| 1. |
- Adielsson, Anna, 1973, et al.
(författare)
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A 20-year perspective of in hospital cardiac arrest : Experiences from a university hospital with focus on wards with and without monitoring facilities.
- 2016
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 216, s. 194-199
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Knowledge about change in the characteristics and outcome of in hospital cardiac arrests (IHCAs) is insufficient.AIM: To describe a 20year perspective of in hospital cardiac arrest (IHCA) in wards with and without monitoring capabilities.SETTINGS: Sahlgrenska University Hospital (800 beds). The number of beds varied during the time of survey from 850-746 TIME: 1994-2013.METHODS: Retrospective registry study. Patients were assessed in four fiveyear intervals.INCLUSION CRITERIA: Witnessed and nonwitnessed IHCAs when cardiopulmonary resuscitation (CPR) was attempted.EXCLUSION CRITERIA: Age below 18years.RESULTS: In all, there were 2340 patients with IHCA during the time of the survey. 30-Day survival increased significantly in wards with monitoring facilities from 43.5% to 55.6% (p=0.002) for trend but not in wards without such facilities (p=0.003 for interaction between wards with/without monitoring facilities and time period). The CPC-score among survivors did not change significantly in any of the two types of wards. In wards with monitoring facilities there was a significant reduction of the delay time from collapse to start of CPR and an increase in the proportion of patients who were defibrillated before the arrival of the rescue team. In wards without such facilities there was a significant reduction of the delay from collapse to defibrillation. However, the latter observation corresponds to a marked decrease in the proportion of patients found in ventricular fibrillation.CONCLUSION: In a 20year perspective the treatment of in hospital cardiac arrest was characterised by a more rapid start of treatment. This was reflected in a significant increase in 30-day survival in wards with monitoring facilities. In wards without such facilities there was a decrease in patients found in ventricular fibrillation.
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| 2. |
- Al-Dury, Nooraldeen, 1986, et al.
(författare)
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Characteristics and outcome among 14,933 adult cases of in-hospital cardiac arrest : A nationwide study with the emphasis on gender and age.
- 2017
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Ingår i: American Journal of Emergency Medicine. - : Elsevier. - 0735-6757 .- 1532-8171. ; 35:12, s. 1839-1844
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate characteristics and outcome among patients suffering in-hospital cardiac arrest (IHCA) with the emphasis on gender and age.METHODS: Using the Swedish Register of Cardiopulmonary Resuscitation, we analyzed associations between gender, age and co-morbidities, etiology, management, 30-day survival and cerebral function among survivors in 14,933 cases of IHCA. Age was divided into three ordered categories: young (18-49years), middle-aged (50-64years) and older (65years and above). Comparisons between men and women were age adjusted.RESULTS: The mean age was 72.7years and women were significantly older than men. Renal dysfunction was the most prevalent co-morbidity. Myocardial infarction/ischemia was the most common condition preceding IHCA, with men having 27% higher odds of having MI as the underlying etiology. A shockable rhythm was found in 31.8% of patients, with men having 52% higher odds of being found in VT/VF. After adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days. Older individuals were managed less aggressively than younger patients. Increasing age was associated with lower 30-day survival but not with poorer cerebral function among survivors.CONCLUSION: When adjusting for various confounders, it was found that men had a 10% lower chance than women of surviving to 30days after in-hospital cardiac arrest. Older individuals were managed less aggressively than younger patients, despite a lower chance of survival. Higher age was, however, not associated with poorer cerebral function among survivors.
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| 3. |
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| 4. |
- Caidahl, Kenneth, 1949, et al.
(författare)
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Homeostatic Chemokines and Prognosisin Patients With Acute Coronary Syndromes.
- 2019
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 1558-3597 .- 0735-1097. ; 74:6, s. 774-782
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Tidskriftsartikel (refereegranskat)abstract
- The chemokines CCL19 and CCL21 are up-regulated in atherosclerotic disease and heart failure, and increased circulating levels are found in unstable versus stable coronary artery disease.The purpose of this study was to evaluate the prognostic value of CCL19 and CCL21 in acute coronary syndrome (ACS).CCL19 and CCL21 levels were analyzed in serum obtained from ACS patients (n=1,146) on the first morning after hospital admission. Adjustments were made for GRACE (Global Registry of Acute Coronary Events) score, left ventricular ejection fraction, pro-B-type natriuretic peptide, troponin I, and C-reactive protein levels.The major findings were: 1) those having fourth quartile levels of CCL21 on admission of ACS had a significantly higher long-term (median 98months) risk of major adverse cardiovascular events (MACE) and myocardial infarction in fully adjusted multivariable models; 2) high CCL21 levels at admission were also independently associated with MACE and cardiovascular mortality during short-time (3months) follow-up; and 3) high CCL19 levels at admission were associated with the development of heart failure.CCL21 levels are independently associated with outcome after ACS and should be further investigated as a promising biomarker in these patients.
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| 5. |
- Libungan, Berglind, et al.
(författare)
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Delay and inequality in treatment of the elderly with suspected acute coronary syndrome
- 2014
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd.. - 0167-5273 .- 1874-1754. ; 176:3, s. 946-950
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND/OBJECTIVES: The aim of this study is to determine differences between elderly patients (≥80 years) and younger patients with suspected acute coronary syndrome (ACS) regarding delay times before diagnostic tests and treatments. METHODS: All patients with chest pain who were admitted to a hospital in the Gothenburg area were included consecutively over a 3-month period. They were divided into an elderly group (≥80 years) and a reference group (<80 years). Previous medical history, ECG findings, treatments, diagnostic tests, and delay times were registered. RESULTS: Altogether, 2588 patients were included (478 elderly and 2110 reference). There were no significant differences in delay time to hospital ward admission, to first medical therapy with aspirin, or to investigation with coronary angiography (CA) between the two groups. The elderly patients had a significantly shorter median time from first medical contact to first ECG (12 vs. 14 min, p=0.002) but after adjustment for confounding factors, especially mode of transport, the opposite was found to be the case (p=0.002). Elderly hospitalized patients with ACS were less often investigated with CA (44% vs. 89%, p<0.0001) and received less medical treatment with P2Y12 antagonists and lipid lowering drugs. CONCLUSIONS: Elderly individuals with chest pain could not be shown to have a delay to hospital admission compared to their younger counterparts. Nevertheless, higher age was associated with a longer time to first ECG. The elderly patients received less active therapy, and fear of age-related side effects might explain this difference.
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| 6. |
- Nymo, St., et al.
(författare)
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Serum neutrophil gelatinase-associated lipocalin (NGAL) concentration is independently associated with mortality in patients with acute coronary syndrome.
- 2018
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 262, s. 79-84
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Tidskriftsartikel (refereegranskat)abstract
- Circulating neutrophil gelatinase-associated lipocalin (NGAL) concentration increases in cardiovascular disease, but the long-term prognostic value of NGAL concentration has not been evaluated in acute coronary syndrome (ACS). We examined the association between NGAL concentration and prognosis in patients with ACS after non-ST-elevation myocardial infarction (NSTEMI) or STEMI.NGAL concentration was measured in blood from 1121 consecutive ACS patients (30% women, mean age 65years) on the first morning after admission. After adjustment for 14 variables, NGAL concentration predicted long-term (median 167months) mortality (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.10-1.61, P=0.003) for quartile (q) 4 of NGAL concentration. NGAL concentrations also predicted long-term mortality (HR=1.63, 95% CI 1.31-2.03, P<0.001, N=741) when adjusting for Global Registry of Acute Coronary Events (GRACE) score, left ventricular ejection fraction (LVEF), and pro-B-type natriuretic peptide (proBNP) and C-reactive protein (CRP) concentrations. With these adjustments, NGAL concentration predicted long-term mortality in NSTEMI patients (HR=2.02, 95% CI 1.50-2.72, P<0.001) but not in STEMI patients (HR=1.32, 95% CI 0.95-1.83, P=0.100). In all patients, the combination of NGAL concentration and GRACE score yielded an HR of 5.56 (95% CI 4.37-7.06, P<0.001) for q4/q4 for both variables.NGAL concentration in ACS is associated with long-term prognosis after adjustment for clinical confounders. Measuring circulating NGAL concentration may help to identify patients-particularly those with NSTEMI-needing closer follow-up after ACS.
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| 7. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Chain of care in chest pain-differenes beteen three hospitals in an urban area.
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 166:2, s. 440-7
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe differences in treatment and delay times in acute chest pain at the three hospitals in Göteborg, Sweden. METHODS: All patients admitted to the three hospitals within Sahlgrenska University (SU) (Sahlgrenska: SU/S, Östra: SU/Ö and Mölndal: SU/M) with acute chest pain during 3 months in 2008 were evaluated for diagnosis, early treatment and outcome. RESULTS: In all, 2588 visits by 2393 patients were included (visits n=1253 SU/S; n=853 SU/Ö; n=482 SU/M) of which 50%, 63% and 51% were hospitalised (p<0.0001). Among hospitalised patients, a diagnosis of ACS was reported in 26%, 9% and 22% respectively (p<0.0001). Among ACS patients, 83%, 66% and 57% respectively underwent coronary angiography (p=0.004). The median delay to coronary angiography in ST-elevation myocardial infarction (STEMI) was 42 min at SU/S, 3h 47 min at SU/Ö and 2h 34 min at SU/M (p=0.008). The corresponding values for coronary angiography in unstable coronary artery disease were 42h 7min, 48h 35 min and 123h 42 min (p=0.007). Overall mortality at 30 days was 3.6%, 3.2% and 1.5% (NS) and, at 1 year, it was 9.9%, 9.6% and 7.3% respectively (NS). CONCLUSION: In acute chest pain in the Municipality of Göteborg, there was a marked difference between hospitals in: 1) the percentage of hospitalised patients, 2) the percentage of ACS among hospitalised patients and 3) the delay to and rate of coronary angiography. The clinical consequences of these deviations remain to be proven.
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| 8. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Community-based gender perspectives of triage and treatment in suspected myocardial infarction.
- 2012
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Ingår i: International journal of cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 156:2, s. 139-143
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Tidskriftsartikel (refereegranskat)abstract
- Abstract BACKGROUND: The gender perspectives of the triage of acute coronary syndromes (ACS) in a community are insufficiently explored. METHODS: Patients (n=3224) with symptoms of ACS, in whom ECG was sent by the ambulance crew to a coronary care unit (CCU)/ cath lab, were investigated in the municipality of Göteborg in 2004-2007. Background, triage priority, investigations and treatment were analysed (p-values age adjusted) in relation to gender. Data were compared with three published studies (1995-2002: Surveys 1-3). RESULTS: Women were directly admitted to the CCU significantly less frequently than men (23 versus 35%, p<0.0001). Adjusted for ECG findings, age, symptoms and medical history, odds ratio and 95% confidence limits (for direct admission; men versus women) were 0.61; 0.46-0.82. SURVEY 1: Patients with ACS, aged <80, in CCU at a university hospital (n=1744). Only minor differences between women and men, with regard to investigations and treatment, were found. SURVEY 2: Patients discharged from hospital (dead or alive) with AMI, regardless of type of ward (n=1423). Fewer women than men were admitted to CCU and fewer women underwent coronary angiography (21% versus 40%; p=0.02) and coronary revascularisation (12% versus 27%; p=0.004). SURVEY 3: Patients with symptoms of AMI (n=930) and patients with a confirmed AMI (n=130) from a pre-hospital perspective. Women tended to be given lower priority than men both by the ambulance dispatchers and by the ambulance crew. CONCLUSION: In our practice setting, men are given priority over women in admission to CCU, but no gender differences are seen thereafter.
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| 9. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Inequalities in the early treatment of women and men with acute chest pain?
- 2012
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Ingår i: American Journal of Emergency Medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 30:8, s. 1515-1521
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this study was to identify sex differences in the early chain of care for patients with chest pain. DESIGN: This is a retrospective study performed at 3 centers including all patients admitted to the emergency department because of chest pain, during a 3-month period in 2008, in the municipality of Göteborg. Chest pain or discomfort in the chest was the only inclusion criterion. There were no exclusion criteria. DATA SOURCES: Data were retrospectively collected from ambulance and medical records and electrocardiogram (ECG), echocardiography, and laboratory databases. MAIN FINDINGS: A total of 2588 visits (1248 women and 1340 men) made by 2393 patients were included. When adjusting for baseline variables, female sex was significantly associated with a prolonged delay time (defined as above median) between (a) admission to hospital and admission to a hospital ward (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.03), (b) first physical contact and first dose of aspirin (OR, 2.22; 95% CI, 1.30-3.82), and (c) admission to hospital and coronary angiography (OR, 2.50; 95% CI, 1.29-5.13). Delay time to the first ECG recording did not differ significantly between women and men. PRINCIPAL CONCLUSIONS: Among patients hospitalized due to chest pain, when adjusting for differences at baseline, female sex was associated with a prolonged delay time until admission to a hospital ward, to administration of aspirin, and to performing a coronary angiography. There was no difference in delay to the first ECG recording.
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| 10. |
- Ravn-Fischer, Annica, 1974, et al.
(författare)
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Seventeen-Year Mortality following the Acute Coronary Syndrome: Gender-Specific Baseline Variables and Impact on Outcome.
- 2019
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Ingår i: Cardiology. - : S. Karger AG. - 1421-9751 .- 0008-6312. ; 143:1, s. 22-31
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Tidskriftsartikel (refereegranskat)abstract
- Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated.To assess long-term mortality and explore its association with the baseline variables in women and men.We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months.At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05-1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78-1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76-0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender.For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.
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