| 1. |
- Holmgren, Christina M, et al.
(författare)
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Presumed arrhythmic death in consecutive survivors of acute myocardial infarction--implications for primary implantable cardioverter defibrillator implantation.
- 2009
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Ingår i: Coronary artery disease. - : Lippincott Williams & Wilkins. - 1473-5830 .- 0954-6928. ; 20:2, s. 155-62
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe the occurrence of arrhythmic death among survivors of acute myocardial infarction (AMI) and the availability of a primary implantable cardioverter defibrillator (ICD). METHODS: Consecutive patients who fulfilled the criteria for AMI admitted to the Sahlgrenska University Hospital during 21 months were prospectively followed for 2 years with a focus on echocardiography and mode of death. RESULTS: Among the 471 patients, for whom information on ejection fraction (EF) was available and who survived the first week, 10 patients died between days 7 and 30 - of whom one had an arrhythmic death. Among the 461 survivors on day 30, 34 patients (7.4%) had an EF of 30% or less. Among these, 24 were judged to be available for ICD implantation, of whom one died an arrhythmic death during follow-up. Among the remaining 10 patients who were excluded from ICD indication because of either high age and/or severe comorbidity, two patients died an arrhythmic death. Among the remaining 427 patients who had an EF greater than 30%, six died an arrhythmic death. Thus, 10 patients, with EF assessed, died an arrhythmic death between day 7 and 2 years after AMI, but only one would have received an ICD according to the Multicenter Automatic Defibrillator Implantation Trial II criteria and clinical judgement. CONCLUSION: Of the 471 consecutive survivors of AMI, 10 (2%) died an arrhythmic death, of whom only one would have received an ICD according to current guidelines and clinical judgement. Predictors of subsequent arrhythmic death after an AMI, useful on a per patient basis, remain an unmet need.
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| 2. |
- Svensson, L., et al.
(författare)
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Comparison of very early treatment with either fibrinolysis or percutaneous coronary intervention facilitated with abciximab with respect to ST recovery and infarct-related artery epicardial flow in patients with acute ST-segment elevation myocardial infarction: the Swedish Early Decision (SWEDES) reperfusion trial
- 2006
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Ingår i: Am Heart J. - : Mosby, Inc.. - 1097-6744 .- 0002-8703. ; 151:4, s. 798 e1-7
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Results from a number of studies indicate that primary percutaneous coronary intervention (PCI) is superior to fibrinolysis for treatment of acute ST-elevation myocardial infarction. Modern adjunctive antithrombotic treatment with systematic use of low-molecular-weight heparins, fibrin-specific thrombolysis, and glycoprotein IIb/IIIa receptor inhibitors may improve the outcome compared with what was achieved in previous studies. METHODS: Patients with ST-elevation myocardial infarction were randomized to receive enoxaparin followed by reteplase (group A; n = 104) or enoxaparin followed by abciximab and transfer to invasive center for optional PCI (group B; n = 101). Primary end points were ST-segment resolution 120 minutes and TIMI flow at coronary angiography 5 to 7 days after randomization. RESULTS: Forty-two percent of the patients started therapy in the prehospital phase. Time from symptom to treatment was 114 minutes in group A and 202 minutes in group B. Baseline characteristics were similar in the 2 groups. Sixty-four percent in group A and 68% in group B had ST resolution of > 50% at 120 minutes (not significant). At control angiography, 54% in the fibrinolytic group and 71% in the invasive group had TIMI 3 flow (P = .04). At 30 days, the composite of death, stroke, or reinfarction occurred in 8% in the fibrinolytic group compared with 3% in the invasive group (not significant). CONCLUSIONS: Despite much shorter time delay to start of fibrinolysis than PCI, this did not result in signs of superior myocardial reperfusion. Epicardial flow in the infarct-related artery was better after invasive therapy, and there was a trend toward better clinical outcome after this treatment compared with after fibrinolysis.
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| 3. |
- Egerod, I., et al.
(författare)
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Trends and recommendations for critical care nursing research in the Nordic countries: Triangulation of review and survey data
- 2020
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397. ; 56
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Tidskriftsartikel (refereegranskat)abstract
- Background: Priorities for critical care nursing research have evolved with societal trends and values. In the 1980s priorities were the nursing workforce, in 1990s technical nursing, in 2000s evidence-based nursing and in 2010s symptom management and family-centred care. Objectives: To identify current trends and future recommendations for critical care nursing research in the Nordic countries. Methods: We triangulated the results of a literature review and a survey. A review of two selected critical care nursing journals (2016-2017) was conducted using content analysis to identify contemporary published research. A self-administered computerised cross-sectional survey of Nordic critical care nursing researchers (2017) reported current and future areas of research. Results: A review of 156 papers identified research related to the patient (13%), family (12%), nurse (31%), and therapies (44%). Current trends in the survey (n = 76, response rate 65%) included patient and family involvement, nurse performance and education, and evidence-based protocols. The datasets showed similar trends, but aftercare was only present in the survey. Future trends included symptom management, transitions, rehabilitation, and new nursing roles. Conclusion: Critical care nursing research is trending toward increased collaboration with patient and family, delineating a shift toward user values. Recommendations include long-term outcomes and impact of nursing. (C) 2019 Elsevier Ltd. All rights reserved.
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| 4. |
- Gardtman, M, et al.
(författare)
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Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome?
- 2000
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - : Lippincott Williams & Wilkins, Ltd.. - 0969-9546 .- 1473-5695. ; 7:1, s. 15-24
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate short- and long-term outcome prior to and after the introduction of a more intensified treatment in the ambulance of patients with acute severe heart failure. Consecutive patients with acute severe heart failure transported by the mobile coronary care unit (MCCU) in the community of Göteborg prior to and after the introduction of an intensified treatment (nitroglycerine, continuous positive airway pressure (CPAP) and furosemide). One hundred and fifty-eight patients were evaluated during each period. The median age was 77 and 76.5 years, respectively, and 52% and 42% were women. The proportion of patients given nitroglycerine in the ambulance was 4% and 68% in the two periods; the proportion of patients treated with furosemide was 13% and 84%, respectively. CPAP was used in less than 1% during period 1 and in 91% during period 2. On admission of the ambulance 60% had fulminant pulmonary oedema during period 1 versus 78% during period 2 (p<0.0001). On admission to hospital the opposite was found, 93% during period 1 versus 76% during period 2 (p<0.0001). The median serum creatinine kinase (CK-MB) maximum activity was 13 microkat/l during period 1 and 8 microkat/l during period 2 (p = 0.007). However, the mortality during the first year remained high during both periods (39.2% and 35.8%, p = 0.64). It is concluded that a more intensive treatment in the ambulance of patients with acute severe heart failure seems to have resulted in an improvement in symptoms during transport and less myocardial damage. However, no significant improvement in long-term mortality was observed.
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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. |
- Halvorsen, K., et al.
(författare)
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Patients' experiences of well-being when being cared for in the intensive care unit—An integrative review
- 2022
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 31:1-2, s. 3-19
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this integrative review was to identify facilitators and barriers to patients’ well-being when being cared for in an ICU setting, from the perspective of the patients. Background: To become critically ill and hospitalised in an ICU is a stressful, chaotic event due to the life-threatening condition itself, as well as therapeutic treatments and the environment. A growing body of evidence has revealed that patients often suffer from physical, psychological and cognitive problems after an ICU stay. Several strategies, such as sedation and pain management, are used to reduce stress and increase well-being during ICU hospitalisation, but the ICU experience nevertheless affects the body and mind. Design; Methods: Since research exploring patients’ sense of well-being in an ICU setting is limited, an integrative review approach was selected. Searches were performed in CINAHL, Medline, Psych Info, Eric and EMBASE. After reviewing 66 studies, 12 studies were included in the integrative review. Thematic analysis was used to analyse the studies. The PRISMA checklist for systematic reviews was used. Results: The results are presented under one main theme, ‘Well-being as a multidimensional experience—interwoven in barriers and facilitators’ and six sub-themes representing barriers to and facilitators of well-being in an ICU. Barriers identified were physical stressors, emotional stressors, environmental disturbances and insecurity relating to time and space. Facilitators were meeting physical needs and activities that included dimensions of a caring and relational environment. Conclusion: Our main findings were that experiences of well-being were multidimensional and included physical, emotional, relational and environmental aspects, and they were more often described through barriers than facilitators of well-being. Relevance for clinical practice: This integrative review has shown that it is necessary to adopt an individual focus on patient well-being in an ICU setting since physical, emotional, relational and environmental stressors might impact each patient differently. © 2021 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.
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| 7. |
- Holmgren, Christina M, et al.
(författare)
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Changes in Medication Preceding Out-of-hospital Cardiac Arrest Where Resuscitation Was Attempted
- 2014
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Ingår i: Journal of Cardiovascular Pharmacology. - : Lippincott Williams & Wilkins. - 0160-2446 .- 1533-4023. ; 63:6, s. 497-503
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. Methods: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. Results: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 +/- 16 years vs. 54 +/- 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded ;rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. Conclusions: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.
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| 8. |
- Holmgren, Christina M, et al.
(författare)
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Out-of-hospital cardiac arrest : Causes according to autopsy and electrocardiography - Analysis of 781 patients with neither hospital care nor prescribed medication during the preceding two years.
- 2020
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 150, s. 65-71
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is a knowledge gap regarding aetiology of and potential for predicting out-of-hospital cardiac arrest (OHCA) among individuals who are healthy before the event.AIM: To describe causes of OHCA and the potential for predicting OHCA in apparently healthy patients.METHODS: Patients were recruited from the Swedish Register of Cardiopulmonary Resuscitation from November 2007 to January 2011. Inclusion criteria were: OHCA with attempted CPR but neither dispensed prescription medication nor hospital care two years before the event The register includes the majority of patients suffering OHCA in Sweden where cardiopulmonary resuscitation (CPR) was attempted. Medication status was defined by linkage to the Swedish Prescribed Drug Register. Cause of death was assessed based on autopsy and the Swedish Cause of Death Register. Prediction of OHCA was attempted based on available electrocardiograms (ECG) before the OHCA event.RESULTS: Altogether 781 individuals (16% women) fulfilled the inclusion criteria. Survival to 30 days was 16%. Autopsy rate was 72%. Based on autopsy, 70% had a cardiovascular aetiology and 59% a cardiac aetiology. An ECG recording before the event was found in 23% of cases. The ECG was abnormal in 22% of them.CONCLUSION: Among OHCA victims who appeared to be healthy prior to the event, the cause was cardiovascular in the great majority according to autopsy findings. A minority had a preceding abnormal ECG that could have been helpful in avoiding the event.
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| 9. |
- Olsson, H, et al.
(författare)
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Predictors of short- and long-term mortality in critically ill, older adults admitted to the emergency department : an observational study
- 2022
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Ingår i: BMC Emergency Medicine. - : Springer Nature. - 1471-227X .- 1471-227X. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In the future, we can expect an increase in older patients in emergency departments (ED) and acute wards. The main purpose of this study was to identify predictors of short- and long-term mortality in the ED and at hospital discharge. Methods This is a retrospective, observational, single-center, cohort study, involving critically ill older adults, recruited consecutively in an ED. The primary outcome was mortality. All patients were followed for 6.5-7.5 years. The Cox proportional hazards model was used. Results Regarding all critically ill patients aged >= 70 years and identified in the ED (n = 402), there was a significant association between mortality at 30 days after ED admission and unconsciousness on admission (HR 3.14, 95% CI 2.09-4.74), hypoxia on admission (HR 2.51, 95% CI 1.69-3.74) and age (HR 1.06 per year, 95% CI 1.03-1.09), (all p < 0.001). Of 402 critically ill patients aged >= 70 years and identified in the ED, 303 were discharged alive from hospital. There was a significant association between long-term mortality and the Charlson Comorbidity Index (CCI) > 2 (HR 1.90, 95% CI 1.46-2.48), length of stay (LOS) > 7 days (HR 1.72, 95% CI 1.32-2.23), discharge diagnosis of pneumonia (HR 1.65, 95% CI 1.24-2.21) and age (HR 1.08 per year, 95% CI 1.05-1.10), (all p < 0.001). The only symptom or vital sign associated with long-term mortality was hypoxia on admission (HR 1.70, 05% CI 1.30-2.22). Conclusions Among critically ill older adults admitted to an ED and discharged alive the following factors were predictive of long-term mortality: CCI > 2, LOS > 7 days, hypoxia on admission, discharge diagnosis of pneumonia and age. The following factors were predictive of mortality at 30 days after ED admission: unconsciousness on admission, hypoxia and age. These data might be clinically relevant when it comes to individualized care planning, which should take account of risk prediction and estimated prognosis.
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| 10. |
- Omland, Torbjörn, et al.
(författare)
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Circulating osteoprotegerin levels and long-term prognosis in patients with acute coronary syndromes.
- 2008
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 1558-3597 .- 0735-1097. ; 51:6, s. 627-33
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study was designed to assess the association between osteoprotegerin (OPG) levels on admission and long-term prognosis in patients with acute coronary syndromes (ACS). BACKGROUND: Osteoprotegerin, a member of the tumor necrosis factor receptor superfamily, has pleiotropic effects on bone metabolism, endocrine function, and the immune system. METHODS: Serum samples for OPG analysis were obtained within 24 h of admission in 897 ACS patients (median age 66 years, 71% men) and related to the incidence of death, heart failure (HF) hospitalizations, myocardial infarction (MI), and stroke. RESULTS: A total of 261 patients died during a median follow-up of 89 months. The baseline OPG concentration was strongly associated with increased long-term mortality (hazard ratio [HR] for HR per 1 SD increase in logarithmically transformed OPG level 1.7 [range 1.5 to 1.9] p < 0.0001) and HF hospitalizations (HR 2.0 [range 1.6 to 2.5]; p < 0.0001) but weaker with recurrent MI (HR 1.3 [range 1.0 to 1.5]; p = 0.02) and not with stroke (HR 1.2 [range 0.9 to 1.6]; p = 0.35). After adjustment for conventional risk markers, including troponin I, C-reactive protein (CRP), B-type natriuretic peptide (BNP), and ejection fraction, the association remained significant for mortality (HR 1.4 [range 1.2 to 1.7]; p < 0.0001) and HF hospitalization (HR 1.6 [range 1.2 to 2.1]; p = 0.0002), but not recurrent MI. By comparison of the area under the receiver-operating characteristics curves, OPG performed similarly to BNP and ejection fraction and significantly better than CRP and troponin I as a predictor of death. CONCLUSIONS: Serum OPG is strongly predictive of long-term mortality and HF development in patients with ACS, independent of conventional risk markers.
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