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- Härdén, Marie, et al.
(författare)
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Responsiveness of AF6, a new, short, validated, atrial fibrillation-specific questionnaire--symptomatic benefit of direct current cardioversion.
- 2010
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Ingår i: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing. - : Springer Science and Business Media LLC. - 1572-8595. ; 28:3, s. 185-191
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To measure the effects on symptoms of electrical cardioversion (DC) in patients with atrial fibrillation (AF) by means of a new, short, validated, AF-specific questionnaire, the AF6. Methods One hundred eleven patients (67 ± 12 years, 89 men) were screened before and 12 ± 3 days after DC using AF6, covering ‘breathing difficulties at rest’, ‘breathing difficulties on exertion’, ‘limitations in day-to-day life due to atrial fibrillation’, ‘feeling of discomfort due to atrial fibrillation’, ‘tiredness due to atrial fibrillation’, and ‘worry/anxiety due to atrial fibrillation’. A single global score was calculated. The Toronto AF Symptoms and Severity Check List (AFSS) and the generic SF-36 were also administered. Patients in sinus rhythm at 12 ± 3 days (n = 56) were defined as responders and patients in AF (n = 55) as non-responders. Results The mean single global score decreased in all patients (18 ± 12.4 to 13 ± 11.6, p < 0.0001) and in responders (22 ± 14 vs. 12 ± 12, p < 0.01) but not in non-responders (14 ± 9 vs. 14 ± 11, N.S). The AFSS frequency scores decreased from 14.5 ± 7.7 to 9.5 ± 7.8 in responders, p = 0.001, but not in non-responders. There was a strong correlation between changes in the AF6 and the SF-36 regarding four of the six items. Effect sizes of AF6 ranged from 0 to 0.52 in all patients, in responders from 0.10 to 0.85 and in non-responders from −0.23 to 0.34, the highest figures consistently referring to ‘tiredness due to atrial fibrillation’. Conclusions The symptom scores measured by AF6 decreased significantly, especially in responders. AF6 demonstrated adequate responsiveness to change, and effect sizes were mostly moderate, in responders moderate to high.
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| 2. |
- Härdén, Marie, 1964, et al.
(författare)
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Validity and reliability of a new, short symptom rating scale in patients with persistent atrial fibrillation
- 2009
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Ingår i: Health and Quality of Life Outcomes. ; 7:65, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: Symptoms related to atrial fibrillation and their impact on health-related quality of life (HRQoL) are often evaluated in clinical trials. However, there remains a need for a properly validated instrument. We aimed to develop and validate a short symptoms scale for patients with AF. Methods: One hundred and eleven patients with a variety of symptoms related to AF were scheduled for DC cardioversion. The mean age was 67.1 ± 12.1 years, and 80% were men. The patients completed the new symptoms scale, the Toronto Symptoms Check List (SCL) and the generic Short Form 36 (SF-36) the day before the planned DC cardioversion. Compliance was excellent, with only 1 of 666 answers missing. Results: One item, 'limitations in working capability', was deleted because of a low numerical response rate, as many of the patients were retired. The internal consistency reliability of the remaining six items was 0.81 (Cronbach's α). Patients scored highest in the items of 'dyspnoea on exertion', 'limitations in daily life due to AF' and 'fatigue due to AF', with scores of 4.5, 3.3 and 4.5, respectively. There was a good correlation to all relevant SF-36 domains and to the relevant questions of the SCL. The Rasch analyses showed that the items are unidimensional and that they are clearly separated and cover an adequate range. Test-retest reliability was performed in patients who failed DC and was adequate for three of six items, >0.70. Conclusion: The psychometric characteristics of the new short symptoms scale were found to have satisfactory reliability and validity.
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| 3. |
- Jansson, Per-Anders, 1961, et al.
(författare)
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Tadalafil increases muscle capillary recruitment and forearm glucose uptake in women with type 2 diabetes
- 2010
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Ingår i: DIABETOLOGIA. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 53:10, s. 2205-2208
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis Recent evidence suggests that reduced synthesis of nitric oxide in endothelial cells, i.e. endothelial dysfunction, contributes to the impaired action of insulin in the vasculature of patients with type 2 diabetes. We investigated whether selective inhibition of phosphodiesterase-5 by tadalafil has beneficial effects on peripheral microcirculation and glucose uptake in these patients. Methods We enrolled seven postmenopausal women with type 2 diabetes and ten age-matched healthy women as controls in a placebo-controlled study to evaluate the acute metabolic effects of tadalafil. We performed microdialysis and blood flow measurements in muscle, and sampled arterial and deep venous blood before and after a single dose of tadalafil 20 mg or placebo. Circulating glucose and insulin levels, muscle capillary recruitment as reflected by permeability surface area for glucose (PSglu) and forearm glucose uptake were measured. Results In women with type 2 diabetes, but not in the control group, tadalafil induced increases in the incremental AUC for PSglu (tadalafil vs placebo 41 ± 11 vs 4 ± 2 ml [100 g]−1 min−1, p < 0.05) and forearm glucose uptake (46 ± 9 vs 8 ± 4 µmol [100 g]−1 min−1, p < 0.05). The variable that best predicted forearm glucose uptake was PSglu, which explained 70% of its variance. However, fasting glucose and insulin concentrations were similar following treatment with placebo or tadalafil in the two groups. Conclusions/interpretation This study suggests that tadalafil evokes positive metabolic effects in insulin-resistant women with type 2 diabetes.
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| 4. |
- Sandstedt, Bengt, 1951, et al.
(författare)
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Testing the implantable cardioverter-defibrillator after implantation--is it necessary?
- 2007
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Ingår i: Pacing Clin Electrophysiol. - 0147-8389. ; 30:8, s. 985-91
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Tidskriftsartikel (refereegranskat)abstract
- The results of intraoperative and postoperative predischarge implantable cardioverter-defibrillator (ICD) testing of 211 consecutive patients, starting at 15 J and requiring two successful terminations of induced VT/VF with a relative defibrillation safety margin (DSM) of >10 J, were reviewed. The aim was to define the type of intraoperative response that would make postoperative predischarge testing unnecessary. The intraoperative responses were divided into three types: A, a DSM > or =10 J and an absolute energy level of < or =20 J; B, a DSM of > or =10 J and an absolute energy level of >20 J; and C, a DSM <10 J and an absolute energy level of >20 J. At operation, the responses to defibrillation were A, 88.6%; B, 7.1%; and C, 4.3%. Accepting an A response only would leave 11.4% of the patients for postoperative testing. The positive and negative predictive values for diagnosing a postoperative C response were 0.78 and 0.97, respectively. Similarly, the predictive values for diagnosing a postoperative B or C response were 0.71 and 0.97, respectively. The postoperative testing responses were A, 89.1%; B, 4.3%; and C, 6.6%. In summary, an intraoperative A response was sufficient to make a postoperative defibrillation testing unnecessary, while it was found that intraoperative B and C responders should undergo postoperative testing. Applying these criteria, approximately 90% of the patients could be discharged without any postoperative induction test.
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