| 1. |
- Boman, Kurt, et al.
(författare)
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Effects of atenolol or losartan on fibrinolysis and von Willebrand factor in hypertensive patients with left ventricular hypertrophy.
- 2010
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Ingår i: Clinical and applied thrombosis/hemostasis. - : SAGE Publications. - 1076-0296 .- 1938-2723. ; 16:2, s. 146-152
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To compare the effects of the beta-blocker atenolol with the angiotensin receptor blocker (ARB) losartan on plasma tissue-type plasminogen activator (tPA) activity and mass concentration, plasminogen activator inhibitor-1 (PAI-1) activity, tPA/PAI-1 complex, and von Willebrand factor (VWF). DESIGN: A prespecified, explorative substudy in 22 patients with hypertension and left ventricular hypertrophy (LVH) performed within randomized multicenter, double-blind prospective study. RESULTS: After a median of 36 weeks of treatment, there were significant differences between the treatment groups, atenolol versus losartan, in plasma median levels of tPA mass (11.9 vs 7.3 ng/mL, P = .019), PAI-1 activity (20.7 vs 4.8 IU/mL, P = .030), and tPA/PAI-1 complex (7.1 vs 2.5 ng/mL, P = .015). In patients treated with atenolol, median levels of tPA mass (8.9-11.9 ng/mL, P = .021) and VWF (113.5%-134.3%, P = .021) increased significantly, indicating a change toward a more prothrombotic state. No significant changes occurred in the losartan group. CONCLUSION: Losartan treatment was associated with preserved fibrinolytic balance compared to a more prothrombotic fibrinolytic and hemostatic state in the atenolol group. These findings suggest different fibrinolytic and hemostatic responses to treatment in hypertensive patients with LVH.
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| 2. |
- Boman, Kurt, et al.
(författare)
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Healthcare resource utilisation and costs associated with a heart failure diagnosis : A retrospective, population-based cohort study in Sweden
- 2021
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 11:10
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden.Design: Retrospective, non-interventional cohort study.Setting: Two cohorts were identified from linked national health registers (cohort 1, 2005-2014) and electronic medical records (cohort 2, 2010-2012; primary/secondary care patients from Uppsala and Västerbotten).Participants: Patients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included.Outcome measures: HRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists.Results: Total annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs.Conclusions: HF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.
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| 3. |
- Ekman, Inger, 1952, et al.
(författare)
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Gender makes a difference in the description of dyspnoea in patients with chronic heart failure.
- 2005
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Ingår i: Eur J Cardiovasc Nurs. - : Oxford University Press (OUP). - 1474-5151. ; 4:2, s. 117-21
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Tidskriftsartikel (refereegranskat)abstract
- Background: Dyspnoea is a common symptom of chronic heart failure (CHF). In the community setting, patients with CHF are most often women. Aim: To examine the impact of gender on the description of dyspnoea and to explore which clinical variables support a diagnosis of CHF. Methods: From four primary health care centres, 158 patients with CHF were included. Patients were examined with echocardiography and a cardiologist assessed the diagnosis of CHF. The patients filled in a questionnaire containing 11 descriptors of dyspnoea. Results: A diagnosis of CHF was confirmed in 87 (55%) patients (47 males and 40 females). One descriptor, I feel that I am suffocating, was significantly scored higher in CHF patients ( p=0.014) as compared to non-CHF patients. Three descriptors, My breath does not go in all the way ( p=0.006), I feel that I am suffocating ( p=0.040), and I cannot get enough air ( p=0.0327) were significantly scored higher among men with CHF, compared to no descriptor among women with CHF. Being male (OR=2.7; CI: 1.3–5.6, p=0.008), having diabetes (OR=5.6; CI: 1.7–18.2, p=0.004), IHD (OR=3.3; CI: 1.3–8.5, p=0.014), and a borderline significance for age (OR=1.04; CI: 0.99–1.08, p=0.058) predicted a confirmed diagnosis of CHF. Conclusion: Three descriptors of dyspnoea were associated with CHF among men, whereas no such association was found among women. Our results suggest that gender is an important factor and should—together with age, underlying heart disease, and diabetes—be taken into account when symptoms are evaluated in the diagnosis of CHF in primary care.
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| 4. |
- Fryxell, Jenni, et al.
(författare)
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Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels : A Substudy of the PREFER Study
- 2021
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Ingår i: World Journal of Cardiovascular Diseases. - : Scientific Research Publishing. - 2164-5329 .- 2164-5337. ; 11:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group.Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design.Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study.Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074); NT-proBNP increased 4% in the control group.Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.
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| 5. |
- Lindmark, Krister, et al.
(författare)
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Epidemiology of heart failure and trends in diagnostic work-up : a retrospective, population-based cohort study in Sweden
- 2019
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Ingår i: Clinical Epidemiology. - : Dove medical press. - 1179-1349. ; 11, s. 231-244
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden.Methods: Adults with incident HF (>= 2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Vasterbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed.Results: Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged >= 85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time).Conclusion: The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.
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| 6. |
- Lindmark, Krister, et al.
(författare)
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Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study
- 2021
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 8:3, s. 2144-2153
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden.Methods and results: Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all-cause mortality were evaluated. A time-dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction-based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient-years of follow-up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all-cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all-cause mortality increased approximately six-fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities.Conclusions: There is a strong association between recurrent HFHs and CV and all-cause mortality, with the risk increasing progressively with each recurrent HFH.
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| 7. |
- Olofsson, Mona, 1952-, et al.
(författare)
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Are elderly patients with suspected HF misdiagnosed? : a primary health care center study
- 2007
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 107:4, s. 226-32
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Tidskriftsartikel (refereegranskat)abstract
- Background: Few studies are published on heart failure patients in primary health care, in elderly in advanced age. Objective: The purpose of this study was to examine the accuracy of the diagnosis of heart failure in all men and women with focus on age and gender. Methods: The patients were recruited from one selected primary health care in the city of Skellefteå, Sweden. The general practitioners included all patients who had symptoms and signs indicating heart failure. The patients were then referred for an echocardiographic examination and a final cardiology consultation. Results: The general practitioners identified 121 women and 49 men with suspected heart failure of whom 39% (51 women and 16 men) were above 80 years. Women were significantly older than men (mean age 78 and 75 years, respectively, p = 0.03). The main symptom was dyspnoea (80%). Confirmed heart failure was verified in 45% of the patients and was significantly more common in men than women (p = 0.02). Of all men and women above 80 years, 75% and 22%, respectively (p = 0.01) had a verified systolic heart failure, while there were no significant gender differences in patients younger than 80. In a multivariate regression analysis taking gender, age, smoking, atrial fibrillation, hypertension, angina, myocardial infarction and diabetes into account, myocardial infarction (OR = 4.3, CL = 1.8–10.6) hypertension (OR = 3.4, CI = 1.6–6.9) atrial fibrillation (OR = 2.8, CL = 1.0–7.9) remained significantly predictive of a confirmed diagnosis of heart failure. Conclusion: This study showed the difficulty of diagnosing heart failure accurately based only on clinical symptoms, especially in women above 80 years.
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| 8. |
- Olofsson, Mona, 1952-, et al.
(författare)
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Characteristics and management of very elderly patients with heart failure : a retrospective, population cohort study
- 2023
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Ingår i: ESC Heart Failure. - : John Wiley & Sons. - 2055-5822. ; 10:1, s. 295-302
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18–84 years) with HF in Sweden.Methods: Incidence of ≥2 HF diagnosis (ICD-10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010–2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality.Results: Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co-morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)-related management after diagnosis in primary care (13.6% vs. 6.5%; P < 0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P < 0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all-cause admissions per patient: 1.9 vs. 2.3; P < 0.0001; CVD-related admissions per patient: 1.8 vs. 2.1; P = 0.0004) or prescribed an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β-blocker (45.2% vs. 56.9%; P < 0.0001) or an ACEI/ARB plus a β-blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P < 0.0001). One-year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3-32.7%) out of 1797 patients.Conclusions: Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work-up and subsequent treatment highlight the inequality of care in this vulnerable population.
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| 9. |
- Olofsson, Mona, 1952-
(författare)
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Heart failure in elderly with focus on diagnosis and prognosis
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients older than 75 years with heart failure (HF) are at increased risk for mortality and hospital admissions. Echocardiography and brain natriuretic peptides (BNP, NTproBNP) are important diagnostic tools but sparsely evaluated in elderly PHC patients. Aims: Validate the clinical diagnosis of HF, investigate the types of HF and underlying cardiovascular disorders with focus on sex and age differences. Explore the sensitivity, specificity, negative and positive predictive values (NPV, PPV) of BNP and NT-proBNP in patients with systolic HF. Study the associations of HF or NTproBNP on all-cause and cardiovascular mortality. Study the prognostic value of different biomarkers and HF, on all-cause and cardiovascular hospitalizations. Methods: Patients with suspected HF were recruited from one selected PHC and registered on a prespecified record and referred for an echocardiographic examination and a final cardiologist consultation. Blood samples for natriuretic peptides were stored frozen at – 70° C. Death certificates were used to register all-cause mortality and cardiovascular mortality. To register hospitalisations, medical records were used and classification was defined according to ICD-10. Results The GPs identified 121 women and 49 men with suspected HF of whom 39% (51 women and 16 men) were above 80 years. Myocardial infarction (OR:4,3 CL: 1,8-10,6) hypertension (OR:3,4 CI:1,6-6,9) atrial fibrillation (OR:2,8 CL:1,0-7,9) predicted a confirmed diagnosis of HF. Confirmed HF was verified in 45% of the patients and was significantly more common in men than women (p=0,02). The best NPV was 88 % for NT-proBNP (200 ng/L) and 87 % for BNP (20 pg/ml). Age and male gender were independently associated with higher levels of NT-proBNP. During the 10-year follow up, 71 out of 144 patients died. In univariate Cox regression analysis, significant associations were found for overall HF (hazard ratio [HR]: 1.86; 95% confidence interval [CI]:1.15- 3.01), isolated systolic HF (HR:1.95; 95% CI:1.06-3.61), and combined (systolic and diastolic) HF (HR:3.28; 95% CI:1.74-6.14) with all-cause mortality, but not for isolated diastolic HF. In multivariable analysis, age (HR: 1.11; 95% CI: 1.06-1.17), kidney dysfunction (HR:1.91; 95% CI:1.11- 3.29), smoking (HR:3.70; 95% CI:2.02-6.77), and NTproBNP (HR:1.01; 95% CI:1.00-1.02), but not any type of HF, significantly predicted all-cause mortality. During ten years, 136 (80%) patients were hospitalised with 660 and 207 for all-cause and cardiovascular hospitalisations, respectively. Age (OR:1.1; 95% CI:1.01-1.15) and underlying heart disease (OR:3.5; 95% CI:1.00-11.89), significantly predicted all-cause hospitalisation. Overall HF (HR:1.8; 95% CI:1.06-2.94) significantly predicted time to first all-cause hospitalisations. For cardiovascular hospitalisations age (OR:1.1;95%CI:1.01-1.12), underlying heart disease (OR:3.4;95%CI:1.04-11.40) and NTproBNP ≥800 ng/L (OR:4,3;95%CI:1.5-12.50) were significant predictors. Conclusion: A confirmed diagnosis of HF was present in 45% of the patients. NPV was high, but not as high as in younger patients with HF. Patients with systolic HF had a higher mortality than patients with diastolic HF compared to patients with no HF. Patients with combined HF were at even higher risk for all-cause mortality and cardiovascular mortality. Age, kidney dysfunction, NTproBNP and smoking predicted mortality. Age and underlying heart diseases were predictors for all-cause hospitalisations and together with NTproBNP they also predicted cardiovascular hospitalisations.
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| 10. |
- Olofsson, Mona, 1952-, et al.
(författare)
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Impact on mortality of systolic and/or diastolic heart failure in the elderly : 10 Years of follow up
- 2015
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Ingår i: Journal of Clinical Gerontology and Geriatrics. - : Elsevier. - 2210-8335 .- 2210-8343. ; 6:1, s. 20-26
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Tidskriftsartikel (refereegranskat)abstract
- Background/purpose: There is a lack of long-term follow-up studies for elderly patients with heart failure (HF) in primary health care. There is conflicting information on prognostic differences between systolic or diastolic HF in elderly patients. Our aims were, first, to study the association between overall HF or types of HF and all-cause and cardiovascular mortality, and second, to explore the impact of N-terminal prohormone of brain natriuretic peptide (NTproBNP) and comorbidities. Methods: A longitudinal, prognostic, observational primary health care study with 10 years of follow-up comparing an elderly patient population with HF (systolic and/or diastolic HF) to patients without HF was conducted. HF was diagnosed with echocardiography according to the European Society of Cardi- ology guidelines. Results: Seventy-seven of 144 patients (102 women and 42 men; mean age, 77 years) had systolic and/or diastolic HF and were compared with 67 patients without HF (Reference group). During the 10-year follow-up, 71 (49%) patients died (women, 68%; men, 32%). In univariate Cox regression analysis, sig- nificant associations were found for overall HF [hazard ratio (HR), 1.86; 95% confidence interval (CI), 1.15 e3.01], isolated systolic HF (HR, 1.95; 95% CI, 1.06e3.61), and combined (systolic and diastolic) HF (HR, 3.28; 95% CI, 1.74e6.14) with all-cause mortality, but not for isolated diastolic HF. Similar results were found for cardiovascular mortality. In multivariate analysis, age (HR, 1.11; 95% CI, 1.06e1.17), kidney dysfunction (HR, 1.91; 95% CI, 1.11e3.29), smoking (HR, 3.70; 95% CI, 2.02e6.77), and NTproBNP (HR, 1.01; 95% CI, 1.00e1.02) significantly predicted all-cause mortality, but not any type of HF. Conclusion: Patients diagnosed with systolic HF had a worse prognosis for mortality compared to the reference group, but in patients with diastolic HF the prognosis for mortality was similar with that in the reference group. NTproBNP was a valuable prognostic factor in elderly patients. Emphasis should be 1. Introduction In the elderly population (>75 years), the prevalence of heart failure (HF) is about 10%.1 The prognosis for patients with HF is poor, comparable to a diagnosis of cancer.2 Severe systolic HF has the most serious prognosis,3 but whether diastolic HF has the same ominous prognosis as systolic HF in both younger and elderly pa- tients is a matter of debate.3e5 Elderly patients, especially females, are known to more often have diastolic HF than younger patients.
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