| 1. |
- Axelsson, C, et al.
(författare)
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Mechanical active compression-decompression cardiopulmonary resuscitation (ACD-CPR) versus manual CPR according to pressure of end tidal carbon dioxide (P(ET)CO2) during CPR in out-of-hospital cardiac arrest (OHCA).
- 2009
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Ingår i: Resuscitation. - : Elsevier BV. - 1873-1570 .- 0300-9572. ; 80:10, s. 1099-103
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Tidskriftsartikel (refereegranskat)abstract
- AIM: In animal and human studies, measuring the pressure of end tidal carbon dioxide (P(ET)CO2) has been shown to be a practical non-invasive method that correlates well with the pulmonary blood flow and cardiac output (CO) generated during cardiopulmonary resuscitation (CPR). This study aims to compare mechanical active compression-decompression (ACD) CPR with standard CPR according to P(ET)CO2 among patients with out-of-hospital cardiac arrest (OHCA), during CPR and with standardised ventilation. METHODS: This prospective, on a cluster level, pseudo-randomised pilot trial took place in the Municipality of Göteborg. During a 2-year period, all patients aged >18 years suffering an out-of-hospital cardiac arrest (OHCA) of presumed cardiac etiology were enrolled. The present analysis included only tracheally intubated patients in whom P(ET)CO2 was measured for 15 min or until the detection of a pulse-giving rhythm. RESULTS: In all, 126 patients participated in the evaluation, 64 patients in the mechanical chest compression group and 62 patients in the control group. The group receiving mechanical ACD-CPR obtained the significantly highest P(ET)CO2 values according to the average (p=0.04), initial (p=0.01) and minimum (p=0.01) values. We found no significant difference according to the maximum value between groups. CONCLUSION: In this hypothesis generating study mechanical ACD-CPR compared with manual CPR generated the highest initial, minimum and average value of P(ET)CO2. Whether these data can be repeated and furthermore be associated with an improved outcome after OHCA need to be confirmed in a large prospective randomised trial.
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| 2. |
- Bengtson, Ann, 1947, et al.
(författare)
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On the waiting list for possible coronary revascularisation. Symptoms relief during the first year and association between quality of life and the very long-term mortality risk
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 123:3, s. 271-6
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe: a/ the improvement in quality of life (QoL) among patients on the waiting list for coronary revascularisation and b/ the association between QoL and very long-term mortality. PATIENTS: All patients on the waiting list for possible coronary revascularisation in western Sweden during one week in September 1990. METHODS: QoL was assessed at the start of the survey and one year later among patients who both were and were not revascularised. Survival data were gathered for the subsequent 14 years. RESULTS: From the start, 883 patients were evaluated in the survey. Among patients who were revascularised, an improvement was seen in all the aspects of QoL that were studied during the first year as compared with patients who were not revascularised, in whom only minor changes in QoL were seen during the first year. After one year, there were seven aspects of QoL which were significantly associated with the risk of death during the subsequent 14 years, when adjusting for age, sex, previous history and extent of coronary artery disease. They were: tiredness (OR=1.4), weakness (OR=1.5), lack of energy (OR=1.5), inability to react (OR=1.7), use of sedatives (OR=3.2), dyspnea when dressing (OR=2.1) and chest pain when dressing (OR=1.9). CONCLUSION: Among patients on the waiting list for possible coronary revascularisation, there was a marked improvement in QoL among those who were revascularised. In a variety of aspects of QoL, an association with the very long-term risk of death was observed.
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| 3. |
- Bång, Angela, et al.
(författare)
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Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction.
- 2008
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 129:3, s. 325-332
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe the short-and long-term outcome among patients with an ST-elevation myocardial infarction (STEMI), assessed and treated by the emergency medical services (EMS) in relation to whether they were fast tracked to a coronary care unit (CCU) or admitted via the emergency department (ED). METHODS: Consecutive patients admitted to the CCU at Sahlgrenska University Hospital with ST elevations on admission ECG were analysed with respect to whether they by the EMS were fast tracked to the CCU or the adjacent coronary angiography laboratory (direct CCU group; n=261) or admitted via the ED (ED group; n=235). RESULTS: Whereas the two groups were similar with regard to age and previous history, those who were fast tracked to CCU were more frequently than the ED patients diagnosed and treated as STEMI already prior to hospital admission. Reperfusion therapy was more commonly applied in the CCU group compared with the ED group (90% vs 67%; <0.0001). The delay times (median) were shorter in the direct CCU group than in the ED group, with a difference of 10 min from the onset of symptoms to arrival in hospital and 25 min from hospital arrival to the start of reperfusion treatment (primary PCI or in-hospital fibrinolysis). Patients in the direct CCU group had lower 30-day mortality (7.3% vs. 15.3%; p=0.004), as well as late mortality (>30 days to five years) (11.6% vs. 20.6%; p=0.008). CONCLUSION: Among patients transported with ambulance due to STEMI there was a significant association between early recognition and treatment followed by fast tracking to the CCU and long term survival. A higher rate of and a more rapid revascularisation were probably of significant importance for the outcome.
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| 4. |
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| 5. |
- Gottfridsson, Christer, 1958, et al.
(författare)
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Sex difference and factors associated with outcome in patients with sustained ventricular arrhythmias.
- 2008
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Ingår i: Scandinavian cardiovascular journal : SCJ. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 42:3, s. 182-91
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe gender differences and factors of importance for outcome in patients referred for sustained ventricular arrhythmias. RESULTS: Two hundred and fifty three patients took part in the survey, 126 (20 women) had sustained monomorphic ventricular tachycardia (VT) and 127 (31 women) had polymorphic VT/ventricular fibrillation. Ischemic heart disease was less common in women than in men (47 vs. 80%). At discharge, an ICD implant was similarly common in women (33%) and men (29%). One hundred and twenty five (65%) men and 37 (79%) women were alive at follow-up, p =0.08 (median follow-up 53 months). Independent predictors of long-term mortality were: 1) PVT/VF as the presenting arrhythmia, 2) a low ejection fraction, 3) increased QRS duration and 4) diabetes mellitus. CONCLUSION: The lower proportion of women compared to men being referred for evaluation of sustained ventricular arrhythmias may contribute to the lower number of ICD implants in women. The long-term survival in women and men did not differ significantly.
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| 6. |
- Hartford, Marianne, 1944, et al.
(författare)
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C-reactive protein, interleukin-6, secretory phospholipase A(2) group IIA and intercellular adhesion molecule-1 in the prediction of late outcome events after acute coronary syndromes
- 2007
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Ingår i: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 262:5, s. 526-536
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Tidskriftsartikel (refereegranskat)abstract
- Objective. We investigated whether levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A(2) group IIA (sPLA(2)-IIA) and intercellular adhesion molecule-1 (ICAM-I) predict late outcomes in patients with acute coronary syndromes (ACS). Design. Prospective longitudinal study. CRP (mg L(-1)), IL-6 (pg mL(-1)), sPLA(2)-IIA (ng mL(-1)) and ICAM-1 (ng mL(-1)) were measured at days 1 (n = 757) and 4 (n = 533) after hospital admission for ACS. Their relations to mortality and rehospitalization for myocardial infarction (MI) and congestive heart failure (CHF) were determined. Setting. Coronary Care Unit at Sahlgrenska University Hospital, Gothenburg, Sweden. Subjects. Patients with ACS alive at day 30; median follow-up 75 months. Results. Survival was related to day 1 levels of all markers. After adjustment for confounders, CRP, IL-6 and ICAM-1, but not sPLA(2)-IIA, independently predicted mortality and rehospitalization for CHF. For CRP, the hazard ratio (HR) was 1.3 for mortality (95% confidence interval (CI): 1.1-1.5, P = 0.003) and 1.4 for CHF (95% CI: 1.1-1.9, P = 0.006). For IL-6, HR was 1.3 for mortality (95% CI: 1.1-1.6, P < 0.001) and 1.4 for CHF (95% CI: 1.1-1.8, P = 0.02). For ICAM-1, HR was 1.2 for mortality (95% CI: 1.0-1.4, P = 0.04) and 1.3 for CHF (95% CI: 1.0-1.7, P = 0.03). No marker predicted MI. Marker levels on day 4 provided no additional predictive value. Conclusions. In patients with ACS, CRP, IL-6, sPLA(2)-IIA and ICAM-1 are associated with long-term mortality and CHF, but not reinfarction. CRP, IL-6 and ICAM-1 provide prognostic information beyond that obtained by clinical variables.
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| 7. |
- Hartford, Marianne, 1944, et al.
(författare)
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CRP, interleukin-6, secretory phospholipase A(2) group IIA, and intercellular adhesion molecule-1 during the early phase of acute coronary syndromes and long-term follow-up
- 2006
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Ingår i: Int J Cardiol. - : Elsevier Ireland Ltd. ; 108:1, s. 55-62
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The objectives of this study were to examine the time course of the inflammatory response in acute coronary syndromes (ACS) and to assess the markers of inflammation and their relation to disease severity. METHODS: We prospectively studied 134 patients with ACS who survived for at least 30 months. The patients were divided into four groups: acute myocardial infarction (MI) with (n=54) or without (n=46) ST-segment elevation and unstable angina with (n=14) or without (n=20) increased risk. Plasma levels of C-reactive protein (CRP), interleukin-6 (IL-6), secretory phospholipase A(2) group IIA (sPLA(2)-IIA), and intercellular adhesion molecule-1 (ICAM-1) were measured on days 1 and 4 and after 3 and 30 months. RESULTS: The highest levels of CRP and sPLA(2)-IIA were seen on day 4 but for IL-6 on day 1. These three markers, but not ICAM-1, were significantly related to disease severity, CKMB, and ejection fraction. Patients in Killip class II-IV had higher levels than those in Killip class I. The individual acute-phase responses correlated with marker levels at 3 and 30 months. ICAM-1 correlated with the development of congestive heart failure. CONCLUSIONS: In ACS there seems to be an individual predisposition to inflammatory response. Plasma IL-6 is the first marker to rise, while sPLA(2)-IIA and CRP peak later. All three markers, especially CRP, may discriminate between MI and non-MI. ICAM-1 seems to reflect other aspects of the inflammatory processes than the other markers. The results emphasize the complexity of the inflammatory response in ACS and stress the need for further studies involving multiple markers.
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| 8. |
- Herlitz, Johan, 1949, et al.
(författare)
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Characteristics and outcome of patients with acute chest pain in relation to the use of ambulances in an urban and a rural area
- 2006
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Ingår i: Am J Emerg Med. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 24:7, s. 775-81
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of the study was to evaluate the rate of ambulance use and the long-term prognosis in acute chest pain in an urban and a rural area and whether there is a difference between an urban and a rural area. PROCEDURES: Patients with acute chest pain consecutively admitted to Sahlgrenska University Hospital (a city hospital) and Uddevalla County Hospital between November 1996 and April 1997 were followed up prospectively for 5 years. RESULTS: In the city hospital, 688 (36%) of 1907 patients were transported by ambulance as compared with 369 (44%) of 842 patients in the county hospital. The patients transported by ambulance were much older (mean, 71 vs 59 years in both areas), and the comorbidity was more severe among patients transported by ambulance in both areas. In the city hospital, the 5-year mortality was 41.8% among those transported by ambulance and 15.8% among those transported by other means (P < .0001). The corresponding figures for the county hospital were 38.7% and 11.0% with a P value of less than .0001. CONCLUSIONS: During the 1990s, patients with acute chest pain who were transported to a hospital by ambulance differed markedly in characteristics and outcome when compared with patients transported by other means. Results did not differ with regard to area.
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| 9. |
- Herlitz, Johan, 1949, et al.
(författare)
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Determinants for an impaired quality of life 10 years after coronary artery bypass surgery
- 2005
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Ingår i: Int J Cardiol. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 98:3, s. 447-52
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify determinants of an inferior quality of life (QoL) 10 years after coronary artery bypass grafting (CABG). SETTING: Sahlgrenska University Hospital, Goteborg, Sweden. PARTICIPANTS: All patients from Western Sweden who underwent CABG between 1988 and 1991 without simultaneous valve surgery and no previous CABG. MAIN OUTCOME MEASURES: Questionnaires for evaluating QoL 10 years after the operation. Three different instruments were used: The Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the Physical Activity Score (PAS). RESULTS: 2000 patients underwent CABG, of whom 633 died during 10 years of follow-up. Information on QoL at 10 years was available in 976 patients (71% of survivors). A history of diabetes and chronic obstructive pulmonary disease were the two independent predictors for an inferior QoL with all three instruments. Furthermore, there were three predictors of an inferior QoL with two of the instruments: high age, female sex and a history of hypertension. A number of factors predicted an inferior QoL with one of the instruments. These were the duration of angina pectoris and functional class prior to CABG, renal dysfunction, a history of cerebrovascular disease, obesity, height, duration of respirator treatment and requirement of inotropic drugs postoperatively. In addition, when introducing preoperative QoL into the model a low QoL before surgery was a strong independent predictor also of an inferior QoL 10 years after CABG. CONCLUSION: Variables independently predictive of an impaired QoL 10 years after CABG, irrespective of the instrument used, were an impaired QoL prior to surgery, chronic obstructive pulmonary disease and a history of diabetes. However, other factors reflecting gender, the previous history as well as postoperative complications were also associated with the QoL 10 years later in at least one of these instruments.
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| 10. |
- Herlitz, Johan, 1949, et al.
(författare)
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Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions
- 2008
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 1874-1754 .- 0167-5273. ; 128:3, s. 342-349
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To describe the characteristics and outcome of patients with acute myocardial infarction (AMI) in a community, with particular emphasis on those who never reached a Coronary Care Unit (CCU) and those in whom the primary diagnosis was something other than a heart attack. METHODS: Patients hospitalised in the city of Goteborg, Sweden, and discharged (dead or alive) with a diagnosis of AMI. RESULTS: Among 1423 patient admissions the mean overall age was 75 years (81 years and 79 years in the two subsets). Among all patients, 33% had a history of heart failure and 20% had a history of cerebrovascular disease. The figures were even higher in the two subsets which were evaluated. In overall terms, an invasive strategy (coronary angiography) was used in 32% (in 5% and 9% in the two subsets respectively). The overall one-year and three-year mortality rate was 30% and 44% respectively. The three-year mortality rate among patients not admitted to a CCU was 65% and, among patients with no suspicion of a heart attack on admission, it was 68%. CONCLUSION: Even in the 21st century, patients with AMI who reach hospital alive run a high risk of death and nearly half are dead within the first three years. In overall terms, patients are characterised by high age and high co-morbidity. Among patients who do not reach a CCU and among patients with no suspicion of AMI on admission, approximately two thirds are dead within the subsequent three years.
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