| 1. |
- Lavesson, Niklas, et al.
(författare)
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Classifying the Severity of an Acute Coronary Syndrome by Mining Patient Data
- 2009
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Konferensbidrag (refereegranskat)abstract
- An Acute Coronary Syndrome (ACS) is a set of clinical signs and symptoms, interpreted as the result of cardiac ischemia, or abruptly decreased blood flow to the heart muscle. The subtypes of ACS include Unstable Angina (UA) and Myocardial Infarction (MI). Acute MI is the single most common cause of death for both men and women in the developed world. Several data mining studies have analyzed different types of patient data in order to generate models that are able to predict the severity of an ACS. Such models could be used as a basis for choosing an appropriate form of treatment. In most cases, the data is based on electrocardiograms (ECGs). In this preliminary study, we analyze a unique ACS database, featuring 28 variables, including: chronic conditions, risk factors, and laboratory results as well as classifications into MI and UA. We evaluate different types of feature selection and apply supervised learning algorithms to a subset of the data. The experimental results are promising, indicating that this type of data could indeed be used to generate accurate models for ACS severity prediction.
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| 2. |
- Odeberg, Jacob, et al.
(författare)
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The influence of smoking and impaired glucose homoeostasis on the outcome in patients presenting with an acute coronary syndrome : a cross-sectional study
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:7, s. e005077-
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Smoking, diabetes, male sex, hypercholesterolaemia and hypertension are well-established risk factors for the development of coronary artery disease (CAD). However, less is known about their role in influencing the outcome in the event of an acute coronary syndrome (ACS). The aim of this study was to determine if these risk factors are associated specifically with acute myocardial infarction (MI) or unstable angina (UA) in patients with suspected ACS. Design: Cross-sectional study. Setting: Patients admitted to the coronary care unit, via the emergency room, at a central county hospital over a 4-year period (1992-1996). Participants: From 5292 patients admitted to the coronary care unit, 908 patients aged 30-74 years were selected, who at discharge had received the diagnosis of either MI (527) or UA (381). A control group consisted of 948 patients aged 30-74 years in whom a diagnosis of ACS was excluded. Main outcome measures: MI or UA. Results: Current smoking (OR 2.42 (1.61 to 3.62)), impaired glucose homoeostasis defined as glycated haemoglobin >= 5.5% + blood glucose >= 7.5 mM (OR 1.78 (1.19 to 2.67)) and male sex (OR 1.71 (1.21 to 2.40)) were significant factors predisposing to MI over UA, in the event of an ACS. Compared with the non-ACS group, impaired glucose homoeostasis, male sex, cholesterol level and age were significantly associated with development of an ACS (MI and UA). Interestingly, smoking was significantly associated with MI (OR 2.00 (1.32 to 3.02)), but not UA. Conclusions: Smoking or impaired glucose homoeostasis is an acquired risk factor for a severe ACS outcome in patients with CAD. Importantly, smoking was not associated with UA, suggesting that it is not a risk factor for all clinical manifestations of CAD, but its influence is important mainly in the acute stages of ACS. Thus, on a diagnosis of CAD, the cessation of smoking and management of glucose homoeostasis are of upmost importance to avoid severe subsequent ACS consequences.
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| 3. |
- Kaszuba, Elzbieta, et al.
(författare)
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Comparing impedance cardiography and echocardiography in the assessment of reduced left ventricular systolic function
- 2013
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Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 6:114, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- Background An early and accurate diagnosis of chronic heart failure is a big challenge for a general practitioner. Assessment of left ventricular function is essential for the diagnosis of heart failure and the prognosis. A gold standard for identifying left ventricular function is echocardiography. Echocardiography requires input from specialized care and has a limited access in Swedish primary health care. Impedance cardiography (ICG) is a noninvasive and low-cost method of examination. The survey technique is simple and ICG measurement can be performed by a general practitioner. ICG has been suggested for assessment of left ventricular function in patients with heart failure. We aimed to study the association between hemodynamic parameters measured by ICG and the value of ejection fraction as a determinant of reduced left ventricular systolic function in echocardiography. Methods A non-interventional, observational study conducted in the outpatients heart failure unit. Thirty-six patients with the diagnosis of chronic heart failure were simultaneously examined by echocardiography and ICG. Distribution of categorical variables was presented as numbers. Distribution of continuous variables was presented as a mean and 95% Confidence Interval. Kruskal-Wallis test was used to compare variables and show differences between the groups. A p-value of <0.05 was considered significant. Results We found that three ICG parameters: pre-ejection fraction, left ventricular ejection time and systolic time ratio were significantly associated with ejection fraction measured by echocardiography. Conclusions The association which we found between EF and ICG parameters was not reported in previous studies. We found no association between EF and ICG parameters which were suggested previously as the determinants of reduced left ventricular systolic function. The knowledge concerning explanation of hemodynamic parameters measured by ICG that is available nowadays is not sufficient to adopt the method in practice and use it to describe left ventricular systolic dysfunction.
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| 4. |
- Kaszuba, Elzbieta, et al.
(författare)
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Heart failure and levels of other comorbidities in patients with chronic obstructive pulmonary disease in a Swedish population : A register-based study
- 2016
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Ingår i: BMC Research Notes. - : Springer Science and Business Media LLC. - 1756-0500. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite the fact that heart failure and chronic obstructive pulmonary disease (COPD) often exist together and have serious clinical and economic implications, they have mostly been studied separately. Our aim was to study prevalence of coexisting heart failure and COPD in a Swedish population. A further goal was to describe levels of other comorbidity and investigate where the patients received care: primary, secondary care or both. Methods: We conducted a register-based, cross-sectional study. The population included all people older than 19 years, living in Östergötland County in Sweden. The data were obtained from the Care Data Warehouse register from the year 2006. The diagnosis-based Adjusted Clinical Groups Case-Mix System 7.1 was used to describe the comorbidity level. Results: The prevalence of the diagnosis of heart failure in patients with COPD was 18.8 % while it was 1.6 % in patients without COPD. Age standardized prevalence was 9.9 and 1.5 %, respectively. Standardized relative risk for the diagnosis of heart failure in patients with COPD was 6.6. The levels of other comorbidity were significantly higher in patients with coexisting heart failure and COPD compared to patients with either heart failure or COPD alone. Primary care was the only care provider for 36.2 % of patients with the diagnosis of heart failure and 20.7 % of patients with coexisting diagnoses of heart failure and COPD. Primary care participated furthermore in shared care of 21.5 % of patients with the diagnosis of heart failure and 21.7 % of patients with coexisting diagnoses of heart failure and COPD. The share of care between primary and secondary care varied depending on levels of comorbidity both in patients with coexisting heart failure and COPD and patients with heart failure alone. Conclusion: Patients with coexisting diagnoses of heart failure and COPD are common in the Swedish population. Patients with coexisting heart failure and COPD have higher levels of other comorbidity than patients with heart failure or COPD alone. Primary care in Sweden participates to a great extent in care of patients with diagnoses of heart failure alone and coexisting heart failure and COPD.
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| 5. |
- Kaszuba, Elzbieta, et al.
(författare)
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Impact of heart failure and other comorbidities on mortality in patients with chronic obstructive pulmonary disease : A register-based, prospective cohort study
- 2018
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multimorbidity has already become common in primary care and will be a challenge in the future. Primary care in Sweden participates to a great extent in the care of patients with two severe, chronic conditions: chronic obstructive pulmonary disease (COPD) and heart failure. Both conditions are characterized by high mortality and often coexist. Age, sex, heart failure and other comorbidities are considered to be the major predictors of mortality in patients with COPD. We aimed to study the impact of heart failure, other comorbidities, age and sex on mortality in patients with COPD. Methods: A register-based, prospective cohort study conducted in Blekinge County in Sweden with about 150,000 inhabitants. The study population was comprised of people aged ≥35 years. The data about diagnoses of COPD and heart failure came from the 2007 health care register, in which we found 984 individuals with a diagnosis of COPD. Date of death was collected from January 1st, 2008 -August 31st, 2015. The diagnosis-based Adjusted Clinical Groups (ACG) Case-Mix System 7.1 was used to describe comorbidity. Each individual was assigned one of six comorbidity levels called resource utilization bands (RUB) graded from 0 to 5. Results: Estimated eight year mortality in patients with COPD and coexisting heart failure was seven times higher than in patients with COPD alone - odds ratio 7.06 (95% CI 3.88-12.84). Adjusting for age and male sex resulted in odds ratio 3.75 (95% CI 1.97-7.15). Further adjusting for other comorbidities resulted in odds ratio 3.26 (95% CI 1.70-6.25). The mortality was strongly associated with the highest comorbidity level - RUB 5 where the odds ratio was 5.19 (95% CI 2.59-10.38). Conclusion: Heart failure has an important impact on mortality in patients with COPD. The mortality in patients with COPD and coexisting heart failure was strongly associated with age, male sex and other comorbidities. Of those three predictors, only other comorbidities can be influenced. Heart failure and other comorbidities should be recognized early and properly treated in order to improve survival in patients with coexisting COPD and heart failure.
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| 6. |
- Kaszuba, Elzbieta, et al.
(författare)
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Using NT-proBNP to Detect Chronic Heart Failure in Elderly Patients with Chronic Obstructive Pulmonary Disease
- 2013
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Ingår i: ISRN Family Medicine. - : Hindawi Limited. - 2314-4769. ; 2013
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To detect chronic heart failure in elderly patients with a registered diagnosis of chronic obstructive pulmonary disease (COPD) treated in Swedish primary health care using natriuretic peptide NT-proBNP. Design. A cross-sectional study. Setting. Two primary health care centres in southeastern Sweden each with about 9000 listed patients. Subjects. Patients aged 65 years and older with a registered diagnosis of COPD. Main Outcome Measures. Percentage of patients with elevated NT-proBNP, percentage of patients with abnormal left ventricular function assessed by echocardiography, and association between elevated NT-proBNP and symptoms, signs, and electrocardiography. Results. Using NT-proBNP threshold of 1200 pg/mL, we could detect and confirm chronic heart failure in 5.6% of the study population with concurrent COPD. An elevated level of NT-proBNP was only associated with nocturia and abnormal electrocardiography. Conclusions. We found considerably fewer cases of heart failure in patients with COPD than could be expected from the results of previous studies. Our study shows the need for developing improved strategies to enhance the validity of a suspected heart failure diagnosis in patients with COPD.
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| 7. |
- Larsson, Hans, et al.
(författare)
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Studies on blood viscosity during the menstrual cycle and in the postmenopausal period in healthy women
- 1989
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 68, s. 483-486
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Blood viscosity was measured in 14 healthy, menstruating women, aged 17-51 years and in 10 healthy, postmenopausal women, aged 55-64 years. The fertile women were studied once a week during a normal menstrual cycle and the postmenopausal women twice with an interval of 2 weeks. Blood viscosity was measured at natural hematocrit as well as at hematocrit 45%. In the postmenopausal women no changes in blood viscosity were found. In the fertile women, blood viscosity at hematocrit 45% was lowest at the start of the menstrual bleeding and increased to a peak at day 7 (p < 0.01), with a similar pattern when measured at natural hematocrit. Plasma viscosity also had its lowest value at the onset of menstrual bleeding, increasing to a maximum at day 21. Changes in plasma triglycerides, but not in fibrinogen or cholesterol, seemed to contribute to this increase. Plasma factors only partly explained the variations in blood viscosity, and changes in red cell properties were also found to be of importance. The clinical significance of these rheological changes remains to be established, but at least theoretically there may be an increased risk for thromboembolism, e.g. at surgery, during days 5-15 of the cycle. In studies on blood flow and rheological conditions in fertile women, it seems advisable to standardize for time in the menstrual cycle.
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| 8. |
- Ovhed, Ingvar, et al.
(författare)
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Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women
- 1998
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 16:3, s. 165-170
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN: A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING: The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS: A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES: Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS: A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION: In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.
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| 9. |
- Persson, Sylvi Ulrika, et al.
(författare)
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How should blood rheology be measured in macroglobulinaemia?
- 1998
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - Norway. - 0036-5513 .- 1502-7686. ; 58, s. 669-676
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Blood and plasma viscosity were measured in 13 patients with monoclonal macroglobulinaemia. Blood viscosity was measured at natural hematocrit and after adjustment to 45%. Studies were performed at three different temperatures, +24oC, +32oC and +37oC. Plasma viscosity was measured in a rotational viscometer and in a capillary tube at the above-mentioned temperatures. Blood viscosity was to some extent related to the patients' symptoms, whereas a correlation between blood and plasma viscosity became less pronounced with decreasing shear rates, indicating that plasma viscosity is not a perfect indicator of blood viscosity in macroglobulinaemia. It was shown that red cell concentration, besides the concentration of monoclonal immunoglobulins (= paraproteins (PP)), is an important determinant of blood viscosity. The correlation between red cell concentration and viscosity became stronger with decreasing shear rate. Whole blood viscosity at low shear rates seems to be the best indicator of rheological symptoms in patients with macroglobulinaemia. It is concluded that blood rheology in patients with macroglobulinaernia is best studied at + 32°C to + 37°C in whole blood and at low shear rates. Key words: Blood viscosity; Hematocrit: Hyperviscosity syndrome; Hypervolemia; IgM; Immunoglobulins; Monoclonal; Plasma viscosity; Waldenström´s disease.
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| 10. |
- Persson, Sylvi Ulrika, et al.
(författare)
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Reduced number of cirkulating monocytes after institution of insulin therapy : Relevance for development of atherosclerosis in diabetics?
- 1998
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Ingår i: Angiology. - New York, USA : Westminster Publications Inc.. - 0003-3197 .- 1940-1574. ; 49:6, s. 423-433
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Twelve patients with Type I1 diabetes mellitus, insufficiently controlled with oral hypoglycaemic agents, were studied before, after 2 months, and after 4 months on insulin therapy. For comparison the same variables were also studied in 10 healthy subjects. From the start, in the diabetic group, the authors found alterations in the hemorheologic parameters indicated by increased values for whole blood viscosity, plasma viscosity, red cell transit time (RCTT), and decreased values for white cell initial relative filtration rate (IrFR). In hematologic parameters they found increased values for mean corpuscular volume (MCV), leukocyte count, counts of neutrophils and rnonocytes, and a decreased count of lymphocytes. They also found increased values in the lipid parameters P-triglycerides and Apo B/Apo A-I ratio, risk factors of coronary atherosclerosis. After 4 months of insu!in treatment whole blood and plasma viscosity were still increased. but there was a partial improvement of lipoprotein abnormalities. Red and white cell filterability, however, tended to normalize. These results indicate that changes in blood cell filterability do not necessarily influence in vitro measurements of blood viscosity. The change in RCTT during the insulin treatment was associated with a decreased MCV and the change in white cell IrFR with a decrease in the number of monocytes. This change of white cell filterability during insulin therapy, probably due to a reduced number of monocytes, may be of interest in the study of atherosclerosis and circulatory disease in diabetics.
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