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  • 1.
    Bay, Annika
    et al.
    Umeå University, Department of Public Health and Clinical Medicine, Umeå University, Sweden; Department of Nursing, Sweden.
    Dellborg, Mikael
    Gothenburg University, Institute of Medicine, The Sahlgrenska Academy, Sweden..
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Centre for Person-Centred Care (GPCC), Sweden.
    Sandberg, Camilla
    Umeå University, Department of Public Health and Clinical Medicine, Sweden.
    Engström, Gunnar
    Umeå University, Department of Surgical and Perioperative Science, Cardiothoracic Surgery Division,.
    Moons, Philip
    KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Sweden..
    Johansson, Bengt
    Umeå University, Department of Public Health and Clinical Medicine, Sweden..
    Patient reported outcomes are associated with physical activity level in adults with congenital heart disease.2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 243, p. 174-179Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In general, adults with congenital heart disease (CHD) have impaired exercise capacity, and approximately 50% do not reach current recommendations on physical activity. Herein we analysed factors associated with physical activity level (PAL) in adults with CHD by using patient-reported outcomes (PRO).

    METHODS: Patients with CHD (n=471) were randomly selected from the national register on CHD and categorized according to complexity of lesions - simple (n=172, 39.1±14.6years), moderate (n=212, 39±14.1years), and severe (n=87, 31.7±10.7years). Participants completed a standardized questionnaire measuring PRO-domains including PAL. Variables associated with PAL were tested in multivariate logistic regression.

    RESULTS: PAL was categorized into high (≥3 METs ≥2.5h/week, n=192) and low (≥3 METs <2.5h/week, n=279). Patients with low PAL were older (42.6 vs. 35.8years, p≤0.001), had more prescribed medications (51% vs. 39%, p=0.009), more symptoms (25% vs. 16%, p=0.02) and comorbidity (45% vs. 34% p=0.02). Patients with low PAL rated a lower quality of life (76.6 vs. 83.4, p<0.001), satisfaction with life (25.6 vs. 27.3, p=0.003), a lower Physical Component Summary score (PCS) (78.1 vs. 90.5, p<0.001) and Mental Component Summary score (MCS) (73.5 vs. 79.5, p<0.001). Complexity of heart lesion was not associated with PAL. The included PROs - separately tested in the model, together with age were associated with PAL.

    CONCLUSIONS: PCS and MCS are stronger associated with PAL than age and medical factors. The use of these PROs could therefore provide valuable information of benefit for individualized advice regarding physical activity to patients with CHD.

  • 2.
    Gellerstedt, Martin
    et al.
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    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 pain2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 220, p. 734-738Article in journal (Refereed)
    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.

  • 3.
    Moons, Philip
    et al.
    KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden..
    Kovacs, Adrienne H.
    University of Toronto, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Knight Cardiovascular Institute, Oregon Health & Science University, Portand, OR, USA..
    Luyckx, Koen
    KU Leuven - University of Leuven, School Psychology and Development in Context, Leuven, Belgium..
    Thomet, Corina
    University of Bern, Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Bern, Switzerland..
    Budts, Werner
    University Hospitals Leuven, Division of Congenital and Structural Cardiology, Leuven, Belgium; KU Leuven Department of Cardiovascular Sciences, KU Leuven - University of Leuven, 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..
    Yang, Hsiao-Ling
    National Taiwan University, School of Nursing, College of MedicineTaipei, Taiwan.
    Jackson, Jamie L.
    Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.
    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, MI, USA..
    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
    Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway..
    Dellborg, Mikael
    University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden; Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden..
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden. 16 Centre for Person-Centred Care (GPCC), UGothenburg, 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.
    Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA.
    White, Kamila
    Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA..
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy..
    Kutty, Shelby
    Adult Congenital Heart Disease Center University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, NE, USA..
    Van Bulck, Liesbet
    KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care,Leuven, Belgium..
    Apers, Silke
    KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care,Leuven, Belgium..
    Patient-reported outcomes in adults with congenital heart disease: Inter-country variation, standard of living and healthcare system factors2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 251, p. 34-41Article in journal (Refereed)
    Abstract [en]

    AimsGeographical differences in patient-reported outcomes (PROs) of adults with congenital heart disease (ConHD) have been observed, but are poorly understood. We aimed to: (1) investigate inter-country variation in PROs in adults with ConHD; (2) identify patient-related predictors of PROs; and (3) explore standard of living and healthcare system characteristics as predictors of PROs.Methods and resultsAssessment of Patterns of Patient-Reported Outcomes in Adults with Congenital Heart disease – International Study (APPROACH-IS) was a cross-sectional, observational study, in which 4028 patients from 15 countries in 5 continents were enrolled. Self-report questionnaires were administered: patient-reported health (12-item Short Form Health Survey; EuroQOL-5D Visual Analog Scale); psychological functioning (Hospital Anxiety and Depression Scale); health behaviors (Health Behavior Scale–Congenital Heart Disease) and quality of life (Linear Analog Scale for quality of life; Satisfaction With Life Scale). A composite PRO score was calculated. Standard of living was expressed as Gross Domestic Product per capita and Human Development Index. Healthcare systems were operationalized as the total health expenditure per capita and the overall health system performance. Substantial inter-country variation in PROs was observed, with Switzerland having the highest composite PRO score (81.0) and India the lowest (71.3). Functional class, age, and unemployment status were patient-related factors that independently and consistently predicted PROs. Standard of living and healthcare system characteristics predicted PROs above and beyond patient characteristics.ConclusionsThis international collaboration allowed us to determine that PROs in ConHD vary as a function of patient-related factors as well as the countries in which patients live.

  • 4.
    Moons, Philip
    et al.
    KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
    Luyckx, Koen
    KU Leuven - University of Leuven, School Psychology and Development in Context, Leuven, Belgium.
    Dezutter, Jessie
    KU Leuven - University of Leuven, School Psychology and Development in Context, Leuven, Belgium.
    Kovacs, Adrienne H
    University of Toronto, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada; Knight Cardiovascular Institute, Oregon Health & Science University, Portand, OR, USA.
    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..
    Yang, Hsiao-Ling
    National Taiwan University, School of Nursing, College of Medicine, Taipei, Taiwan..
    Jackson, Jamie L
    Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.
    Khairy, Paul
    Université de Montréal, Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Canada.
    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
    Adult Congenital Heart Disease Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
    Dellborg, Mikael
    University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden; Adult Congenital Heart Unit, Sahlgrenska University Hospital, Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden.
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Institute of Health and Care Sciences, 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, OH, USA.
    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, Division of Pediatric Cardiology and Cardiovascular Medicine, Palo Alto, CA, USA.
    White, Kamila
    Washington University and Barnes Jewish Heart & Vascular Center, Adult Congenital Heart Disease Center, University of Missouri, Saint Louis, MO, USA.
    Callus, Edward
    Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.
    Kutty, Shelby
    Center University of Nebraska Medical Center, Adult Congenital Heart Disease, Children's Hospital and Medical Center, Omaha, NE, USA.
    Apers, Silke
    KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care, Leuven, Belgium..
    Religion and spirituality as predictors of patient-reported outcomes in adults with congenital heart disease around the globe.2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 274, p. 93-99, article id S0167-5273(18)30967-7Article in journal (Refereed)
    Abstract [en]

    AIMS: Religion and spirituality can be resources for internal strength and resilience, and may assist with managing life's challenges. Prior studies have been undertaken primarily in countries with high proportions of religious/spiritual people. We investigated (i) whether being religious/spiritual is an independent predictor of patient-reported outcomes (PROs) in a large international sample of adults with congenital heart disease, (ii) whether the individual level of importance of religion/spirituality is an independent predictor for PROs, and (iii) if these relationships are moderated by the degree to which the respective countries are religious or secular.

    METHODS AND RESULTS: APPROACH-IS was a cross-sectional study, in which 4028 patients from 15 countries were enrolled. Patients completed questionnaires to measure perceived health status; psychological functioning; health behaviors; and quality of life. Religion/spirituality was measured using three questions: Do you consider yourself religious or spiritual?; How important is religion, spirituality, or faith in your life?; and If religious, to what religion do you belong?. The country level of religiosity/secularity was appraised using data from the Gallup Poll 2005-2009. General linear mixed models, adjusting for patient characteristics and country differences were applied. Overall, 49.2% of patients considered themselves to be religious/spiritual. Being religious/spiritual and considering religion/spirituality as important in one's life was positively associated with quality of life, satisfaction with life and health behaviors. However, among patients living in more secular countries, religion/spirituality was negatively associated with physical and mental health.

    CONCLUSION: Religiosity/spirituality is an independent predictor for some PROs, but has differential impact across countries.

  • 5.
    Rassart, Jessica
    et al.
    University of Leuven, Leuven, Belgium; Research Foundation Flanders, Belgium.
    Apers, Silke
    University of Leuven, Leuven, Belgium.
    Kovacs, Adrienne H.
    University of Toronto, Toronto, Canada..
    Moons, Philip
    University of Leuven, Leuven, Belgium; University of Gothenburg, Gothenburg, Sweden.
    Thomet, Corina
    University Hospital Bern, Bern, Switzerland..
    Budts, Werner
    University of Leuven, Leuven, Belgium; University Hospitals Leuven, Leuven, Belgium.
    Enomoto, Junko
    Chiba Cardiovascular Center, Chiba, Japan..
    Sluman, Maayke A.
    Amsterdam Medical Center, Amsterdam, The Netherlands..
    Wang, Jou-Kou
    National Taiwan University Hospital, Taipei, Taiwan..
    Jackson, Jamie L.
    Nationwide Children's Hospital, Columbus, USA.
    Khairy, Paul
    Montreal Heart Institute, Montreal, Canada..
    Cook, Stephen C.
    Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital Grand Rapids, MI, USA..
    Subramanyan, Raghavan
    Frontier Lifeline Hospital, Dr. K. M. Cherian Heart Foundation, Chennai, India..
    Alday, Luis
    Hospital de Niños, Córdoba, Argentina..
    Eriksen, Katrine
    Oslo University Hospital, Oslo, Norway..
    Dellborg, Mikael
    University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Berghammer, Malin
    University West, Department of Health Sciences, Section for nursing - graduate level. University of Gothenburg, Gothenburg, Sweden.
    Johansson, Bengt
    University Hospital of Umeå, Umeå, Sweden.
    Rempel, Gwen R.
    University of Alberta, Edmonton, Canada.
    Menahem, Samuel
    Monash Medical Center, Melbourne, Australia..
    Caruana, Maryanne
    Mater Dei Hospital, Msida, Malta.
    Veldtman, Gruschen
    Cincinnati Children's Hospital Medical Center, Cincinnati, USA..
    Soufi, Alexandra
    Hospital Louis Pradel, Lyon, France..
    Fernandes, Susan M.
    Stanford University, Palo Alto, USA.
    White, Kamila S.
    Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, USA..
    Callus, Edward
    IRCCS Policlinco San Donato Hospital, Milan, Italy..
    Kutty, Shelby
    Children's Hospital & Medical Center, Omaha, USA.
    Luyckx, Koen
    University of Leuven, Leuven, Belgium.
    Illness perceptions in adult congenital heart disease: A multi-center international study2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 244, p. 130-138Article in journal (Refereed)
    Abstract [en]

    Background Illness perceptions are cognitive frameworks that patients construct to make sense of their illness. Although the importance of these perceptions has been demonstrated in other chronic illness populations, few studies have focused on the illness perceptions of adults with congenital heart disease (CHD). This study examined (1) inter-country variation in illness perceptions, (2) associations between patient characteristics and illness perceptions, and (3) associations between illness perceptions and patient-reported outcomes. Methods Our sample, taken from APPROACH-IS, consisted of 3258 adults with CHD from 15 different countries. Patients completed questionnaires on illness perceptions and patient-reported outcomes (i.e., quality of life, perceived health status, and symptoms of depression and anxiety). Patient characteristics included sex, age, marital status, educational level, employment status, CHD complexity, functional class, and ethnicity. Linear mixed models were applied. Results The inter-country variation in illness perceptions was generally small, yet patients from different countries differed in the extent to which they perceived their illness as chronic and worried about their illness. Patient characteristics that were linked to illness perceptions were sex, age, employment status, CHD complexity, functional class, and ethnicity. Higher scores on consequences, identity, and emotional representation, as well as lower scores on illness coherence and personal and treatment control, were associated with poorer patient-reported outcomes. Conclusions This study emphasizes that, in order to gain a deeper understanding of patients’ functioning, health-care providers should focus not only on objective indicators of illness severity such as the complexity of the heart defect, but also on subjective illness experiences.

  • 6.
    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
    University West, Department of Economics and IT, Divison of Informatics.
    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 pain2014In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 176, no 3, p. 859-865Article in journal (Refereed)
    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. 

  • 7.
    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
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics. University West, School of Business, Economics and IT, Divison of Informatics.
    Emergency medical dispatch priority in chest pain patients due to life threatening conditions: A cohort study examining circadian variations and impact of the education2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 236, no I June, p. 43-48Article in journal (Refereed)
    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.

  • 8.
    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
    University West, School of Business, Economics and IT, Divison of Informatics.
    Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain2017In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 248, no 1 December, p. 77-81Article in journal (Refereed)
    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.

  • 9.
    Rawshani, Nina
    et al.
    Varberg Hospital, Varberg, Halland County, Sweden.
    Rawshani, Araz
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Gelang, Carita
    University College of Borås, The Pre-hospital Research Centre of Western Sweden, Prehospen, Borås, Sweden.
    Herlitz, Johan
    University of Gothenburg, Department of Medicine, Göteborg, Sweden.
    Bång, Angela
    University of Borås, School of Health Science, Borås, Sweden.
    Andersson, Jan-Otto
    Ambulance Service, Skaraborg, Sweden.
    Gellerstedt, Martin
    University West, School of Business, Economics and IT, Divison of Law, Economics, Statistics and Politics.
    Could ten questions asked by the dispatch center predict the outcome for patients with chest discomfort?2016In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 209, no April, p. 223-225Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND AIMS: From 2009 to 2010, approximately 14,000 consecutive persons who called for the EMS due to chest discomfort were registered. From the seventh month, dispatchers ask 2285 patient ten pre-specified questions. We evaluate which of these questions was independently able to predict an acute coronary syndrome (ACS), life-threatening condition (LTC) and death.

    METHODS: The questions asked mainly dealt with previous history and type of symptoms, each with yes/no answers. The dispatcher took a decision on priority; 1) immediately with sirens/blue light; 2) EMS on the scene within 30min; 3) normal waiting time.We examined the relationship between the answers to these questions and subsequent dispatch priority, as well as outcome, in terms of ACS, LTC and all-cause mortality.

    RESULTS: 2285 patients (mean age 67years, 49% women) took part, of which 12% had a final diagnosis of ACS and 15% had a LTC. There was a significant relationship between all the ten questions and the priority given by dispatchers. Localisation of the discomfort to the center of the chest, more intensive pain, history of angina or myocardial infarction as well as experience of cold sweat were the most important predictors when evaluating the probability of ACS and LTC. Not breathing normally and having diabetes were related to 30-day mortality.

    CONCLUSIONS: Among individuals, who call for the EMS due to chest discomfort, the intensity and the localisation of the pain, as well as a history of ischemic heart disease, appeared to be the most strongly associated with outcome.

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