, Roland
    PCI-Centrum.
    Hambraeus, Kristina
    Falu hospital.
    Johansson, Pelle
    Riksförbundet HjärtLung.
    Lisspers, Jan
    Mid Sweden University.
    Allvarliga brister i rådgivning till koronarsjuka patienter efter ballongvidgning: patienter undervärderar levnadsvanors betydelse, visar enkätstudie2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 42Article in journal (Refereed)
    Abstract [en]

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

  • 41.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    De Backer, Guy
    Gohlke, Helmut
    Graham, Ian
    Reiner, Zeljko
    Verschuren, W. M. Monique
    Albus, Christian
    Benlian, Pascale
    Boysen, Gudrun
    Cifkova, Renata
    Deaton, Christi
    Ebrahim, Shah
    Fisher, Miles
    Germano, Giuseppe
    Hobbs, Richard
    Hoes, Arno
    Karadeniz, Sehnaz
    Mezzani, Alessandro
    Prescott, Eva
    Ryden, Lars
    Scherer, Martin
    Syvanne, Mikko
    Reimer, Wilma J. M. Scholte Op
    Vrints, Christiaan
    Wood, David
    Luis Zamorano, Jose
    Zannad, Faiez
    European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts).2012In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 19, no 4, p. 585-667Article in journal (Refereed)
  • 42.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    DeBacker, Guy
    Saner, Hugo
    Wood, David
    Giannuzzi, Pantaleo
    Gielen, Stephan
    Pelloiccia, Antonio
    The 10-year anniversary of the European Association for Cardiovascular Prevention and Rehabilitation: achievements and challenges2015In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 22, no 10, p. 1340-1345Article in journal (Other academic)
    Abstract [en]

    On the occasion of the 2014 European Society of Cardiology annual congress in Barcelona the European Association for Cardiovascular Prevention and Rehabilitation (EACPR) will celebrate its 10-year anniversary, having been initiated in Munich in 2004. In this article each EACPR president gives their personal recollections and views on the main achievements under their leadership and discusses the challenges for preventive cardiology that still lay ahead.

  • 43.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Graham, Ian
    Trinity Coll Dublin.
    De Backer, Guy
    Univ Ghent.
    Prevention of cardiovascular disease: new guidelines, new tools, but challenges remain2014In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 100, no 9, p. 675-677Article in journal (Other academic)
  • 44.
    Perk, Joep
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hambraeus, Kristina
    Falun Hospital.
    Burell, Gunilla
    Uppsala University.
    Carlsson, Roland
    Swedish PCI AB.
    Johansson, Pelle
    Heart and Lung Patients Association.
    Lisspers, Jan
    Mid Sweden University.
    Study of patient information after percutaneous coronary intervention (SPICI): should prevention programmes become more effective?2015In: EuroIntervention, ISSN 1774-024X, E-ISSN 1969-6213, Vol. 10, no 11, p. e1-e7Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 45.
    Perk, Joep
    et al.
    Kalmar County Public Health Centre, Oskarshamn, Sweden.
    Hellström, L
    Svensson, J
    Improving childrens’ lifestyle: the Cool School Project2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no Supplement 1, p. S30-Article in journal (Refereed)
  • 46.
    Rodríguez-Artalejo, Fernando
    et al.
    Universidad Autónoma de Madrid, Spain ; AstraZeneca Europe, -.
    Guallar, Eliseo
    Johns Hopkins Bloomberg School of Public Health, USA ; National Center for Cardiovascular Research (CNIC), Spain.
    Borghi, Claudio
    University of Bologna, Italy.
    Dallongeville, Jean
    Institut Pasteur de Lille, France.
    De Backer, Guy
    University of Gent, France.
    Halcox, Julian P
    Cardiff University, Wales.
    Hernández-Vecino, Ramón
    AstraZeneca Farmacéutica Spain, Spain.
    Jiménez, Francisco J
    AstraZeneca Farmacéutica Spain, Spain.
    Massó-González, Elvira L
    AstraZeneca Farmacéutica Spain, Spain.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Steg, Philippe G.
    Assistance Publique-Hôpitaux de Paris and Université, France.
    Banegas, José R
    Universidad Autónoma de Madrid, Spain.
    EURIKA Investigators,
    Rationale and methods of the European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA)2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, article id 382Article in journal (Refereed)
    Abstract [en]

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

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

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

  • 48.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nilsson, L
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    The assessment of adverse events in medical care: lack of consistency between experienced teams using the Global Trigger Tool2012Conference paper (Refereed)
  • 49.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Nilsson, Lena
    Linköpings Universitetssjukhus.
    Perk, Joep
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linköpings Universitet.
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Strengths and weaknesses of working with the Global Trigger Tool method for retrospective record review: focus group interviews2013In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, p. e003131-Article in journal (Refereed)
    Abstract [en]

    Objectives The aim was to describe the strengths and weaknesses, from team member perspectives, of working with the Global Trigger Tool (GTT) method of retrospective record review to identify adverse events causing patient harm.

    Design A qualitative, descriptive approach with focus group interviews using content analysis.

    Setting 5 Swedish hospitals in 2011.

    Participants 5 GTT teams, with 5 physicians and 11 registered nurses.

    Intervention 5 focus group interviews were carried out with the five teams. Interviews were taped and transcribed verbatim.

    Results 8 categories emerged relating to the strengths and weaknesses of the GTT method. The categories found were: Usefulness of the GTT, Application of the GTT, Triggers, Preventability of harm, Team composition, Team tasks, Team members’ knowledge development and Documentation. Gradually, changes in the methodology were made by the teams, for example, the teams reported how the registered nurses divided up the charts into two sets, each being read respectively. The teams described the method as important and well functioning. Not only the most important, but also the most difficult, was the task of bringing the results back to the clinic. The teams found it easier to discuss findings at their own clinics.

    Conclusions The GTT method functions well for identifying adverse events and is strengthened by its adaptability to different specialties. However, small, gradual methodological changes together with continuingly developed expertise and adaption to looking at harm from a patient's perspective may contribute to large differences in assessment over time.

  • 50.
    Schildmeijer, Kristina
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nilsson, Lena
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Perk, Joep
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Assessment of adverse events in medical care: lack of consistency between experienced teams using the global trigger tool.2012In: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 21, no 4, p. 307-314Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Many patients are harmed as the result of healthcare. A retrospective structured record review is one way to identify adverse events (AEs). One such review approach is the global trigger tool (GTT), a consistent and well-developed method used to detect AEs. The GTT was originally intended to be used for measuring data over time within a single organisation. However, as the method spreads, it is likely that comparisons of GTT safety outcomes between hospitals will occur.

    OBJECTIVE: To evaluate agreement in judgement of AEs between well-trained GTT teams from different hospitals.

    METHODS: Five teams from five hospitals of different sizes in the southeast of Sweden conducted a retrospective review of patient records from a random sample of 50 admissions between October 2009 and May 2010. Inter-rater reliability between teams was assessed using descriptive and κ statistics.

    RESULTS: The five teams identified 42 different AEs altogether. The number of identified AEs differed between the teams, corresponding to a level of AEs ranging from 27.2 to 99.7 per 1000 hospital days. Pair-wise agreement for detection of AEs ranged from 88% to 96%, with weighted κ values between 0.26 and 0.77. Of the AEs, 29 (69%) were identified by only one team and not by the other four groups. Most AEs resulted in minor and transient harm, the most common being healthcare-associated infections. The level of agreement regarding the potential for prevention showed a large variation between the teams.

    CONCLUSIONS: The results do not encourage the use of the GTT for making comparisons between hospitals. The use of the GTT to this end would require substantial training to achieve better agreement across reviewer teams.

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