| 1. |
- Andersson, Jonas, et al.
(författare)
-
Diabetes mellitus, high BMI and low education level predict sudden cardiac death within 24 hours of incident myocardial infarction
- 2016
-
Ingår i: European Journal of Preventive Cardiology. - : Oxford University Press (OUP). - 2047-4873 .- 2047-4881. ; 23:17, s. 1814-1820
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: More than half of cardiovascular mortality occurs outside the hospital, mainly due to consistently low survival rates from out-of-hospital cardiac arrest.METHODS: This is a prospective, nested, case-control study derived from the Västerbotten Intervention Programme and the World Health Organization's Multinational Monitoring of Trends and Determinants in Cardiovascular Disease study in northern Sweden (1986-2006). To determine predictors for sudden cardiac death risk factors for cardiovascular disease were compared between incident myocardial infarction with sudden cardiac death (n = 363) and survivors of incident myocardial infarction (n = 1998) using multivariate logistic regression analysis.RESULTS: Diabetes had the strongest association with sudden cardiac death out of all evaluated risk factors (odds ratio (OR) 1.83, 95% confidence interval (CI) 1.30-2.59), followed by low education (OR 1.55, 95% CI 1.19-2.01), high body mass index (OR 1.05, 95% CI 1.02-1.08) and male sex (OR 1.42, 95% CI 1.001-2.01).CONCLUSIONS: The pattern of risk factors for incident myocardial infarction is different among survivors and those who die within 24 hours. The risk factors that contribute the most to death within 24 hours are diabetes mellitus, high body mass index and low education level, and can be addressed at both the public health level and by general practitioners.
|
|
| 2. |
- Eliasson, Mats, et al.
(författare)
-
The disparity between long-term survival in patients with and without diabetes following a first myocardial infarction did not change between 1989 and 2006 : an analysis of 6,776 patients in the Northern Sweden MONICA Study
- 2011
-
Ingår i: Diabetologia. - : SpringerLink. - 0012-186X .- 1432-0428. ; 54:10, s. 2538-2543
-
Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: Long-term survival after myocardial infarction(MI) has improved in the population, but data ondiabetic patients is lacking. We analysed survival for up to18 years after a first MI in patients with or without diabetesMethods: The Northern Sweden MONICA MyocardialInfarction Registry was linked to the Cause-of-DeathRegistry for a total of 6,776 patients, 25–64 years of age,with a first MI during 1989–2006. Prehospital deaths wereincluded. Follow-up ended on 30 August 2008.Results: Sixteen per cent had diabetes. Median follow-uptime was 6.8 years, and the study included 50,667 patientyears.One third of the non-diabetic patients died vs half ofthe diabetic patients. Median survival for non-diabetic menwas 227 months and for diabetic men 123 months.Corresponding figures for the non-diabetic and diabeticwomen were 222 and 81 months respectively. Men withdiabetes had an age-adjusted HR for all-cause mortality of 1.56 (95% CI 1.39, 1.79) vs men without diabetes. Mortality risk was higher among diabetic women, HR1.97 (1.62, 2.39) (diabetes × sex interaction, p=0.03). Survival increased for three consecutive cohorts and washigher in non-diabetic patients for all durations of follow-upand in all three cohorts. The interaction of diabetes x cohortwas not significant over time (p=0.5) and HRs did notdiffer either.Conclusions/interpretation Long-term survival after a firstMI is markedly lower in diabetic patients, especially amongwomen, over an 18-year observation time. Althoughsurvival has improved in diabetic patients, the effect ofdiabetes upon mortality has not diminished.
|
|
| 3. |
- Eriksson, Marie, et al.
(författare)
-
Large improvements in major cardiovascular risk factors in the population of northern Sweden : the MONICA study 1986–2009
- 2011
-
Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 269:2, s. 219-231
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives. The incidence of cardiovascular disease has declined rapidly in Sweden since the 1980s. We explored changes in major cardiovascular risk factors in northern Sweden between 1986 and 2009.Design. Since 1986, six population surveys have been carried out in northern Sweden using procedures of the World Health Organization MONICA project. The population age range was 25–64 years in 1986 and 1990, and 25–74 years from 1994. Trends were analysed using generalized linear models.Results. A total of 10 586 subjects were included in the surveys. Blood pressure decreased by 4.9/3.9 mmHg in women and 1.8/1.5 mmHg in men aged 25–64 years between 1986 and 2009. In men and women aged 65–74 years, the decrease was 12.6/6.1 mmHg between 1994 and 2009. From 1994, the use of blood pressure‐lowering drugs increased, particularly among the older subgroup. The prevalence of smoking halved between 1986 and 2009; 11% of women and 9% of men were smokers in 2009. Cholesterol levels decreased by 0.9 mmol L−1 in the younger age group (25–64 years), and the use of lipid‐lowering agents increased from 1994. Among subjects aged 25–64 years, one in five was obese in 2009, which was twice as many as in 1986, and body mass index (BMI) increased by 1.5 kg m−2, corresponding to an increase in weight of 4 kg. There was no further increase in BMI from 2004. The prevalence of diabetes did not change between 1986 and 2009. The proportion that received a university education increased markedly in all age groups, especially in women, during the study period.Conclusions. Significant improvements were observed in major cardiovascular risk factors in northern Sweden between 1986 and 2009.
|
|
| 4. |
- Forslund, Ann-Sofie, et al.
(författare)
-
A second chance at life : People's lived experiences of surviving out-of-hospital cardiac arrest
- 2017
-
Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 31:4, s. 878-886
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is more to illuminate about people's experiences of surviving out-of-hospital cardiac arrest (OHCA) and how such an event affects people's lives over time.AimsThis study aimed to elucidate meanings of people's lived experiences and changes in everyday life during their first year after surviving OHCA.MethodsA qualitative, longitudinal design was used. Eleven people surviving OHCA from northern Sweden agreed to participate and were interviewed 6 and 12 months after the event. A phenomenological hermeneutic interpretation was used to analyse the transcribed texts.FindingsThe structural analysis resulted in two themes: (i) striving to regain one's usual self and (ii) a second chance at life, and subthemes (ia) testing the body, (ib) pursuing the ordinary life, (ic) gratitude for help to survival, (iia) regaining a sense of security with one's body, (iib) getting to know a new self, and (iic) seeking meaning and establishing a future.ConclusionTo conclude, we suggest that people experienced meanings of surviving OHCA over time as striving to regain their usual self and getting a second chance at life. The event affected them in many ways and resulted in a lot of emotions and many things to think about. Participants experienced back-and-forth emotions, when comparing their present lives to both their lives before cardiac arrest and those lives they planned for the future. During their first year, participants’ daily lives were still influenced by ‘being dead’ and returning to life. As time passed, they wanted to resume their ordinary lives and hoped for continued lives filled with meaning and joyous activities.
|
|
| 5. |
- Forslund, Ann-Sofie, et al.
(författare)
-
Meanings of people's lived experiences of surviving an out-of-hospital cardiac arrest, 1 month after the event
- 2014
-
Ingår i: Journal of Cardiovascular Nursing. - 0889-4655 .- 1550-5049. ; 29:5, s. 464-471
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The out-of-hospital cardiac arrest (OHCA) survival rate has been poor and stable for a long time, but more recent studies describe its increase. However, there are few studies in which people narrate their experiences from surviving. Objective: The aim of this study was to elucidate meanings of people's lived experiences of surviving an OHCA with validated myocardial infarction (MI) etiology, 1 month after the event. Methods: A purposive sample of 2 women and 9 men was interviewed between February 2011 and May 2012. A phenomenological hermeneutical method was used for analysis, which involved 3 steps: naive reading and understanding, structural analysis, and comprehensive understanding. Results: There were 2 themes, (1) returning to life and (2) revaluing life, and five subthemes, (1a) waking up and missing the whole picture, (1b) realizing it was not time to die, (2a) wondering why and seeking explanations, (2b) feeling ambiguous in relations, and (2c) wondering whether life will be the same. All were constructed from the analysis. Conclusions: Surviving an OHCA with validated MI etiology meant waking up and realizing that one had experienced a cardiac arrest and had been resuscitated. These survivors had memory loss and a need to know what had happened during the time they were dead/unconscious. They searched for a reason why they experienced an MI and cardiac arrest and had gone from being "heart-healthy'' to having a lifelong illness. They all had the experience of passing from life to death and back to life again. For the participants, these differences led to a revaluation of what is important in life.
|
|
| 6. |
- Forslund, Ann-Sofie, et al.
(författare)
-
Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle
- 2013
-
Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 12:Suppl. 1, s. S13-S14
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle.Design: An explanatory mixed methods design was used.Methods: All people registered in the northern Sweden Monica myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n=71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis.Results: The quantitative results showed that about 60% of the people had no history of ischemic heart disease or hypertension before the out-of-hospital cardiac arrest whereas 25% and 17% had been diagnosed with myocardial infarction and diabetes mellitus, respectively. Eighty percent of the people had total cholesterol levels greater than 5.0 mmol/l and/or were taking lipid lowering medications. Almost half were smokers and overweight. The qualitative results are presented in three categories ‘descriptions of lifestyle after surviving’, ‘modifying the lifestyle to the new life situation’ and ‘a changed view on life’. The participants described that their lifestyle focused on the importance of being needed and meaning something to others, feeling well and doing things of their choice. They tried to find a reason why the cardiac arrest happened and make appropriate lifestyle changes although they made their own assessmnet of risk behaviours. The participants expressed being grateful for a second chance at life and tried to have a positive outlook on life.Conclusions: For most people in this study out-of-hospital cardiac arrest was the first symptom of coronary heart disease. In the interviews the participants expressed that they were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some of the patricipants chose to ignore this knowledge to some extent and preferred to live a ‘good life’. A life where risk factor treatment played a minor part. The results of this study indicates that health care workers and patients should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours and lifestyle changes linked to these things.
|
|
| 7. |
- Forslund, Ann-Sofie, et al.
(författare)
-
Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them : a mixed methods study
- 2013
-
Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 13:August
-
Tidskriftsartikel (refereegranskat)abstract
- Background The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n = 71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis. Results About 60 % of the people had no history of ischemic heart disease before the out-of-hospital cardiac arrest, but 20 % had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus, total cholesterol of more or equal 5 mmol/l or taking lipid lowering medication, and current smoker). Three categories (i.e., significance of lifestyle, modifying the lifestyle to the new life situation and a changed view on life) and seven sub-categories emerged from the qualitative analysis. Conclusions For many people out-of-hospital cardiac arrest was the first symptom of coronary heart disease. Interview participants were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some chose to ignore this knowledge to some extent and preferred to live a "good life", where risk factor treatment played a minor part. The importance of the support of family members in terms of feeling happy and having fun was highlighted by the interview participants and expressed as being the meaning of lifestyle. Perhaps the person with illness together with health care workers should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours linked to these things.
|
|
| 8. |
- Forslund, Ann-Sofie, et al.
(författare)
-
Trends in incidence and outcome of out-of-hospital cardiac arrest among people with validated myocardial infarction
- 2013
-
Ingår i: European Journal of Preventive Cardiology. - London, England : Oxford University Press (OUP). - 2047-4873 .- 2047-4881 .- 1741-8267 .- 1741-8275. ; 20:2, s. 260-267
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe trends in incidence, outcome, and background characteristics among people who suffered an out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V).Methods and results: People from the northern Sweden MONICA myocardial registry (1989–2007) with OHCA-V (n = 2977) were divided in two age groups (25–64 and 65–74 years). Both those who were resuscitated outside hospital and those who died before resuscitation was started were included in the study. The younger age group was studied during 1989–2007 and the older group during 2000–2007. The incidence of OHCA-V decreased in both the younger group (men p < 0.0001, women p = 0.04) and the older group (men p < 0.0001, women p < 0.0007, respectively). The proportion with a history of ischaemic heart disease prior to the event decreased (p < 0.0001). The proportion of previous myocardial infarction decreased (p < 0.0001), diabetes mellitus increased (p = 0.001), coronary interventions increased (p < 0.0001), and survival after OHCA-V increased (p < 0.0001) in the younger group but not in the older group. Long-term survival after OHCA-V was better in the younger than in the older group (p = 0.026).Conclusion: The incidence of OHCA-V decreased in both sexes. The proportion surviving after OHCA-V was small but increased, and long-term survival (≥28 days) was better in the younger age group. Primary preventive measures may explain most of the improvements. However, the effects of secondary preventive measures cannot be excluded.
|
|
| 9. |
- Höglund, Henrik, et al.
(författare)
-
Prodromal symptoms and health care consumption prior to out-of-hospital cardiac arrest in patients without previously known ischaemic heart disease
- 2014
-
Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 85:7, s. 864-868
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe prodromal symptoms and health care consumption prior to an out-of-hospital cardiac arrest (OHCA) in patients without previously known ischaemic heart disease (IHD). Background: The most common lethal event of cardiovascular disease is sudden cardiac death, and the majority occur outside hospital. Little is known about prodromal symptoms and health care consumption associated with OHCAs. Design: Case-crossover study. Methods: Medical records of 403 OHCA cases without previously known IHD, age 25-74 years in the MONICA myocardial registry in Norrbotten County 2000-2008, were reviewed. Presenting symptoms and emergency visits at public primary care facilities and internal medicine clinics in Norrbotten County were analyzed from the week prior to the OHCA and from the same week one year previously, which served as a control week. Unlike most studies we included unwitnessed arrests and those where no cardiopulmonary resuscitation (CPR) was attempted. Results: Emergency visits were more common during the week prior to the OHCA than during the control week, both for visits to primary care (29 vs. 6, p < 0.001) and to internal medicine clinics (16 vs. 0, p < 0.001). Symptoms were more prevalent during the week prior to the OHCA (36.7 vs. 6.7%, p < 0.001). The most prevalent symptoms were chest pain (14.6 vs. 0%, p < 0.001), gastrointestinal symptoms (7.7 vs. 1.2%, p < 0.001) and dyspnoea/peripheral oedema (6.9 vs. 0.2%, p < 0.001). Conclusions: Patients who suffer an OHCA seek health care and present prodromal symptoms significantly more often the week prior to the event than the same week one year earlier.
|
|
| 10. |
|
|
