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  • 1.
    Bay, Annika
    et al.
    Umeå University, Public Health and Clinical Medicine, Umeå, Sweden.
    Berghammer, Malin
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Lamas, K
    Umeå University, Nursing, Umeå, Sweden.
    Sandberg, Camilla
    Umeå University, Public Health and Clinical Medicine, Umeå, Sweden.
    Johansson, Bengt
    Umeå University, Public Health and Clinical Medicine, Umeå, Sweden.
    Facilitators and barriers for physical activity in adults with congenital heart disease2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr suppl_1, s. 1120-1121, artikkel-id ehy566.P5433Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: A majority of adults with congenital heart disease (CHD) have reduced exercise capacity and do not reach the recommended level of physical activity. A physically active lifestyle is essential to maintain health and counteract acquired cardiovascular disease. This study illuminates aspects that may be relevant for performing physical activity.Purpose: To describe facilitators and barriers for physical activity in adults with CHD.Methods: Semi-structured interviews were performed individually with fourteen adults (age 19–68 years, women=7) with complex CHD. The interviews were analyzed using qualitative content analysis.Results: Aspects that may enable or inhibit physical activity were found in two domains; Facilitators and Barriers, which both consisted of four categories physical, psychological, psychosocial and environmental aspects (Table 1).

  • 2.
    Berghammer, Malin
    et al.
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Johansson, B.
    Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden.
    Mattson, E.
    Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
    Moons, P.
    The Sahlgrenska Academy at Gothenburg University, Institute of health and caring sciences, Gothenburg, Sweden;.
    Dellborg, M.
    University of Gothenburg, Institute of medicine, Sahlgrenska Academy, Gothenburg, Sweden.
    Exploration of disagreement between the patient’s self reported limitations and limitations assessed by caregivers in adults with congenital heart disease2018Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, nr Suppl 1, artikkel-id 2406Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The New York Heart Association (NYHA) classification is applied in a wide spectrum of heart diseases including adult patients with congenital heart disease (ACHD). The NYHA-class assessment is often based on the evaluation by the caregiver, but to what extent it correlates with the patient's view of their function is not fully known.Purpose: To investigate the relation between the patient's self-reported physical limitations, symptoms, other heart defect related factors and NYHA-class assessed by the caregiver.Methods: Eligible patients (n=333, age 39.2±13.6 years) were identified and randomly selected from the national registry for CHD. All of the patients completed a standardized questionnaire measuring different PRO-domains. By combing self-reported data with registry data including NYHA-class, analyses of agreement of physical limitations were performed.Results: Almost 30% of the patients rated their limitations higher compared to the NYHA-class estimated by the caregiver. Patients with self-reported limitations and their NYHA-class underestimated by caregivers, more often reported symptoms, anxiety, lower health and worked fewer hours/week compared to other patients with CHD. There were no differences regarding sex, type of symptoms, prescribed medications, or complexity of cardiac lesion. In patients without self-reported limitations agreement with NYHA-class estimated by caregivers was 97%.Conclusion: Adult patients with CHD and self-reported limitations may not be correctly identified by the care-giver. Instruments for patient reported outcomes might improve the assessment of physical limitations and could further improve the correctness in evaluating the patient's status.

  • 3.
    Brink, Eva
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på avancerad nivå.
    Alsén, Pia
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för vårdvetenskap på grundnivå.
    Cliffordson, Christina
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa, kultur och pedagogik.
    Validation of the Revised Illness Perception Questionnaire (IPQ-R) in a sample of persons recovering from myocardial infarction – the Swedish version.2011Inngår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 52, nr 6, s. 573-579Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    When people’s health is threatened, they generally develop illness perceptions to make sense of their illness. The Illness Perception Questionnaire (IPQ-R), developed by Moss-Morris et al (2002), has been widely used in many countries to measure such representations. However, since studies in this crucial research area are lacking in Sweden a Swedish version of IPQ-R was validated with a focus on the seven subscales: timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations. Using confirmatory factor analysis, the aim of the present study was to validate the internal structure of the Swedish version in a sample of 202 persons (144 men and 58 women) who had been diagnosed with myocardial infarction four months earlier. Additionally, inter-correlations among the seven subscales and external concurrent validity were also investigated. The results of confirmatory factor analysis revealed that, in line with the English version of the IPQ-R, the specified seven-factor model had a satisfactory fit. One item was however not considered reliable and was therefore excluded from the instrument. The internal consistency (Cronbach’s alpha coefficients) and the inter-factor correlations were relatively similar to those reported in the validation study of the original English IPQ-R. In tests of concurrent validity, the seven IPQ-R subscales were, as hypothesized, mainly associated with external variables. To conclude, the Swedish version of the IPQ-R’s seven dimensions, with one item removed, (total 37 items) was found to be a reliable and valid measure of illness perception.

  • 4.
    Brink, Eva
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för hälsa och kultur.
    Grankvist, Gunne
    Högskolan Väst, Institutionen för individ och samhälle, Avd för psykologi och organisationsstudier.
    Associations between depression, fatigue, and life orientation in myocardial infarction patients2006Inngår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, Vol. 21, nr 5, s. 407-411Artikkel i tidsskrift (Annet vitenskapelig)
  • 5.
    Brink, Eva
    et al.
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för specialistsjuksköterskeutbildning.
    Grankvist, Gunne
    Högskolan Väst, Institutionen för individ och samhälle, Avd för psykologi och organisationsstudier.
    Karlson, Björn W
    Sahlgrenska University, Division of Cardiology.
    Hallberg, Lillemor R M
    Halmstad University, School of Social and Health Sciences.
    Health-related quality of life in women and men one year after acute myocardial infarction2005Inngår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 14, nr 3, s. 749-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purpose of the present study was, first, to detect possible changes in health-related quality of life (HRQL) over time and, second, to predict HRQL at 1 year based on measures made 1 week and 5 months after a first-time acute myocardial infarction. There was an improvement in HRQL at 1 year, as measured by the questionnaire 36-item Medical Outcomes Study Short-Form (SF-36), for both men and women as compared with the assessment 5 months after the acute myocardial infarction. However, the pattern was somewhat different for women and men. Women mainly reported increased scores on scales reflecting better mental health, whereas men, on the whole, demonstrated higher scores in the physical health domain. Depression (HAD) and fatigue were identified as early predictors of lower HRQL at the 1-year follow-up. Our conclusion is that early assessment of fatigue and depression is worthwhile, as they may indicate decreased HRQL in men and women 1 year after first-time myocardial infarction.

  • 6.
    Gellerstedt, Martin
    et al.
    Högskolan Väst, Institutionen för ekonomi och it, Avd för datavetenskap och informatik.
    Bång, Angela
    University College of Borås, Prehospital Research Centre of Western Sweden.
    Andréasson, Emma
    Högskolan Väst.
    Johansson, Anna
    Högskolan Väst.
    Herlitz, Johan
    Sahlgrenska University Hospital,, The Prehospital Research Centre of Western Sweden, Institute of Medicine, Department of Molecular and Clinical Medicine,.
    Does sex influence the allocation of life support level by dispatchers in acute chest pain?2010Inngår i: American Journal of Emergency Medicine, ISSN 0735-6757, E-ISSN 1532-8171, Vol. 28, nr 8, s. 922-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: The aim of this study was to evaluate (a) the differences between men and women in symptom profile, allocated life support level (LSL), and presence of acute myocardial infarction (AMI), life-threatening condition (LTC), or death and (b) whether a computer-based decision support system could improve the allocation of LSL. PATIENTS: All patients in Göteborg, Sweden, who called the dispatch center because of chest pain during 3 months (n = 503) were included in this study. METHODS: Age, sex, and symptom profile were background variables. Based on these, we studied allocation of LSL by the dispatchers and its relationship to AMI, LTC, and death. All evaluations were made from a sex perspective. Finally, we studied the potential benefit of using a statistical model for allocating LSL. RESULTS: The advanced life support level (ALSL) was used equally frequently for men and women. There was no difference in age or symptom profile between men and women in relation to allocation. However, the allocation of ALSL was predictive of AMI and LTC only in men. The sensitivity was far lower for women than for men. When a statistical model was used for allocation, the ALSL was predictive for both men and women. Using a separate model for men and women respectively, sensitivity increased, especially for women, and specificity was kept at the same level. CONCLUSION: This exploratory study indicates that women would benefit most from the allocation of LSL using a statistical model and computer-based decision support among patients who call for an ambulance because of acute chest pain. This needs further evaluation.

  • 7.
    Gellerstedt, Martin
    et al.
    Högskolan Väst, Institutionen för ekonomi och it, Avd för juridik, ekonomi, statistik och politik. Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Rawshani, Nina
    Department of Emergency Medicine, University of Gothenburg, Göteborg, Sweden.
    Herlitz, Johan
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden, Department of Medicine, University of Gothenburg, Göteborg, Sweden.
    Bång, Angela
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Gelang, Carita
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden, Department of Ambulance and Prehospital Emergency Care, University of Gothenburg, Göteborg, Sweden.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care, Skaraborg, Sweden.
    Larsson, Anna
    The Pre-hospital Research Centre of Western Sweden, Prehospen, University College of Borås, Borås, Sweden.
    Rawshani, Araz
    Department of Medicine, University of Gothenburg, Göteborg, Sweden.
    Could prioritisation by emergency medicine dispatchers be improved by using computer-based decision support?: A cohort of patients with chest pain2016Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, s. 734-738Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: To evaluate whether a computer-based decision support system could improve the allocation of patients with acute coronary syndrome (ACS) or a life-threatening condition (LTC). We hypothesised that a system of this kind would improve sensitivity without compromising specificity. Methods: A total of 2285 consecutive patients who dialed 112 due to chest pain were asked 10 specific questions and a prediction model was constructed based on the answers. We compared the sensitivity of the dispatchers' decisions with that of the model-based decision support model. Results: A total of 2048 patients answered all 10 questions. Among the 235 patients with ACS, 194 were allocated the highest prioritisation by dispatchers (sensitivity 82.6%) and 41 patients were given a lower prioritisation (17.4% false negatives). The allocation suggested by the model used the highest prioritisation in 212 of the patients with ACS (sensitivity of 90.2%), while 23 patients were underprioritised (9.8% false negatives). The results were similar when the two systems were compared with regard to LTC and 30-day mortality. This indicates that computer-based decision support could be used either for increasing sensitivity or for saving resources. Three questions proved to be most important in terms of predicting ACS/LTC, [1] the intensity of pain, [2] the localisation of pain and [3] a history of ACS. Conclusion: Among patients with acute chest pain, computer-based decision support with a model based on a few fundamental questions could improve sensitivity and reduce the number of cases with the highest prioritisation without endangering the patients.

  • 8.
    Hedemalm, Azar
    Högskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för specialistsjuksköterskeutbildning. Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå.
    Vård av patient med utländsk härkomst som har hjärtsjukdom2012Inngår i: Kardiologisk omvårdnad / [ed] Fridlund, Bengt; Malm, Dan; Mårtensson, Jan, Lund: Studentlitteratur AB, 2012, 2, s. 303-322Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 9.
    Ko, Jong Mi
    et al.
    The University of Texas, Department of Internal Medicine, Division of Cardiology, Southwestern Medical Center, Dallas, Texas.
    White, Kamila S
    University of Missouri, Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, Saint Louis, Missouri.
    Kovacs, Adrienne H
    University of Toronto, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
    Tecson, Kristen M
    Baylor Heart & Vascular Institute, Baylor Scott & White Research Institute, Dallas, Texas.
    Apers, Silke
    KU Leuven-University of Leuven, KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.
    Luyckx, Koen
    KU Leuven-University of Leuven, School Psychology and Child and Adolescent Development, Leuven, Belgium.
    Thomet, Corina
    University of Bern, Center for Congenital Heart Disease, Inselspital-Bern University Hospital, Bern, Switzerland.
    Budts, Werner
    KU Leuven-University of Leuven, Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, Leuven, Belgium.
    Enomoto, Junko
    Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan.
    Sluman, Maayke A
    Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
    Wang, Jou-Kou
    National Taiwan University, School of Nursing, College of Medicine,Taipei, Taiwan.
    Jackson, Jamie L
    Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio.
    Khairy, Paul
    Université de Montréal, Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Canada.
    Cook, Stephen C
    Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, Michigan.
    Subramanyan, Raghavan
    Frontier Lifeline Hospital, Dr. K. M. Cherian Heart Foundation, Chennai, India..
    Alday, Luis
    Division of Cardiology, Hospital de Niños, Córdoba, Argentina.
    Eriksen, Katrine
    Department of Cardiology, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
    Dellborg, Mikael
    The Sahlgrenska Academy at University of Gothenburg, Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, Sweden; University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
    Berghammer, Malin
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
    Johansson, Bengt
    Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden.
    Mackie, Andrew S
    University of Alberta, Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada.
    Menahem, Samuel
    Monash University, Monash Heart, Monash Medical Centre, Melbourne, Australia.
    Caruana, Maryanne
    Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta.
    Veldtman, Gruschen
    Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
    Soufi, Alexandra
    Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France.
    Fernandes, Susan M
    Stanford University School of Medicine, Department of Pediatrics and Medicine, Divisions of Pediatric Cardiology and Cardiovascular Medicine, Palo Alto, California.
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.
    Kutty, Shelby
    University of Nebraska Medical Center/ Children's Hospital and Medical Center, Adult Congenital Heart Disease Center, Omaha, Nebraska, USA.
    Gandhi, Amarendra
    KU Leuven-University of Leuven, School Psychology and Child and Adolescent Development, Leuven, Belgium.
    Moons, Philip
    University of Gothenburg, KU Leuven Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium; Centre for Person-Centred Care (GPCC), Gothenburg, Sweden; University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden..
    Cedars, Ari M
    The University of Texas Southwestern Medical Center, Department of Internal Medicine, Division of Cardiology, Dallas, Texas.
    Physical Activity-Related Drivers of Perceived Health Status in Adults With Congenital Heart Disease2018Inngår i: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 122, nr 8, s. 1437-1442, artikkel-id S0002-9149(18)31423-1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Data on the differential impact of physical activity on perceived health status (PHS) in a large adult congenital heart disease (ACHD) patient population are lacking. We conducted a cross-sectional assessment of 4,028 ACHD patients recruited from 24 ACHD-specialized centers in 15 countries across 5 continents to examine the association between physical activity and PHS in a large international cohort of ACHD patients. A linear analog scale of the EuroQol-5D 3 level version and the 12-item Short Form Health Survey-version 2 were used to assess self-reported health status and the Health-Behavior Scale-Congenital Heart Disease was used as a subjective measurement of physical activity type, participation, and level. Correlation analyses and Wilcoxon Rank Sum tests examined bivariate relations between sample characteristics and PHS scores. Then, multivariable models were constructed to understand the impact of physical activity on PHS. Only 30% of our sample achieved recommended physical activity levels. Physically active patients reported better PHS than sedentary patients; however, the amount of physical activity was not associated with PHS. Further statistical analyses demonstrated that specifically sport participation regardless of physical activity level was a predictor of PHS. In conclusion, the majority of ACHD patients across the world are physically inactive. Sport participation appears to be the primary physical activity-related driver of PHS. By promoting sport-related exercise ACHD specialists thus may improve PHS in ACHD patients.

  • 10.
    Lévesque, Valérie
    et al.
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Laplante, Laurence
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Shohoudi, Azadeh
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Apers, Silke
    KU Leuven Department of Public Health and Primary Care; University of Leuven, Leuven, Belgium.
    Kovacs, Adrienne H
    Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
    Luyckx, Koen
    KU Leuven - University of Leuven, School Psychology and Child and Adolescent Development,Leuven, Belgium; University of the Free State, UNIBS, Bloemfontein, South Africa .
    Thomet, Corina
    University of Bern, Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland.
    Budts, Werner
    Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; KU Leuven - University of Leuven, KU Leuven Department of Cardiovascular Sciences, Leuven, Belgium..
    Enomoto, Junko
    Department of Adult Congenital Heart Disease,Cardiovascular Center, Chiba, Chiba, Japan.
    Sluman, Maayke A
    Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Jeroen Bosch Hospital, Hertogenbosch, Amsterdam, the Netherlands.
    Lu, Chun-Wei
    Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
    Jackson, Jamie L
    Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.
    Cook, Stephen C
    Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA.
    Chidambarathanu, Shanthi
    Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India.
    Alday, Luis
    Monash University,Monash Medical Centre, Melbourne, Australia.
    Eriksen, Katrine
    Department of Cardiology, Oslo University Hospital–Rikshospitalet, Oslo, Norway.
    Dellborg, Mikael
    Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden; University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
    Berghammer, Malin
    Högskolan Väst, Institutionen för hälsovetenskap, Avdelningen för omvårdnad - avancerad nivå. University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden.
    Johansson, Bengt
    Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden.
    Mackie, Andrew S
    University of Alberta, Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada.
    Menahem, Samuel
    Monash University, Monash Heart, Monash Medical Centre, Melbourne, Australia.
    Caruana, Maryanne
    Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta.
    Veldtman, Gruschen
    Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
    Soufi, Alexandra
    Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France.
    Fernandes, Susan M
    Department of Pediatrics and Medicine, Palo Alto, California.
    White, Kamila S
    Washington University, Adult Congenital Heart Disease Center, ; University of Missouri, Barnes Jewish Heart & Vascular Center, Saint Louis, Missour.
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy; Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy.
    Kutty, Shelby
    University of Nebraska Medical Center, Adult Congenital Heart Disease Center, Children's Hospital and Medical Center, Omaha, NE, USA.
    Brouillette, Judith
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Casteigt, Benjamin
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Moons, Philip
    KU Leuven–University of Leuven, Leuven, Belgium; University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden; University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa .
    Khairy, Paul
    Université de Montréal, Montreal Heart Institute, Montreal, Canada.
    Implantable Cardioverter-Defibrillators and Patient-Reported Outcomes in Adults with Congenital Heart Disease: an International Study2019Inngår i: Heart Rhythm, ISSN 1547-5271, E-ISSN 1556-3871, artikkel-id S1547-5271(19)31089-6Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Implantable cardioverter-defibrillators (ICDs) are increasingly used to prevent sudden deaths in the growing population of adults with congenital heart disease (CHD). Yet, little is known about their impact on patient-reported outcomes (PROs).

    OBJECTIVE: We assessed and compared PROs in adults with CHD with and without ICDs.

    METHODS: A propensity-based matching weight analysis was conducted to evaluate PROs in an international cross-sectional study of adults with CHD from 15 countries across 5 continents.

    RESULTS: A total of 3,188 patients were included: 107 with ICDs and 3,081 weight-matched controls without ICDs. ICD recipients averaged 40.1±12.4 years of age, with >95% having moderate or complex CHD. Defibrillators were implanted for primary and secondary prevention in 38.3% and 61.7%, respectively. Perceived health status, psychological distress, sense of coherence, and health behaviours did not differ significantly in patients with and without ICDs. However, ICD recipients had a more threatening view of their illness (relative % difference 8.56, P=0.011). Those with secondary compared to primary prevention indications had a significantly lower quality of life score (linear analogue scale 72.0±23.1 versus 79.2±13.0, P=0.047). Marked geographic variations were observed. Overall sense of well-being, assessed by a summary score that combines various PROs, was significantly lower in ICD recipients (versus controls) from Switzerland, Argentina, Taiwan, and USA.

    CONCLUSIONS: In an international cohort of adults with CHD, ICDs were associated with a more threatening illness perception, with a lower quality of life in those with secondary compared to primary prevention indications. However, marked geographic variability in PROs was observed.

  • 11.
    Monneret, Denis
    et al.
    Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik. Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Scandinavian Surgical Outcomes Research Group, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bonnefont-Rousselot, Dominique
    Paris Descartes University, Faculty of Pharmacy, Department of Biochemistry, Paris, France.
    Determination of age- and sex-specific 99th percentiles for high-sensitive troponin T from patients: An analytical imprecision- and partitioning-based approach2018Inngår i: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 56, nr 5, s. 818-829Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Detection of acute myocardial infarction (AMI) is mainly based on a rise of cardiac troponin with at least one value above the 99th percentile upper reference limit (99th URL). However, circulating high-sensitive cardiac troponin T (hs-cTnT) concentrations depend on age, sex and renal function. Using an analytical imprecision-based approach, we aimed to determine age- A nd sex-specific hs-cTnT 99th URLs for patients without chronic kidney disease (CKD). A 3.8-year retrospective analysis of a hospital laboratory database allowed the selection of adult patients with concomitant plasma hs-cTnT (<300 ng/L) and creatinine concentrations, both assayed twice within 72 h with at least 3 h between measurements. Absence of AMI was assumed when the variation between serial hs-cTnT values was below the adjusted-analytical change limit calculated according to the inverse polynomial regression of analytical imprecision. Specific URLs were determined using Clinical and Laboratory Standards Institute (CLSI) methods, and partitioning was tested using the proportion method, after adjustment for unequal prevalences. After outlier removal (men: 8.7%; women: 6.6%), 1414 men and 1082 women with estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 were assumed as non-AMI. Partitioning into age groups of 18-50, 51-70 and 71-98 years, the hs-cTnT 99th URLs adjusted on French prevalence were 18, 33, 66 and 16, 30, 84 ng/L for men and women, respectively. Age-partitioning was clearly required. However, sex-partitioning was not justified for subjects aged 18-50 and 51-70 years for whom a common hs-cTnT 99th URLs of about 17 and 31 ng/L could be used. Based on a laboratory approach, this study supports the need for age-specific hs-cTnT 99th URLs. © 2017 Walter de Gruyter GmbH.

  • 12.
    Monneret, Denis
    et al.
    Department of Biochemistry and Molecular Biology, South Lyon Hospital Group, Hospices Civils de Lyon (HCL), 165 Chemin du Grand Revoyet, Pierre-Bénite, 69495, France.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Roche, Frédéric
    Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, France; EA 4607 SNA-EPIS, PRES Lyon, Saint-Etienne, France .
    Bonnefont-Rousselot, Dominique
    Department of Metabolic Biochemistry, La Pitié Salpêtrière-Charles Foix University Hospital (AP-HP), Paris, France; CNRS UMR8258, INSERM U1022, Faculty of Pharmacy, Sorbonne Paris Cité, Paris Descartes University, Paris, France.
    Outlier removal methods for skewed data: Impact on age-specific high-sensitive cardiac troponin T 99th percentiles2019Inngår i: Clinical Chemistry and Laboratory Medicine, ISSN 1434-6621, E-ISSN 1437-4331, Vol. 57, nr 10, s. E244-E247Artikkel i tidsskrift (Fagfellevurdert)
  • 13.
    Rawshani, Araz
    et al.
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Larsson, Anna
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Gelang, Carita
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Lindqvist, Jonny
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Bång, Angela
    University College of Borås,The Pre-hospital Research Centre of Western Sweden, Prehospen.
    Herlitz, Johan
    University of Gothenburg, Department of Medicine, Sahlgrenska Academy.
    Characteristics and outcome among patients who dial for the EMS due to chest pain2014Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, nr 3, s. 859-865Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: This study aims to describe patients who called for the emergency medical service (EMS) due to chest discomfort, in relation to gender and age. Methods: All patients who called the emergency dispatch centre of western Sweden due to chest discomfort, between May 2009 and February 2010, were included. Initial evaluation, aetiology and outcome are described as recorded in the databases at the dispatch centre, the EMS systems and hospitals. Patients were divided into the following age groups: ≀ 50, 51-64 and ≥ 65 years. Results: In all, 14,454 cases were enrolled. Equal proportions of men (64%) and women (63%) were given dispatch priority 1. The EMS clinicians gave priority 1 more frequently to men (16% versus 12%) and older individuals (10%, 15% and 14%, respective of age group). Men had a significantly higher frequency of central chest pain (83% versus 81%); circulatory compromise (34% versus 31%); ECG signs of ischaemia (17% versus 11%); a preliminary diagnosis of acute coronary syndrome (40% versus 34%); a final diagnosis of acute myocardial infarction (14% versus 9%) and any potentially life-threatening condition (18% versus 12%). Individuals aged ≥ 65 years were given a lower priority than individuals aged 51-64 years, despite poorer characteristics and outcome. In all, 78% of cases with a potentially life-threatening condition and 67% of cases that died within 30 days of enrolment received dispatch priority 1. Mortality at one year was 1%, 4% and 18% in each individual age group. Conclusion: Men and the elderly were given a disproportionately low priority by the EMS. 

  • 14.
    Rawshani, Araz
    et al.
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Rawshani, Nina
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Andersson, Jan-Otto
    The Sahlgrenska University Hospital, Gothenburg, Sweden.
    Larsson, Anna
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Bång, Angela
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för juridik, ekonomi, statistik och politik. Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, nr I June, s. 43-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and aims: We examined the accuracy in assessments of emergency dispatchers according to their education and time of the day. We examined this in chest pain patients who were diagnosed with a potentially life-threatening condition (LTC) or died within 30 days. Methods: Among 2205 persons, 482 died, 1631 experienced an acute coronary syndrome (ACS), 1914 had a LTC.Multivariable logistic regression was used to study how time of the call and the dispatcher's education were associated with the risk of missing to give priority 1 (the highest). Results: Among patients who died, a 7-fold increase in odds of missing to give priority 1 was noted at 1.00 pm, as compared with midnight. Compared with assistant nurses, odds ratio for dispatchers with no (medical) training was 0.34 (95% CI 0.14 to 0.77). Among patients with an ACS, odds ratio for calls arriving before lunch was 2.02 (95% CI 1.22 to 3.43), compared with midnight. Compared with assistant nurses, odds ratio for operators with no training was 0.23 (95% CI 0.13 to 0.40). Similar associations were noted for those with any LTC. Dispatcher's education was not associated with the patient's survival. Conclusions: In this group of patients, which experience substantial mortality and morbidity, the risk of not obtaining highest dispatch priority was increased up to 7-fold during lunchtime. Dispatch operators without medical education had the lowest risk, compared with nurses and assistant nurses, of missing to give priority 1, at the expense of lower positive predictive value. Key messages: What is already known about this subject? Use of the emergency medical service (EMS) increases survival among patients with acute coronary syndromes. It is unknown whether the efficiency – as judged by the ability to identify life-threatening cases among patients with chest pain – varies according to the dispatcher's educational level and the time of day.What does this study add? We provide evidence that the dispatcher's education does not influence survival among patients calling the EMS due to chest discomfort. However, medically educated dispatchers are at greatest risk of missing to identify life threatening cases, which is explained by more parsimonious use of the highest dispatch priority. We also show that the risk of missing life-threatening cases is at highest around lunch time.How might this impact on clinical practice? Dispatch centers are operated differently all over the world and chest discomfort is one of the most frequent symptoms encountered; we provide evidence that it is safe to operate a dispatch center without medically trained personnel, who actually miss fewer cases of acute coronary syndromes. However, non-medically trained dispatchers consume more pre-hospital resources.

  • 15.
    Rawshani, Nina
    et al.
    Sahlgrenska University Hospital, Östra Sjukhuset, Department of Emergency Medicine, Göteborg, Sweden.
    Rawshani, Araz
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    University of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Department of Ambulance and Prehospital Emergency Care, Skaraborg, Sweden.
    Gellerstedt, Martin
    Högskolan Väst, Institutionen för ekonomi och it, Avd för informatik.
    Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain2017Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, nr 1 December, s. 77-81Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality).

    Methods

    The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n = 13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG.

    Results

    In the overall cohort, 21% (n = 2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n = 1159) did not undergo a pre-hospital ECG while 32% (n = 1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p &lt; 0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p &lt; 0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74).

    Conclusion

    Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality.

  • 16.
    Östman-Smith, Ingegerd
    et al.
    Gothenburg University, Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy.
    Wisten, Aase
    Sunderby Hospital, Luleå, Department of Internal Medicine.
    Nylander, Eva
    Linköping University, Department of Clinical Physiology/CVM, Faculty of Health Science.
    Bratt, Ewa-Lena
    Gothenburg University, Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy.
    de-Wahl Granelli, Anne
    Gothenburg University, Division of Paediatrics, Department of Clinical Sciences, Sahlgrenska Academy.
    Oulhaj, Abderrahim
    University of Oxford, OPTIMA, Department of Physiology, Anatomy and Genetics.
    Ljungström, Erik
    Lund University, Department of Cardiology, University Hospita.
    Electrocardiographic amplitudes: a new risk factor for sudden death in hypertrophic cardiomyopathy.2010Inngår i: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 31, nr 4, s. 439-449Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIMS: Assessment of ECG-features as predictors of sudden death in adults with hypertrophic cardiomyopathy (HCM).

    METHODS AND RESULTS: ECG-amplitude sums were measured in 44 normals, 34 athletes, a hospital-cohort of 87 HCM-patients, and 29 HCM-patients with sudden death or cardiac arrest (HCM-CA). HCM-patients with sudden death or cardiac arrest had substantially higher ECG-amplitudes than the HCM-cohort for limb-lead and 12-lead QRS-amplitude sums, and amplitude-duration products (P = 0.00003-P = 0.000002). Separation of HCM-CA from the HCM-cohort is obtained by limb-lead QRS-amplitude sum >or=7.7 mV (odds ratio 18.8, sensitivity 87%, negative predictive value (NPV) 94%, P < 0.0001), 12-lead amplitude-duration product >or=2.2 mV s (odds ratio 31.0, sensitivity 92%, NPV 97%, P < 0.0001), and limb-lead amplitude-duration product >or=0.70 mV s (odds ratio 31.5, sensitivity 93%, NPV 96%, P < 0.0001). Sensitivity in HCM-patients <40 years is 90, 100, and 100% for those ECG-variables, respectively. Qualitative analysis showed correlation with cardiac arrest for pathological T-wave-inversion (P = 0.0003), ST-depression (P = 0.0010), and dominant S-wave in V(4) (P = 0.0048). A risk score is proposed; a score >or=6 gives a sensitivity of 85% but a higher positive predictive value than above measures. Optimal separation between HCM-CA <40 years and athletes is obtained by a risk score >or=6 (odds ratio 345, sensitivity 85%, specificity 100%, P < 0.0001).

    CONCLUSION: Twelve-lead ECG is a powerful instrument for risk-stratification in HCM.

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