| 1. |
- Dejby, Ellen, et al.
(author)
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Left-sided valvular heart disease and survival in out-of-hospital cardiac arrest: a nationwide registry-based study.
- 2023
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In: Scientific reports. - 2045-2322. ; 13:1
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Journal article (peer-reviewed)abstract
- Survival in left-sided valvular heart disease (VHD; aortic stenosis [AS], aortic regurgitation [AR], mitral stenosis [MS], mitral regurgitation [MR]) in out-of-hospital cardiac arrest (OHCA) is unknown. We studied all cases of OHCA in the Swedish Registry for Cardiopulmonary Resuscitation. All degrees of VHD, diagnosed prior to OHCA, were included. Association between VHD and survival was studied using logistic regression, gradient boosting and Cox regression. We studied time to cardiac arrest, comorbidities, survival, and cerebral performance category (CPC) score. We included 55,615 patients; 1948 with AS (3,5%), 384 AR (0,7%), 17 MS (0,03%), and 704 with MR (1,3%). Patients with MS were not described due to low case number. Time from VHD diagnosis to cardiac arrest was 3.7years in AS, 4.5years in AR and 4.1years in MR. ROSC occurred in 28% with AS, 33% with AR, 36% with MR and 35% without VHD. Survival at 30days was 5.2%, 10.4%, 9.2%, 11.4% in AS, AR, MR and without VHD, respectively. There were no survivors in people with AS presenting with asystole or PEA. CPC scores did not differ in those with VHD compared with no VHD. Odds ratio (OR) for MR and AR showed no difference in survival, while AS displayed OR 0.58 (95% CI 0.46-0.72), vs no VHD. AS is associated with halved survival in OHCA, while AR and MR do not affect survival. Survivors with AS have neurological outcomes comparable to patients without VHD.
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| 2. |
- Albert, Malin, et al.
(author)
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Hospitalized patients' attitudes towards participating in a randomized control trial in case of a cardiac arrest.
- 2024
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In: Resuscitation Plus. - 2666-5204. ; 18
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Journal article (peer-reviewed)abstract
- No previous study has evaluated patients attitudes towards inclusion in an ongoing cardiac arrest clinical trial. The aim of this study was to assess patientś willingness and motives to participate in the ongoing randomized controlled drug trial "Vasopressin and Steroids in addition to Adrenaline in cardiac arrest" (VAST-A trial) in case of an in-hospital cardiac arrest (IHCA).Hospitalized patients, men≥18 and women≥50years, were asked for informed consent for inclusion in the VAST-A trial in case of an IHCA, the reason for approving or declining inclusion in the trial and baseline characteristics.Patients admitted to hospital were asked to give informed consent of inclusion in VAST-A in case of an IHCA during their hospital stay. Patients were also asked why they approved or declined inclusion as well as baseline characteristics questions.1,064 patients were asked about willingness to participate in the VAST-A trial, of these 902 (84.8%) patients approved inclusion. A subgroup of 411 patients were, except willingness, also asked about motives to participate or not and basic characteristics. The main reason for approving inclusion was to contribute to research (n=328, 83.9%). The main reason for declining inclusion was concerns regarding testing the drug treatment (n=6, 30%).Among hospitalized patients the vast majority gave informed consent to inclusion in an ongoing randomized cardiac arrest drug trial. The main reason for approving inclusion was to contribute to research.
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| 3. |
- Albert, Malin, et al.
(author)
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Hospitalized patients’ attitudes towards participating in a randomized control trial in case of a cardiac arrest
- 2024
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In: Resuscitation Plus. - 2666-5204. ; 18
-
Journal article (peer-reviewed)abstract
- BackgroundNo previous study has evaluated patients attitudes towards inclusion in an ongoing cardiac arrest clinical trial. The aim of this study was to assess patientś willingness and motives to participate in the ongoing randomized controlled drug trial “Vasopressin and Steroids in addition to Adrenaline in cardiac arrest” (VAST-A trial) in case of an in-hospital cardiac arrest (IHCA).ObjectivesHospitalized patients, men ≥ 18 and women ≥ 50 years, were asked for informed consent for inclusion in the VAST-A trial in case of an IHCA, the reason for approving or declining inclusion in the trial and baseline characteristics.MethodsPatients admitted to hospital were asked to give informed consent of inclusion in VAST-A in case of an IHCA during their hospital stay. Patients were also asked why they approved or declined inclusion as well as baseline characteristics questions.Results1,064 patients were asked about willingness to participate in the VAST-A trial, of these 902 (84.8%) patients approved inclusion. A subgroup of 411 patients were, except willingness, also asked about motives to participate or not and basic characteristics. The main reason for approving inclusion was to contribute to research (n = 328, 83.9%). The main reason for declining inclusion was concerns regarding testing the drug treatment (n = 6, 30%).ConclusionAmong hospitalized patients the vast majority gave informed consent to inclusion in an ongoing randomized cardiac arrest drug trial. The main reason for approving inclusion was to contribute to research.
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| 4. |
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| 5. |
- Fedchenko, Maria, 1988, et al.
(author)
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Ischemic heart disease in children and young adults with congenital heart disease in Sweden
- 2017
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 248, s. 143-148
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Journal article (peer-reviewed)abstract
- Background: An increasing proportion of congenital heart disease (CoHD) patients survive to an age associated with increased risk of developing ischemic heart disease (IHD). The aim was to investigate the risk of developing IHD among children and young adults with CoHD. Methods: Using the Swedish National Patient Register, we created a cohort of all CoHD patients born between January 1970 and December 1993. Ten controls matched for age, sex, county were randomly selected from the general population for each patient (n = 219,816). Patients and controls were followed from birth until first IHD event, death, or December 31, 2011. Results: We identified 21,982 patients with CoHD (51.6% men), mean follow-up was 26.4 (21.2-33.9) years. CoHD patients had 16.5 times higher risk of being hospitalized with or dying from IHD compared to controls (95% CI: 13.7-19.9), p < 0.0001. Patients with conotruncal defects and severe nonconotruncal defects, had the highest IHD incidence rate (71.1 and 56.3 cases per 100,000 person-years, respectively, compared to 2.9 and 2.3 in controls). Hypertension and diabetes were less common among CoHD patients with IHD than among controls with IHD (hypertension 9.7% vs 19.7%, diabetes 1.8% vs 7.7% in CoHD patients and controls). Patients with aortic coarctation did not have a specific increase in the risk of developing IHD or acute myocardial infarction. Conclusions: In this large case-control cohort study, the relative risk of developing IHD was markedly higher in CoHD patients than in controls. However, the absolute risk was low in both groups. (C) 2017 Elsevier B.V. All rights reserved.
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| 6. |
- Gilljam, Thomas, et al.
(author)
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Development of heart failure in young patients with congenital heart disease: a nation-wide cohort study.
- 2019
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In: Open heart. - : BMJ. - 2053-3624. ; 6:1
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Journal article (peer-reviewed)abstract
- Heart failure (HF) is a common cause of hospitalisation and death in adults with congenital heart disease (CHD). However, the risk of HF in young patients with CHD has not been determined.By linkage of national patient registers in Sweden, we identified 21 982 patients with CHD born between 1970 and 1993, and compared these with 10 controls per case. Follow-up data were collected from birth until 2011 or death.Over a mean follow-up of 26.6 years in patients with CHD and 28.5 years in controls, 729 (3.3%) and 75 (0.03%) developed HF, respectively. The cumulative incidence of HF in all CHD was 6.5% and in complex CHD 14.8% up to age 42 years. Thus, one patient in 15 with CHD runs the risk of developing HF before age 42 years, a risk that is 105.7 times higher (95 % CI 83.2 to 134.8) compared with controls. For patients with complex CHD (such as conotruncal defects, univentricular hearts, endocardial cushion defects), one in seven will develop HF, a HR of 401.5; 95%CI 298 to 601 as compared with controls. The cumulative probability of death in patients with CHD, after HF diagnosis, was 63.4% (95% CI 57.5 to 69.3).An extremely high risk of developing HF (more than 100-fold) was found in patients with CHD, compared with matched controls, up to the age of 42 years. Patients with complex congenital heart malformations carried the highest risk and have to be considered as the main risk group for developing HF.
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| 7. |
- Helleryd, Edvin, 1997, et al.
(author)
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Association between exercise load, resting heart rate, and maximum heart rate and risk of future ST-segment elevation myocardial infarction (STEMI).
- 2023
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In: Open heart. - 2053-3624. ; 10:2
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Journal article (peer-reviewed)abstract
- This study aimed to examine the association between exercise workload, resting heart rate (RHR), maximum heart rate and the risk of developing ST-segment elevation myocardial infarction (STEMI).The study included all participants from the UK Biobank who had undergone submaximal exercise stress testing. Patients with a history of STEMI were excluded. The allowed exercise load for each participant was calculated based on clinical characteristics and risk categories. We studied the participants who exercised to reach 50% or 35% of their expected maximum exercise tolerance. STEMI was adjudicated by the UK Biobank. We used Cox regression analysis to study how exercise tolerance and RHR were related to the risk of STEMI.A total of 66 949 participants were studied, of whom 274 developed STEMI during a median follow-up of 7.7 years. After adjusting for age, sex, blood pressure, smoking, forced vital capacity, forced expiratory volume in 1 s, peak expiratory flow and diabetes, we noted a significant association between RHR and the risk of STEMI (p=0.015). The HR for STEMI in the highest RHR quartile (>90 beats/min) compared with that in the lowest quartile was 2.92 (95% CI 1.26 to 6.77). Neither the maximum achieved exercise load nor the ratio of the maximum heart rate to the maximum load was significantly associated with the risk of STEMI. However, a non-significant but stepwise inverse association was noted between the maximum load and the risk of STEMI.RHR is an independent predictor of future STEMI. An RHR of >90 beats/min is associated with an almost threefold increase in the risk of STEMI.
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| 8. |
- Hellsén, Gustaf, et al.
(author)
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Predicting recurrent cardiac arrest in individuals surviving Out-of-Hospital cardiac arrest
- 2023
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 184
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Journal article (peer-reviewed)abstract
- Background: Despite improvements in short-term survival for Out-of-Hospital Cardiac Arrest (OHCA) in the past two decades, long-term survival is still not well studied. Furthermore, the contribution of different variables on long-term survival have not been fully investigated. Aim: Examine the 1-year prognosis of patients discharged from hospital after an OHCA. Furthermore, identify factors predicting re-arrest and/or death during 1-year follow-up. Methods: All patients 18 years or older surviving an OHCA and discharged from the hospital were identified from the Swedish Register for Car-diopulmonary Resuscitation (SRCR). Data on diagnoses, medications and socioeconomic factors was gathered from other Swedish registers. A machine learning model was constructed with 886 variables and evaluated for its predictive capabilities. Variable importance was gathered from the model and new models with the most important variables were created. Results: Out of the 5098 patients included, 902 (-18%) suffered a recurrent cardiac arrest or death within a year. For the outcome death or re-arrest within 1 year from discharge the model achieved an ROC (receiver operating characteristics) AUC (area under the curve) of 0.73. A model with the 15 most important variables achieved an AUC of 0.69. Conclusions: Survivors of an OHCA have a high risk of suffering a re-arrest or death within 1 year from hospital discharge. A machine learning model with 15 different variables, among which age, socioeconomic factors and neurofunctional status at hospital discharge, achieved almost the same predictive capabilities with reasonable precision as the full model with 886 variables.
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| 9. |
- Karazisi, Christina, et al.
(author)
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Risk of cancer in young and older patients with congenital heart disease and the excess risk of cancer by syndromes, organ transplantation and cardiac surgery: Swedish health registry study (1930-2017)
- 2022
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In: Lancet Regional Health-Europe. - : Elsevier BV. - 2666-7762. ; 18
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Journal article (peer-reviewed)abstract
- Background Increasing survival of patients with congenital heart disease (CHD) will result in an increased risk of age-dependent acquired diseases later in life. We aimed to investigate the risk of cancer in young and older patients with CHD and to evaluate the excess risk of cancer by syndromes, organ transplantation and cardiac surgery. Methods Patients with CHD born between 1930 and 2017 were identified using Swedish Health Registers. Each patient with CHD (n = 89,542) was matched by sex and birth year with ten controls without CHD (n = 890,472) from the Swedish Total Population Register. Findings 4012 patients with CHD (4.5%) and 35,218 controls (4.0%) developed cancer. The median follow-up time was 58.8 (IQR 42.4-69.0) years. The overall cancer risk was 1.23 times higher (95% confidence interval (CI) 1.19 -1.27) in patients with CHD compared with matched controls, and remained significant when patients with syndromes and organ transplant recipients were excluded. The risk of cancer was higher in all CHD age groups, and in patients that underwent cardiac surgery during the first year after birth (Hazard Ratio 1.83; 95% CI 1.32-2.54). The highest risk was found in children (0 -17 years), HR 3.21 (95% CI 2.90-3.56). Interpretation The cancer risk in patients with CHD was 23% higher than in matched controls without CHD. The highest risk was found in children and in the latest birth cohort (1990-2017). Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 10. |
- Lachonius, Maria, 1962, et al.
(author)
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Patients' motivation to undergo transcatheter aortic valve replacement. A phenomenological hermeneutic study.
- 2023
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In: International journal of older people nursing. - : Wiley. - 1748-3743 .- 1748-3735. ; 18:1
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Journal article (peer-reviewed)abstract
- Aortic stenosis is the most common valvular disease, and its prevalence is increasing due to the ageing population. Transcatheter aortic valve replacement (TAVR) is the recommended method when treating frail, older patients. Knowledge of what motivates older patients to undergo TAVR is important, in order to meet patients' expectations.The study aimed to explore the meaning of older patients' motivation to undergo TAVR.The design was a qualitative study, analysed using a phenomenological hermeneutic approach. In-depth, semi-structured interviews with open-ended questions were conducted. Participants were selected from a specialist cardiology clinic in Sweden. Eighteen patients, six women and twelve men, aged 66-92, were recruited.The analysis showed that patients who had agreed to undergo TAVR were deeply affected by their body's failure. Before the TAVR procedure, the participants were limited in their daily activities and experienced that their life was on hold. They experienced that they were barely existing. They were aware of their life-threatening condition and were forced to confront death. Yet despite an advanced age, they still had considerable zest for life. It was very important to them to remain independent in everyday life, and fear of becoming dependent had a strong impact on their motivations for undergoing TAVR.Older patients' motivations to undergo TAVR are strongly influenced by their fear of being dependent on others and their zest for life. Health care professionals need to support these patients in setting realistic and personalised goals.Person-centered care actions could facilitate patients' involvement in the decision about TAVR and strenghten patients' beliefs in their own capabilities, before and after TAVR.
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| 11. |
- Lachonius, Maria, 1962, et al.
(author)
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Socioeconomic factors and long-term mortality risk after surgical aortic valve replacement.
- 2023
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In: International journal of cardiology. Cardiovascular risk and prevention. - 2772-4875. ; 19
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Journal article (peer-reviewed)abstract
- There is scarce knowledge about the association between socioeconomic status and mortality in patients undergoing surgical aortic valve replacement. This study explores the associations between income, education and marital status, and long-term mortality risk.In this national registry-based observational cohort study we included all 14,537 patients aged >18 years who underwent isolated surgical aortic valve replacement for aortic stenosis in Sweden 1997-2020. Socioeconomic status and comorbidities were collected from three mandatory national registries. Cox regression models adjusted for patient characteristics and comorbidities were used to estimate the mortality risk.Mortality risk was higher for patients in the lowest versus the highest income quintile (adjusted hazard ratio [aHR] 1.36, 95% confidence interval [CI]: 1.11-1.65), for patients with <10 years education versus >12 years (aHR 1.20, 95% CI:1.08-1.33), and for patients who were not married/cohabiting versus those who were (aHR 1.24, 95% CI:1.04-1.48). Patients with the most unfavorable socioeconomic status (lowest income, shortest education, never married/cohabiting) had an adjusted median survival of 2.9 years less than patients with the most favorable socioeconomic status (14.6 years, 95% CI: 13.2-17.4 years vs. 11.7 years, 95% CI: 9.8-14.4).Low socioeconomic status in patients undergoing surgical aortic valve replacement is associated with shorter survival and an increased long-term adjusted mortality risk. These results emphasize the importance of identifying surgical aortic valve replacement patients with unfavorable socioeconomic situation and ensure sufficient post-discharge surveillance.
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| 12. |
- Mandalenakis, Zacharias, 1979, et al.
(author)
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Atrial Fibrillation Burden in Young Patients with Congenital Heart Disease.
- 2018
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In: Circulation. - 1524-4539. ; 137:9, s. 928-937
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Journal article (peer-reviewed)abstract
- Background -Patients with congenital heart disease (CHD) are assumed to be vulnerable to atrial fibrillation (AF) due to residual shunts, anomalous vessel anatomy, progressive valvulopathy, hypertension, and atrial scars from previous heart surgery. However, the risk of developing AF as well as the complications associated with AF in children and young adults with CHD have not been compared with those in controls. Methods -Data from the Swedish Patient and Cause of Death Registers were used to identify all patients with a diagnosis of CHD who were born from 1970 to 1993. Each patient with CHD was matched by birth year, sex, and county with 10 controls from the Total Population Register in Sweden. Follow-up data were collected until 2011. Results -Among 21,982 patients (51.6% men) with CHD and 219,816 matched controls, 654 and 328 developed AF, respectively. The mean follow-up was 27 years. The risk of developing AF was 21.99 times higher (95% confidence interval, 19.26-25.12) in patients with CHD than controls. According to a hierarchic CHD classification, patients with conotruncal defects had the highest risk (hazard ratio, 84.27; 95% confidence interval, 56.86-124.89). At the age of 42 years, 8.3% of all patients with CHD had a recorded diagnosis of AF. Heart failure was the quantitatively most important complication in patients with CHD and AF, with a 10.7% (70/654) recorded diagnosis of heart failure. Conclusions -The risk of AF in children and young adults with CHD was 22 times higher than that in matched controls. Up to the age of 42 years, 1 of 12 patients with CHD had developed AF and 1 of 10 patients with CHD with AF had developed heart failure. The patient groups with the most complex congenital defects carried the greatest risk of AF and could be considered for targeted monitoring.
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| 13. |
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| 14. |
- Mandalenakis, Zacharias, 1979, et al.
(author)
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Risk of Cancer Among Children and Young Adults With Congenital Heart Disease Compared With Healthy Controls
- 2019
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In: Jama Network Open. - : American Medical Association (AMA). - 2574-3805. ; 2:7
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Journal article (peer-reviewed)abstract
- IMPORTANCE Adult patients with congenital heart disease (CHD) have an increased incidence of cancer, presumably owing to repeated radiation exposure, genetic predisposition, or repeated stress factors during heart interventions. However, there are limited data on the risk of cancer in children and young adults with CHD compared with the general population. OBJECTIVE To determine the risk of developing cancer from birth to age 41 years among patients with CHD compared with healthy matched controls. DESIGN, SETTING, AND PARTICIPANTS This registry-based, matched, prospective cohort study in Sweden used data from the Patient and Cause of Death Registers. Successive cohorts of patients with CHD born from 1970 to 1979, 1980 to 1989, and 1990 to 1993 were identified. Each patient (n = 21 982) was matched for birth year, sex, and county with 10 controls without CHD from the general population (n = 219 816). Follow-up and comorbidity data were collected from 1970 until 2011. Data analysis began in September 2018 and concluded in February 2019. MAIN OUTCOMES AND MEASURES Risk of cancer among children and young adults with CHD and among healthy controls. RESULTS Among 21 982 individuals with CHD and 219 816 healthy matched controls, 428 patients with CHD (2.0%) and 2072 controls (0.9%) developed cancer. Among patients with CHD, the mean (SD) age at follow-up was 26.6 (8.4) years, and 11332 participants (51.6%) were men. Among healthy controls, the mean (SD) age at follow-up was 28.5 (9.1) years, and 113 319 participants (51.6%) were men. By the age of 41 years, 1 of 50 patients with CHD developed cancer. The overall hazard ratio (HR) for cancer was 2.24 (95% CI, 2.01-2.48) in children and young adults with CHD compared with controls. Risk increased by each successive birth cohort to an HR of 3.37 (95% CI, 2.60-4.35) among those born from 1990 to 1993. The risk of cancer was similar in men and women with CHD (men: HR, 2.41; 95% CI, 2.08-2.79; women: HR, 2.08; 95% CI, 1.80-2.41). The HR for cancer among patients with CHD who underwent surgery was 1.95 (95% CI, 1.58-2.33) compared with controls; for patients with CHD who had not undergone surgery, the HR was 2.43 (95% CI, 2.12-2.76). According to a hierarchical classification, a significantly increased risk of cancer was found among patients with complex heart lesions, such as conotruncal defects (HR, 2.29; 95% CI, 1.62-3.25), compared with healthy controls. CONCLUSIONS AND RELEVANCE Children and young adult patients with CHD had an increased risk of developing cancer compared with healthy matched controls, and the risk was significantly higher among patients with CHD from the most recent birth cohort. An increased risk of cancer in all CHD lesion groups was found, and a systematic screening for cancer could be considered for this at-risk group of patients.
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| 15. |
- Mandalenakis, Zacharias, 1979, et al.
(author)
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Survivorship in Children and Young Adults With Congenital Heart Disease in Sweden
- 2017
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In: JAMA internal medicine. - : American Medical Association (AMA). - 2168-6106 .- 2168-6114. ; 177:2, s. 224-230
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Journal article (peer-reviewed)abstract
- Importance: Mortality in patients with congenital heart disease (CHD) has markedly decreased during recent decades because of advancement in pediatric care. However, there are limited data on survival trends in children and young adults with CHD compared with the general population. Objective: To determine survivorship in children and young adults with CHD compared with matched controls. Design, Setting, and Participants: A registry-based, prospective, matched-cohort study was conducted in Sweden. Data from the national patient and cause of death registers were linked to identify individuals with CHD born between January 1, 1970, and December 31, 1993, who were registered at or after birth. Follow-up and comorbidity data were collected until December 31, 2011. Survival analyses were performed with the Cox proportional hazards model; these analyses were performed from January 1, 1970, to December 31, 2011. A total of 21982 patients with CHD in Sweden were identified. The mean (SD) follow-up time was 27.0 (8.86) years. Children serving as controls (n = 219816) (10 for each patient), matched for birth year, sex, and county, were randomly selected from the general population. Main Outcomes and Measures: Survivorship in young patients with CHD and controls. Results: Of the 21982 patients who were born between 1970 and 1993 and were registered with the diagnosis of CHD, 10650 were female (48.4%). Median age at index registration was 4.22 years (interquartile range, 17.07 years). Survivorship among children younger than 5 years was increased from 96% in those born in 1970-1979 to 98% in those born in 1990-1993. Hazard ratios (HRs) of death in relation to that in control individuals decreased from 225.84 (95% CI, 136.84-372.70) to 33.47 (95% CI, 22.54-49.70). A substantial, but less pronounced, absolute and relative increase in survivorship was found in older patients (HRs ranged from 24.52; 95% CI, 11.72-51.26, at 5-9 years to 4.27; 95% CI, 2.29-7.95, at 18-29 years). According to a hierarchical CHD classification, the group of patients with the most severe complex defects (ie, common arterial trunk, transposition of the great vessels, double inlet ventricle, hypoplastic left heart syndrome, tetralogy of Fallot, and atrioventricular septal defect) had the highest risk for death (HR, 64.07; 95% CI, 53.39-76.89). Conclusions and Relevance: Despite substantially increasing absolute and relative survivorship in children and young adults with CHD, the mortality risk remains high compared with the risk in matched controls. Further research on reducing the death rate in this vulnerable group is required.
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| 16. |
- Sattar, N., et al.
(author)
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Twenty Years of Cardiovascular Complications and Risk Factors in Patients With Type 2 Diabetes: A Nationwide Swedish Cohort Study
- 2023
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In: Circulation. - 0009-7322. ; 147:25, s. 1872-1886
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Journal article (peer-reviewed)abstract
- Background:The goal of this work was to investigate trends (2001-2019) for cardiovascular events and cardiometabolic risk factor levels in individuals with type 2 diabetes (T2D) and matched control subjects. Methods:This study included 679 072 individuals with T2D from the Swedish National Diabetes Register and 2 643 800 matched control subjects. Incident outcomes comprised coronary artery disease, acute myocardial infarction, cerebrovascular disease, and heart failure (HF). Trends in time to first event for each outcome were analyzed with Cox regression and standardized incidence rates. In the group with T2D, Cox regression was also used to assess risk factor levels beyond target and outcomes, as well as the relative importance of each risk factor to each model. Results:Among individuals with T2D, incidence rates per 10 000 person-years in 2001 and 2019 were as follows: acute myocardial infarction, 73.9 (95% CI, 65.4-86.8) and 41.0 (95% CI, 39.5-42.6); coronary artery disease, 205.1 (95% CI, 186.8-227.5) and 80.2 (95% CI, 78.2-82.3); cerebrovascular disease, 83.9 (95% CI, 73.6-98.5) and 46.2 (95% CI, 44.9-47.6); and HF, 98.3 (95% CI, 89.4-112.0) and 75.9 (95% CI, 74.4-77.5). The incidence for HF plateaued around 2013, a trend that then persisted. In individuals with T2D, glycated hemoglobin, systolic blood pressure, estimated glomerular filtration rate, and lipids were independently associated with outcomes. Body mass index alone potentially explained >30% of HF risk in T2D. For those with T2D with no risk factor beyond target, there was no excess cardiovascular risk compared with control subjects except for HF, with increased hazard with T2D even when no risk factor was above target (hazard ratio, 1.50 [95% CI, 1.35-1.67]). Risk for coronary artery disease and cerebrovascular disease increased in a stepwise fashion for each risk factor not within target. Glycated hemoglobin was most prognostically important for incident atherosclerotic events, as was body mass index for incident of HF. Conclusions:Risk and rates for atherosclerotic complications and HF are generally decreasing among individuals with T2D, although HF incidence has notably plateaued in recent years. Modifiable risk factors within target levels were associated with lower risks for outcomes. This was particularly notable for systolic blood pressure and glycated hemoglobin for atherosclerotic outcomes and body mass index for heart failure.
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| 17. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Decline in Self-reported Health (EQ-5D) over Time after Surgical Reconstruction of the Right Ventricular Outflow Tract: A Longitudinal Cohort Study of 103 Patients
- 2015
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In: Congenital Heart Disease. - : Computers, Materials and Continua (Tech Science Press). - 1747-079X .- 1747-0803. ; 10:2, s. 54-59
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Journal article (peer-reviewed)abstract
- ObjectivePatients with congenital heart disease may be operated with surgical reconstruction of the right ventricular outflow tract (RVOT). Reintervention is common in this group of patients. The aim of this study was to examine longitudinal self-reported health measured by the EQ-5D questionnaire. DesignData were collected from the Swedish Registry of Congenital Heart Disease. EQ-5D, which measures health outcome, was introduced into the registry in 2005. All adult patients with previous surgical reconstruction of the RVOT who had EQ-5D data from their first and latest visit were analyzed. ResultsAmong 103 patients (65 male and 38 female), mean age 31 (range 19-78 years), the diagnoses were: tetralogy of Fallot (n=66); truncus, transpositions, and double outlet right ventricle (n=23); and Ross-operated congenital aortic valve disease (n=14). Time from first to latest visit was 3 years (range 1-7 years). Eighteen patients underwent 26 reinterventions in the observational period from the first to latest visit, including operations, percutaneous interventions, pacemaker implantations, and ablations. Health perception, mean EQ-5D visual analog scale, VAS, declined from 84.4 (standard deviation (SD)=14.6) to 78.6 (SD=18.3) at the latest visit, P=.001. The decline is almost exclusively seen in patients without reinterventions. Low EQ-VAS was associated with symptoms and New York Heart Association class II-IV. Patient-reported problems in the EQ-5D dimension usual activities were more common in the patients having reinterventions (25%) than those without reintervention (7%), P=.04. ConclusionIn this longitudinal cohort study of patients with previous surgical reconstruction of the RVOT, health perception declined over time. The decline was not observed in patients undergoing any additional interventions.
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| 18. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Effect of medical treatment in patients with systemic right ventricle
- 2020
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In: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 54:5, s. 300-305
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Journal article (peer-reviewed)abstract
- Objective: Congenitally corrected and surgical atrial redirected transposition of the great arteries (TGA) represents states where the morphological right ventricle serves as a systemic ventricle (S-RV). The S-RV is prone to failure, but data on medical treatment on this problem is limited. The purpose of this study was to evaluate the survival in adults with S-RV, with or without heart failure treatment.Design: The SWEDCON registry was used to collect data. All adults with S-RV and minimum follow-up of 1 year were included retrospectively. Medical treatment was defined as taking beta-blockers and/or ACE inhibitors and/or ARBs for more than 50% of the time.Results: We identified 343 patients with S-RV (median age: 21 years). Surgical atrial redirected TGA was present in 58% and congenitally corrected TGA in 42% of patients. The medically treated group (n = 126) had higher rates of impaired S-RV function, use of diuretics, pacemaker and higher NYHA functional class at baseline compared to controls. The proportion of patients with impaired functional class did not change over time in the medically treated group, but increased in controls (21% vs. 30%, p = .015). In Kaplan–Meier analysis, the mean follow-up was 10.3 years, no difference in survival was seen between the groups.Conclusions: Medical treatment may be beneficial in patients with S-RV and impaired functional class and appears to be safe in the long term. The treatment group had equal survival to controls, despite worse baseline characteristics, which might be a result of slower progression of disease in this group.
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| 19. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Homograft reconstruction of the right ventricular outflow tract in adults with congenital heart disease: a systematic review.
- 2016
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In: Interactive cardiovascular and thoracic surgery. - : Oxford University Press (OUP). - 1569-9285 .- 1569-9293. ; 22:1, s. 57-62
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Research review (peer-reviewed)abstract
- Reconstruction of the right ventricular outflow tract with a homograft is an established surgical method in congenital heart disease. Studies from children and adolescents suggest that homograft durability is shorter than the life expectancy of the patient; therefore, durability in adults is addressed in this systematic review. The PubMed database was searched in May 2012 and repeated in May 2015 with the terms 'homograft AND pulmonary valve', generating 665 hits. We included only studies involving more than 50 patients with a mean or median age >18 years. Six studies with a cumulative total of 560 patients were included. The long-term mortality rate was 2-8.8% at 8.1-10 years. Reintervention was common during patients' life spans, with a 10-year event-free survival rate of 78-80%. Early postoperative echocardiographic or magnetic resonance imaging defects appear to predict rapid homograft degeneration. Further studies on various malformations and risk markers for degeneration are needed to make qualified and accurate decisions regarding lifetime management.
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| 20. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Long-term outcome after right ventricle to pulmonary artery conduit surgery and reintervention.
- 2017
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In: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 51:5, s. 284-291
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Journal article (peer-reviewed)abstract
- Reconstruction of the right ventricular outflow tract with a conduit is an established surgical procedure in congenital heart disease and reinterventions are common.An increasing number of patients have a conduit, but there are few population-based studies of long-term outcomes after conduit surgery, reoperations, and transcatheter pulmonary valve replacement.In April 2015, all adult patients with a conduit were identified in the Swedish National Registry for Congenital Heart Disease (SWEDCON). Data on patients who died before age of 16 years are not included in the registry and thus not included in the study.We found 574 patients with a mean age 36.1 years. The largest proportion had tetralogy of Fallot (45%). In total there were 762 operations and 50 transcatheter pulmonary valve replacements. Mean age at first conduit operation was 20.2 years. Long-term survival up to 48 years including perioperative mortality (<1%) was 93% at 20 years. The most common cause of death was cardiac-related. Higher age at first conduit operation was associated with increased mortality risk. Reintervention-free survival was 77% and 54% at 10 and 20 years, respectively. Conduit reinterventions were common. Ten-year reintervention-free survival after first conduit reintervention (n=176) was significantly lower than after first conduit operation (70% vs 77% p=.04). Higher age at first conduit operation was associated with a reduced risk of reintervention, whereas male sex and complex malformations were associated with increased risk of reintervention.The mortality of repeated conduit reinterventions is low. The need for reintervention of conduits is considerable, and reintervention-free survival after the first conduit reintervention is poorer than after first conduit implantation. The findings in this study only applies for patients reaching 16 years of age.
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| 21. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Long-term survival in patients with isolated pulmonary valve stenosis: a not so benign disease?
- 2021
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In: Open Heart. - : BMJ. - 2053-3624. ; 8:2
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Journal article (peer-reviewed)abstract
- Background and objectives During the last decades, the survival rates in patients with congenital heart disease have increased dramatically, particularly in patients with complex heart malformations. However, the survival in patients with simple defects is still unknown. We aimed to determine the characteristics and the risk of mortality in patients with isolated pulmonary valve stenosis (PS). Methods Swedish inpatient, outpatient and cause of death registries were used to identify patients born between 1970 and 2017 with a diagnosis of PS, without any other concomitant congenital heart lesion. For each patient with PS, 10 control individuals without congenital heart disease were matched by birth year and sex from the total population registry. We used median-unbiased method and Kaplan-Meier survival analysis to examine the risk of mortality. Results We included 3910 patients with PS and 38 770 matched controls. The median age of diagnosis of PS was 0.7 years (IQR 0.3-7.0). During a median follow-up of 13.5 years (IQR 6.5-23.5), 88 patients with PS and 192 controls died; 500 patients with PS (12%) underwent at least one transcatheter or surgical valve intervention. The overall mortality rate was significantly higher in patients with PS compared with matched controls (HR 4.67, 95% CI 3.61 to 5.99, p=0.001). Patients with an early diagnosis of PS (0-1 year) had the highest risk of mortality (HR 10.99, 95% CI 7.84 to 15.45). Conclusions In this nationwide, register-based cohort study, we found that the risk of mortality in patients with PS is almost five times higher compared with matched controls. Patients with an early diagnosis of PS appears to be the most vulnerable group and the regular follow-up in tertiary congenital heart units may be the key to prevention.
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| 22. |
- Skoglund, Kristofer, 1976, et al.
(author)
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Multidisciplinary approach and treatment options in right ventricular outflow tract malformations
- 2018
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In: Journal of Multidisciplinary Healthcare. - : Informa UK Limited. - 1178-2390. ; 11, s. 333-338
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Journal article (peer-reviewed)abstract
- Background: Among patients with congenital heart disease, implantation of a valved conduit is common practice for surgical reconstruction of malformations involving the right ventricular outflow tract (RVOT). The conduit has limited durability, and treatments with surgical replacement and transcatheter pulmonary valve replacement (TPVR) are common. Previous studies indicate that TPVR, despite being a less invasive alternative, is not used for the majority of these patients. Methods and results: This is a descriptive study of the medical records of 100 consecutive adult patients with RVOT malformations who were evaluated a total of 118 times between January 1, 2008 and December 31, 2015, at meetings of the hospital's multidisciplinary heart patient review board, in which relevant specialists make all treatment decisions on each case through a consensus process. The most common overall outcome decision was surgical conduit implantation. In 51 cases, the patient had a pre-existing conduit and, of those, 16 cases were recommended for TPVR. In seven of those 16, TPVR could not be performed, most commonly due to the risk of coronary compression or unfavorable conduit anatomy. Conclusion: Among patients with congenital heart disease involving the RVOT, surgical conduit implantation was the main treatment both in native RVOT malformations and in the case of a pre-existing dysfunctional conduit, despite the introduction of TPVR. Although the hospital's multidisciplinary heart patient review board often recommended TPVR, it was found to be unfeasible in many cases. The main reasons were risk of coronary compression and unfavorable conduit anatomy.
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| 23. |
- Skoglund, Kristofer, 1976
(author)
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Reconstruction of the RVOT with a conduit: Lifetime follow up
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: The use of a conduit is an established surgical method for reconstruction of the right ventricular outflow tract in congenital heart disease. The most commonly used conduit is a homograft. Its limited durability makes reinterventions almost inevitable but the actual durability of a conduit in the adult population is poorly described. The introduction of transcatheter pulmonary valve replacement (TPVR) has expanded the possibilities for conduit reintervention but the impact of this new technique on clinical practice is unknown. Furthermore, little is known on the influence of reinterventions on quality of life. Conduit surgery and reintervention is among the most common surgical procedures in adult congenital heart disease but relative lack of knowledge complicates decision making. Method: Paper 1: The PubMed database was searched in May 2015 with the terms “homograft AND pulmonary valve,” generating 665 hits. Studies involving more than 50 patients with a mean or median age >18 years were included. Papers 2–4: The Swedish registry of congenital heart disease (SWEDCON) was used to collect data. Patients were identified by codes for classification of surgical procedures and a group variable specific for patients with a conduit. Results: Paper 1: Six studies with a cumulative total of 560 patients were found and included. Perioperative mortality was 0%–2.9%, and long-term mortality was 2%–8.8% at 8.1–10 years. Reinterventions of homografts were common during patients’ lifespans, with a 10-year event-free survival of 78%–80%. Early postoperative echocardiographic or magnetic resonance imaging defects appear to predict rapid homograft degeneration. Paper 2: Data on quality of life (EQ-5D) from the first and latest visit were collected from 103 patients with a mean age of 31 years. Mean time from first to latest visit was 3 years. Health perception (mean EQ-VAS) declined from 84.4 (SD=14.6) at the first visit to 78.6 (SD=18.3) at the latest visit (P=0.001). This decline was not observed in patients with reinterventions between visits (n=18). Low EQ-VAS was associated with symptoms and NYHA class II–IV. Problems in the EQ-5D dimension “usual activities” were more common in patients with reinterventions (25%) than in those without reinterventions (7%) (P=0.04). Paper 3: From 2000 to 2014, there was an increase in the number of adult patients with conduits from 122 to 536, including 60 surgical conduit replacements, 40 TPVRs, and 176 new conduit implantations. There was a significant increase in new implantations (P=0.007) and surgical conduit replacements (P=0.024) across all three time periods. Patients with new implantations were older (median age, 32 years) compared with those in the reoperation and TPVR groups (median age, 26 years), with the majority of patients having tetralogy of Fallot (57%). The majority of conduit reinterventions were surgical also after the introduction of TPVR in 2007, with no significant difference regarding diagnosis, gender, age, or previous number or longevity of conduits between surgical replacement and TPVR. Paper 4: A total of 574 patients with a conduit (mean age 36.1 years) were identified. Tetralogy of Fallot represented the largest group (45%). There were 769 operations and 50 TPVRs. Long-term survival after the first conduit operation (mean age 20.2 years) including perioperative mortality (<1%) was 93% at 20 years. The most common cause of death was cardiac-related. Higher age at first conduit operation was associated with an increased mortality risk. Event-free survival was 77% and 54% at 10 and 20 years, respectively. Ten-year event-free survival after the first conduit reintervention (n=176) was 70%, significantly lower than after the first conduit operation (P=0.04). Higher age at the first conduit operation had a protective association, whereas male gender and complex malformations were associated with an increased risk of further reintervention. Conclusion: Patients perceive a decline in their health over time after right ventricular outflow tract surgery. This decline was not observed in patients with further reinterventions. The number of patients with a conduit is increasing, and reinterventions for conduits are common. Since the introduction of TPVR, less than half of all patients with conduit failure are treated by this technique.Long-term mortality after conduit surgery and reinterventions is low, but the need for conduit reinterventions is substantial. Perioperative mortality is low in relation to cardiac-related death.
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| 24. |
- Skoglund, Kristofer, 1976, et al.
(author)
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RV to PA conduits: impact of transcatheter pulmonary valve replacement in adults - a national register study
- 2017
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In: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 51:3, s. 153-158
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Journal article (peer-reviewed)abstract
- Objective: The use of a conduit is an established surgical method for reconstruction of the right ventricular outflow tract in congenital heart disease; however, its limited durability makes reintervention almost inevitable. We studied the trends in new implantation, reoperation, and transcatheter pulmonary valve replacement (TPVR) from a Swedish national perspective. Design and results: The Swedish registry of congenital heart disease (SWEDCON) was used to collect data. From 2000-2014, there was an increase in adult patients with conduits from 122 to 536. There were 60 surgical conduit replacements, 40 TPVRs and 176 new conduit implantations in the study period. Perioperative mortality was < 1%. The yearly number of new implantations and reoperations both doubled over the study period. Patients with new implantations were older (mean age, 36 years) compared with the reoperation and TPVR groups (mean age, 26 years) with the majority of patients having tetralogy of Fallot. The majority of conduit reinterventions were surgical also after the introduction of TPVR in 2007, with no significant difference regarding diagnosis, gender, age, or previous number or longevity of conduits. Conclusion: The number of adults with conduits increased steadily with most conduit-related operations being new implantations in patients with tetralogy of Fallot. Surgical conduit replacements increased significantly and represented the majority of conduit reinterventions after the introduction of TPVR, indicating that TPVR is not used for the majority of patients with conduit failure. Diagnosis, gender, age, or previous number or longevity of conduits had no impact on choosing surgical replacement vs. TPVR.
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| 25. |
- Thuccani, Meena, et al.
(author)
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The association between signs of medical distress preceding in-hospital cardiac arrest and 30-day survival : A register-based cohort study
- 2022
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In: Resuscitation Plus. - : Elsevier. - 2666-5204. ; 11
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Journal article (peer-reviewed)abstract
- Background: Identifying signs of medical distress prior to in-hospital cardiac arrest (IHCA) is important to prevent IHCA and improve survival. The primary objective of this study was to investigate the association between signs of medical distress present within 60 minutes prior to cardiac arrest and survival after cardiac arrest.Methods: The register-based cohort study included adult patients (≥18 years) with IHCA in the Swedish Registry of Cardiopulmonary Resuscitation (SRCR) from 2017-01-01 to 2020-07-15. Signs of distress prior to IHCA were defined as the medical signs arrhythmia, pulmonary oedema, hypotension, hypoxia or seizures present within 60 minutes prior to cardiac arrest (pre-arrest signs). Using multivariable logistic regression, the association between these pre-arrest signs and 30-day survival was analysed in both unadjusted and adjusted models. The covariates used were demographics, comorbidities, characteristics and treatment of cardiac arrest.Results: In total, 8525 patients were included. After adjusting for covariates, patients with arrhythmia had a 58% higher probability of 30-day survival. The adjusted probability of 30-day survival was 41% and 52% lower for patients with hypotension and hypoxia prior to IHCA, respectively. Pulmonary oedema and seizures were not associated with any change in 30-day survival.Conclusions: Among signs of medical distress prior to in-hospital cardiac arrest, arrhythmia was associated with a higher 30-day survival. Hypotension and hypoxia were associated with lower survival after IHCA. These findings indicate that future research on survival after cardiac arrest should take pre-arrest signs into account as it impacts the prerequisites for survival.
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