| 1. |
- Berglin Blohm, Marianne, et al.
(författare)
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A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI.
- 1994
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Ingår i: The American journal of emergency medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 12:3, s. 315-8
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Tidskriftsartikel (refereegranskat)abstract
- To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its performance, whereas ambulance use was not affected.
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| 2. |
- Herlitz, Johan, 1949, et al.
(författare)
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Impact of early thrombolysis on chest pain score reflecting myocardial ischemia in relation to various markers of ischemic damage. TEAHAT Study Group.
- 1993
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Ingår i: International journal of cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 41:2, s. 123-31
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with pain suggestive of acute myocardial infarction who were seen less than 3 h after onset of symptoms to either tissue plasminogen activator or placebo. The impact of treatment on chest pain score was assessed during the first 24 h and related to limitation of final myocardial damage as assessed by various indirect markers. The most marked effect of tissue plasminogen activator was observed in the chest pain score being reduced by 43% in the tissue plasminogen activator group as compared with placebo. Limitation of infarct size with tissue plasminogen activator reached the following percentage values when various methods were used: maximum serum lactate dehydrogenase I activity, 32%; vectorcardiography (QRS vector difference), 20%; electrocardiography (Palmeri score), 20%; ejection fraction, 9%. We conclude that early thrombolysis in acute myocardial infarction reduces the severity of chest pain by nearly 50%. The effect on chest pain is much more marked as compared with the effect on various markers of the final ischemic damage.
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| 3. |
- Herlitz, Johan, 1949, et al.
(författare)
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Mortality and morbidity 1 year after early thrombolysis in suspected AMI: results from the TEAHAT Study.
- 1991
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Ingår i: Journal of internal medicine. Supplement. - : Journal of Internal Medicine. - 0955-7873. ; 734:suppl 1, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with suspected acute myocardial infarction (AMI) to treatment with rt-PA (n = 177) or placebo (n = 175). Patients were eligible if evaluated within 2 h and 45 min from onset of chest pain, and if aged less than 75 years. There were no ECG criteria for inclusion. A mobile coronary-care unit with a cardiologist present was used to initiate treatment at home in 29% of cases. During 1 year of follow-up the mortality in patients treated with rt-PA was 10.2%, as compared with 14.3% in patients the initial ECG, the mortality during the first year was 8% in the rt-PA group vs. 18% in the placebo group (P less than 0.05). Among patients without ST-elevation the mortality was 9% for the rt-PA group vs. 12% for the placebo group (NS). Requirement for rehospitalization, symptoms of angina pectoris and congestive heart failure, time of return to work and requirement for various medications did not differ significantly between the two groups, regardless of the initial ECG pattern.
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| 4. |
- Karlson, Björn, et al.
(författare)
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Influence of intensified insulin regimen on quality of life and metabolic control in insulin-dependent diabetes mellitus
- 1994
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 1872-8227 .- 0168-8227. ; 25:2, s. 111-115
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Tidskriftsartikel (refereegranskat)abstract
- Seventy-eight non-randomized patients with IDDM, aged 33.8 +/- 9.6 years (mean +/- S.D.), with a duration of diabetes of 16.6 +/- 9.5 years and a HbA1c level of 8.0% +/- 1.5 at baseline were included in the study. The effects of a change from a 3-dose insulin regimen using conventional syringes to a treatment mode using 4 injections per day with a pen injector on metabolic control, perceived distress from diabetes on everyday life and correspondence between expectations and experiences of treatment during a 1-year trial were assessed. The experience measures were registered at baseline and after 3 and 12 months, respectively. HbA1c levels were measured every 3 months. Neither the metabolic control nor the body mass index or rate of hypoglycemic episodes changed during the study period. However, the patients experienced a decreased distress from diabetes, which appeared during the first 3 months and remained unchanged thereafter. The expectations of advantages from the intensified insulin therapy were generally high and were mostly either fulfilled or exceeded by experiences. We conclude that multiple insulin injection therapy, under routine treatment conditions, is subjectively preferable to patients and has favourable effects on their quality of life although something more is required in order to also achieve an improvement of metabolic control.
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| 5. |
- Karlson, Björn W., 1953, et al.
(författare)
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Prognosis and symptoms one year after discharge from the emergency department in patients with acute chest pain.
- 1994
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Ingår i: Chest. - : American College of Chest Physicians. - 0012-3692 .- 1931-3543. ; 105:5, s. 1442-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A high proportion of patients admitted to a medical emergency department due to chest pain are directly sent home, since the initial suspicion of acute myocardial infarction (AMI) can be quickly ruled out. AIM: To describe the outcome of such patients during 1 year of follow-up in terms of mortality, development of AMI, and especially severity of symptoms 1 year after discharge. METHODS: All patients who during 21 months were admitted to the medical emergency department at Sahlgrenska Hospital, Göteborg, Sweden, due to chest pain, and who could be directly sent home, were prospectively followed up for 1 year. Their outcome was compared with patients who had chest pain and were hospitalized for AMI during the same time. RESULTS: Patients with chest pain directly sent home (n = 2,102) had a median age of 52 years (age range, 16 to 96 years), and 54 percent were men. The mortality during 1 year was 3 percent, and 3 percent developed AMI. As compared with patients with AMI, those who were directly sent home less frequently reported various cardiovascular symptoms, with the exception for chest pain at rest and palpitations. On the other hand, various emotional and psychosomatic symptoms were more frequently reported by patients who were directly sent home than by patients with AMI. CONCLUSION: Patients who came to a medical emergency department due to chest pain, and who were sent home, had a low risk of death and development of infarction during the following year. Survivors after 1 year do, however, more frequently report emotional and psychosomatic symptoms than survivors of AMI.
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| 6. |
- Karlson, Björn W., 1953, et al.
(författare)
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Prognosis, severity of symptoms, and aspects of well-being among patients in whom myocardial infarction was ruled out.
- 1994
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Ingår i: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 17:8, s. 427-31
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Tidskriftsartikel (refereegranskat)abstract
- In a high proportion of patients hospitalized due to suspected acute myocardial infarction (AMI) the diagnosis cannot be confirmed. The majority of these patients have ischemic heart disease and are at risk for subsequent cardiac events. The aim of this study was to describe the severity of symptoms and various aspects of well-being 1 year after hospitalization due to suspected AMI in surviving patients in whom the diagnosis was not confirmed, and to relate the observations to those found among survivors of a confirmed AMI. All patients admitted to Sahlgrenska Hospital, Göteborg, due to suspected AMI and who were alive after 1 year were asked to answer a questionnaire including questions regarding cardiovascular, psychiatric, and psychological symptoms. Patients in whom AMI was not confirmed reported more cardiovascular symptoms, for example, chest pain (p < 0.001), dyspnea (p < 0.01), palpitations (p < 0.001), and fatigue (p < 0.01) when compared with patients who suffered confirmed AMI. The majority of psychosomatic and psychological parameters evaluated were also more frequently reported by these patients and their quality of life seems to be worse compared with survivors of AMI.
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| 7. |
- Karlson, Björn W., 1953, et al.
(författare)
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The prognosis of patients suspected of having acute myocardial infarction subsequent to its exclusion as the diagnosis.
- 1990
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Ingår i: International journal of cardiology. - 0167-5273. ; 26:3, s. 251-7
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Tidskriftsartikel (refereegranskat)abstract
- This review of the literature concerns the prognosis of patients suspected of having myocardial infarction subsequent to its exclusion as the diagnosis. Several investigations show a surprisingly bad prognosis for patients in this category, almost comparable to that of patients with a confirmed infarction. When the results of the different studies are pooled, however, there is a significant difference between those patients with true infarction, and those in whom infarction was excluded, in terms of overall mortality (12% and 7%; P less than 0.0001) and the development of subsequent non-fatal infarction (11% and 6%; P less than 0.05) when the results are analysed for a period of follow-up of one year. The difference was significant even when both fatal and non-fatal infarctions were taken into account over the one-year period of follow-up (13% and 8%; P less than 0.0001). The analysis shows that electrocardiographic ST-T changes are a risk factor for coronary events, but the results are conflicting for other possible risk factors. The selection of patients varies between the different studies, which probably contributes to the different results reported. Prospective studies with well defined groups of patients large enough to permit analysis of subgroupings will be needed to resolve the outstanding questions.
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| 8. |
- Wiklund, Ingela, et al.
(författare)
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Subjective symptoms and well-being differ in women and men after myocardial infarction
- 1993
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 14:10, s. 1315-1319
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Tidskriftsartikel (refereegranskat)abstract
- The frequency of subjective cardiac and psychological complaints among men and women a year after a confirmed diagnosis of myocardial infarction (MI) were compared. Among 660 survivors, 595 patients completed mailed questionnaires at home one year after the MI. There were 421 men, mean age 67.1±10.7 years, and 174 women, mean age 72.1±10.6 years. Controlling for the significantly higher mean age among the women, the latter more often had a previous history of angina pectoris, 54.6% (P≤0.05) versus 42.9%, and heart failure, 24.7% versus 13.5% (P≤0.01). Despite these facts, the women were significantly less often referred to CCU, 82.2% versus 91.7% (P≤0.05). One year after the MI, controlling for differences in age and co-morbidity, women reported significantly higher frequencies of psychological and psychosomatic complaints, including sleep disturbances. These differences may have clinical implications for diagnosis and treatment of women with coronary heart disease.
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