| 191. |
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| 192. |
- Wallert, John, et al.
(författare)
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Cognitive ability, lifestyle risk factors, and two-year mortality in first myocardial infarction men: a Swedish national registry study
- 2016
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Ingår i: Circulation. - : Lippincott Williams & Wilkins. - 0009-7322 .- 1524-4539.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: General cognitive ability (CA) estimated early in life is positively associated with later physical and mental health, health literacy, and longevity.Methods: We investigated young adulthood CA as a long-term risk indicator for the lifestyle factors smoking, diabetes, hypertension, obesity, and two-year mortality in the largest sample to date of 60 years or younger Swedish first MI males. CA was estimated from mandatory conscript register data (INSARK) gathered when patients were 18-20 years old. The national quality register SWEDEHEART/RIKS-HIA provided data on cardiac functioning and lifestyle risk factors ~ 30 years later at first MI hospital admission. An additional two years later, the Cause of Death Register provided death dates for those deceased. The 5,680 complete cases including deceased (n = 110) and still alive (n = 5,570) were descriptively compared on CA, lifestyle risk factors and mortality. Logistic regression was used to model crude and adjusted associations.Results: Early first MI non-survivors had 0.28 SD lower young adulthood CA (M = 4.38, SD = 1.49) compared to survivors (M = 4.81, SD = 1.51). The whole first MI group CA was also 0.13 SD lower (M = 4.80, SD = 1.51) than the expected population norm (M = 5.00, SD = 1.56). Adjusting for covariates, one SD increase in CA was associated with decreased probability of being a current smoking (OR = 0.62 [0.59, 0.67], P < 0.001), previous smoker (0.79 [0.73, 0.84], P < 0.001), having diabetes (0.81 [0.74, 0.89], P < 0.001), obesity (0.89 [0.84, 0.95], P < 0.001) at hospital admission, and increased odds of being alive two years thereafter (1.27 [1.04, 1.53], P < 0.001). CA was not associated with hypertension at hospital admission (1.04 [0.97, 1.11], P = 0.228).Conclusion: This study confirms substantial inverse associations between CA, and lifestyle related cardiovascular risk factors, and mortality in the earliest first MI male patients. Our findings also expand the CA - morbidity association to comorbid diabetes and obesity. Since CA is highly stable from 18-65 years, can be cost-effectively estimated, and is presently not evaluated in clinical care, CA assessment might provide a better risk stratification and possibly aid further tailoring of secondary prevention.
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| 193. |
- Wallert, John, et al.
(författare)
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Cognitive ability, lifestyle risk factors, and two-year survival in first myocardial infarction men : A Swedish National Registry study
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 231, s. 13-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: General cognitive ability (CA) is positively associated with later physical and mental health, health literacy, and longevity. We investigated whether CA estimated approximately 30 years earlier in young adulthood predicted lifestyle-related risk factors and two-year survival in first myocardial infarction (MI) male patients.Methods: Young adulthood CA estimated through psychometric testing at age 18–20 years was obtained from the mandatory military conscript registry (INSARK) and linked to national quality registry SWEDEHEART/RIKS-HIA data on smoking, diabetes, hypertension, obesity (BMI > 30 kg/m2) in 60 years or younger Swedish males with first MI. Patients were followed up in the Cause of Death registry. The 5659 complete cases (deceased = 106, still alive = 5553) were descriptively compared. Crude and adjusted associations were modelled with logistic regression.Results: After multivariable adjustment, one SD increase in CA was associated with a decreased odds ratio of being a current smoker (0.63 [0.59, 0.67], P < 0.001), previous smoker (0.79 [0.73, 0.84], P < 0.001), having diabetes (0.82 [0.74, 0.90], P < 0.001), being obese (0.90 [0.84, 0.95], P < 0.001) at hospital admission, and an increased odds ratio of two-year survival (1.26 [1.02, 1.54], P < 0.001). CA was not associated with hypertension at hospital admission (1.03 [0.97, 1.10], P = 0.283).Conclusions: This study found substantial inverse associations between young adulthood CA, and middle-age lifestyle risk factors smoking, diabetes, and obesity, and two-year survival in first MI male patients. CA assessment might benefit risk stratification and possibly aid further tailoring of secondary preventive strategy.
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| 194. |
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| 195. |
- Wallert, John, 1982-
(författare)
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Forecasting myocardial infarction and subsequent behavioural outcomes
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is compiled from four studies dealing with the prediction of myocardial infarction (MI) and some associated risk behaviours post MI.Study 1 extends the field of possible psychosocial stress-triggering of MI to Sweden, and to the phenomenon of temporal crests and troughs in national MI rates. These findings are in the present thesis integrated into a more comprehensive theoretical framework than provided by previous studies. By controlling for different confounders, analysis in subgroups, and more, the probable effect of psychosocial stress on the triggering of MI producing slight oscillations in daily MI rates at different temporal cycles was supported.Study 2 extends the existing literature of cognitive epidemiology to secondary preventive cardiology. Males with higher cognitive ability (CA), as assessed at mandatory military conscription in young adulthood, were found to be more adherent to their statin medication post MI, approximately 30 years later. The association is likely causal, given the fundamental importance of CA as a predictor for our individual ability to understand, plan, and execute everyday behaviour, including such health promoting behaviour as adhering to statin medication after MI.Study 3 continues the thesis thread of predicting clinically relevant health-promoting behaviour. It generated important hypotheses of what predicts adherence to internet-based cognitive behaviour therapy (ICBT) for symptoms of anxiety and/or depression after MI. In particular, the linguistic variables which were derived from what the patients actually wrote online to their ICBT therapist, predicted adherence. Using a flexible random forest model with a moderately sized sample, the aim was to handle a range of predictors and possible higher order effects in the relative strength estimation of these predictors.Study 4 presents the derivation and external validation of a new risk model, STOPSMOKE. Developed as a linear support vector machine with robust resampling, STOPSMOKE proved accurate in the unseen validation cohort for predicting one-year smoking abstinence at the start of cardiac rehabilitation (CR) post MI. STOPSMOKE predictions may inform the targeting of more elaborate interventions to high risk patients. Today, such intervention is not systematic as standard counselling does not account for the individual probability of future smoking abstinence failure. STOPSMOKE thus provides a novel real-world probabilistic basis for the risk of future smoking abstinence failure after MI. This basis may then be used by clinicians, patients, and organisations to tailor smoking intervention as best suited the particular individual or high-risk group. Implemented as part of a spectrum of models in a semi-automatic system, cost-effective tailored risk assessment could allow for augmented CR for future patients.
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| 196. |
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| 197. |
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| 198. |
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| 199. |
- Wallert, J., et al.
(författare)
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Predicting adherence to internet-delivered cognitive behaviour therapy for comorbid symptoms of depression and anxiety after myocardial infarction
- 2018
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 39, s. 1112-1112
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Psychotherapeutic treatment for the subgroup of patients with MI that also suffer from comorbid symptoms of anxiety and/or depression (MI-ANXDEP) is part of cardiac rehabilitation (CR). Adherence to a range of treatments and lifestyle advice is crucial for risk reduction in these patients. Understanding the relative importance of predictors of adherence to internet-delivered cognitive behaviour therapy (ICBT) for MI-ANXDEP could improve their targeted care.Purpose: We estimated the relative importance of a range of established and novel predictors of adherence to ICBT for MI-ANXDEP patients.Method: The study sample consisted of 90 MI-ANXDEP patients (58.4 years, 62% men) recruited from 25 hospitals in Sweden who were randomised to active treatment in the ICBT trial U-CARE Heart. Time-point of prediction was at completion of the first homework assignment (HWA), and adherence was gauged at the end of treatment (48% adherers). Adherence was defined as completing at least the first two HWAs within the 14-week treatment period. A supervised machine learning (ML) procedure, applying 3x10 cross-validated recursive feature elimination with a random forest model as internal classifier, estimated the relative importance of predictors for adherence from a range of patient demographic, clinical, and linguistic variables that were available at completion of the first HWA.Result: Out of 34 potential predictors, ML selected an optimal set of 19 predictors (Accuracy 0.64, 95% CI 0.61–0.68). The strongest predictors for being classified as adherent were in order of relative importance (1) higher self-rated cardiac fear (CAQ fear), (2) female sex, (3) more words used by the patient to answer the first homework assignment (Number of words), (4) higher self-rated general cardiac anxiety (CAQ total), and (5) a higher rate of words used by the patient that were identical with words prompted by the first homework assignment (Number of mutual words), as depicted in the figure.Conclusion(s): It is of clinical importance to understand poor adherence to ICBT treatment in the high risk MI-ANXDEP subpopulation. Higher cardiac anxiety and female sex were the strongest predictors for adherence. A novel finding was that linguistic variables were important for predicting adherence, particularly the number of words used may signify the degree of personal investment and motivation for treatment, and the number of mutual words used may be a proxy for therapeutic alliance within the treatment. Education had no predictive value. Future research should investigate potential causal mechanisms, and whether these findings replicate outside of Sweden, in larger samples, and for similar eHealth treatments.
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| 200. |
- Wallert, John, et al.
(författare)
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Predicting Adherence to Internet-Delivered Psychotherapy for Symptoms of Depression and Anxiety After Myocardial Infarction : Machine Learning Insights From the U-CARE Heart Randomized Controlled Trial
- 2018
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Ingår i: Journal of Medical Internet Research. - : Air University Press. - 1438-8871. ; 20:10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low adherence to recommended treatments is a multifactorial problem for patients in rehabilitation after myocardial infarction (MI). In a nationwide trial of internet-delivered cognitive behavior therapy (iCBT) for the high-risk subgroup of patients with MI also reporting symptoms of anxiety, depression, or both (MI-ANXDEP), adherence was low. Since low adherence to psychotherapy leads to a waste of therapeutic resources and risky treatment abortion in MI-ANXDEP patients, identifying early predictors for adherence is potentially valuable for effective targeted care.Objectives: The goal of the research was to use supervised machine learning to investigate both established and novel predictors for iCBT adherence in MI-ANXDEP patients.Methods: Data were from 90 MI-ANXDEP patients recruited from 25 hospitals in Sweden and randomized to treatment in the iCBT trial Uppsala University Psychosocial Care Programme (U-CARE) Heart study. Time point of prediction was at completion of the first homework assignment. Adherence was defined as having completed more than 2 homework assignments within the 14-week treatment period. A supervised machine learning procedure was applied to identify the most potent predictors for adherence available at the first treatment session from a range of demographic, clinical, psychometric, and linguistic predictors. The internal binary classifier was a random forest model within a 3×10–fold cross-validated recursive feature elimination (RFE) resampling which selected the final predictor subset that best differentiated adherers versus nonadherers.Results: Patient mean age was 58.4 years (SD 9.4), 62% (56/90) were men, and 48% (43/90) were adherent. Out of the 34 potential predictors for adherence, RFE selected an optimal subset of 56% (19/34; Accuracy 0.64, 95% CI 0.61-0.68, P<.001). The strongest predictors for adherence were, in order of importance, (1) self-assessed cardiac-related fear, (2) sex, and (3) the number of words the patient used to answer the first homework assignment.Conclusions: For developing and testing effective iCBT interventions, investigating factors that predict adherence is important. Adherence to iCBT for MI-ANXDEP patients in the U-CARE Heart trial was best predicted by cardiac-related fear and sex, consistent with previous research, but also by novel linguistic predictors from written patient behavior which conceivably indicate verbal ability or therapeutic alliance. Future research should investigate potential causal mechanisms and seek to determine what underlying constructs the linguistic predictors tap into. Whether these findings replicate for other interventions outside of Sweden, in larger samples, and for patients with other conditions who are offered iCBT should also be investigated.
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