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Träfflista för sökning "WFRF:(Alfredsson Joakim) srt2:(2005-2009)"

Sökning: WFRF:(Alfredsson Joakim) > (2005-2009)

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  • Alfredsson, Joakim, et al. (författare)
  • Although women are less likely to be admitted to coronary care units, they are treated equally to men and have better outcome : A prospective cohort study in patients with non ST-elevation acute coronary syndromes
  • 2009
  • Ingår i: Acute cardiac care. - : Informa Healthcare. - 1748-295X .- 1748-2941. ; 11:3, s. 173-180
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to assess gender differences in admission level of care, management and outcome in patients with non ST-elevation acute coronary syndromes (NSTE-ACS), initially admitted to either coronary care units (CCU) or general wards. Method: Patients admitted to CCUs were routinely registered in the RIKS-HIA registry. In addition, patients admitted to general wards with suspected ACS were also identified and registered. Multivariable regression analysis was used to adjust for baseline differences between the genders. Results: We included 570 consecutive patients with a discharge diagnosis of NSTE-ACS. Women were less likely to be admitted to coronary care units (56% versus 69%, P=0.002), even after adjustment (odds ratio (OR), 0.65; 95% confidence interval (CI): 0.43-0.98). After adjustment for differences in baseline characteristics, women were treated similarly to men. We found no significant differences in crude short-, or long-term mortality between the genders. However, adjustment for background characteristics revealed lower one-year mortality in women (OR: 0.58; 95% CI: 0.34-0.99). Conclusion: In this study on patients with NSTE-ACS, women were less likely to be admitted to coronary care units. However, the overall treatment was as intensive for women as for men. Moreover, after adjustment, one-year mortality was lower in women.
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  • Alfredsson, Joakim, et al. (författare)
  • Gender differences in management and outcome in non-ST-elevation acute coronary syndrome
  • 2007
  • Ingår i: Heart. - : BMJ Publishing group Ltd. - 1355-6037 .- 1468-201X. ; 93:11, s. 1357-1362
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To study gender differences in management and outcome in patients with non-ST-elevation acute coronary syndrome. Design, setting and patients: Cohort study of 53 781 consecutive patients (37% women) from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 1998 and 2002, and followed for 1 year. Main outcome measures: Treatment intensity and in-hospital, 30-day and 1 -year mortality. Results: Women were older (73 vs 69 years, p<0.001) and more likely to have a history of hypertension and diabetes, but less likely to have a history of myocardial infarction or revascularisation. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge. Revascularisation was, however, even after adjustment, performed more often in men (OR 1.15, 95% CI, 1.09 to 1.21). After adjustment, there was no significant difference in in-hospital (OR 1.03, 95% CI, 0.94 to 1.13) or 30-days (OR 1.07, 95% CI, 0.99 to 1.15) mortality, but at 1 year being male was associated with higher mortality (OR 1.12, 95% CI, 1.06 to 1.19). Conclusion: Although women are somewhat less intensively treated, especially regarding invasive procedures, after adjustment for differences in background characteristics, they have better long-term outcomes than men.
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  • Alfredsson, Joakim (författare)
  • Management and Outcome in Non ST-Elevation Acute Coronary Syndromes : Similarities and Differences Between Women and Men
  • 2009
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Background: Non ST-elevation Acute Coronary Syndromes are the most frequent manifestations of acute ischemic heart disease. Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. The aims of the studies in this thesis were to assess differences between the genders in baseline characteristics, level of care, medical treatment and non-invasive and invasive cardiac procedures. The aims were also to determine gender differences in short and long-term mortality, including impact of level of care, and to determine differences between the genders in benefit from an invasive strategy, with special reference to benefit in women.Method: We used prospectively collected data from the RIKS-HIA registry in two studies (Paper I and IV). In one study we merged data from patients admitted to general wards in the south-east region of Sweden (The AKUT registry), with data from patients admitted to CCU´s (RIKS-HIA) at participating hospitals during the same time (Paper II). We also randomly assigned women to a routine invasive or a selective invasive treatment strategy, and performed a meta-analysis, to determine gender differences in benefit from a routine invasive strategy (Paper III).Results: Women were older than men and more likely to have a history of diabetes and hypertension, while men were more likely to have a history of myocardial infarction and revascularisation. Women were also more likely to have normal coronary arteries on the angiogram. After adjustment for baseline differences there were only minor, and directionally inconsistent, differences between women and men in pharmacological treatment. Men were more often referred for coronary angiography, even after adjustment. While CABG-rate was lower in women, after adjustment PCI-rate was similar or even higher compared to men. After adjustment for differences in age, longterm outcome was better in women. In our small but randomised trial there was no benefit from a routine invasive strategy in women. A meta-analysis indicated interaction between gender and treatment strategy, with lack of benefit in women, in contrast to in men. However, our large observational study indicated no gender difference with an invasive strategy. Moreover, benefit was similar in women and men with invasive treatment.Conclusion: There are substantial differences between women and men in baseline characteristics that affect management and outcome more than gender per se. After adjustment women have better long-term outcome than men. There appear to be a difference in benefit from a routine invasive strategy between the genders, with less benefit in women, but in routine clinical management there was no difference between women and men managed with an invasive strategy.
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  • Ehnsio, G., et al. (författare)
  • Platelet Reactivity During Carciopulmonary Bypass : Marked Reduction Followed by Early Restitution
  • 2009
  • Ingår i: in Intensive Care Medicine, vol 35, Supplement 1, Posters. - : Springer. ; , s. 132-132
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • INTRODUCTION. Cardiopulmonary bypass (CPB) affects platelets, and platelet dysfunction is considered to be an important risk factor for post-operative bleeding after coronary artery bypass graft (CABG) surgery. Monitoring platelet function in the peri-operative period therefore is of importance to reduce morbidity due to both bleeding and post-operative graft occlusion. Our aim was to study platelet reactivity in CABG patients in the peri-operative period.METHODS. Platelet function in 30 patients undergoing CABG was analyzed using an impedance aggregometry point-of-care (POC) instrument (Multiplate). Platelet reactivity was measured preoperatively at induction of anaesthesia, preoperatively immediately before CPB, after 30 minutes of CPB, after end of CPB, postoperatively at arrival to the ICU and finally at 3 and 18 h after surgery. Whole blood platelet aggregation was measured after activation with ADP (adenosin diphosphate), TRAP (thrombin receptor activating peptide), AA (arachidonic acid) and collagen. Platelet count was measured, and circulating platelet pool was assessed by correcting for hemodilution by indexing to hemoglobin. Non-parametric statistics were used, results are presented as median and 25–75%-percentiles.RESULTS. Reactivity to ADP, TRAP and AA agonists was significantly reduced at 30 min of CPB and at the end of CPB, followed by a rapid increase after CPB to preoperative values. Collagen showed a similar, but not significant, decrease during CPB followed by a post-CPB increase to values above baseline (p\0.001). Platelet count dropped after 30 min of CPB from 240 (204–301) preoperatively to 150 (132–189) after 30 min of CPB and further to 134 (120–151) 9 109/L at the end of CPB (p\0.001). Corrected for blood loss and hemodilution there was a reduced platelet pool at the end of CPB and at arrival at the ICU (p\0.001)CONCLUSION. There is an early decrease in platelet reactivity during CPB followed by a rapid post-CPB restitution of platelet function, despite low preoperative aggregometry values and lower post-CPB platelet count. The rapid preoperative changes in aggregometry points to a possible role for POC analysis of hemostatic function. The post-CPB increase in platelet reactivity simultaneously to the decrease in platelet count could imply increased aggregating tendency for remaining platelets, with possible implications for early graft failure and postoperative anti-platelet therapy.
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