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- Bengtsson, A, et al.
(författare)
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The appropriateness of performing coronary angiography and coronary artery revascularization in a Swedish population
- 1994
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Ingår i: Journal of the American Medical Association (JAMA). - : American Medical Association. - 0098-7484 .- 1538-3598. ; 271:16, s. 1260-1265
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Tidskriftsartikel (refereegranskat)abstract
- Objective. —To evaluate the appropriateness of performing coronary angiography and revascularization in a Swedish population. Design. —Prospective population study of questionnaires and medical records. Setting. —All the hospitals in southwestern Sweden that perform coronary angiography and revascularization. Patients. —Random sample of 831 patients (with chronic stable angina) on the waiting list for coronary angiography or revascularization in southwestern Sweden in September 1990. Main Outcome Measure. —Percentage of patients referred for coronary angiography or revascularization for appropriate, uncertain, or inappropriate indications. Results. —Of the patients referred for angiography, 89% were classified as appropriate, 9% as uncertain, and 2% as inappropriate. The percentages are similar for patients referred for coronary artery bypass graft surgery and for angioplasty (91% and 86%, respectively, classified as appropriate). The majority of patients had chest pain rated as Canadian Cardiovascular Society classes II through IV (93%), despite maximum anti-ischemic therapy in 90% of these patients. Conclusions. —Few patients were referred for coronary angiography or revascularization for inappropriate or uncertain indications. The percentage of these patients who are from southwestern Sweden is similar to the percentage recently reported from New York State.
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| 2. |
- Bengtsson, A, et al.
(författare)
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The epidemiology of a coronary waiting list. A description of all patients
- 1994
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 235:3, s. 263-269
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Tidskriftsartikel (refereegranskat)abstract
- Keywords: cardiac symptoms; chest pain; coronary revascularization; delay; ischaemic heart disease; nervous reactions; waiting list Abstract. Objectives. To describe the characteristics and the severity of symptoms amongst patients on the waiting list for possible coronary revascularization. Design. All the patients were sent a postal questionnaire for symptom evaluation. Setting. All hospitals in western Sweden. Subjects. All patients in western Sweden on the waiting list in September 1990, who had been referred for coronary angiography or revascularization (n = 904) and a sex- and age-matched reference group (n = 809). Results. More than half of the patients had daily attacks of chest pain, whereas 16% reported less than one attack per week or no pain at all. However, other symptoms such as dyspnoea, tachycardia and nervous reactions were also common and 25% of all patients used sedatives. A long waiting time for a given procedure was not associated with more pain but with more nervous symptoms such as restlessness and insomnia (P < 0.0001) and greater use of sedatives and cigarettes (P < 0.05). Conclusions. We conclude that a long waiting time for possible coronary revascularization is associated with more nervous symptoms but not with more pain.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Causes of death in patients presenting to hospital with symptoms suggestive of acute myocardial infarction : a one-year follow-up study with autopsy results
- 1994
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 5:1, s. 51-60
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: About 20% of patients admitted to a medical emergency room have chest pain or other symptoms raising suspicion of acute myocardial infarction. AIM: To describe the place and mode of death in such patients during 1 year of follow-up. PATIENTS: All patients (n = 5362) admitted to a single hospital during 21 months because of such symptoms. RESULTS: In all, 565 patients (11%) died. Death rate was directly related to the initial degree of suspicion of acute myocardial infarction. Of these patients, 196 (35%) died during initial hospitalization and only 89 (16%) died outside the hospital. The overall autopsy rate was 53%. Of the deaths that occurred during initial hospitalization, the majority were judged as cardiac, most being due to acute myocardial infarction, particularly if the patients died in the coronary care unit. Among patients who died after discharge from hospital, non-cardiac factors contributed more substantially to death, particularly in patients who died during rehospitalization. The cause of death was not established in a high proportion of patients who died outside hospital. CONCLUSION: The results suggest that, among patients admitted to the emergency room because of suspected acute myocardial infarction, causes of death other than a documented cardiac event become increasingly important when the interval between admittance to the emergency room and death increases.
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| 4. |
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| 5. |
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| 6. |
- Herlitz, Johan, et al.
(författare)
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Mortality and morbidity during one year of follow-up in suspected acute myocardial infarction in relation to early diagnosis : experiences from the MIAMI trial
- 1990
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 228:2, s. 125-131
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Tidskriftsartikel (refereegranskat)abstract
- From a large randomized multicentre trial of metoprolol in suspected acute myocardial infarction (n = 5778) we report on the outcome during 1 year of follow-up, in relation to early diagnosis. Patients who developed a confirmed infarction had a 1-year mortality rate of 12.8%. This was significantly higher than the mortality rate of 6.3% (P less than 0.001) in patients with possible infarction and it was also higher than that in patients with no infarction, which was 5.0% (P less than 0.001). A multivariate analysis showed that independent risk predictors in the clinical history of patients without confirmed infarction were a history of angina pectoris, chronic use of digitalis and advanced age. After 1 year, angina pectoris was most common in patients with an initial possible infarction. These patients were also in most urgent need of bypass surgery. We thus conclude that the mortality during 1 year of follow-up among patients with an initially strongly suspected acute myocardial infarction was clearly related to whether or not the patient developed a myocardial infarction.
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| 7. |
- Herlitz, Johan, et al.
(författare)
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Occurence of chest pain more than 24 hours after hospital admission in acute myocardial infarction and its relation to prognosis
- 1992
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 81:1, s. 46-53
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Tidskriftsartikel (refereegranskat)abstract
- In 857 consecutive patients with acute myocardial infarction (AMI), the occurrence of chest pain more than 24 h after hospital admission is described and related to death or reinfarction during one year of follow-up. Prolonged chest pain was observed in 333 patients (39%). In this group 15% died and 7% developed reinfarction during the first month as compared with 10% (p < 0.05) and 2% (p < 0.01) respectively in patients without prolonged pain. However, during one year of follow-up mortality did not differ significantly between patients with (27%) and without (24%) prolonged pain. The 1-year reinfarction rate was similar in the two groups (18% and 14%, respectively; NS). We conclude that AMI patients with prolonged chest pain have a particularly high mortality during the first month. However, during a longer follow-up the prognosis is similar in patients with and without prolonged chest pain.
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| 8. |
- Herlitz, Johan, et al.
(författare)
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Occurrence of angina pectoris prior to acute myocardial infarction and its relation to prognosis
- 1993
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 14:4, s. 484-491
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Tidskriftsartikel (refereegranskat)abstract
- In 917 patients with acute myocardial infarction (AMI) we evaluated the impact of previous angina pectoris on the prognosis. Thirty-four percent of the patients had chronic angina prior to AMI, and 22% had angina pectoris of short duration. Patients with chronic angina pectoris differed from the remaining patients having a more frequent previous history of AMI, diabetes mellitus, hypertension, and congestive heart failure. They less frequently developed a Q-wave AMI, and had smaller infarcts according to maximum serum-enzyme activity as compared with the remaining patients. They had a higher one-year mortality rate (36%) as compared with those having angina pectoris of short duration (22%), and those with no angina pectoris (26%). Their reinfarction rate was also higher (26%) as compared with that in the other two groups (15% and 9% respectively). In a multivariate analysis considering age, sex, clinical history, initial symptoms, initial electrocardiogram and estimated infarct size, previous chronic angina pectoris was not an independent risk factor for death, but was independently associated with the risk of reinfarction (P<0.001) Among patients with a history of angina pectoris the outcome was related to medication prior to onset of AMI and at discharge from hospital. Patients in whom beta-blockers were prescribed at discharge had a one-year mortality of 13% as compared with 30% in the remaining patients
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| 9. |
- Herlitz, Johan, et al.
(författare)
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Predictors of death and ventricular fibrillation in acute myocardial infarction
- 1992
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Ingår i: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 3:7, s. 651-658
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study is to describe predictors of death and ventricular fibrillation during hospitallzation and predictors of death during the first year after hospital discharge in patients having suffered from acute myocardial infarction (AMI). Methods: Seven hundred seventy-nine consecutive patients admitted to the coronary care unit in one single hospital are included in the analysis. Results: Predictors of death during hospitalization in order of significance were: 1) age (P< 0.001); 2) Q-wave on admission (P< 0.01); 3) a previous history of diabetes mellitus (P< 0.01); 4) arrhythmia at onset of symptoms (P< 0.05); and 5) S-enzyme maximum activity (P< 0.05). The only risk indicator for ventricular fibrillation was enzyme-estimated infarct size (P< 0.001). Risk indications for death after hospital discharge were: 1) age (P< 0.001); 2) acute congestive heart failure on admission (P< 0.01); 3) previous history of hypertension (P< 0.01); and 4) previous history of myocardial infarction (P< 0.05). Patients in whom [beta]-blockers were prescribed at discharge had a 1-year mortality rate of 10% versus 24% for those in whom p-blockers were not prescribed (P< 0.001). Conclusions: With the exception of age, risk indicators for death during hospitalization differ from risk indicators for death after hospital discharge among patients admitted to the coronary care unit due to AMI.
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| 10. |
- Herlitz, Johan, et al.
(författare)
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Prognosis during one year follow-up after acute myocardial infarction with emhpasis on morbidity
- 1994
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Ingår i: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 17:1, s. 15-20
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Tidskriftsartikel (refereegranskat)abstract
- Previous descriptions of the prognosis after acute myocardial infarction (AMI) have mainly included patients admitted to coronary care units, often with an upper age limit. This study describes the prognosis, with emphasis on morbidity, during 1 year in 921 patients admitted to one single hospital with AMI regardless of age and regardless of whether or not they were admitted to the coronary care unit. During the first year, 29% of the patients died and 16% developed a reinfarction. Fifty-four percent required rehospitalization for various reasons, mainly for AMI, chest pain of other origins, and congestive heart failure. After 1 year, 52% of the surviving patients had symptoms of angina pectoris. Among patients younger than 65 years, only 37% were back to work full time after 1 year. Of patients alive after 1 year, 25% fulfilled the following criteria: no reinfarction, no rehospitalization, and no angina pectoris. Of patients aged less than 65 years at follow-up, 12% fulfilled the same criteria and were back to work full time after 1 year. In this unselected, consecutive series of patients with AMI, mortality and morbidity were high during the first year. Only a small percentage of patients were free of events or symptoms of angina pectoris.
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