| 1. |
- Hager, Jakob, 1967-
(författare)
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Abdominal Aortic Aneurysm : Aspects on how to affect mortality from rupture
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abdominal Aortic Aneurysm (AAA) is a disease that mainly affects elderly men, and ruptured AAA (rAAA) is associated with a mortality of > 80%. AAA seldom gives any symptoms prior to rupture.The aims of this thesis were to investigate different aspects of how to affect mortality from rAAA.In Study I, we identified 849 patients treated for rAAA during 1987-2004, and studied the 30-day survival after surgery, depending on whether they came directly to the treating hospital (one-stop) or were transferred via another hospital (two-stop). A two-stop referral pattern resulted in a 27% lower population-based survival rate for patients 65-74 years of age. However, the consequences would be small even if a one-stop referral pattern could be generally accomplished, due to the huge over-all mortality related to rAAA, hence an argument to find and treat AAA before rupture, e.g. by screening.In Study II, we examined the AAA-prevalence and the risk factors for AAA among 70-year-old men. The screening-detected AAA-prevalence was 2.3%, thus less than half the predicted. The most important risk factor was smoking.In Study III, we compared the screening-detected AAA-prevalence, the attendance rate, and the rate of opportunistic detection of AAA, between almost 8000 65- and 6000 70-year-old men. There was no difference in the screening-detected prevalence; probably due to the fact that almost 40% of the AAAs among the 70-year-old were already known prior to screening, compared to roughly 25% in the 65-year-old. The attendance rate was higher among the 65-year-old men, 85.7% compared 84.0% in the 70-year-old. Thus, there is no benefit of screening for AAA among 70- instead of 65-year-old men.In Study IV, a cost-effectiveness analysis, we found that screening for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management.In conclusion, we found that mortality from rAAA is not affected in any substantial way by different referral patterns and hence centralisation of services for AAA/rAAA is not a solution. A better alternative is to prevent rupture through early detection by screening. Screening 65-year-old men for AAA still appears to be cost-effective, despite profound changes in disease pattern and AAA-management during the last decade. Screening 70- instead of 65-year-old men will not increase the efficacy of screening.
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| 2. |
- Hager, Jakob, et al.
(författare)
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Changing Conditions - the same Conclusion : Cost-effective to Screen for Abdominal Aortic Aneurysm among 65-year-old Men, based on Data from an Implemented Screening Programme
- 2014
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Health economic analyses based on randomized trials have shown that screening for abdominal aortic aneurysm (AAA) cost-effectively decreases AAA-related as well as allcause mortality. However, results from running screening programmes now reveal substantially changed conditions in terms of prevalence, attendance rate, costs and mortality after intervention. Our aim was to evaluate whether screening for AAA among 65-year-old men on a general basis is cost-effective under current clinical practice.Methods: A decision-analytic model, previously used to show the cost-effectiveness of an AAA-screening programme before decision to introduce screening in practice, was updated using results from implemented screening-programmes as well as data from contemporary published data and the Swedvasc registry.Results: The base-case analysis showed that the cost per life-year gained and quality-adjusted life year (QALY) gained were 3252 € and 4231 €, respectively. The probability of screening being cost-effective was high.Conclusion: Despite profound changes in disease pattern and AAA-management, the current results are similar to those reported almost 10 years ago, and thus screening 65-year-old men for AAA still appears to be cost-effective.
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| 3. |
- Hager, Jakob, et al.
(författare)
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Lower Prevalence than Expected when Screening 70-year-old Men for Abdominal Aortic Aneurysm
- 2013
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Ingår i: European Journal of Vascular and Endovascular Surgery. - : Elsevier BV. - 1078-5884 .- 1532-2165. ; 46:4, s. 453-459
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundScreening 65-year-old men for abdominal aortic aneurysms (AAA) is a cost-effective method to reduce the mortality from ruptured AAA. However, contemporary results show a lower than expected prevalence of AAA, thus questioning the benefit of screening. Since the prevalence increases with age, a possible way to enhance the benefit of screening might be to screen older men. Our aim was to determine the contemporary screening-detected prevalence among 70-year-old men.MethodsA total of 5,623 unscreened 70-year-old men were invited to ultrasound screening. Uni- and multivariable analyses were used to assess the risk factors for AAA.ResultsThe attendance rate was 84.0%. The prevalence of previously unknown AAAs was 2.3%. When adding the 64 men with an already known AAA to the screening-detected ones, the total prevalence in the population was at least 3.0%, and the previously discovered AAAs constituted 37.4% of the total prevalence. “Ex smoker” and “Current smoker” were the most important risk factors.ConclusionsWhen screening 70-year-old men for AAA, the prevalence was less than half that expected, despite a high attendance rate. Smoking was the strongest risk factor. Almost 40% of the men with AAAs were already known from other means than screening.
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| 4. |
- Hager, Jakob, et al.
(författare)
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No benefit of screening for abdominal aortic aneurysm among 70- instead of 65-year-old men
- 2014
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Ingår i: International Angiology. - : EDIZIONI MINERVA MEDICA. - 0392-9590. ; 33:5, s. 474-479
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Screening 65-year-old men for abdominal aortic aneurysm (AAA) reduces mortality from ruptured AAA (rAAA). Lower than expected prevalence of AAA is now found, why screening at a higher age and rescreening has been discussed. Our aim was to determine if screening at 70 years of age, instead of 65, increases clinical effectiveness.Methods: 7951 and 5623 previously un-screened 65- and 70-year old men were invited to ultrasound screening.Results: The attendance rate was 85.7% and 84.0%, p<0.01, for the 65- and 70-year old men respectively. The screening-detected prevalence did not differ, being 1.9% and 2.3%, p=0.15, respectively, probably due to the fact that 23.5% and 37.4% of all known AAA among 65- and 70-year-old men, were detected by other means prior to screening, p<0.01. However, the total known prevalence differed between the age-groups, being at least 2.1% and 3.0% respectively, p<0.001.Conclusion: The screening-detected AAA-prevalence did not differ between 65- and 70-yearold men, due to the greater number of AAA known prior to screening among 70- compared to 65-year-old men. Screening men at 70 instead of 65 years of age would not result in detection of substantially more previously unknown AAA, thus not preventing rAAA and consequently not more saved life-years. Further, data also indicates that it is questionable if re-screening the 65-year-old male population after five years would generate any important clinical effect.
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| 5. |
- Hager, Jakob, 1967-, et al.
(författare)
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Population-based survival rate with a one- or two-stop referral pattern for patients with ruptured abdominal aortic aneurysms
- 2013
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Ingår i: International Journal of Angiology. - Turin, Italy : Edizioni Minerva Medica. - 0392-9590 .- 1827-1839. ; 32:5, s. 492-500
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Tidskriftsartikel (refereegranskat)abstract
- AIM:Is there a difference in the population-based survival rate for patients with ruptured abdominal aortic aneurysms (rAAA), handled by a "one-stop" or a "two-stop" referral pattern?METHODS:Ten regions in Sweden were identified where clear-cut "one-stop" or "two-stop" referral-patterns prevailed. From the Swedvasc Registry we identified 849 patients operated on for rAAA, 1987 to 2004, living in any of these ten regions, and related the number of survivors to the whole population served by each hospital.RESULTS:The population-based survival rate was 14% lower for patients following a "two-stop" compared to a "one-stop" referral pattern (P=0.084). For the group 65-74 years-of-age the difference was significant (P=0.021), but no corresponding effect was seen regarding operative mortality rate or sex.CONCLUSION:Compared to a "one-stop" referral pattern for rAAA, a "two-stop" referral pattern results in a lower population-based survival rate for patients 65-74 years old, but the consequences would be small even if a "one-stop" referral pattern could be generally accomplished.
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| 6. |
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KTHA #1
- 2010
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Samlingsverk (redaktörskap) (populärvet., debatt m.m.)abstract
- Innehåll|Contents"Gunnar Henriksson: Mannen bakom allt", Ola Andersson, Hans Loord"Nittonhundraåttiofem" Ola Andersson"Landscape as a Body (To Dress)", Katja Grillner"Nya Slussen", Daniel Johansson, Johanna Håkansdotter- Karlsson, Tor Lindstrand, Martin Losos, Victor Mickelsson, Sara Vall, Ann-Charlotte Wiklander, Frida Öhlin"Patchwork: Albano Sustainable Campus", Stephan Bartel, Johan Colding, Hanna Erixon, Henrik Ernstson, Sara Grahn, Matts Ingman, Carl Kärsten, Lars Marcus, Jonas Torsvall"Multireligiös begravningsplats på Järva friområde", Henrik Vogt"Bridging the Gap", Alexis Pontvik"Tullinge Idea Store: Plats, struktur, program" Jesús Azpeitia"Treasures from the Archive: Der Städtebau nach seinen künstlerischen Grundsätzen, Camillo Sitte", Anders Bergström"Reading Architecture and Beauty: Conversations with Architects about a Troubled Relationship, Yael Reisner with Fleur Watson", Frida Rosenberg"Leon Battista Alberti, Identical Copies, and the Early Modern Invention of Architectural Design", Mario Carpo"Three Concepts of Performative Design: Proturbance, Porosity, Venation", Marcelyn Gow, Ulrika Karlsson, Daniel Norell
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| 7. |
- Lundgren, Jakob, et al.
(författare)
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Pathophysiology and Potential Treatments of Pulmonary Hypertension due to Systolic Left Heart Failure.
- 2014
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Ingår i: Acta Physiologica. - : Wiley. - 1748-1716 .- 1748-1708. ; 211:2, s. 314-333
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Forskningsöversikt (refereegranskat)abstract
- Pulmonary hypertension (PH) due to left heart failure is becoming increasingly prevalent, and is associated with poor outcome. The precise pathophysiological mechanisms behind PH due to left heart failure are, however, still unclear. In its early course, PH is caused by elevated left ventricular filling pressures, without pulmonary vessel abnormalities. Conventional treatment for heart failure may partly reverse such passive PH by optimizing left ventricular function. However, if elevated pulmonary pressures persists, endothelial damage, excessive vasoconstriction and structural changes in the pulmonary vasculature may occur. There is, at present, no recommended medical treatment for this active component of PH due to left heart failure. However, as the vascular changes in PH due to left heart failure may be similar to those in pulmonary arterial hypertension (PAH), a selected group of these patients may benefit from PAH treatment targeting the endothelin, nitric oxide or prostacyclin pathways. Such potent pulmonary vasodilators could, however, be detrimental in patients with left heart failure without pulmonary vascular pathology, as selective pulmonary vasodilatation may lead to further congestion in the pulmonary circuit, resulting in pulmonary oedema. The use of PAH therapies is therefore, currently not recommended, and would require the selection of suitable patients based on the underlying causes of the disease, and careful monitoring of their progress. The present review focuses on: i. the pathophysiology behind PH resulting from systolic left heart failure and: ii. the current evidence for medical treatment of this condition, especially the role of PAH-targeted therapies in systolic left heart failure. This article is protected by copyright. All rights reserved.
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| 8. |
- Lundgren, Jakob, et al.
(författare)
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Preoperative pulmonary hypertension and its impact on survival after heart transplantation.
- 2014
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1651-2006 .- 1401-7431. ; 48:1, s. 47-58
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objectives. Pulmonary hypertension (PH) due to left heart disease may impair outcome after heart transplantation (HT). To evaluate to what extent previous, and present, haemodynamic criteria discriminate the impact of pre-operative-PH on survival, we characterized the PH in our HT-patients according to ESC's guidelines, ISHLT's summary statement and ISHLT's relative contraindications and criteria for early risk of death after HT. Design. Records from the 215 HT-patients in Lund during 1988-2010 were reviewed. Subsequent analysis included adults (n = 94) evaluated with right-heart-catheterization at our lab, at rest before HT. End of follow-up was 30th of June 2012. Results. Survival (mean, n) did not differ (p = ns) for the 94 HT-patients; without (13.0 years, n = 28) or with (13.9 years, n = 66) PH, passive (13.8 years, n = 50) or reactive (12.2 years, n = 13) post-capillary-PH, "modified" passive (13.1 years, n = 40), mixed (16.6 years, n = 23), "modified" reactive (12.6 years, n = 7) or non-reactive (12.2 years, n = 8) post-capillary-PH; or for ISHLT's relative contraindications (12.0 years, n = 22) or increased risk of right-heart-failure and early death (16.5 years, n = 23) after HT. Conclusions. As previous and present haemodynamic criteria did not sufficiently discriminate the impact of pre-operative-PH for survival after HT at our centre, larger multi-centre studies are encouraged to redefine criteria that may influence outcome.
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| 9. |
- Petersen, Jakob, et al.
(författare)
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Improvement in social function and health-related quality of life after shunt surgery for idiopathic normal-pressure hydrocephalus
- 2014
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Ingår i: Journal of Neurosurgery. - : Journal of Neurosurgery Publishing Group (JNSPG). - 0022-3085 .- 1933-0693. ; 121:4, s. 776-784
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Tidskriftsartikel (refereegranskat)abstract
- Object. To investigate the impact of shunt surgery on the activity, participation, autonomy, and health-related quality of life (HRQOL) of patients with idiopathic normal-pressure hydrocephalus (iNPH) as well as the effect on caregiver burden. Methods. Thirty-seven patients (median age 70 years, range 50-89 years) with iNPH were evaluated before and 6 months after surgery. Symptoms and signs were assessed by the iNPH scale, activities of daily living (ADL) with the Functional Independence Measure (FIM) and Assessment of Motor and Process Skills (AMPS), autonomy and participation with Impact on Participation and Autonomy (IPA), and caregiver burden with the Caregiver Burden Scale (CBS). HRQOL was evaluated with the EQ-5D (EuroQol Group-5 Dimension health survey). Results. Twenty-four patients (65%) improved clinically (iNPH scale score) and 31(86%) improved their HRQOL after surgery, almost to the same level as found in the normal population. The patients became more independent in physical and cognitive activities, and participation and autonomy improved. The caregiver burden was decreased among caregivers to male patients but remained unchanged on the overall group level. Conclusions. After shunt surgery, patients with iNPH showed improvement in most aspects of social life, they became more independent, and their quality of life returned to nearly normal.
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