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- Adielsson, A, et al.
(author)
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Increase in survival and bystander CPR in out-of-hospital shockable arrhythmia : bystander CPR and female gender are predictors of improved outcome. Experiences from Sweden in an 18-year perspective
- 2011
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In: Heart. - : B M J Group. - 1355-6037 .- 1468-201X. ; 97:17, s. 1391-1396
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Journal article (peer-reviewed)abstract
- Objectives In a national perspective, to describe survival among patients found in ventricular fibrillation or pulseless ventricular tachycardia witnessed by a bystander and with a presumed cardiac aetiology and answer two principal questions: (1) what are the changes over time? and (2) which are the factors of importance? Design Observational register study. Setting Sweden. Patients All patients included in the Swedish Out of Hospital Cardiac Arrest Register between 1 January 1990 and 31 December 2009 who were found in bystander-witnessed ventricular fibrillation with a presumed cardiac aetiology. Interventions Bystander cardiopulmonary resuscitation (CPR) and defibrillation. Main outcome measures Survival to 1 month. Results In all, 7187 patients fulfilled the set criteria. Age, place of out-of-hospital cardiac arrest (OHCA) and gender did not change. Bystander CPR increased from 46% to 73%; 95% CI for OR 1.060 to 1.081 per year. The median delay from collapse to defibrillation increased from 12 min to 14 min (p for trend 0.0004). Early survival increased from 28% to 45% (95% CI 1.044 to 1.065) and survival to 1 month increased from 12% to 23% (95% CI 1.058 to 1.086). Strong predictors of early and late survival were a short interval from collapse to defibrillation, bystander CPR, female gender and OHCA outside the home. Conclusion In a long-term perspective in Sweden, survival to 1 month after ventricular fibrillation almost doubled. This was associated with a marked increase in bystander CPR. Strong predictors of outcome were a short delay to defibrillation, bystander CPR, female gender and place of collapse.
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| 3. |
- Engdahl, J, et al.
(author)
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Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? Experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same Emergency Medical Service and admitted to one of two hospitals over a 16-year period in the municipality of Göteborg
- 2000
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In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 43:3, s. 201-211
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Journal article (peer-reviewed)abstract
- AIM: To describe patient characteristics, hospital investigations and interventions and early mortality among patients being hospitalized after out-of-hospital cardiac arrest in two hospitals. SETTING: Municipality of Göteborg, Sweden. PATIENTS: All patients suffering an out-of-hospital cardiac arrest who were successfully resuscitated and admitted to hospital between 1 October 1980 and 31 December 1996. All patients were resuscitated by the same Emergency Medical Service and admitted alive to one of the two city hospitals in Göteborg. RESULTS: Of 579 patients admitted to Sahlgrenska Hospital, 253 (44%) were discharged alive and of 459 patients admitted to Ostra Hospital, 152 (33%) were discharged alive (P < 0.001). More patients in Sahlgrenska Hospital were still receiving cardiopulmonary resuscitation (CPR) treatment (P = 0.03), but patients in Ostra had a lower systolic blood pressure and higher heart rate on admission. A larger percentage of patients admitted to Sahlgrenska Hospital underwent coronary angiography (P < 0.001), electrophysiological testing (P < 0.001), Holter recording (P < 0.001), echocardiography (P = 0.004), percutaneous transluminal coronary angioplasty (PTCA, P = 0.009), implantation of automatic implantable cardioverter defibrillator (AICD, P = 0.03) and exercise stress tests (P = 0.003). Inhabitants in the catchment area of Ostra Hospital had a less favourable socio-economic profile. CONCLUSION: Survival after out-of-hospital cardiac arrest may be affected by the course of hospital management. Other variables that might influence survival are socio-economic factors and cardiorespiratory status on admission to hospital. Further investigation is called for as more patients are being hospitalised alive after out-of-hospital cardiac arrest.
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| 4. |
- Dellborg, M, et al.
(author)
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Changes in the use of medication after acute myocardial infarction : Possible impact on post-myocardial infarction mortality and long-term outcome
- 2001
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In: Coronary Artery Disease. - : Lippincott Williams & Wilkins. - 0954-6928 .- 1473-5830. ; 12:1, s. 61-67
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Journal article (peer-reviewed)abstract
- Objective: To describe the change in the use of medication after acute myocardial infarction (AMI) and discuss its possible impact on risk and risk indicators for death. Patients: All patients discharged alive after hospitalization for AMI at Sahlgrenska Hospital (covering half the community of Goteborg, i.e. 250 000 of 500 000 inhabitants) during 1986-1987 (period I) and at Sahlgrenska Hospital and Ostra Hospital (covering the whole community of Goteborg, 500 000 inhabitants) during 1990-1991 (period II). Methods: Overall mortality was retrospectively evaluated during 5 years of follow-up. Results: In all, 740 patients were included in the study during period I and 1448 during period II. The 5-year mortalities were 44.1% for period I patients and 39.3% for period II patients (P = 0.036). The relative risk of death for period II patients was 0.78 [95% confidence interval (CI) 0.67-0.89, P = 0.0005] after adjustment for differences at baseline. There was a significant interaction with a history of congestive heart failure; improvement in duration of survival was found only for patients without such a history. During period I, only 3% of patients were administered fibrinolytic agents, compared with 33% of patients during period II (P < 0.0001). During period I, aspirin was prescribed for 13% of patients discharged from hospital compared with 79% during period II. Other changes in treatment on going from period I to period II included increases in prescription of [beta]-blockers and angiotensin converting enzyme inhibitors. After adjustment for various risk indicators for death, relative risk of death for those administered fibrinolytic agents was 0.60 (95% CI 0.18-2.02) for patients in the period-I cohort and 0.68% (95% CI 0.51-0.91) for those in the period-II cohort. Adjusted relative risk of death for those prescribed aspirin upon discharge from hospital was 0.81 (95% CI 0.52-1.25) for period-I patients and 0.71 (95% CI 0.56-0.91) for period-II patients. The adjusted relative risk of death for those administered [beta]-blockers was 0.72 (95% CI 0.55-0.96) for period-I patients and 0.70 (95% CI 0.55-0.90) for period-II patients. Conclusion: Increased use of fibrinolytic agents and aspirin for AMI as well as a moderate increase in use of [beta]-blockers and angiotensin converting enzyme inhibitors was associated with a parallel reduction in age-adjusted mortality during the 5 years after discharge from hospital. However, this improvement was seen only for patients without histories of congestive heart failure.
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| 5. |
- Hedner, J, et al.
(author)
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Sleep habits and their association with mortality during 5-year follow-up after coronary artery bypass surgery
- 2002
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In: Acta Cardiologica. - : La Societe Belge de Cardiologie. - 0001-5385 .- 1784-973X. ; 57:5, s. 341-348
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study various aspects of sleep quality and sleep patterns prior to and after coronary artery bypass surgery and their implications for 5-year survival. METHODS: All patients from western Sweden who underwent coronary artery bypass grafting (CABG) between 1988 and 1991 (n = 2,121) received a questionnaire addressing sleep habits prior to and I year after surgery. Various symptoms and habits related to sleep at the two evaluations were compared. Symptoms and habits related to sleep prior to CABG were then related to 5-year survival. RESULTS: In all, 1,224 patients took part in the evaluation. A highly significant improvement was observed with regard to the following symptoms and habits related to sleep: feeling refreshed upon awakening, feeling tired during daytime, waking up with headache, nightmares, sweating during night time, medication for pain relief at bedtime, involuntarily falling asleep during daytime, apnoea during sleep and mouth dryness during the night. Various symptoms and habits associated with sleep prior to CABG were generally not strongly related to prognosis. Exceptions were feeling refreshed upon awakening and infrequent consumption of pain relief medication at bedtime which both were associated with an improved long-term survival. CONCLUSIONS: A variety of symptoms associated with sleep improve highly significantly after CABG. The occurrence of these symptoms prior to CABG do not generally seem to influence the long-term prognosis.
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| 6. |
- Herlitz, Johan, et al.
(author)
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Five year mortality in patients with acute chest pain in relation to smoking habits
- 2000
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In: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 23:2, s. 84-90
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Journal article (peer-reviewed)abstract
- BACKGROUND: Smoking is one of the major risk indicators for development of coronary artery disease, and smokers develop acute myocardial infarction (AMI) approximately a decade earlier than nonsmokers. In smokers with established coronary artery disease, quitting smoking has been associated with a more favorable prognosis. However, most of these studies comprised younger patients, the majority of whom were males. HYPOTHESIS: The purpose of the study was to determine mortality, mode of death, and risk indicators of death in relation to smoking habits among consecutive patients admitted to the emergency department with acute chest pain. METHODS: In all, 4,553 patients admitted with acute chest pain to the emergency department at Sahlgrenska University Hospital during a period of 21 months were included in the analyses and were prospectively followed for 5 years. RESULTS: Of these patients, 36% admitted current smoking. They were younger and had a lower prevalence of previous cardiovascular diseases than did nonsmokers. The 5-year mortality was 19.4% among smokers and 24.9% among non-smokers (p < 0.0001). However, when adjusting for difference in age, smoking was associated with an increased risk [relative risk (RR) 1.51; 95% confidence interval (CI) 1.32-1.74; p < 0.0001]. Among patients presenting originally with chest pain, the increased mortality for smokers was more pronounced in patients with non-acute than acute myocardial infarction (AMI). Among patients who died, death in smokers was less frequently associated with new-onset myocardial infarction (MI) and congestive heart failure. Among those who smoked at onset of symptoms and were alive 1 year later, 25% had stopped smoking. Patients with a confirmed AMI who continued smoking 1 year after onset of symptoms had a higher mortality (28.4%) during the subsequent 4 years than patients who stopped smoking (15.2%; p = 0.049). CONCLUSION: In consecutive patients admitted to the emergency department with acute chest pain, current smoking was significantly associated with an increased risk of death during 5 years of follow-up. Among patients who died, death in smokers was less frequently associated with new-onset MI and congestive heart failure than was death in nonsmokers.
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| 7. |
- Herlitz, Johan, et al.
(author)
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Occurrence, characteristics and outcome of patients hospitalized with diagnosis of acute myocardial infarction who do not fulfil traditional criteria
- 1998
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In: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 21:6, s. 405-409
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Journal article (peer-reviewed)abstract
- BACKGROUND: The diagnosis of acute myocardial infarction (AMI) is traditionally based on clinical history, elevation of serum enzyme activity, and typical changes in the electrocardiogram (ECG); however, not all patients who develop AMI fulfill these criteria on discharge from hospital. HYPOTHESIS: The aim of the study was to evaluate (1) the frequency with which the traditional criteria for AMI are not fulfilled among patients diagnosed with AMI on discharge, and (2) whether patients with and without these criteria differ in terms of characteristics, treatment, and outcome. METHODS: All patients aged < 75 years and hospitalized in the municipality of Göteborg with a discharge diagnosis of AMI were included. Fulfillment criteria for AMI were two of the following three points: (1) chest pain, (2) increase in cardiac enzymes, and (3) development of Q waves. RESULTS: In all, 1,188 admitted patients, 27% of whom were women, were included in the analysis. Of these, 193 (16%) did not fulfill the traditional criteria for AMI. These patients had an in-hospital mortality rate of 48%; of these, 59% died a sudden death, and of those who were autopsied (62%), 96% showed signs of a fresh AMI. The most common symptom on admission to hospital in patients who did not fulfill the traditional criteria was chest pain (34%), followed by dyspnea (27%) and fatigue (14%). Of those who died suddenly, fewer than half had been admitted to the coronary care unit. CONCLUSION: Patients diagnosed with AMI who do not fulfill the traditional diagnosis criteria have high mortality. On admission to hospital, the initial suspicion of AMI is often vague. Measures for earlier detection of life-threatening coronary artery disease among these patients are warranted.
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| 8. |
- Herlitz, Johan, et al.
(author)
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Predictors of death during 5 years after hospital discharge among patients with a suspected acute coronary syndrome with particular emphasis on whether an infarction was developed
- 1998
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In: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 66:1, s. 73-80
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Journal article (peer-reviewed)abstract
- Aim: To describe predictors of death after hospital discharge during 5 years of follow-up in a consecutive series of patients surviving hospitalization for symptoms and signs of a confirmed or suspected acute coronary syndrome. Patients and methods: All patients who between February 15, 1986 and November 9, 1987, were hospitalized at Sahlgrenska University Hospital in Göteborg, Sweden, and fulfilled the above given criteria. Results: In all, 1948 patients were included of whom 731 (38%) had a confirmed acute myocardial infarction (AMI). Independent risk indicators for death were: age (P=0.0001); male sex (P=0.005); a history of previous AMI (P=0.0001), diabetes mellitus (P=0.003) and smoking (P=0.0001); development of AMI during first 3 days in hospital (P=0.0001); in-hospital signs of congestive heart failure (P=0.0001); prescription of digitalis (P=0.001) and diuretics (P=0.02) at hospital discharge. A history of smoking interacted significantly (P=0.02) with the relationship between development of AMI and prognosis. Thus, the difference between patients who did and who did not develop an AMI was more pronounced among non-smokers than smokers. Other factors which interacted significantly with this relationship were a history of angina pectoris, and development of ventricular fibrillation and hypotension while in hospital. Conclusion: Among hospital survivors of a confirmed or suspected acute coronary syndrome predictors of death during 5 years were: age, male sex, history of AMI, diabetes mellitus and smoking, development of AMI and congestive heart failure while in hospital and prescription of digitalis and diuretics at hospital discharge. A history of smoking and angina pectoris as well as development of hypotension and ventricular fibrillation while in hospital interacted significantly with the relationship between development of AMI and prognosis.
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