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- Fors, Andreas, 1977, et al.
(author)
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Effectiveness of person-centred care after acute coronary syndrome in relation to educational level: Subgroup analysis of a two-armed randomised controlled trial
- 2016
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In: International journal of cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 221, s. 957-962
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Journal article (peer-reviewed)abstract
- AIM: The aim of this study was to evaluate the effects of person-centred care (PCC) after acute coronary syndrome (ACS) in relation to educational level of participants. METHOD: 199 Patients <75years with ACS were randomised to PCC plus usual care or usual care alone and followed for 6months from hospital to outpatient care and primary care. For the PCC group, patients and health care professionals co-created a PCC health plan reflecting both perspectives, which induced a continued collaboration in person-centred teams at each health care level. A composite score of changes that included general self-efficacy assessment, return to work or previous activity level, re-hospitalisation or death was used as outcome measure. RESULTS: In the group of patients without postsecondary education (n=90) the composite score showed a significant improvement in favour of the PCC intervention (n=40) vs. usual care (n=50) at six months (35.0%, n=14 vs. 16.0%, n=8; odds ratio (OR)=2.8, 95% confidence interval (CI): 1.0-7.7, P=0.041). In patients with postsecondary education (n=109), a non-significant difference in favour of the PCC intervention (n=54) vs. usual care (n=55) was observed in the composite score (13.0%, n=7 vs 3.6%, n=2; OR=3.9, 95% CI: 0.8-19.9, P=0.097). CONCLUSION: A PCC approach, which stresses the necessity of a patient-health care professional partnership, is beneficial in patients with low education after an ACS event. Because these patients have been identified as a vulnerable group in cardiac rehabilitation, we suggest that PCC can be integrated into conventional cardiac rehabilitation programmes to improve both equity in uptake and health outcomes. TRIAL REGISTRATION: Swedish registry, Researchweb.org, ID NR 65 791.
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| 2. |
- Fors, Andreas, 1977, et al.
(author)
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Effects of person-centred care after an event of acute coronary syndrome: Two-year follow-up of a randomised controlled trial
- 2017
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 249, s. 42-47
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Journal article (peer-reviewed)abstract
- © 2017 The Authors. Aim: To assess the long-term effect of person-centred care (PCC) in patients with acute coronary syndrome (ACS). Method: Patients with ACS were randomly assigned to treatment as usual (control group) or an added PCC intervention for six months. The primary endpoint was a composite score of changes in general self-efficacy. ≥. five units, return to work or to a prior activity level and re-hospitalisation or death. Results: The composite score improved in the PCC intervention group (n = 94) at a two-year follow-up compared with the control group (n = 105) (18.1%, n = 17 vs. 10.5%, n = 11; P = 0.127). In the per-protocol analysis (n = 183) the improvement was significant in favour of the PCC intervention (n = 78) compared with usual care (n = 105) (21.8%, n = 17 vs. 10.5%, n = 11; P = 0.039). This effect was driven by the finding that more patients in the PCC group improved their general self-efficacy score. ≥. 5. units (32.2%, n = 19 vs. 17.3%, n = 14; P = 0.046). The composite score improvement was significantly higher in the PCC intervention group without post-secondary education (n = 33) in comparison with corresponding patients in the control group (n = 50) (30.3%, n = 10 vs. 10.0%, n = 5; P = 0.024). Conclusion: Implementation of PCC results in sustained improvements in health outcome in patients with ACS. PCC can be incorporated into conventional cardiac prevention programmes to improve equity in uptake and patient health outcomes. Trial registration: Swedish registry, Researchweb.org, ID NR 65791.
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| 3. |
- Mentz, R. J., et al.
(author)
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The past, present and future of renin-angiotensin aldosterone system inhibition
- 2013
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In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 167:5, s. 1677-1687
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Research review (peer-reviewed)abstract
- The renin-angiotensin aldosterone system (RAAS) is central to the pathogenesis of cardiovascular disease. RAAS inhibition can reduce blood pressure, prevent target organ damage in hypertension and diabetes, and improve outcomes in patients with heart failure and/or myocardial infarction. This review presents the history of RAAS inhibition including a summary of key heart failure, myocardial infarction, hypertension and atrial fibrillation trials. Recent developments in RAAS inhibition are discussed including implementation and optimization of current drug therapies. Finally, ongoing clinical trials, opportunities for future trials and issues related to the barriers and approvability of novel RAAS inhibitors are highlighted.
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| 4. |
- Olsson, Lars G., 1970, et al.
(author)
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Trends in stroke incidence after hospitalization for atrial fibrillation in Sweden 1987 to 2006
- 2013
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In: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 167:3, s. 733-738
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Journal article (peer-reviewed)abstract
- BACKGROUND: To investigate recent trends in incidence of hemorrhagic and non-hemorrhagic strokes in patients with atrial fibrillation (AF). METHODS: The Swedish Hospital Discharge and Cause of Death Registries were linked to provide outcome data. RESULTS: 321,276 patients 35 to 84years (56.5% male, mean age 71.5years) free of prior stroke with a first AF diagnosis during 1987-2006 were included. Over 3year follow-up 24,733 patients (7.7%) were diagnosed with ischemic stroke and 2292 (0.7%) with hemorrhagic stroke. The 3-year incidence of ischemic stroke decreased from 8.7% for patients diagnosed in 1987-1991 to 6.6% for those diagnosed in 2002 to 2006. The corresponding incidence of hemorrhagic stroke increased from 0.38% for patients diagnosed in 1987-1991 to 0.57% for those diagnosed in 2002 to 2006. Covariable-adjusted risk of ischemic stroke was significantly reduced (HR 0.65; 0.63-0.68) while risk of hemorrhagic stroke was significantly increased (HR 1.19; 1.05-1.36). Compared to the general population, total stroke risk decreased more among AF patients. CONCLUSION: We found a considerable decrease in risk of ischemic stroke in Sweden in patients without prior stroke and with a first hospital diagnosis of AF. There was an increased risk of hemorrhagic stroke, but because hemorrhagic stroke represented only a small proportion of all strokes, the overall risk of stroke declined.
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| 7. |
- Ford, I., et al.
(author)
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Top ten risk factors for morbidity and mortality in patients with chronic systolic heart failure and elevated heart rate: The SHIFT Risk Model
- 2015
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 184, s. 163-169
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Journal article (peer-reviewed)abstract
- Aims: We identified easily obtained baseline characteristics associated with outcomes in patients with chronic heart failure (HF) and elevated heart rate (HR) receiving contemporary guideline-recommended therapy in the SHIFT trial, and used them to develop a prognostic model. Methods: We selected the 10 best predictors for each of four outcomes (cardiovascular death or HF hospitalisation; all-cause mortality; cardiovascular mortality; and HF hospitalisation). All variables with p < 0.05 for association were entered into a forward stepwise Cox regression model. Our initial analysis excluded baseline therapies, though randomisation to ivabradine or placebo was forced into the model for the composite endpoint and HF hospitalisation. Results: Increased resting HR, low ejection fraction, raised creatinine, New York Heart Association class III/IV, longer duration of HF, history of left bundle branch block, low systolic blood pressure and, for three models, age were strong predictors of all outcomes. Additional predictors were low bodymass index, male gender, ischaemic HF, low total cholesterol, no history of hyperlipidaemia or dyslipidaemia and presence of atrial fibrillation/flutter. The c-statistics for the four outcomes ranged from 67.6% to 69.5%. There was no evidence for lack of fit of the models with the exception of all-cause mortality (p = 0.017). Similar results were found including baseline therapies. Conclusion: The SHIFT Risk Model includes simple, readily obtainable clinical characteristics to produce important prognostic information in patients with chronic HF, systolic dysfunction, and elevated HR. This may help better calibrate management to individual patient risk. (C) 2015 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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| 8. |
- Fors, Andreas, 1977, et al.
(author)
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Person-centred care after acute coronary syndrome, from hospital to primary care - A randomised controlled trial
- 2015
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 187, s. 693-699
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Journal article (peer-reviewed)abstract
- AIM: To evaluate if person-centred care can improve self-efficacy and facilitate return to work or prior activity level in patients after an event of acute coronary syndrome. METHOD: 199 patients with acute coronary syndrome <75years were randomly assigned to person-centred care intervention or treatment as usual and followed for 6months. In the intervention group a person-centred care process was added to treatment as usual, emphasising the patient as a partner in care. Care was co-created in collaboration between patients, physicians, registered nurses and other health care professionals and documented in a health plan. A team-based partnership across three health care levels included transparent knowledge about the disease and medical state to achieve agreed goals during recovery. Main outcome measure was a composite score of changes in general self-efficacy >/=5units, return to work or prior activity level and re-hospitalisation or death. RESULTS: The composite score showed that more patients (22.3%, n=21) improved in the intervention group at 6months compared to the control group (9.5%, n=10) (odds ratio, 2.7; 95% confidence interval: 1.2-6.2; P=0.015). The effect was driven by improved self-efficacy >/=5units in the intervention group. Overall general self-efficacy improved significantly more in the intervention group compared with the control group (P=0.026). There was no difference between groups on re-hospitalisation or death, return to work or prior activity level. CONCLUSION: A person-centred care approach emphasising the partnership between patients and health care professionals throughout the care chain improves general self-efficacy without causing worsening clinical events.
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| 9. |
- Olsson, Lars G., 1970, et al.
(author)
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Trends in mortality after first hospitalization with Atrial Fibrillation diagnosis in Sweden 1987 to 2006
- 2013
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 170:1, s. 75-80
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Journal article (peer-reviewed)abstract
- Background: To examine trends in 3-yearmortality after a first hospitalization with diagnosed atrial fibrillation in a large cohort with and without important comorbidities. Methods: The Swedish Hospital Discharge and Cause of Death Registries were linked to investigate trends in mortality for all patients 35 to 84 years hospitalized for the first time with a discharge diagnosis (principal or contributory) of atrial fibrillation in Sweden during 1987 to 2006. We performed an analysis of temporal trends in mortality stratified for presence or absence of co-morbidities affecting survival. Results: Exactly 376,000 patients (56% male, mean age 72years) with a first diagnosis of atrial fibrillation during 1987-2006were identified and followed for 3years. Patients with one or more of the prespecified comorbidities had the highestmortality and the largest absolute decline in mortality, but patients without these comorbidities had a slightly larger relative decline (absolute risk reduction in 3-yearmortality (AAR) from42.5 to 34.7%, Hazard Ratio (HR) 0.76; 95% confidence interval (95% CI) 0.74 to 0.77 versus ARR 16.2% to 11.7%, HR 0.71; 0.68 to 0.74. In patients aged below 65years, with no comorbidities, therewasminimal change inmortality, and they still had a 2 times increased mortality compared to the general population (SMR 1.95; 1.84-2.06). Conclusions: Survival after a first hospitalization with a diagnosis of atrial fibrillation improved regardless comorbidities. Patients agedb65years old without diagnosed comorbidities still had a poor prognosis compared to the general population. c 2013 Elsevier Ireland Ltd. All rights reserved.
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| 10. |
- Tavazzi, L., et al.
(author)
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Clinical profiles and outcomes in patients with chronic heart failure and chronic obstructive pulmonary disease: An efficacy and safety analysis of SHIFT study
- 2013
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273. ; 170:2, s. 182-8
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Journal article (peer-reviewed)abstract
- BACKGROUND: Heart failure (HF) and chronic obstructive pulmonary disease (COPD) frequently coexist, with undefined prognostic and therapeutic implications. We investigated clinical profile and outcomes of patients with chronic HF and COPD, notably the efficacy and safety of ivabradine, a heart rate-reducing agent. METHODS: 6505 ambulatory patients, in sinus rhythm, heart rate >/=70bpm and stable systolic HF were randomised to placebo or ivabradine (2.5 to 7.5mg bid). Multivariate Cox model analyses were performed to compare the COPD (n=730) and non-COPD subgroups, and the ivabradine and placebo treatment effects. RESULTS: COPD patients were older and had a poorer risk profile. Beta-blockers were prescribed to 69% of COPD patients and 92% of non-COPD patients. The primary endpoint (PEP) and its component, hospitalisation for worsening HF, were more frequent in COPD patients (HRs f, 1.22 [p=0.006]; and 1.34 [p<0.001]) respectively, but relative risk was reduced similarly by ivabradine in both COPD (14%, and 17%) and non-COPD (18% and 27%) patients (p interaction=0.82, and 0.53, respectively). Similar effect was noted also for cardiovascular death. Adverse events were more common in COPD patients, but similar in treatment subgroups. Bradycardia occurred more frequently in ivabradine subgroups, with similar incidence in patients with or without COPD. CONCLUSIONS: The association of COPD and HF results in a worse prognosis, and COPD represents a barrier to optimisation of beta-blocker therapy. Ivabradine is similarly effective and safe in chronic HF patients with or without COPD, and can be safely combined with beta-blockers in COPD.
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