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- Al-Khaiat, Sara, 1994, et al.
(author)
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Anticoagulation treatment in adult patients with congenital heart defects and bleeding-related mortality
- 2023
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In: Progress in Pediatric Cardiology. - : Elsevier BV. - 1058-9813. ; 68
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Journal article (peer-reviewed)abstract
- Background: Congenital heart disease (CHD) is the most common type of birth defect. Survival, especially for patients with complex heart defects, has increased dramatically and today 97 % of those born with heart defects reach adulthood. As a late effect of both the congenital malformations and various types of interventions, these patients generally have an increased risk of atrial fibrillation, which is strongly associated with stroke. Additionally, implantation of foreign materials such as mechanical heart valves is also associated with higher risk for embolization. Therefore, adult patient with congenital heart disease (ACHD) are at a substantially increased risk of thromboembolism which necessitates anticoagulant therapy. However, the impact and risk of bleeding and bleeding-related mortality, particularly in young ACHD patients, during long-term anticoagulation treatment is unclear. Methods: In this retrospective cohort study, 117 deceased ACHD patients with anticoagulant treatment were identified by using the Swedish registry of congenital heart disease between 2005 and 2021. Data from medical records were collected and analyzed. Variables obtained were main diagnosis, indication and type of anticoagulation treatment, complications, and cause of death. Results: A total of 17 ACHD patients (14.5 %) experienced bleeding events. Ten ACHD patients (8.5 %) experienced major bleeding, including five patients (4.3 %) who died of a hemorrhagic stroke. Another seven ACHD patients had minor bleeding (6 %). Conclusion: Despite the occurrence of bleeding-related complications, the proportion of serious, fatal bleeding was low among deceased ACHD patients with anticoagulation treatment.
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| 4. |
- Avdic, Tarik, et al.
(author)
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Risk Factors for and Risk of Peripheral Artery Disease in Swedish Individuals With Type 2 Diabetes: A Nationwide Register-Based Study.
- 2024
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In: Diabetes care. - 1935-5548. ; 47:1, s. 109-116
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Journal article (peer-reviewed)abstract
- To investigate to what extent having control of peripheral artery disease (PAD) risk factors is associated with the risk of incident PAD in individuals with type 2 diabetes.A total of 148,096 individuals with type 2 diabetes in the Swedish National Diabetes Register between 2005 and 2009 were included and matched with 320,066 control subjects on the basis of age, sex, and county. A few control subjects who developed type 2 diabetes after recruitment, during wash-in (<0.2%), were not censored but instead matched with two new control subjects. Individuals with type 2 diabetes were evaluated according to the number of PAD risk factors beyond recommended guideline levels at baseline, including LDL cholesterol, blood pressure, smoking, glycated hemoglobin, and estimated glomerular filtration rate. Incident PAD events were ascertained from 2006 to 2019.A graded association was observed between the number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes. The adjusted hazard ratio for PAD was 1.41 (95% CI 1.23-1.63) for those with type 2 diabetes with all PAD risk factors within target compared with control subjects matched for sex, age, and county but not risk factor status, in contrast with 9.28 (95% CI 3.62-23.79) for those with all five PAD risk factors not at target.A graded association was observed between increasing number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes.
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- Barywani, Salim B., 1968, et al.
(author)
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Body iron stores had no impact on coronary heart disease outcomes: a middle-aged male cohort from the general population with 21-year follow-up
- 2022
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In: Open Heart. - : BMJ. - 2053-3624. ; 9:1
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Journal article (peer-reviewed)abstract
- Background Body iron stores (BISs) have been proposed to be related to the development of cardiovascular diseases. However, results from epidemiological studies are conflicting. Knowledge on the long-term impact of BIS on cardiovascular outcomes in the general population is lacking. Purpose The aim of this study was to explore the relationship between BIS and coronary heart disease (CHD) including death due to CHD. Methods This investigation is part of 'The Study of Men Born in 1943', a longitudinal prospective study of men living in the city of Gothenburg, Sweden. This random population sample was examined in 1993 (all at 50 years of age at baseline). A medical examination was performed, and questionnaires were used to evaluate lifestyle factors. Biomarkers for iron stores (serum ferritin and serum transferrin receptor) was analysed from frozen blood samples in 2014. All hospital admissions were registered through national registers during the entire follow-up from 1993 to 2014. HRs were estimated by Cox proportional-hazard regression analyses. Results During the 21 years follow-up period, 120 participants (15.2%) developed CHD and 16 patients (2%) died due to CHD. The all-cause mortality was 15.2% (n=120) including 40 cardiovascular deaths (5.1%). In a multivariable Cox regression analysis, the daily smoking, hypertension and the increased resting heart rate was independent predictors of CHD, while no significant association was found between BIS and risk of CHD. Conclusions In a cohort of middle-aged men from the general population with well validated and prospectively collected data, we did not find any association between serum ferritin or serum transferrin receptor as markers of BIS and CHD events after 21 years of follow-up.
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| 7. |
- Barywani, Salim B., 1968, et al.
(author)
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Impact of elevated systolic arterial pulmonary pressure on the total mortality rate after acute myocardial infarction in the elderly
- 2022
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In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
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Journal article (peer-reviewed)abstract
- Reduced left ventricular ejection fraction (LVEF) is associated with increased mortality after acute myocardial infarction (AMI). However, the prognostic impact of elevated systolic pulmonary artery pressure (sPAP) in the very elderly patients after AMI is lacking. We aimed to study the impact of elevated sPAP on one- and five-year all-cause mortality after AMI in very elderly patients, 80 years of age and older. Of a total number of 353 patients (>= 80 years) who were hospitalized with acute coronary syndrome, 162 patients presenting with AMI and with available data of sPAP on echocardiography were included and followed-up for 5 years. The survival analyses were performed using Cox-Regression models adjusted for conventional risk factors including LVEF. Altogether 66 of 162 patients (41%) had ST-segment elevation MI, and 121 (75%) of patients were treated with percutaneous coronary intervention in the acute phase. Echocardiography during the admission revealed that 78 patients (48%) had a LVEF <= 45% and 66 patients (41%) had a sPAP >= 40 mmHg. After one and five years of follow-up, 23% (n = 33) and 53% (n = 86) of patients died, respectively. A multivariable Cox-Regression analysis showed that the elevated sPAP (>= 40 mmHg) was an independent predictor of increased mortality in both one and five years after AMI; HR of 2.63 (95%, CI 1.19-5.84, P 0.017) and HR of 2.08 (95%, CI 1.25-3.44, P 0.005) respectively, whereas LVEF <= 45% did not show any statistically significant impact, neither on one- nor on five-year mortality (HR 1.3, 95% CI 0.6-2.9, p = 0.469) and (HR 1.4, 95% CI 0.8-2.4, p = 0.158), respectively. Elevated sPAP was an independent risk factor for one- and five-year all-cause mortality after AMI in very elderly patients and sPAP seems to be a better prognostic predictor for all-cause mortality than LVEF. The risk of all-cause mortality after AMI increased with increasing sPAP.
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- Basic, Carmen, 1975, et al.
(author)
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Heart failure outcomes in low-risk patients with atrial fibrillation: a case-control study of 680 523 Swedish individuals
- 2023
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In: Esc Heart Failure. - 2055-5822. ; 10:4, s. 2281-2289
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Journal article (peer-reviewed)abstract
- AimsKnowledge of long-term outcomes in patients with atrial fibrillation (AF) remains limited. We sought to evaluate the risk of new-onset heart failure (HF) in patients with AF and a low cardiovascular risk profile. Methods and resultsData from the Swedish National Patient Register were used to identify all patients with a first-time diagnosis of AF without underlying cardiovascular disease at baseline between 1987 and 2018. Each patient was compared with two controls without AF from the National Total Population Register. In total, 227 811 patients and 452 712 controls were included. During a mean follow-up of 9.1 (standard deviation 7.0) years, the hazard ratio (HR) for new-onset HF was 3.55 [95% confidence interval (CI) 3.51-3.60] in patients compared with controls. Women with AF (18-34 years) had HR for HF onset 24.6 (95% CI 7.59-80.0) and men HR 9.86 (95% CI 6.81-14.27). The highest risk was within 1 year in patients 18-34 years, HR 103.9 (95% CI 46.3-233.1). The incidence rate within 1 year increased from 6.2 (95% CI 4.5-8.6) per 1000 person-years in young patients (18-34 years) to 142.8 (95% CI 139.4-146.3) per 1000 person-years among older patients (>80 years). ConclusionsPatients studied had a three-fold higher risk of developing HF compared with controls. Young patients, particularly women, carry up to 100-fold increased risk to develop HF within 1 year after AF. Further studies in patients with AF and low cardiovascular risk profile are needed to prevent serious complications such as HF.
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| 10. |
- Berglund, Sara, et al.
(author)
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Cardiorenal function and survival in in-hospital cardiac arrest : A nationwide study of 22,819 cases
- 2022
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 172, s. 9-16
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Journal article (peer-reviewed)abstract
- Background: We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital Methods: We included cases aged 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). Results: We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15-29, 30-44, 45-59, 60-89, 90-130 and 130-150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR < 15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m2, and least for those with normal eGFR. Conclusions: All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
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