| 1. |
- Levin, Lars-Åke, et al.
(författare)
-
Health-Related Quality of Life of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes-Results from the PLATO Trial
- 2013
-
Ingår i: Value in Health. - : Wiley-Blackwell: No OnlineOpen / Elsevier. - 1098-3015 .- 1524-4733. ; 16:4, s. 574-580
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study was to compare the effects of ticagrelor versus clopidogrel on health-related quality of life in the PLATelet inhibition and patient Outcomes (PLATO) trial. Background: The PLATO trial showed that ticagrelor was superior to clopidogrel for the prevention of cardiovascular death, myocardial infarction, or stroke in a broad population of patients with acute coronary syndromes. Methods: HRQOL in the PLATO study was measured at hospital discharge, 6-month visit, and end of treatment (anticipated at 12 months) by using the EuroQol five-dimensional (EQ-5D) questionnaire. All patients who had an EQ-5D questionnaire assessment at discharge from the index hospitalization (n = 15,212) were included in the study. Patients who died prior to the end-of-treatment visit were assigned an EQ-5D questionnaire value of 0. Results: The EQ-5D questionnaire value at discharge among 7631 patients assigned to ticagrelor was 0.847 and among 7581 patients assigned to clopidogrel was 0.846 (P = 0.71). At 12 months, the mean EQ-5D questionnaire value was 0.840 for ticagrelor and 0.832 for clopidogrel (P = 0.046). Excluding patients who died resulted in mean EQ-5D questionnaire values of 0.864 among ticagrelor patients and 0.863 among clopidogrel patients (P = 0.69). Conclusions: In patients hospitalized with acute coronary syndromes with or without ST-segment elevation, treatment with ticagrelor was associated with a lower mortality but otherwise no difference in quality of life relative to treatment with clopidogrel. The improved survival and reduction in cardiovascular events with ticagrelor are therefore obtained with no loss in quality of life.
|
|
| 2. |
- Wallentin, Lars, 1943-, et al.
(författare)
-
Early invasive versus non-invasive treatment in patients with non-ST-elevation acute coronary syndrome (FRISC-II) : 15 year follow-up of a prospective, randomised, multicentre study
- 2016
-
Ingår i: The Lancet. - : ELSEVIER SCIENCE INC. - 0140-6736 .- 1474-547X. ; 388:10054, s. 1903-1911
-
Tidskriftsartikel (refereegranskat)abstract
- Background The FRISC-II trial was the first randomised trial to show a reduction in death or myocardial infarction with an early invasive versus a non-invasive treatment strategy in patients with non-ST-elevation acute coronary syndrome. Here we provide a remaining lifetime perspective on the effects on all cardiovascular events during 15 years' follow-up. Methods The FRISC-II prospective, randomised, multicentre trial was done at 58 Scandinavian centres in Sweden, Denmark, and Norway. Between June 17, 1996, and Aug 28, 1998, we randomly assigned (1:1) 2457 patients with non-ST-elevation acute coronary syndrome to an early invasive treatment strategy, aiming for revascularisation within 7 days, or a non-invasive strategy, with invasive procedures at recurrent symptoms or severe exercise-induced ischaemia. Plasma for biomarker analyses was obtained at randomisation. For long-term outcomes, we linked data with national health-care registers. The primary endpoint was a composite of death or myocardial infarction. Outcomes were compared as the average postponement of the next event, including recurrent events, calculated as the area between mean cumulative count-of-events curves. Analyses were done by intention to treat. Findings At a minimum of 15 years' follow-up on Dec 31, 2014, data for survival status and death were available for 2421 (99%) of the initially recruited 2457 patients, and for other events after 2 years for 2182 (89%) patients. During follow-up, the invasive strategy postponed death or next myocardial infarction by a mean of 549 days (95% CI 204-888; p= 0.0020) compared with the non-invasive strategy. This effect was larger in non-smokers (mean gain 809 days, 95% CI 402-1175; p(interaction) = 0.0182), patients with elevated troponin T (778 days, 357-1165; p (interaction) = 0.0241), and patients with high concentrations of growth differentiation factor-15 (1356 days, 507-1650; p (interaction) = 0.0210). The difference was mainly driven by postponement of new myocardial infarction, whereas the early difference in mortality alone was not sustained over time. The invasive strategy led to a mean of 1128 days (95% CI 830-1366) postponement of death or next readmission to hospital for ischaemic heart disease, which was consistent in all subgroups (p< 0.0001). Interpretation During 15 years of follow-up, an early invasive treatment strategy postponed the occurrence of death or next myocardial infarction by an average of 18 months, and the next readmission to hospital for ischaemic heart disease by 37 months, compared with a non-invasive strategy in patients with non-ST-elevation acute coronary syndrome. This remaining lifetime perspective supports that an early invasive treatment strategy should be the preferred option in most patients with non-ST-elevation acute coronary syndrome.
|
|
| 3. |
- Aasa, Mikael, et al.
(författare)
-
Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
- 2010
-
Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 160:2, s. 322-8
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
|
|
| 4. |
- Cowper, Patricia A, et al.
(författare)
-
Economic Analysis of Ticagrelor Therapy From a U.S. Perspective : Results From the PLATO Study
- 2015
-
Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 65:5, s. 465-476
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Based on results of the PLATO (Platelet Inhibition and Patient Outcomes) trial comparing ticagrelor with clopidogrel therapy, the U.S. Food and Drug Administration approved ticagrelor in 2011 for reducing thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) with the proviso that it be taken with low-dose aspirin.OBJECTIVES: This study sought to assess the cost and cost effectiveness of ticagrelor therapy relative to clopidogrel in treating ACS patients from the perspective of the U.S. health care system.METHODS: We estimated within-trial resource use and costs using U.S. low-dose aspirin patients in PLATO (n = 547). Quality-adjusted life expectancy was estimated using the total PLATO population (n = 18,624), combined with baseline risk and long-term survival data from an external ACS patient cohort. Study drugs were valued at current costs. Cost effectiveness was assessed, as was the sensitivity of results to sampling and methodological uncertainties.RESULTS: One year of ticagrelor therapy, relative to that of generic clopidogrel, cost $29,665/quality-adjusted life-year gained, with 99% of bootstrap estimates falling under a $100,000 willingness-to-pay threshold. Results were robust to extensive sensitivity analyses, including variations in clopidogrel cost, exclusion of costs in extended years of life, and a recalibrated estimate of survival reflecting a lower underlying mortality risk in the United States.CONCLUSIONS: For PLATO-eligible ACS patients, a U.S. perspective comparison of the current standard of dual antiplatelet therapy of aspirin with clopidogrel versus aspirin plus ticagrelor showed that the ticagrelor regimen increased life expectancy at an incremental cost well within accepted benchmarks of good value for money. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872).
|
|
| 5. |
- Cowper, Patricia A., et al.
(författare)
-
Economic Analysis of Ticagrelor Therapy From a US Perspective
- 2015
-
Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 65:5, s. 465-476
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Based on results of the PLATO (Platelet Inhibition and Patient Outcomes) trial comparing ticagrelor with clopidogrel therapy, the U.S. Food and Drug Administration approved ticagrelor in 2011 for reducing thrombotic cardiovascular events in patients with acute coronary syndrome (ACS) with the proviso that it be taken with low-dose aspirin. OBJECTIVES This study sought to assess the cost and cost effectiveness of ticagrelor therapy relative to clopidogrel in treating ACS patients from the perspective of the U.S. health care system. METHODS We estimated within-trial resource use and costs using U.S. low-dose aspirin patients in PLATO (n = 547). Quality-adjusted life expectancy was estimated using the total PLATO population (n = 18,624), combined with baseline risk and long-term survival data from an external ACS patient cohort. Study drugs were valued at current costs. Cost effectiveness was assessed, as was the sensitivity of results to sampling and methodological uncertainties. RESULTS One year of ticagrelor therapy, relative to that of generic clopidogrel, cost $29,665/quality-adjusted life-year gained, with 99% of bootstrap estimates falling under a $100,000 willingness-to-pay threshold. Results were robust to extensive sensitivity analyses, including variations in clopidogrel cost, exclusion of costs in extended years of life, and a recalibrated estimate of survival reflecting a lower underlying mortality risk in the United States. CONCLUSIONS For PLATO-eligible ACS patients, a U.S. perspective comparison of the current standard of dual antiplatelet therapy of aspirin with clopidogrel versus aspirin plus ticagrelor showed that the ticagrelor regimen increased life expectancy at an incremental cost well within accepted benchmarks of good value for money. (C) 2015 by the American College of Cardiology Foundation.
|
|
| 6. |
- Engström, Gunnar, et al.
(författare)
-
Blood pressure increase and incidence of hypertension in relation to inflammation-sensitive plasma proteins.
- 2002
-
Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - 1524-4636. ; 22:12, s. 2054-2058
-
Tidskriftsartikel (refereegranskat)abstract
- Objective— The reasons for the relationship between inflammation-sensitive plasma proteins (ISPs) and incidence of cardiovascular diseases are poorly understood. This study explored the hypothesis that ISPs are associated with future hypertension and age-related blood pressure increase. Method and Results— Blood pressure and plasma levels of fibrinogen, {alpha}1-antitrypsin, haptoglobin, ceruloplasmin, and orosomucoid were determined in 2262 healthy men aged 35 to 50 years, initially without treatment for hypertension. The cohort was re-examined after 15.7 (±2.2) years. Incidence of hypertension and blood pressure increase was studied in relation to number of elevated proteins (ie, in the top quartile) at baseline. Among men without treatment for hypertension at follow-up, mean (±SD) increase in systolic blood pressure was 18.8±17, 19.2±17, 19.3±17, and 22.1±18 mm Hg, respectively, for men with 0, 1, 2, and >=3 elevated proteins (P for trend=0.02, adjusted for confounders). The corresponding values for pulse pressure increase was 15.5±14, 15.8±14, 17.4±14, and 17.8±15 mm Hg, respectively (P=0.02). Incidence of hypertension (>=160/95 mm Hg or treatment) and future blood pressure treatment showed similar associations with ISPs. Increase in diastolic blood pressure showed no association with ISPs. Conclusions— Plasma levels of ISPs are associated with a future increase in blood pressure. This could contribute to the relationship between ISP levels and cardiovascular disease.
|
|
| 7. |
|
|
| 8. |
- Engström, Gunnar, et al.
(författare)
-
Inflammation-sensitive plasma proteins and incidence of myocardial infarction in men with low cardiovascular risk.
- 2003
-
Ingår i: Arteriosclerosis, Thrombosis and Vascular Biology. - 1524-4636. ; 23:12, s. 2247-2251
-
Tidskriftsartikel (refereegranskat)abstract
- Objective— Myocardial infarction (MI) is sometimes experienced by individuals without any traditional risk factor. This prospective study explored whether incidence of MI in nonsmoking, nondiabetic men with normal blood pressure and serum lipids is related to inflammation-sensitive plasma proteins (ISPs). Methods and Results— Five ISPs ({alpha}1-antitrypsin, haptoglobin, ceruloplasmin, fibrinogen, orosomucoid) were analyzed in 6075 men, 47±3.6 years old. A low-risk group (no traditional risk factor, n=1108) and a high-risk group (>=2 major risk factors, n=1011) were defined. Incidence of MI (n=227) was monitored over 18.1±4.3 years of follow-up. In the low-risk group, the age-adjusted relative risks (RRs) were 1.00 (reference), 1.9 (95% CI, 0.8 to 4.2), 1.8 (95% CI, 0.6 to 5.4), and 2.9 (95% CI, 1.05 to 8.1), respectively, for men with 0, 1, 2 and >=3 ISPs in the top quartile (trend: P=0.03). In this group, the increased risk was observed only after >=10 years of follow-up. In the high-risk group, the age-adjusted RRs were 1.00, 1.4 (95% CI, 0.9 to 2.2), 1.9 (95% CI, 1.2 to 3.1), and 2.0 (95% CI, 1.3 to 3.1), respectively, for men with 0, 1, 2, and >=3 ISPs in the top quartile (trend: P=0.0004). Conclusion— Incidence of MI in nonsmoking, nondiabetic men with normal blood pressure and lipids was related to ISPs. The causes for this relationship remain to be explored.
|
|
| 9. |
- Engström, Gunnar, et al.
(författare)
-
Inflammation-sensitive plasma proteins are associated with future weight gain.
- 2003
-
Ingår i: Diabetes. - : American Diabetes Association. - 1939-327X .- 0012-1797. ; 52:8, s. 2097-2101
-
Tidskriftsartikel (refereegranskat)abstract
- Cross-sectional studies have associated obesity and other components of the so-called metabolic syndrome with low-grade inflammation. The temporal and causal relations of this association have not been fully explored. This study explored whether elevated levels of inflammation-sensitive plasma proteins (ISPs) (fibrinogen, orosomucoid, {alpha}1-antitrypsin, haptoglobin, and ceruloplasmin) are associated with future weight gain. Five ISPs were measured in 2,821 nondiabetic healthy men (38–50 years of age) who were reexamined after a mean follow-up of 6.1 years. Future weight gain was studied in relation to the number of elevated ISPs (i.e., in the top quartile). The proportion with a large weight gain (75th percentile >=3.8 kg) was 21.0, 25.9, 26.8, and 28.3%, respectively, among men with none, one, two, and three or more ISPs in the top quartile (P for trend 0.0005). This relation remained significant after adjustments for weight at baseline, follow-up time, height (at baseline and follow-up), physical inactivity (at baseline and follow-up), smoking (at baseline and follow-up), high alcohol consumption, and insulin resistance. The relations were largely similar for all individual ISPs. Elevated ISP levels predict a large weight gain in middle-aged men. This relation could contribute to the relation between inflammation, the metabolic syndrome, and cardiovascular disease. Several cross-sectional studies have reported positive correlations between body fatness and inflammation-sensitive plasma proteins (ISPs) and other inflammatory markers (1–4). Weight reduction in obese subjects has been associated with reduced inflammation (5–7). It has been proposed that proinflammatory cytokines formed in the adipose tissue, e.g., interleukin (IL)-6 and tumor necrosis factor-{alpha} (TNF-{alpha}), increase the hepatic synthesis of ISPs (4,8–10). However, the temporal and causal relations between obesity and elevated ISPs are incompletely understood. Even though inflammation is mainly considered an effect of obesity or weight increase, it also has been suggested that there could be a reverse relation, i.e., that inflammation could promote weight gain (11). A 3-year follow-up of the Atherosclerosis Risk in Communities (ARIC) study reported that a large weight gain was more common in subjects with elevated fibrinogen, white blood cells, von Willebrand factor, or factor VIII, i.e., four putative markers of inflammation (12). The Malmö Preventive Study cohort includes ~6,000 men with data on five ISPs (fibrinogen, haptoglobin, {alpha}1-antitrypsin, orosomucoid, and ceruloplasmin). Previous studies from this cohort have shown cross-sectional relations between ISP levels and BMI, blood pressure, and insulin resistance (1,13,14). Follow-up studies have shown that these proteins are associated with an increased incidence of cardiovascular diseases and an increased incidence of high blood pressure (15,16). The present study sought to explore whether these proteins predicted weight gain over a mean follow-up of 6 years.
|
|
| 10. |
- Engström, Gunnar, et al.
(författare)
-
Inflammation-sensitive plasma proteins, diabetes, and mortality and incidence of myocardial infarction and stroke: a population-based study.
- 2003
-
Ingår i: Diabetes. - : American Diabetes Association. - 1939-327X .- 0012-1797. ; 52:2, s. 442-447
-
Tidskriftsartikel (refereegranskat)abstract
- This study explores the relationship of inflammation-sensitive plasma proteins (ISPs) with the prevalence of diabetes and the interrelationships between ISPs and diabetes in the prediction of death and incidence of myocardial infarction and stroke. Plasma levels of fibrinogen, α1-antitrypsin, haptoglobin, ceruloplasmin, and orosomucoid were assessed in 6,050 men, aged 28–61 years. All-cause and cardiovascular mortality and incidence of myocardial infarction and stroke were monitored over 18.7 ± 3.7 years. Prevalence of diabetes (n = 321) was significantly associated with ISP levels among overweight and obese men but not among men with BMI <25 kg/m2. The association was similar for insulin resistance according to homeostasis model assessment. High ISP levels (two or more ISPs in the top quartile) increased the cardiovascular risk among diabetic men. The risk factor-adjusted relative risks for cardiovascular mortality, myocardial infarction, and stroke were 2.8 (CI 1.8–4.5), 2.2 (1.5–3.2), and 2.5 (1.4–4.6), respectively, for diabetic men with high ISP levels (reference: nondiabetic men with low ISP levels). The corresponding risks for diabetic men with low ISP levels were 1.8 (1.1–3.0), 1.3 (0.8–2.1), and 1.2 (0.6–2.5), respectively. In conclusion, in this population-based cohort, diabetes was associated with increased ISP levels among overweight and obese men but not among men with normal weight. High ISP levels increased the cardiovascular risk similarly in diabetic as compared with nondiabetic men.
|
|
| 11. |
- Hedblad, Bo, et al.
(författare)
-
COHb% as a marker of cardiovascular risk in never smokers: results from a population-based cohort study.
- 2006
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 34:6, s. 609-615
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: Carbon monoxide (CO) in blood as assessed by the COHb% is a marker of the cardiovascular ( CV) risk in smokers. Non-smokers exposed to tobacco smoke similarly inhale and absorb CO. The objective in this population-based cohort study has been to describe inter-individual differences in COHb% in never smokers and to estimate the associated cardiovascular risk. Methods: Of the 8,333 men, aged 34-49 years, from the city of Malmo, Sweden, 4,111 were smokers, 1,229 ex-smokers, and 2,893 were never smokers. Incidence of CV disease was monitored over 19 years of follow up. Results: COHb% in never smokers ranged from 0.13% to 5.47%. Never smokers with COHb% in the top quartile (above 0.67%) had a significantly higher incidence of cardiac events and deaths; relative risk 3.7 (95% CI 2.0-7.0) and 2.2 (1.4-3.5), respectively, compared with those with COHb% in the lowest quartile (below 0.50%). This risk remained after adjustment for confounding factors. Conclusion: COHb% varied widely between never-smoking men in this urban population. Incidence of CV disease and death in non-smokers was related to COHb%. It is suggested that measurement of COHb% could be part of the risk assessment in non-smoking patients considered at risk of cardiac disease. In random samples from the general population COHb% could be used to assess the size of the population exposed to second-hand smoke.
|
|
| 12. |
- Janzon, Ellis, et al.
(författare)
-
Smoking as a determinant of the geographical pattern of cardiac events among women in an urban population
- 2007
-
Ingår i: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 35:3, s. 272-277
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. To assess to what extent geographical differences of the female incidence of myocardial infarction in the city of Malmö in Sweden can be accounted for by smoking and to what extent intra-urban variances of smoking are related to socio-economic circumstances. Method. Area specific prevalence’s of smokers is based on a sample of 17319 women, aged 45-73 years. A comprehensive score was used to rank the 17 residential areas in terms of socioeconomic circumstances. Incidence of myocardial infarction and death is based on official statistics 1989-97. Results. The area-specific prevalence of female smokers, which ranged from 17.5 to 32.5% was inversely related to the socio-economic score in 45-54 and 55-64 years old, r = -0.65 (p<0.05) and -0.59 (p<0.05). No correlation was found for women above 65 years of age. The annual age-adjusted incidence of cardiac events in the residential areas which ranged from 151 to 414 per 100 000 person years, was strongly related to the prevalence of smokers, r = 0.75 (p < 0.001). Conclusion. Between 50-60% of the intra-urban variance of the female incidence of myocardial infarction was accounted for by smoking in this urban population. The geographical pattern of smoking was strongly related to inferior socio-economic circumstances. Key words: cardiac events, smoking women, risks and prevention
|
|
| 13. |
- Janzon, Ellis, et al.
(författare)
-
Who are the "quitters"? a cross-sectional study of circumstances associated with women giving up smoking.
- 2005
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 33:3, s. 175-182
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Smoking is an important preventable risk factor for cardiovascular disease, cancer, and many other diseases. Even though tobacco consumption is declining in Sweden, it is not declining in all groups. This study explored socioeconomic and psychosocial circumstances hindering or facilitating smoking cessation in three birth cohorts of women from the general population. Methods: Between 1991 and 1996 a comprehensive questionnaire was administered to 17,319 women, 45–73 years old, from the Malmo¨ Diet and Cancer cohort. Smoking habits were compared in relation to socioeconomic and psychosocial circumstances in three birth cohorts. Results: Of these women, 44% were never smokers, 28% were ex-smokers, and 28% were smokers (regular or occasional). When compared with smokers, ex-smokers were more often married, had a higher socioeconomic position, a longer education, more smoke-free surroundings, better emotional support, higher BMI, and better self-perceived health. Ex-smokers reported less work-related stress and less shift work. A history of cardiovascular disease was not associated with smoking cessation. The socioeconomic differences between current and former smokers were higher for young women as compared with older birth cohorts. Conclusions: Continuing smokers and quitters differ with regard to socioeconomic and psychosocial circumstances and factors related to working life and environmental tobacco exposure. By determining who the quitters are through continued follow-up, useful insights can be gained to develop strategies to achieve successful cessation of smoking.
|
|
| 14. |
|
|
| 15. |
|
|
| 16. |
|
|
| 17. |
- Lind, Peter, et al.
(författare)
-
Incidence of myocardial infarction and death in relation to walking-induced calf pain and plasma levels of inflammation-sensitive proteins.
- 2005
-
Ingår i: Angiology. - : SAGE Publications. - 0003-3197 .- 1940-1574. ; 56:5, s. 507-516
-
Tidskriftsartikel (refereegranskat)abstract
- Walking-induced calf pain as well as levels of different inflammation-sensitive plasma proteins (ISPs) are related to cardiovascular disease (CVD). This prospective cohort study explored the relationship between ISPs and walking-related calf pain and the interrelationships between ISPs and calf pain in the prediction of death and incidence of coronary events (CE). In 5,725 apparently healthy men, 46 ±3.0 years old, plasma concentrations of orosomucoid (a1-acid glycoprotein), a1-antitrypsin, haptoglobin, fibrinogen, and ceruloplasmin were measured. Walking-induced calf pain was assessed by questionnaire. Mortality and incidence of CE were monitored over a mean follow-up of 18 years in subjects defined by the presence of calf pain and ISP level (0 to 1 or 2 to 5 ISP(s) in the top quartile). The prevalence of calf pain (7.3%) was significantly related to age, lifestyle, and traditional risk factors of CVD and ISP levels. The risk factor-adjusted relative risks for CE, CVD- and all-cause mortality were 1.89 (CI: 1.27 to 2.82), 2.90 (CI: 1.82 to 4.62), and 2.67 (CI: 1.97 to 3.57), respectively, for men with calf pain and high ISP levels (reference: no calf pain and low ISP levels). The corresponding risk for those with calf pain and low ISP levels were 1.34 (CI: 0.91 to 1.97), 1.47 (CI: 0.90 to 2.41), and 1.31 (CI: 0.95 to 1.81), respectively. These results indicate, on the one hand, that walking-induced calf pain is associated with high ISP levels and, on the other, that the risk of CVD in men with calf pain is substantially higher in those with high ISP levels than in those with low levels.
|
|
| 18. |
|
|
| 19. |
- Lind, Peter, et al.
(författare)
-
Risk of myocardial infarction in relation to plasma levels of homocysteine and inflammation-sensitive proteins: a long-term nested case-control study.
- 2003
-
Ingår i: Angiology. - 0003-3197. ; 54:4, s. 401-410
-
Tidskriftsartikel (refereegranskat)abstract
- Several studies have found that the homocysteine plasma level is associated with cardiovascular disease. The authors previously described a relationship between concentrations of fibrinogen and other inflammation-sensitive plasma proteins, namely, alpha1-antitrypsin, ceruloplasmin, haptoglobin, and orosomucoid (alpha1-acid glucoprotein) and the incidence of myocardial infarction (MI). Whether levels of these proteins are related to homocysteine has not been clarified. The aim of this study was to investigate whether a supposed relationship between homocysteine in plasma and the occurrence of MI is modified by these inflammation-sensitive proteins. A nested case-control study was designed, comprising 241 cases of MI, with a mean age of 48 years at baseline, and 241 controls matched for age, month of examination, and duration of follow-up. The mean homocysteine concentration did not differ between cases and controls and there was no association between the baseline homocysteine level and the time lapse before the occurrence of the MI. For the cases, there was no correlation between homocysteine and any of the measured proteins, but for the controls, homocysteine was weakly but significantly negatively correlated to haptoglobin and ceruloplasmin and slightly positively correlated to albumin. For the separated groups of cases and controls there was no association between the number of inflammation-sensitive proteins in the top quartiles and homocysteine concentration. In this population-based, prospective cohort study the occurrence of MI had no relationship to homocysteine baseline plasma level. Furthermore, there was no strong association between homocysteine and the concentrations of any of these inflammation-sensitive proteins.
|
|
| 20. |
- Rohrmann, Sabine, et al.
(författare)
-
Ethanol intake and risk of lung cancer in the European prospective investigation into cancer and nutrition (EPIC)
- 2006
-
Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 164:11, s. 1103-1114
-
Tidskriftsartikel (refereegranskat)abstract
- Within the European Prospective Investigation into Cancer and Nutrition (EPIC), the authors examined the association of ethanol intake at recruitment (1,119 cases) and mean lifelong ethanol intake (887 cases) with lung cancer. Information on baseline and past alcohol consumption, lifetime tobacco smoking, diet, and the anthropometric characteristics of 478,590 participants was collected between 1992 and 2000. Cox proportional hazards regression was used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals. Overall, neither ethanol intake at recruitment nor mean lifelong ethanol intake was significantly associated with lung cancer. However, moderate intake (5-14.9 g/day) at recruitment (hazard ratio (HR) = 0.76, 95% confidence interval (CI): 0.63, 0.90) and moderate mean lifelong intake (HR = 0.80, 95% CI: 0.66, 0.97) were associated with a lower lung cancer risk in comparison with low consumption (0.1-4.9 g/day). Compared with low intake, a high (>= 60 g/day) mean lifelong ethanol intake tended to be related to a higher risk of lung cancer (HR = 1.29, 95% CI: 0.93, 1.74), but high intake at recruitment was not. Although there was no overall association between ethanol intake and risk of lung cancer, the authors cannot rule out a lower risk for moderate consumption and a possibly increased risk for high lifelong consumption.
|
|
| 21. |
- André-Petersson, Lena, et al.
(författare)
-
A comparison of cognitive ability in normotensive and hypertensive 68-year-old men: results from population study "men born in 1914," in Malmo, Sweden
- 2001
-
Ingår i: Experimental Aging Research. - : Informa UK Limited. - 0361-073X .- 1096-4657. ; 27:4, s. 319-340
-
Tidskriftsartikel (refereegranskat)abstract
- Hypertension and its consequences on cognition was analyzed using data from the study "Men born in 1914" in Malmo, Sweden, a prospective cohort study of cardiovascular disease. The baseline examinations took place in 1982/83 where 500 men participated in extensive medical and social examinations. A neuropsychological investigation was completed including five standardized cognitive tests. The specific purpose of the study was to investigate whether hypertension was associated with cognitive performance. By the use of multiple regression analyses, normal blood pressure and three stages of hypertension were analyzed in relation to test performance. Hypertension Stage 3 was associated with lower performance on tests measuring psychomotor speed and visuospatial memory, whereas hypertension Stage 1 was associated with higher performance on tests measuring verbal ability and constructional ability. The associations were unconfounded by clinical manifestations of atherosclerosis, history of stroke, depressive mood, and antihypertensive drug treatment.
|
|
| 22. |
- André-Petersson, Lena, et al.
(författare)
-
Adaptive behavior in stressful situations and stroke incidence in hypertensive men: results from prospective cohort study "men born in 1914" in Malmo, Sweden
- 2001
-
Ingår i: Stroke: a journal of cerebral circulation. - 1524-4628. ; 32:8, s. 1712-1717
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. METHODS: Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. RESULTS: Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). CONCLUSIONS: The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.
|
|
| 23. |
- André-Petersson, Lena, et al.
(författare)
-
Adaptive behavior in stressful situations in relation to postinfarction mortality results from prospective cohort study "Men born in 1914" in Malmo, Sweden
- 2003
-
Ingår i: International Journal of Behavioral Medicine. - 1070-5503. ; 10:1, s. 79-92
-
Tidskriftsartikel (refereegranskat)abstract
- The serial Color Word Test, which is a semi-experimental way to differentiate adaptive behavior in stressful situations, was administered at baseline to men participating in the prospective cohort study "Men born in 1914". During follow-up, from 1982-1983 until December 31, 1996, 133 men experienced a myocardial infarction. Four patterns of adaptive behavior in 2 separate dimensions, the Variability and the Regression, can be discerned during testing. These patterns were compared regarding outcome following the myocardial infarction. The Cumulative-dissociative pattern of the Regression dimension was univariately associated with mortality within 28 days (OR 5.75, CI 1.85-17.88, p = .003). Dissociative (OR 3.87, CI 1.21-12.42, p = .023) and Cumulative-dissociative (OR 5.46, CI 1.66-17.96, p = .005) patterns, of the same dimension, were independently associated with mortality within one year. Specific difficulties in adaptation to stressful situations were associated with increased risk of death following a myocardial infarction. In this male sample, these difficulties could be identified with the serial Color Word Test.
|
|
| 24. |
|
|
| 25. |
- André-Petersson, Lena, et al.
(författare)
-
Incidence of cardiac events in hypertensive men related to adaptive behavior in stressful encounters
- 1999
-
Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 6:4, s. 331-355
-
Tidskriftsartikel (refereegranskat)abstract
- The Serial Color Word Test was administered at baseline to 253 hypertensive men participating in the prospective cohort study of cardiovascular diseases "Men born in 1914" in Malmo, Sweden. This test of psychological adaptation to a stressful encounter was used to investigate whether susceptibility to stress moderates the risk of a cardiac event in association with hypertension. Adaptive behavior, as measured by test performance, can be categorized in two dimensions. The regression dimension refers to linear change of time spent in the test session whereas the variability dimension refers to nonlinear change. Both dimensions consist of four different patterns. At follow-up (mean time = 8.2 +/- 3.5 years), the risk of a cardiac event varied between men with different adaptive patterns. One pattern, the Cumulative-Dissociative pattern of the variability dimension, characterized by a discontinuous and fluctuating time-consumption, was associated to an almost three-fold risk of a cardiac event during follow-up (relative risk [RR], 2.99; 95% confidence interval [CI], 1.33 - 6.70, p = .010) after adjustment for medical-, socioeconomic-, and lifestyle-related factors. No association existed between adaptive patterns and overall mortality.
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
- André-Petersson, Lena, et al.
(författare)
-
Social support and behavior in a stressful situation in relation to myocardial infarction and mortality: who is at risk? Results from prospective cohort study "men born in 1914," malmö, sweden.
- 2006
-
Ingår i: International Journal of Behavioral Medicine. - : Springer Science and Business Media LLC. - 1070-5503 .- 1532-7558. ; 13:4, s. 340-347
-
Tidskriftsartikel (refereegranskat)abstract
- Coronary heart disease remains an important cause of morbidity and mortality. Much data support the view that social support is associated with coronary heart disease. Participants of the study "Men born in 1914," (414 men) were followed from a baseline measurement in 1982183 until the end of 1996. At baseline, the men answered a questionnaire on social support and participated in a stressful test where their behavior was categorized as adaptive or maladaptive. This study examined whether social support had a prospective impact on the incidence of myocardial infarction and all-cause mortality when behavior in the stressful task was taken into consideration. The conclusion of the study was that unsatisfactory levels of social support is associated with an increased risk of incident myocardial infarction (HR 2.40, CI 1.36-4.25, p = .003) and premature death (HR 1.99, CI 1.32-3.00, p = .001) but only in men who had shown maladaptive behavior in the test.
|
|
| 29. |
- André-Petersson, Lena, et al.
(författare)
-
Social support at work and the risk of myocardial infarction and stroke in women and men.
- 2007
-
Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 64:4, s. 830-841
-
Tidskriftsartikel (refereegranskat)abstract
- It has been proposed that lack of social support in a work place characterized by high levels of stress, may increase the likelihood of future cardiovascular disease. The aim of this study was to analyze the prospective impact of social support at work in combination with self-reported work stress on incidence of myocardial infarction (MI) and stroke in a cohort of 4707 women (mean age: 54.2 years) and 3063 men (mean age: 55.5 years) in Malmo, Sweden. The results are based oil self-reports of work-related stress and social support collected at baseline examinations between the years 1992 and 1996. Work-stress was operationalized according to the Karasek job strain model. Data on incidence of NIL and stroke were obtained from national and regional registers. At the end of follow-up, December 31, 2001, 38 women had experienced an MI and 53 had had a stroke. Corresponding figures for men were 114 MIs and 81 strokes. The first finding was that social support at work was an independent predictor of an M I and stroke among women. The second finding was that there was no evidence to support the iso-strain model. The third finding was that low levels of social support at work together with a passive work situation indicated an increased risk of a future cardiovascular outcome (NI I or stroke) during follow-up in the female group. In men, no association was found between any psychosocial work conditions and incidence of MI or stroke during the same follow-up period. (c) 2006 Elsevier Ltd. All rights reserved.
|
|
| 30. |
|
|
| 31. |
- Aronsson, Mattias, et al.
(författare)
-
The cost-effectiveness of radiofrequency catheter ablation as first-line treatment for paroxysmal atrial fibrillation : results from a MANTRA-PAF substudy.
- 2015
-
Ingår i: Europace. - : Oxford University Press (OUP). - 1099-5129 .- 1532-2092. ; 17:1, s. 48-55
-
Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this prospective substudy was to estimate the cost-effectiveness of treating paroxysmal atrial fibrillation (AF) with radiofrequency catheter ablation (RFA) compared with antiarrhythmic drugs (AADs) as first-line treatment.METHODS AND RESULTS: A decision-analytic Markov model, based on MANTRA-PAF (Medical Antiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation) study data, was developed to study long-term effects and costs of RFA compared with AADs as first-line treatment. Positive clinical effects were found in the overall population, a gain of an average 0.06 quality-adjusted life years (QALYs) to an incremental cost of €3033, resulting in an incremental cost-effectiveness ratio of €50 570/QALY. However, the result of the subgroup analyses showed that RFA was less costly and more effective in younger patients. This implied an incremental cost-effectiveness ratio of €3434/QALY in ≤50-year-old patients respectively €108 937/QALY in >50-year-old patients.CONCLUSION: Radiofrequency catheter ablation as first-line treatment is a cost-effective strategy for younger patients with paroxysmal AF. However, the cost-effectiveness of using RFA as first-line therapy in older patients is uncertain, and in most of these AADs should be attempted before RFA (MANTRA-PAF ClinicalTrials.gov number; NCT00133211).
|
|
| 32. |
- Bengtsson, Henrik, et al.
(författare)
-
A population based screening of abdominal aortic aneurysms (AAA)
- 1991
-
Ingår i: European Journal of Vascular Surgery. - 0950-821X. ; 5:1, s. 53-57
-
Tidskriftsartikel (refereegranskat)abstract
- The prevalence of abdominal aortic aneurysm (AAA) in a defined population of elderly men and its correlation to some risk factors were studied in the population cohort "men born in 1914 from Malmo". A total of 499 were invited to attend and 375 (75%) did so. The aorta could be visualised with ultrasound in 364 patients, 39 (10.7%) of whom had aneurysmal changes. The presence of an AAA was related to the findings at a general health examination undertaken 5 years previously. Tobacco and alcohol consumption, impaired lung function and a history of angina pectoris were related to the presence of an AAA. No relationship was found between an AAA and hypertension, hyperlipidaemia or hyperglycaemia. A decreased tissue elasticity as a common denominator for the lung function impairment and development of AAA is discussed.
|
|
| 33. |
- Bergström, Göran, et al.
(författare)
-
Self-Report Tool for Identification of Individuals With Coronary Atherosclerosis : The Swedish CardioPulmonary BioImage Study
-
Ingår i: Journal of the American Heart Association. - 2047-9980. ; , s. 1-13
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Coronary atherosclerosis detected by imaging is a marker of elevated cardiovascular risk. However, imaging involves large resources and exposure to radiation. The aim was, therefore, to test whether nonimaging data, specifically data that can be self-reported, could be used to identify individuals with moderate to severe coronary atherosclerosis.METHODS AND RESULTS: We used data from the population-based SCAPIS (Swedish CardioPulmonary BioImage Study) in individuals with coronary computed tomography angiography (n=25 182) and coronary artery calcification score (n=28 701), aged 50 to 64 years without previous ischemic heart disease. We developed a risk prediction tool using variables that could be assessed from home (self-report tool). For comparison, we also developed a tool using variables from laboratory tests, physical examinations, and self-report (clinical tool) and evaluated both models using receiver operating characteristic curve analysis, external validation, and benchmarked against factors in the pooled cohort equation. The self-report tool (n=14 variables) and the clinical tool (n=23 variables) showed high-to-excellent discriminative ability to identify a segment involvement score ≥4 (area under the curve 0.79 and 0.80, respectively) and significantly better than the pooled cohort equation (area under the curve 0.76, P<0.001). The tools showed a larger net benefit in clinical decision-making at relevant threshold probabilities. The self-report tool identified 65% of all individuals with a segment involvement score ≥4 in the top 30% of the highest-risk individuals. Tools developed for coronary artery calcification score ≥100 performed similarly. CONCLUSIONS: We have developed a self-report tool that effectively identifies individuals with moderate to severe coronary atherosclerosis. The self-report tool may serve as prescreening tool toward a cost-effective computed tomography-based screening program for high-risk individuals.
|
|
| 34. |
- Calling, Susanna, et al.
(författare)
-
Effects of body fatness and physical activity on cardiovascular risk: risk prediction using the bioelectrical impedance method.
- 2006
-
Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 34:6, s. 568-575
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore the effects of body fat percentage (BF%) on incidence of and mortality from cardiovascular disease (CVD) and to study the cardio-protective effect of physical activity in relation to BF%. Methods: A total of 26,942 men and women, aged 45-73 years, without history of CVD were followed up for incidence of coronary events (CE), ischaemic stroke, and CVD mortality over seven years in relation to sex-specific quartiles (Q1-Q4) of BF%. The cardio-protective effect of leisure-time physical activity was studied in relation to BF%. Results: In men, the relative risk (RR) for CE and CVD mortality increased progressively with BF%. RR for CE in Q4 was 1.37 (95% confidence interval: 1.07-1.74), adjusted for age, height, smoking, high alcohol intake, and physical activity, compared with Q1. In women, BF% was significantly associated with incidence of CE and stroke. BF% was more strongly correlated to body mass index (BMI) (r=50.83) and waist circumference (r=0.76) in women than in men (r=0.59 and r=50.66, respectively). BF% was a stronger risk factor than BMI in women, and equally strong as waist circumference. A significant interaction (p=0.013 for incidence of CE, p=0.026 for ischaemic stroke) was found between BF% and sex. The raised cardiovascular risk was reduced by physical activity in subjects with high BF%. Conclusions: BF% is a risk factor for CE, ischaemic stroke, and CVD mortality. An interaction between BF% and sex suggests that BF% is a stronger CVD risk factor in women. The raised cardiovascular risk associated with high BF% is reduced by physical activity.
|
|
| 35. |
- Davidson, Thomas, et al.
(författare)
-
CMT rapport: kostnader och kostnadseffektivitet av ett införande av dabigatran hos patienter med förmaksflimmer
- 2011
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Förmaksflimmer är den vanligaste arytmin i Sverige och orsakar stora kostnader inom hälso- och sjukvården. Förutom att patienterna vanligen drabbas av försämrad livskvalitet går det också åt stora resurser för komplikationer i form av tromboembolier och stroke. De flesta behandlingar inom förmaksflimmer kombineras med antikoagulationsbehandling för att förebygga eller förhindra uppkomst av tromboembolier och ischemisk stroke. Vid denna behandling krävs noggrann dosering för att sänka risken för stroke utan att kraftigt höja risken för blödningar. Warfarin har under lång tid varit det mest effektivaantikoagulationsläkemedlet för skydd mot tromboembolier vid förmaksflimmer. Ett annat behandlingsalternativ är acetylsalicylsyra (ASA). Ett nytt antikoagulationsläkemedel som heter dabigatran (Pradaxa®) har nyligen godkänts som förebyggande behandling av stroke och systemisk embolism hos patienter med förmaksflimmer. Dabigatran har i en stor studie, (RE-LY), visat sig reducera risken för stroke jämfört med warfarin.Det övergripande syftet med denna rapport är att beräkna hälsoekonomiska konsekvenser i form av kostnader och kostnadseffektivitet av ett införande av dabigatran (Pradaxa®) som förebyggande behandling av stroke och systemisk embolism hos patienter med förmaksflimmer. I grundanalysen analyseras dabigatran 150 mg två gånger per dag för personer som är under 80 år och dabigatran 110 mg två gånger per dag för personer 80 år eller äldre. Jämförelser görs med warfarin och ASA, och warfarinbehandlingen delas dessutom in i tre subgrupper; välinställda, dåligt inställda samt warfarin-naïva patienter.En simuleringsmodell har skapats för att beräkna långsiktiga kostnader och effekter för de olika behandlingsalternativen. Effekterna mäts i antal förhindrade stroke, antal vunna levnadsår samt antal vunna kvalitetsjusterade levnadsår (QALYs). Priset för de båda dagliga doserna av dabigatran (150 mg gånger två och 110 mg gånger två) är 25,39 kronor per dag.Analyserna i den här rapporten visar att kostnaden för förmaksflimmer i Sverige beräknas till drygt 4,1 miljarder kronor år 2010. Denna kostnad förväntas sjunka vid införande av dabigatran, till följd av besparingar inom vården av stroke och ett sänkt produktionsbortfall. Kostnaden per vunnet QALY för dabigatran 150 mg / 110 mg jämfört med warfarin, hos patienter som är 65 år gamla och följs upp i 20 år, har beräknats till 74 216 kronor. Vid jämförelse med välinställd warfarinbehandling höjs kostnaden per vunnet QALY till 107 186 kronor. Om dabigatran 110 mg två gånger dagligen jämförs med ASA leder det till lägre kostnader och bättre effekter, vilket innebär att dabigatran 110 mg två gånger dagligen är en dominant behandling för patienter som inte är lämpliga för warfarinbehandling.Ett införande av dabigatran leder till kostnadsförskjutningar inom flera olika områden. En ökad kostnad uppkommer för läkemedel, medan sänkta kostnader uppkommer till följd av färre stroke. För patienten innebär dabigatran lägre risk för stroke och färre besök i sjukvården.
|
|
| 36. |
- Davidson, Thomas, et al.
(författare)
-
Cost-effectiveness of dabigatran compared with warfarin for patients with atrial fibrillation in Sweden
- 2013
-
Ingår i: European Heart Journal. - : Oxford University Press (OUP): Policy B. - 0195-668X .- 1522-9645. ; 34:3, s. 177-183
-
Tidskriftsartikel (refereegranskat)abstract
- Patients with atrial fibrillation have a significantly increased risk of thromboembolic events such as ischaemic stroke, and patients are therefore recommended to be treated with anticoagulation treatment. The most commonly used anticoagulant consists of vitamin K antagonist such as warfarin. A new oral anticoagulation treatment, dabigatran, has recently been approved for stroke prevention among patients with atrial fibrillation. The purpose of this study was to estimate the cost-effectiveness of dabigatran as preventive treatment of stroke and thromboembolic events compared with warfarin in 65-year-old patients with atrial fibrillation in Sweden. less thanbrgreater than less thanbrgreater thanA decision analytic simulation model was used to estimate the long-term (20-year) costs and effects of the different treatments. The outcome measures are the number of strokes prevented, life years gained, and quality-adjusted life years (QALYs) gained. Costs and effect data are adjusted to a Swedish setting. Patients below 80 years of age are assumed to start with dabigatran 150 mg twice a day and switch to 110 mg twice a day at the age of 80 years due to higher bleeding risk. The price of dabigatran in Sweden is Euro2.82 (Swedish kronor 25.39) per day for both doses. The cost per QALY gained for dabigatran compared with warfarin is estimated at Euro7742, increasing to Euro12 449 if dabigatran is compared with only well-controlled warfarin treatment. less thanbrgreater than less thanbrgreater thanDabigatran is a cost-effective treatment in Sweden, as its incremental cost-effectiveness ratio is below the normally accepted willingness to pay limit.
|
|
| 37. |
- Davidson, Thomas, 1977-, et al.
(författare)
-
Direct valuation of health state among patients with chest pain : Does income level matter
-
Annan publikation (populärvet., debatt m.m.)abstract
- There is still uncertainty over where to include the production loss caused by morbidity in cost-effectiveness analyses. This loss could be included as a cost; but if individuals take their own income into consideration when valuing health states, this would lead to double counting. The purpose of this study was to find out whether individuals’ incomes can explain their valuations of their own current health states.The sample consisted of 156 patients (312 observations) admitted to hospital with chest pain (the FRISC II trial). These patients valued their own current health states by using the time trade-off method (TTO) and a visual analogue scale (VAS). They also answered the EQ-5D instrument and stated their monthly income. Income level was additionally controlled via their taxed income at the tax agency, together with their income generated from capital. Generalised estimation equations were used to test whether the EQ- 5D dimensions and monthly gross income could explain the variation in the valuations of the health states.The results indicate that neither self-stated nor taxed income could explain the variation in the valuations made by TTO. However, self-stated income (but not taxed income) was a significant variable in explaining variation in the VAS valuations.These findings support the inclusion of the production loss caused by morbidity in the analysis, as these costs are not, or at least not to any great extent, implicitly incorporated in the individuals’ QALY weights when TTO is used to value the health states. Using a VAS, some income effects may be included.
|
|
| 38. |
|
|
| 39. |
- Davidson, Thomas, et al.
(författare)
-
The Cost of Thromboembolic Events and their Prevention among Patients with Atrial Fibrillation
- 2011
-
Ingår i: Journal of Atrial Fibrillation. - : CardioFront. - 1941-6911. ; 2:4, s. 00-00
-
Tidskriftsartikel (refereegranskat)abstract
- Aim: Atrial fibrillation (AF) is the most common type of cardiac arrhythmia. People with AF have a significantly increased risk of thromboembolic events, including stroke, and the main treatment is therefore aimed at preventing thromboembolic events via anticoagulation with warfarin or acetylsalicylic acid. However, the development of new anticoagulation treatments has prompted a need to know the current cost of AF-related thromboembolic events, for future cost-effectiveness comparisons with the existing treatments. In this study, we estimated the cost of thromboembolic events and their prevention among Swedish AF patients in 2010. Methods: The relevant costs were identified, quantified, and valued. The complications included were ischaemic and haemorrhagic stroke, gastrointestinal bleeding, and other types of major bleeding caused by AF. Treatments intended to lower the risk of ischaemic stroke were also included. A societal perspective was used, including productivity loss due to morbidity. Patients with a CHADS2 score of 1 or higher were included. Results: Among the 9 340 682 inhabitants of Sweden, there are 118 000 patients with AF and at least one more risk factor for stroke, comprising 1.26% of the population. Of these patients, 43.3% are treated with warfarin, 28.3% use acetylsalicylic acid, and 28.3% are assumed to have no anticoagulation treatment. The cost of AF-related complications and its prevention in Sweden was estimated at €437 million for 2010, corresponding to €3 712 per AF patient per year. The highest cost was caused by stroke, and the second highest by the cost of monitoring the warfarin treatment. As the prevalence of AF is expected to increase in the future, AF-related costs are also expected to rise. Conclusion: Thromboembolic events cause high costs. New, easily-administered treatments that could reduce the risk of stroke have the potential to be cost-effective.
|
|
| 40. |
|
|
| 41. |
|
|
| 42. |
|
|
| 43. |
- Eckard, Nathalie, et al.
(författare)
-
Compilation of cost-effectiveness evidence for different heart conditions and treatment strategies
- 2011
-
Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 45:2, s. 72-76
-
Forskningsöversikt (refereegranskat)abstract
- Objectives. Despite the continuing interest in health economic research, we could find no accessible data set on cost-effectiveness, useful as practical information to decision makers who must allocate scarce resources within the cardiovascular field. The aim of this paper was to present cost-effectiveness ratios, based on a systematic literature search for the treatment of heart diseases. Design. A comprehensive literature search on cost-effectiveness analyses of intervention strategies for the treatment of heart diseases was conducted. We compiled available cost-effectiveness ratios for different heart conditions and treatment strategies, in a cost-effectiveness ranking table. The cost-effectiveness ratios were expressed as a cost per quality adjusted life year (QALY) or life year gained. Results. Cost-effectiveness ratios, ranging from dominant to those costing more than 1,000,000 Euros per QALY gained, and bibliographic references are provided for. The table was categorized according to disease group, making the ranking table readily available. Conclusions. Cost-effectiveness ranking tables provide a means of presenting cost-effectiveness evidence. They provide valid information within a limited space aiding decision makers on the allocation of health care resources. This paper represents an extensive compilation of health economic evidence for the treatment of heart diseases.
|
|
| 44. |
- Eckard, Nathalie, et al.
(författare)
-
Reaching agreement in uncertain circumstances : the practice of evidence-based policy in the case of the Swedish National Guidelines for heart diseases
- 2017
-
Ingår i: Evidence and Policy: A Journal of Research, Debate and Practice. - : Informa Healthcare. - 1744-2648. ; :4, s. 687-707
-
Tidskriftsartikel (refereegranskat)abstract
- This paper explores the practice of evidence-based policy in a Swedish healthcare context. The study focused on how policymakers in the specific working group, the Priority-Setting Group (PSG), handled the various forms of evidence and values and their competing rationalities, when producing the Swedish National Guidelines for heart diseases that are based on both clinical and economic evidence and are established to support explicit priority-setting in healthcare. The study contributes to the theoretical and practical debate on evidence-based policy (EBP) by illustrating how the practical tensions of coming to agreement were managed, to a large extent, through deliberation and by creativity.
|
|
| 45. |
- Eckard, Nathalie, 1973-
(författare)
-
The matter of economic evaluations in health policy decision-making : The case of the Swedish national guidelines for heart diseases
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Economic evaluations are used to inform decision makers about the efficient allocation of scarce healthcare resources and are generated with the direct intent to support decisions in healthcare. Producing guidelines is a complex process and the inclusion of health-economic aspects in the formulation of the Swedish national guidelines as a basis for the written recommendations (priority gradings), distinguishes them from their European counterparts. Despite the increased use of cost-effectiveness data in decision-making, little is known about the actual use of such data. This thesis covers issues concerning how economic evaluations matter in health policy decision-making. The thesis includes four papers based on the Swedish national guidelines for heart diseases, one of the most prominent examples in Sweden of following the notion of evidence-based policy (EBP), in order to inform explicit priority setting.Both Papers I and II followed a qualitative case study design, based on the same data set. Paper I explored how a specific working group, the Priority Setting Group (PSG), handled the various forms of evidence and values when producing the national guidelines. Two themes were identified in reaching collective agreement in priority gradings; group facilitation activities and avoiding deadlock in the discussion. The work process involved disagreement and negotiation as part of that task. Paper I contributes to the theoretical and practical debate on EBP. Paper II focused on the use of cost-effectiveness data as decision support in the PSG work process. The paper addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. Three themes were identified. The paper contributes to knowledge on how cost-effectiveness evidence was used in actual decision-making. The use of cost-effectiveness evidence was one of many tools employed to avoid deadlock in discussion and to reach a priority grading, when the overall evidence base was weak, in times of uncertainty and on the introduction of new expensive medical technologies.Quantitative research methods were used for both Papers III and IV. Paper III explored how the PSG was presented with cost-effectiveness evidence as decision support and as a basis for their priority gradings. Cost-effectiveness ratios (ICERs) were provided, based on a systematic literature review, as well as how the results may be conveyed and communicated, for the treatment of heart diseases using a cost-effectiveness ranking or league and providing valid information within a limited space, aiding decision makers on the allocation of healthcare resources. The thesis also includes decision support in the form of cost-effectiveness analysis on catheter ablation treatment. Paper IV provides an example of presenting evidence in the form of a decision-analytic model. The modelling approach provides an analytic framework for decision-making, specifically under conditions of uncertainty as in the introduction of new medical technology. Catheter ablation was associated with reduced cost and an incremental gain in quality adjusted life years (QALYs), and was considered a cost-effective treatment strategy compared to the medical treatment strategy in a lifetime perspective.
|
|
| 46. |
- Eckard, Nathalie, et al.
(författare)
-
Use of cost-effectiveness data in priority setting decisions : experiences from the national guidelines for heart diseases in Sweden
- 2014
-
Ingår i: International Journal of Health Policy and Management. - : Kerman University of Medical Sciences. - 2322-5939. ; 3:6, s. 323-332
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases.METHODS: A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions.RESULTS: This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies.CONCLUSION: Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.
|
|
| 47. |
- Ekelund, Göran, et al.
(författare)
-
För tidigt att rekommendera allmän screening för kolorektal cancer
- 2003
-
Ingår i: Läkartidningen. - 0023-7205. ; 100:38, s. 2922-2926
-
Tidskriftsartikel (refereegranskat)abstract
- Randomised controlled trials have shown that screening may significantly reduce mortality in coloretcal cancer. In the present evaluation it is shown that the reported reduction of 15 per cent, or higher, is given in relative figures. With absolute figures the reduction is only 0.15 per cent or lower. The number of individuals needed to invite for screening (NNT) biannually for 10 years to prevent one death in colorectal cancer is 1,173 (confidence interval 741-2,807). Side-effects, costs and ethical issues are seldom, or never, discussed. Postopeative follow-up may be regardes as the screening of a high-risk group. The reduced mortality seen in the metaanalysis of randomised controlled trials is here regarded as small and should also be weighed against the drawbacks of follow-up before any recommendation for more active surveillance is given.
|
|
| 48. |
|
|
| 49. |
|
|
| 50. |
- Engström, Gunnar, et al.
(författare)
-
Asymptomatic leg and carotid atherosclerosis in smokers is related to degree of ventilatory capacity: longitudinal and cross-sectional results from 'Men born in 1914', Sweden
- 2001
-
Ingår i: Atherosclerosis. - 1879-1484. ; 155:1, s. 237-243
-
Tidskriftsartikel (refereegranskat)abstract
- Although smoking is associated with cardiovascular disease (CVD), many individuals remain healthy after many years of smoking. The population based cohort 'Men born in 1914' was used to investigate whether the occurrence of non-invasively detected atherosclerosis among smokers is associated with lung function [(i.e. height-adjusted forced expiratory volume during 1 s (FEV1.0) and vital capacity (VC)]. Two hundred and seven smokers without history of CVD were examined with spirometry and calf plethysmography at 55 years, and with spirometry, ankle-arm blood pressure recordings and ultrasound examinations of the carotid arteries at 68 years. Eighty-three men had atherosclerosis defined as carotid stenosis >30% or ankle-arm index <0.9. FEV1.0 and VC were both at 55 years (longitudinally) and at 68 years (cross-sectionally) lower among men with atherosclerosis at 68 years (55 years: FEV1.0, 3.2+/-0.6 vs. 3.4+/-0.5 l; P=0.02; VC, 4.2+/-0.5 vs. 4.4+/-0.5 l; P=0.02; 68 years: FEV1.0, 2.6+/-0.6 vs. 2.9+/-0.7 l; P=0.004; VC, 3.8+/-0.6 vs. 4.0+/-0.6; P=0.009, for men with and without atherosclerosis). The longitudinal and cross-sectional associations between FEV1.0, VC and atherosclerosis remained significant after adjustments for several potential confounders (tobacco consumption at 55 and 68 years, hypertension, diabetes, alcohol consumption at 68 years, and pulse wave amplitude as a measure of degree of atherosclerosis at 55 years). We conclude that the risk of developing atherosclerosis is associated with the degree of ventilatory capacity. The results suggest that in smokers, reduced lung function is a marker of susceptibility for atherosclerosis.
|
|
