| 1. |
- Daniel, Maria, et al.
(författare)
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Effect of Myocardial Infarction With Nonobstructive Coronary Arteries on Physical Capacity and Quality-of-Life
- 2017
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Ingår i: American Journal of Cardiology. - : Elsevier BV. - 0002-9149 .- 1879-1913. ; 120:3, s. 341-346
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Tidskriftsartikel (refereegranskat)abstract
- Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA), including Takotsubo syndrome (TS), are considered to have a better survival compared with those with coronary heart disease (CHD). Studies of patients with MINOCA measuring physical and mental function including matched control groups are lacking. The aim of this study was to determine the physical capacity and quality of life in patients with MINOCA. One-hundred patients with MINOCA along with TS (25%) were investigated from 2007 to 2011. A bicycle exercise stress test was performed 6 weeks after hospitalization and QoL was investigated by the Short Form Survey 36 at 3 months' follow-up. Both a healthy and a CHD group that were age and gender matched were used as controls. The MINOCA group had a lower physical capacity (139 ± 42 W) compared with the healthy control group (167 ± 53 W, p <0.001) but better than the CHD control group (124 ± 39 W, p = 0.023). Patients with MINOCA had lower physical and mental component summary scores compared with the healthy controls (p <0.001) and lower mental component summary (p = 0.012), mental health (p = 0.016), and vitality (p = 0.008) scores compared with the CHD controls. In conclusion, the findings of this first study on exercise capacity and QoL in patients with MINOCA showed both physical and mental distress from 6 weeks to 3 months after the acute event similar to CHD controls and in some perspectives even lower scores especially in the mental component of QoL.
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| 2. |
- Desta, Liyew, et al.
(författare)
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Adherence to beta-blockers and long-term risk of heart failure and mortality after a myocardial infarction
- 2021
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Ingår i: ESC Heart Failure. - : Wiley. - 2055-5822. ; 8:1, s. 344-355
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of this study is to investigate the association between adherence to beta-blocker treatment after a first acute myocardial infarction (AMI) and long-term risk of heart failure (HF) and death. Methods and results: All patients admitted for a first AMI included in the nationwide Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies register between 2005 and 2010 were eligible (n = 71 638). After exclusion of patients who died in-hospital, patients with previous HF, patients with unknown left ventricular ejection fraction (EF), and patients who died during the first year after the index event, 38 608 patients remained in the final analysis. Adherence to prescribed beta-blockers was determined for 1 year after the index event using the national registry for prescribed drugs and was measured as proportion of days covered, the ratio between the numbers of days covered by the dispensed prescriptions and number of days in the period. As customary, a threshold level for proportion of days covered ≥80% was used to classify patients as adherent or non-adherent. At discharge 90.6% (n = 36 869) of all patients were prescribed a beta-blocker. Among 38 608 1 year survivors, 31.1% (n = 12 013) were non-adherent to beta-blockers. Patients with reduced EF without HF and patients with HF with reduced EF were more likely to remain adherent to beta-blockers at 1 year compared with patients with normal EF (NEF) without HF. Being married/cohabiting and having higher income level, hypertension, ST-elevation MI, and percutaneous coronary intervention were associated with better adherence. Adherence was independently associated with lower all-cause mortality [hazard ratio (HR) 0.77, 95% confidence interval [CI] 0.71–0.84] and a lower risk for the composite of HF readmission/death, (HR 0.83, 95% CI 0.78–0.89, P value <0.001) during the subsequent 4 years of follow up. These associations were favourable but less apparent in patients with HFNEF and NEF. Conclusions: Nearly one in three AMI patients was non-adherent to beta-blockers within the first year. Adherence was independently associated with improved long-term outcomes; however, uncertainty remains for patients with HFNEF and NEF.
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| 3. |
- Hjort, Marcus, et al.
(författare)
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Increased Inflammatory Activity in Patients 3 Months after Myocardial Infarction with Nonobstructive Coronary Arteries
- 2019
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Ingår i: Clinical Chemistry. - : AMER ASSOC CLINICAL CHEMISTRY. - 0009-9147 .- 1530-8561. ; 65:8, s. 1023-1030
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Around 5%-10% of patients with myocardial infarction (MI) present with nonobstructive coronary arteries (MINOCA). We aimed to assess pathophysiological mechanisms in MINOCA by extensively evaluating cardiovascular biomarkers in the stable phase after an event, comparing MINOCA patients with cardiovascular healthy controls and MI patients with obstructive coronary artery disease (MI-CAD).METHODS: Ninety-one biomarkers were measured with a proximity extension assay 3 months after MI in 97 MINOCA patients, 97 age-and sex-matched MI-CAD patients, and 98 controls. Lasso analyses (penalized logistic regression models) and adjusted multiple linear regression models were used for statistical analyses.RESULTS: In the Lasso analysis (MINOCA vs MI-CAD), 8 biomarkers provided discriminatory value: P-selectin glycoprotein ligand 1, C-X-C motif chemokine 1, TNF-related activation-induced cytokine, and pappalysin-1 (PAPPA) with increasing probabilities of MINOCA, and tissue-type plasminogen activator, B-type natriuretic peptide, myeloperoxidase, and interleukin-1 receptor antagonist protein with increasing probabilities of MI-CAD. Comparing MINOCA vs controls, 7 biomarkers provided discriminatory value: N-terminal pro-B-type natriuretic peptide, renin, NF-kappa-B essential modulator, PAPPA, interleukin-6, and soluble urokinase plasminogen activator surface receptor with increasing probabilities of MINOCA, and agouti-related protein with increasing probabilities of controls. Adjusted multiple linear regression analyses showed that group affiliation was associated with the concentrations of 7 of the 8 biomarkers in the comparison MINOCA vs MI-CAD and 5 of the 7 biomarkers in MINOCA vs controls.CONCLUSIONS: Three months after the MI, the biomarker concentrations indicated greater inflammatory activity in MINOCA patients than in both MI-CAD patients and healthy controls, and a varying degree of myocardial dysfunction among the 3 cohorts.
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| 4. |
- Hofman-Bang, Claes
(författare)
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Evaluation of a multifactorial rehabilitation programme on lifestyle behaviour and secondary prevention in patients with coronary artery disease
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of the present work have been to study the effects of a multifactorial rehabilitation programme on rehabilitative and secondary prevention endpoints in patients with coronary artery disease. The programme focused on lifestyle and behavioural changes (smoking, diet, exercise and stress) and was initiated by a four weeks residential stay followed by an eleven months structured follow-up period. The specific aims and results have been the following: Study I: To describe the feasibility of the programme 292 patients with either acute myocardial infarction, coronary artery bypass surgery or percutaneous transluminal coronary angioplasty (PTCA) were included. Positive effects were seen in lifestyle and behavioural changes as well as medical risk indicators after one and 12 months. The study, which lacked a control group, is to be considered as a pilot study. Study II: In a randomised study to evaluate effects on achieved lifestyle and behavioural changes after 12 months and relate these changes to the outcome of secondary preventive end-points. Out of a consecutive population of 151 patients treated with PTCA, 87 were randomly allocated to an intervention (n=46) or to a control group (n=41). In both groups morbidity was low, symptoms few and rate of return to work high. The intervention group improved significantly more in several lifestyle dependent behaviours corresponding to an improved exercise capacity and weight loss of 1.6 kg. Psychological variables revealed only minor changes between groups. Study III: In the same patient population as study II to evaluate the effects of maintenance of achieved lifestyle and behavioural changes after an additional year of follow-up and to relate these changes to the outcome of secondary preventive end-points. During the second year a trend towards lower morbidity was seen in the intervention group compared with the control group. Several life style dependent behaviour changes were maintained in the intervention group. However, the control group attenuated the gap by a gradual improvement over time. After two years exercise capacity in the intervention group still had improved significantly but other medical risk factors as blood lipids, weight, and blood pressure were not different between the groups. Psychological variables revealed only minor changes between groups. Study IV: To evaluate the effect of the programme on progression of coronary atherosclerosis assessed by means of quantitative coronary arteriography (QCA). Out of the 87 patients 73 with available angiography films at inclusion and after two years of follow-up were included. Minimum lumen diameter (MLD) decreased significantly less in the intervention (-0.03 mm) than in the control group (-0.09 mm). However, mean lumen diameter and percentage stenosis did not differ significantly between the groups. Combining the intervention and control groups change in exercise habits related positively and change in weight negatively with change in MLD. Study V: To describe associations between known risk factors and measures of heart rate variability (HRV) and evaluate the applicability as regards disease progress or regress. Applying necessary quality criteria on the ECG recordings from 63/87 patients at inclusion and 48/87 both at inclusion and after two years of follow-up were included. Exercise capacity, type A behaviour and high-density lipoprotein levels associated positively with HRV while norepinephrine, neuropeptide Y and low-density lipoprotein levels demonstrated an inverse association. Changes in HRV over time associated negatively with changes in systolic blood pressure, body mass index, low-density lipoprotein cholesterol, neuropeptide Y and norepinephrine, and positively with change in high-density lipoprotein level. Finally, a proportionally high HRV related to decreased cardiovascular morbidity as defined by the need for hospitalisation. The observed associations were biologically relatively weak. The results suggest that this method is unsuitable for clinical monitoring of patients such as ours. Conclusions: This programme induced favourable but modest changes in a number of parameters considered important for rehabilitation and secondary prevention of patients with coronary artery disease. However, "time trends" attenuated the initial achieved gap between those subjected to the programme compared to those in routine care. Before being generally recommended the programme ought to be revised regarding some of its content. Effects on morbidity and mortality can not yet be fully evaluated.
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| 5. |
- Hofman-Bang, Claes, et al.
(författare)
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Two year results of a controlled study of a residential rehabilitation for patients treated with percutaneous transluminal coronary angioplasty : A randomized study of a multifactorial programme
- 1999
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 20:20, s. 1465-1474
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Tidskriftsartikel (refereegranskat)abstract
- Aims In a multifactorial lifestyle behaviour programme, of 2 years duration, to study the maintenance of achieved behaviour and risk factor-related changes. Methods and Results Out of a consecutive population of 151 patients treated with percutaneous transluminal angioplasty under 65 years of age, 87 were randomly allocated to an intervention group (n=46) or to a control group (n=41). The programme started with a 4 week residential stay, which was focused on health education and the achievement of behaviour change. During the first year of follow-up, a maintenance programme included regular contacts with a nurse, while no further rehabilitative efforts were offered during the second year. One patient died (control). During the second year the proportion of hospitalized patients was lower in the intervention group (4% vs 20%;P<0·05). Patients in the intervention group improved several lifestyle dependent behaviours: diet (index at 0, 12 and 24 months): 10·5±3·4, 12·9±2·5 and 12·4±2·6 in the intervention group (I) vs 10·1±3·2, 10·7±3·0 and 11·8±3·2 in the control group (C);P<0·05, exercise sessions per week: 2·5±2·3, 4·5±1·9 and 4·4±2·1 (I) vs 3·1±2·2, 3·5±2·3 and 3·7±2·7 (C);P<0·05, and smoking; 18%, 6% and 9% (I) vs 12%, 21% and 18% (C);P<0·05. This corresponded to improvement in exercise capacity (0, 12 and 24 months): 156±42, 174±49 and 165±47W (I) vs 164±40, 163±49 and 156±48 watts (C);P<0·05. There were no significant differences between the two groups with regard to serum cholesterol levels at 0 and 24 months: 5·4±0·8 and 5·2±0·9mmol.l–1(I) vs 5·4±1·0 and 4·9±0·9mmol.l–1(C); ns, low density lipoprotein cholesterol level: 3·6±0·8 and 3·4±0·8mmol.l–1(I) vs 3·7±0·9 and 3·3±0·7mmol.l–1(C); ns, triglyceride level: 2·2±1·6 and 1·8±1·3mmol.l–1(I) vs 2·2±1·4 and 1·6±0·6mmol.l–1(C); ns, body mass index (0, 12 and 24 months): 27·5±4·5, 27·0±4·3 and 27·4± 4·5kg.m–2(I) vs 26·8±2·8, 26·9±2·7 and 26·9± 3·2kg.m–2(C); ns, waist/hip ratio or blood pressure. The two groups did not differ in quality of life, or psychological factors. Return to work after 12 and 24 months was 74% and 78% (I) vs 68% and 61% (C); ns. Conclusion This rehabilitation programme influenced important lifestyle behaviour and reduced some, but not all, important risk factors Key Words: Rehabilitation, risk factors
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| 6. |
- Lisspers, Jan, et al.
(författare)
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Behavioral effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty : A prospective, randomized, controlled study
- 1999
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Ingår i: Journal of Psychosomatic Research. - 0022-3999. ; 46:2, s. 143-154
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Tidskriftsartikel (refereegranskat)abstract
- A group of 93 coronary patients recently treated with percutaneous transluminal coronary angioplasty (PTCA) were randomly assigned to either an intervention or a control group. Subjects in the intervention group participated in a comprehensive behaviorally oriented program aimed at achieving significant long-term changes in risk factor–related lifestyle behavior. Assessments of lifestyle behaviors, psychological factors, biological risk factors, and rehabilitation as well as secondary prevention endpoints were carried out, at inclusion and after 12 months. Results showed that the intervention patients, as compared with controls, improved significantly on measures assessing smoking, exercise, and diet habits. These self-rated changes were confirmed by weight reductions and improved exercise capacity, as well as by between-group differences in subclinical chest pain during an exercise test. However, few effects were found on the different psychological variables, as well as on morbidity or return to work.
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| 7. |
- Lisspers, Jan, et al.
(författare)
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Long-term effects of lifestyle behavior change in coronary artery disease : Effects on recurrent coronary events after Percutaneous Coronary Intervention
- 2005
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Ingår i: Health Psychology. - : American Psychological Association (APA). - 0278-6133 .- 1930-7810. ; 24:1, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluated the effects of a behaviorally oriented cardiac rehabilitation and secondary prevention program on lifestyle changes and on coronary recurrence rates. Patients recently treated with percutaneous coronary intervention (PCI) were randomized to an intervention with an aggressive focus on lifestyle changes (smoking, diet, exercise, and stress; n = 46) or to a standard-care control group (n = 42). Results showed that the intervention group had significantly larger overall lifestyle changes than the control group after 12, 24, 36, and 60 months. The intervention group had significantly lower rates of all coronary events (acute myocardial infarction, coronary artery bypass graft, PCI, cardiac death; 30.4% vs. 53.7%), and of cardiovascular mortality (2.2% vs. 14.6%). The need for future large-scale and long-term evaluations of lifestyle-oriented secondary prevention interventions of this kind is emphasized. (PsycINFO Database Record (c) 2007 APA, all rights reserved)
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| 8. |
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| 9. |
- Lisspers, Jan, et al.
(författare)
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Long-term effects of lifestyle behaviour change intervention after PTCA: Effects on lifestyle, progression of CAD, and on cardiac events. : The VI Nordic Congress on Cardiac Rehabilitation, June 14th-16th 2002, Reykjavik, Iceland.
- 2002
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Föredrag vid The VI Nordic Congress on Cardiac Rehabilitation, June 14th-16th 2002, Reykjavik, Iceland (Belönades med titeln: First price for an outstanding oral presentation at the VI Nordic Congress on Cardiac Rehabilitation, Reykjavik, 2002).
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| 10. |
- Lisspers, Jan, et al.
(författare)
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Multifactorial evaluation of a program for lifestyle behavior change in rehabilitation and secondary prevention of coronary artery disease
- 1999
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 33:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- A comprehensive, multifactorial lifestyle behavior change program was developed for rehabilitation and secondary prevention of subjects with coronary artery disease. The purpose of the present report is to describe this intervention model and to analyze results achieved in a first group of consecutive participants. Main inclusion criteria for the 292 subjects were a recent history of acute myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal coronary angioplasty. The program commenced with a 4-week residential stay, with the focus on health education and the achievement of behavior change in major lifestyle areas. During the year of follow-up a systematic maintenance program included regular contact with a nurse. Morbidity and mortality was low. Self-reported quality of life improved and there were significant improvements in blood lipids, exercise capacity and body mass index. There were also significant changes both in psychological variables such as Type A behavior, anger, hostility, and in major lifestyle areas such as stress reactions, diet, exercise and smoking. These changes compared favorably with data from relevant samples from the Swedish normal population. This program had a considerable effect on a number of important factors for rehabilitation and secondary prevention of coronary artery disease.
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