| 1. |
- Patel, Harshida, 1958, et al.
(författare)
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Fathers’ experiences of care when their partners suffer from peripartum cardiomyopathy: a qualitative interview study
- 2018
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Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Peripartum cardiomyopathy (PPCM), a potentially life-threatening condition in women, can have a profound impact on thefamily. Although structured support systems are developed, these systems tend to be based on the healthcare providers’ perceptions and focus mainly on mothers’ care. Fathers’ vital role in supporting their partners has been advocated in previous research. However, the impact of PPCM on the male partners of women is less understood. The aim of this study was to explore the experiences of healthcare in fathers whose partner was suffering from peripartum cardiomyopathy. Methods: The data from interviews with fourteen fathers were analysed using inductive content analysis. Results: An overarching category “The professionals could have made a difference” was identified from the data, characterised by the sub-categories: ‘To be informed/not informed,’ ‘To feel secure/insecure,’ ‘To feel visible/invisible’ and ‘Wish that it had been different’. Lack of timely information did not allow fathers to understand their partner´s distress, and plan for the future. The birth of the child was an exciting experience, but a feeling of helplessness was central, related to seeing their partner suffering. A desire for follow-up regarding the effect of PPCM on themselves was expressed. Conclusions: When men, as partners of women with PPCM, get adequate information of their partner´s condition, they gain a sense of security and control that gives them strength to handle their personal and emotional life-situation during the transition of becoming a father, along with taking care of an ill partner with PPCM. Hence, maternity professionals should also focus on fathers’ particular needs to help them fulfil their roles. Further research is urgently required in this area.
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| 2. |
- Patel, Harshida, 1958, et al.
(författare)
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Fathers’ reactions over their partner's diagnosis of peripartum cardiomyopathy: A qualitative interview study
- 2019
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 71, s. 42-48
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Tidskriftsartikel (refereegranskat)abstract
- Background Fathers' experience of childbirth has been described as both distressing and wonderful, but little has been described in the literature about fathers´ reactions when their partners get life threatening diagnoses such as peripartum cardiomyopathy (PPCM) during the peripartum period. Aim To learn more about fathers' reactions over their partner's diagnosis of peripartum cardiomyopathy. Methods Fourteen fathers, whose partner was diagnosed with PPCM before or after giving birth, were interviewed. Data were analysed using inductive content analysis technique. Results The first reaction in fathers was shock when they heard their partner had PPCM, which was sudden, terrible and overwhelming news. Their reactions to trauma are described in the main category: The appalling diagnosis gave a new perspective on life with emotional sub-categories: overwhelmed by fear, distressing uncertainty in the situation and for the future, feeling helpless but have to be strong, disappointment and frustration, and relief and acceptance. Although terrified, fathers expressed gratitude towards health care professionals for the diagnosis that made it possible to initiate adequate treatment. Conclusion Exploring father's reactions will help peripartum and cardiology healthcare professionals to understand that emotional support for fathers is equally important as the support required for mothers during the peripartum period. Specifically they will help professionals to focus on future efforts in understanding and meeting the supportive care needs of fathers when their partner suffers from a life-threatening diagnosis like PPCM.
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| 3. |
- Patel, Harshida, 1958, et al.
(författare)
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Symptoms in women with Peripartum Cardiomyopathy: a mixed method study
- 2016
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138. ; 32, s. 14-20
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Peripartum Cardiomyopathy is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth. The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with Peripartum Cardiomyopathy, leading to missed or delayed diagnosis. Women´s experiences of Peripartum Cardiomyopathy symptoms remain poorly studied. The aim of this study was to explore and describe women’s experiences of symptoms in Peripartum Cardiomyopathy. Design: A triangulation of methods with individual interviews and data from medical records. Setting: Mothers with Peripartum Cardiomyopathy diagnosis were recruited from Western Sweden as a part of research project. Participants: 19 women were interviewed and medical records were reviewed by authors. Data analysis: All interview transcripts were analyzed using qualitative inductive content analysis to identify key themes. Results: The main theme, meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness. Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum and time from symptoms to diagnosis varied between 3–190 days (median 40). The physical symptoms were: shortness of breath, excessive fatigue and swelling, bloatedness, nausea, palpitation, coughing, chest tightness, bodily pain, headache, fever, tremor, dizziness, syncope, restless and tingly body and reduced urine output. Emotional symptoms were: fear, anxiety, feelings of panic, and thoughts of impending death. Conclusions and implications for practice: Symptoms of Peripartum Cardiomyopathy were debilitating, exhausting and frightening for the women interviewed in this study. Health care professionals responsible for the antenatal care, especially midwives, need skills to identify initial symptoms of Peripartum Cardiomyopathy for early referral and treatment by a specialist. In order to give optimal care more research is needed to show how to improve midwives’ knowledge of Peripartum Cardiomyopathy
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| 4. |
- Patel, Harshida, 1958, et al.
(författare)
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What do we know about women with Peripartum Cardiomyopathy?
- 2017
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Ingår i: Virginia Henderson Global Nursing e-Repository. - USA : Sigma Theta Tau.
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Konferensbidrag (refereegranskat)abstract
- Peripartum Cardiomyopathy (PPCM) is a form of cardiac disease often associated with cardiac failure, occurring in late pregnancy or after childbirth (Sliwa et al., 2010). The anatomical and physiological changes in the mother associated with normal pregnancy are profound, and this may result in symptoms and signs that overlap with PPCM, leading to missed or delayed diagnosis (Germain and Nelson-Piercy, 2011). The aim of the study was to describe women’s experiences of symptoms of PPCM and received care, and identify the areas for improvement. Nineteen women were interviewed. The key themes were identified using content analysis. The main theme emerged is, The eternal suffering. The meaning of onset and occurrence of symptoms is captured in the metaphor: being caught in a spider web, comprising subthemes, invasion of the body by experienced symptoms and feeling of helplessness (Patel et al., 2016). The care experiences are captured in exacerbated suffering, comprising subthemes, not being cared about, not being cared for and not feeling secure (Patel et al., 2016). Symptoms related to Peripartum Cardiomyopathy started for 17 women during pregnancy and in 2 postpartum, and time from symptoms to diagnosis varied between 3–190 days (median 40). Although women expressed miscellaneous experiences of care, majority of them described being not cared in adequate manner. The suffering was present in relation to the illness with failing health symptoms, but most of all in relation to not being taken seriously and adequately cared for by healthcare professionals. The deprecation of symptoms and missed diagnosis of PPCM can lead to a life threatening consequences. To prompt timely diagnosis and avoid unnecessary suffering it is important to listen seriously to, and respect, women’s narratives and act on expressions of symptoms of peripartum cardiomyopathy, even those overlapping normal pregnancy symptoms. The analyses shows the importance of respecting women’s narratives and positive interactions with midwives and obstetricians as well as the knowledge gap is highlighted in the maternity care personnel.
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| 5. |
- Fu, Michael, 1963, et al.
(författare)
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Optimizing the Management of Heart Failure with Preserved Ejection Fraction in the Elderly by Targeting Comorbidities (OPTIMIZE-HFPEF).
- 2016
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Ingår i: Journal of cardiac failure. - : Elsevier BV. - 1532-8414 .- 1071-9164. ; 22:7, s. 539-544
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Tidskriftsartikel (refereegranskat)abstract
- The pathophysiology of heart failure with preserved ejection fraction (HFPEF) is not fully understood. A recently proposed mechanism for HFPEF is that it is a systemic pro-inflammatory state induced by comorbidities, leading to microvascular endothelial dysfunction and subsequent cardiac remodelling and dysfunction. We hypothesize that targeting comorbidities will improve outcomes in elderly patients with HFPEF. Thus, the aim of this study is to determine whether the combination of systematic screening of patients with HFPEF and optimal management of comorbidities associated with HFPEF improves outcomes.
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| 6. |
- Schaufelberger, Maria, 1954, et al.
(författare)
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Validity of heart failure diagnoses made in 2000-2012 in western Sweden
- 2020
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Ingår i: ESC Heart Failure. - : WILEY PERIODICALS, INC. - 2055-5822. ; 7:1, s. 37-46
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of this study is to validate a diagnosis of heart failure (HF) according to the European Society of Cardiology (ESC) guidelines among patients hospitalized at Sahlgrenska University Hospital, Gothenburg, Sweden, between 2000 and 2012. Methods and results In Sweden, it is mandatory to report all hospital discharge diagnoses to the Swedish national inpatient register. In total, 27 517 patients were diagnosed with HF at the Sahlgrenska University hospital between 2000 and 2012. Altogether, 1100 records with a primary (n = 550) or contributory (n = 550) diagnosis of HF were randomly selected. The diagnosis was validated according to the ESC guidelines from 1995, 2001, 2005, and 2008, and cases were divided into three groups: definite, probable, and miscoded. In total, 965 cases were validated, while 135 records were excluded for various reasons. Of the 965 records, the diagnosis was validated as definite in 601 (62.3%) and as probable in 310 (32.1%); only 54 (5.6%) of cases had been miscoded. Echocardiography, as an objective evidence of cardiac dysfunction, had been performed in 581 (96.7%) of the definite, 106 (34.2%) of the probable, and 31 (57.4%) of the miscoded cases. Among the probable cases, the main reason they had not been classified as a definitive diagnosis of HF was lack of examination by echocardiography (63.8%). Conclusions The overall validity of HF diagnosis at Sahlgrenska University Hospital is high. This may reflect a high diagnostic validity at the time of diagnosis in the national Swedish patient register, supporting the continued use of this register in epidemiological research.
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| 7. |
- Åberg, N David, 1970, et al.
(författare)
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Diverging trends for onset of acute myocardial infarction, heart failure, stroke and mortality in young males: role of changes in obesity and fitness
- 2021
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Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 290:2, s. 373-385
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Tidskriftsartikel (refereegranskat)abstract
- Background As opposed to the decreasing overall rates of coronary heart disease (CHD) incidence and overall cardiovascular disease (CVD) mortality, heart failure (HF) and stroke incidence are increasing in young people, potentially due to rising rates of obesity and reduced cardiorespiratory fitness (CRF). Objectives We investigated trends in early major CVD outcomes in a large cohort of young men. Methods Successive cohorts of Swedish military conscripts from 1971 to 1995 (N = 1,258,432; mean age, 18.3 years) were followed, using data from the National Inpatient and Cause of Death registries. Cox proportional hazard models were used to analyse changes in 21-year CVD event rates. Results 21-year CVD and all-cause mortality and incidence of acute myocardial infarction (AMI) decreased progressively. Compared with the cohort conscripted in 1971-1975 (reference), the hazard ratios (HRs) for the last 1991-1995 cohort were 0.50 [95% confidence interval (CI) 0.42-0.59] for CVD mortality; 0.57 (95% CI 0.54-0.60) for all-cause mortality; and 0.63 (95% CI 0.53-0.75) for AMI. In contrast, the incidence of ischaemic stroke, intracerebral haemorrhage and HF increased with HRs of 1.43 (95% CI 1.17-1.75), 1.30 (95% CI 1.01-1.68) and 1.84 (95% CI 1.47-2.30), respectively. During the period, rates of obesity increased from 1.04% to 2.61%, whilst CRF scores decreased slightly. Adjustment for these factors influenced these secular trends only moderately. Conclusion Secular trends of young-onset CVD events demonstrated a marked shift from AMI and CVD mortality to HF and stroke incidence. Trends were significantly, though moderately, influenced by changing baseline BMI and CRF.
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| 8. |
- Lindgren, Martin, et al.
(författare)
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Resting heart rate in late adolescence and long term risk of cardiovascular disease in Swedish men
- 2018
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 259, s. 109-115
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the association of resting heart rate (RHR) measured in late adolescence with the long term risk of myocardial infarction (MI), ischemic stroke (IS), heart failure (HF), atrial fibrillation (AF), cardiovascular- and all-cause death. Methods and results: We followed a cohort of Swedish men enrolled for conscription in 1968–2005 (n = 1,008,485; mean age = 18.3 years) until December 2014. Outcomes were collected from the national inpatient - (IPR), outpatient - (OPR) and cause of death registries. Cox proportional hazard models were used to analyze the longitudinal association between RHR and outcomes while adjusting for potential confounders. While we found no independent association between RHR and risk of IS or MI when comparing the highest with the lowest quintile of the RHR distribution, but a positive association persisted between RHR and incident HF (Hazard ratio (HR) = 1.39 [95% confidence interval (CI) = 1.29–1.49]) after adjustment for body mass index (BMI) and blood pressure (BP). In similarly adjusted models, an inverse association was found for AF while there were weaker associations with death from cardiovascular disease (CVD) and all causes (adjusted HR = 1.12 [CI = 1.04–1.21] and 1.20 [CI = 1.17–1.24]). After further adjustment for cardiorespiratory fitness (CRF), the associations persisted for HF (HR = 1.26 [1.17–1.35] for any diagnostic position and HR = 1.43 [1.28–1.60] for HF as a main diagnosis) and for all-cause death (HR 1.09 [1.05–1.12]) but not for CVD death. Conclusion: Adolescent RHR is associated with future risk of HF and death, independently of BP, BMI and CRF, but not with CVD death, MI or IS, suggesting a causal pathway between elevated heart rate and myocardial dysfunction. © 2018 The Authors
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| 9. |
- Åberg, Maria A I, 1972, et al.
(författare)
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Body Weight in Adolescent Men in Sweden and Risk of an Early Acute Coronary Event: A Prospective Population-Based Study
- 2023
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Ingår i: Journal of the American Heart Association (JAHA). - 2047-9980. ; 12:12
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundCoronary heart disease remains the dominant cause of death worldwide. To improve cardiovascular disease prevention, knowledge of early key risk factors, especially those that are modifiable, is essential. The ongoing global obesity epidemic is of particular concern. We aimed to determine whether body mass index at conscription predicts early acute coronary events among men in Sweden. Methods and ResultsThis was a population-based Swedish cohort study of conscripts (n=1 668 921; mean age, 18.3 years; 1968-2005), with follow-up through linkage to the nationwide Swedish patient and death registries. Risk of a first acute coronary event (hospitalization for acute myocardial infarction or coronary death) during follow-up (1-48 years) was calculated with generalized additive models. Objective baseline measures of fitness and cognition were included in the models in secondary analyses. During follow-up, there were 51 779 acute coronary events, of which 6457 (12.5%) were fatal within 30 days. Compared with men at the lowest end of the normal body mass index spectrum (body mass index, 18.5 kg/m(2)), an increasing risk for a first acute coronary event was observed, with hazard ratios (HRs) peaking at 40 years of age. After multivariable adjustments, men with a body mass index of 35 kg/m(2) had an HR of 4.84 (95% CI, 4.29-5.46) for an event before the age of 40 years. ConclusionsAn increased risk of an early acute coronary event was detectable within normal levels of body weight at the age of 18 years, increasing to almost 5-fold in the highest weight category at 40 years of age. Given increasing levels of body weight and prevalence of overweight and obesity in young adults, the current decrease in coronary heart disease incidence in Sweden may flatten or even reverse in the near future.
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| 10. |
- Barasa, Anders, 1973, et al.
(författare)
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Heart failure in young adults: 20-year trends in hospitalization, aetiology, and case fatality in Sweden
- 2014
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 35:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To describe trends in incidence and case fatality among younger (18-54 years) and older (55-84 years) Swedish patients with heart failure (HF). METHODS AND RESULTS: Through linking the Swedish national hospital discharge and the cause-specific death registries, we identified patients aged 18-84 years that were discharged 1987-2006 with a diagnosis of HF. Age-specific mean incidence rates per 100 000 person-years were calculated in four 5-year periods. Kaplan-Meier survival curves were plotted up to 3 years. From 1987 to 2006, there were 443 995 HF hospitalizations among adults 18-84 years. Of these, 4660 (1.0%) and 13 507 (3.0%) occurred in people aged 18-44 and 45-54 years (31.6% women), respectively. From the first to the last 5-year period, HF incidence increased by 50 and 43%, among people aged 18-34 and 35-44 years, respectively. Among people >/=45 years, incidence peaked in the mid-1990s and then decreased. Heart failure in the presence of cardiomyopathy increased more than two-fold among all age groups. Case fatality decreased for all age groups until 2001, after which no further significant decrease <55 years was observed. CONCLUSION: Increasing HF hospitalization in young adults in Sweden opposes the general trend seen in older patients, a finding which may reflect true epidemiological changes. Cardiomyopathy accounted for a substantial part of this increase. High case fatality and lack of further case fatality reduction after 2001 are causes for concern.
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