| 1. |
- Herlitz, Johan, et al.
(author)
-
Characteristics of cardiac arrest and resuscitation by age group : an analysis from the Swedish Cardiac Arrest Registry
- 2007
-
In: American Journal of Emergency Medicine. - : W. B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 25:9, s. 1025-1031
-
Journal article (peer-reviewed)abstract
- AIM: The objective of this study was to describe patients who experienced an out-of-hospital cardiac arrest (OHCA) by age group.METHODS: All patients who suffered from an OHCA between 1990 and 2005 and are included in the Swedish Cardiac Arrest Registry (n = 40,503) were classified into the following age groups: neonates, younger than 1 year; young children, between 1 and 4 years; older children, between 5 and 12 years; adolescents, between 13 and 17 years; young adults, between 18 and 35 years; adults not retired, between 36 and 64 years; adults retired, between 65 and 79 years; and older adults, 80 years or older.RESULTS: Ventricular fibrillation was lowest in young children (3%) and highest in adults (35%). Survival to 1 month was lowest in neonates (2.6%) and highest in older children (7.8%). Children (<18 years), young adults (18-35 years), and adults (>35 years) survived to 1 month 24.5%, 21.2%, and 13.6% of cases, respectively (P = .0003 for trend) when found in a shockable rhythm. The corresponding figures for nonshockable rhythms were 3.8%, 3.2%, and 1.6%, respectively (P < .0001 for trend).CONCLUSIONS: There is a large variability in characteristics and outcome among patients in various age groups who experienced an OHCA. Among the large age groups, there was a successive decline in survival with increasing age in shockable and nonshockable rhythms.
|
|
| 2. |
- Hessulf, Fredrik, 1986, et al.
(author)
-
Adherence to Guidelines is Associated With Improved Survival Following In-hospital Cardiac Arrest in Sweden
- 2020
-
In: Resuscitation. - : Lippincott Williams & Wilkins. - 0300-9572 .- 1873-1570. ; 155, s. -21
-
Journal article (peer-reviewed)abstract
- Background: Most resuscitation guidelines have recommendations regarding maximum delay times from collapse to calling for the rescue team and initiation of treatment following cardiac arrest. The aim of the study was to investigate the association between adherence to guidelines for cardiopulmonary resuscitation (CPR) after in-hospital cardiac arrest (IHCA) and survival with a focus on delay to treatment.Methods: We used the Swedish Registry for CPR to study 3212 patients with a shockable rhythm and 9113 patients with non-shockable rhythm from January 1, 2008 to December 31, 2017. Adult patients older than or equal to 18 years with a witnessed IHCA where resuscitation was initiated were included. We assessed trends in adherence to guidelines and their associations with 30-day survival and neurological function. Adherence to guidelines was defined as follows: time from collapse to calling for the rescue team and CPR within 1 min for non-shockable rhythms. For shockable rhythms, adherence was defined as the time from collapse to calling for the rescue team and CPR within 1 min and defibrillation within 3 min.Results: In patients with a shockable rhythm, the 30-day survival for those treated according to guidelines was 66.1%, as compared to 46.5% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.84 (95% CI 1.52-2.22). Among patients with a non-shockable rhythm the 30-day survival for those treated according to guidelines was 22.8%, as compared to 16.0% among those not treated according to guidelines on one or more parameters, adjusted odds ratio 1.43 (95% CI 1.24-1.65). Neurological function (cerebral performance category 1-2) among survivors was better among patients treated in accordance with guidelines for both shockable (95.7% vs 91.1%, <0.001) and non-shockable rhythms (91.0% vs 85.5%, p < 0.008). Adherence to the Swedish guidelines for CPR increased slightly 2008-2017.Conclusions: Adherence to guidelines was associated with increased probability of survival and improved neurological function in patients with a shockable and non-shockable rhythm, respectively. Increased adherence to guidelines could increase cardiac arrest survival.
|
|
| 3. |
- Langhelle, A., et al.
(author)
-
Recommended guidelines for reviewing, reporting, and conducting research on post-resuscitation care: the Utstein style
- 2005
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 66:3, s. 271-83
-
Journal article (peer-reviewed)abstract
- The aim of this report is to establish recommendations for reviewing, reporting, and conducting research during the post-resuscitation period in hospital. It defines data that are needed for research and more specialised registries and therefore supplements the recently updated Utstein template for resuscitation registries. The updated Utstein template and the out-of-hospital "Chain of Survival" describe factors of importance for successful resuscitation up until return of spontaneous circulation (ROSC). Several factors in the in-hospital phase after ROSC are also likely to affect the ultimate outcome of the patient. Large differences in survival to hospital discharge for patients admitted alive are reported between hospitals. Therapeutic hypothermia has been demonstrated to improve the outcome, and other factors such as blood glucose, haemodynamics, ventilatory support, etc., might also influence the result. No generally accepted, scientifically based protocol exists for the post-resuscitation period in hospital, other than general brain-oriented intensive care. There is little published information on this in-hospital phase. This statement is the result of a scientific consensus development process started as a symposium by a task force at the Utstein Abbey, Norway, in September 2003. Suggested data are defined as core and supplementary and include the following categories: pre-arrest co-morbidity and functional status, cause of death, patients' quality of life, in-hospital system factors, investigations and treatment, and physiological data at various time points during the first three days after admission. It is hoped that the publication of these recommendations will encourage research into the in-hospital post-resuscitation phase, which we propose should be included in the chain-of-survival as a fifth ring. Following these recommendations should enable better understanding of the impact of different in-hospital treatment strategies on outcome.
|
|
| 4. |
- Lindgren, Johan, et al.
(author)
-
Molecular composition and ultrastructure of Jurassic paravian feathers
- 2015
-
In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 5
-
Journal article (peer-reviewed)abstract
- Feathers are amongst the most complex epidermal structures known, and they have a well-documented evolutionary trajectory across non-avian dinosaurs and basal birds. Moreover, melanosome-like microbodies preserved in association with fossil plumage have been used to reconstruct original colour, behaviour and physiology. However, these putative ancient melanosomes might alternatively represent microorganismal residues, a conflicting interpretation compounded by a lack of unambiguous chemical data. We therefore used sensitive molecular imaging, supported by multiple independent analytical tests, to demonstrate that the filamentous epidermal appendages in a new specimen of the Jurassic paravian Anchiornis comprise remnant eumelanosomes and fibril-like microstructures, preserved as endogenous eumelanin and authigenic calcium phosphate. These results provide novel insights into the early evolution of feathers at the sub-cellular level, and unequivocally determine that melanosomes can be preserved in fossil feathers.
|
|
| 5. |
- Tomasdottir, Maria, et al.
(author)
-
Risk markers of incident atrial fibrillation in patients with coronary heart disease
- 2021
-
In: American Heart Journal. - : Elsevier. - 0002-8703 .- 1097-6744. ; 233, s. 92-101
-
Journal article (peer-reviewed)abstract
- BackgroundIn patients with coronary heart disease (CHD), atrial fibrillation (AF) is associated with increased morbidity and mortality. We investigated the associations between clinical risk factors and biomarkers with incident AF in patients with CHD.Methods and resultsAround 13,153 patients with optimally treated CHD included in the STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial with plasma samples obtained at randomization. Mean follow-up time was 3.5 years. The association between clinical risk factors and biomarkers with incident AF was estimated with Cox-regression models. Validation was performed in 1,894 patients with non-ST-elevation acute coronary syndrome included in the FRISC-II trial.The median (min-max) age was 64 years (range 26-92) and 2,514 (19.1%) were women. A total of 541 patients, annual incidence rate of 1.2%, developed AF during follow-up. In multivariable models, older age, higher levels of NT-proBNP, higher body mass index (BMI), male sex, geographic regions, low physical activity, and heart failure were independently associated with increased risk of incident AF with hazard ratios ranging from 1.04 to 1.79 (P ≤ .05). NT-proBNP improved the C-index from 0.70 to 0.71. In the validation cohort, age, BMI, and NT-proBNP were associated with increased risk of incident AF with similar hazard ratios.ConclusionsIn patients with optimally treated CHD, the incidence of new AF was 1.2% per year. Age, NT-proBNP as a marker of impaired cardiac function, and BMI were the strongest factors, independently and consistently associated with incident AF. Male sex and low physical activity may also contribute to the risk of AF in patients with CHD.
|
|
| 6. |
|
|
| 7. |
- Claesson, Andreas, et al.
(author)
-
Defibrillation before EMS arrival in western Sweden
- 2017
-
In: American Journal of Emergency Medicine. - : Elsevier. - 0735-6757 .- 1532-8171. ; 35:8, s. 1043-1048
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Bystanders play a vital role in public access defibrillation (PAD) in out-of-hospital cardiac arrest (OHCA). Dual dispatch of first responders (FR) alongside emergency medical services (EMS) can reduce time to first defibrillation. The aim of this study was to describe the use of automated external defibrillators (AEDs) in OHCAs before EMS arrival.METHODS: All OHCA cases with a shockable rhythm in which an AED was used prior to the arrival of EMS between 2008 and 2015 in western Sweden were eligible for inclusion. Data from the Swedish Register for Cardiopulmonary Resuscitation (SRCR) were used for analysis, on-site bystander and FR defibrillation were compared with EMS defibrillation in the final analysis.RESULTS: Of the reported 6675 cases, 24% suffered ventricular fibrillation (VF), 162 patients (15%) of all VF cases were defibrillated before EMS arrival, 46% with a public AED on site. The proportion of cases defibrillated before EMS arrival increased from 5% in 2008 to 20% in 2015 (p<0.001). During this period, 30-day survival increased in patients with VF from 22% to 28% (p=0.04) and was highest when an AED was used on site (68%), with a median delay of 6.5min from collapse to defibrillation. Adjusted odds ratio for on-site defibrillation versus dispatched defibrillation for 30-day survival was 2.45 (95% CI: 1.02-5.95).CONCLUSIONS: The use of AEDs before the arrival of EMS increased over time. This was associated with an increased 30-day survival among patients with VF. Thirty-day survival was highest when an AED was used on site before EMS arrival.
|
|
| 8. |
|
|
| 9. |
- Engdahl, Johan, 1968, et al.
(author)
-
Localization of out-of-hospital cardiac arrest in Goteborg 1994-2002 and implications for public access defibrillation
- 2005
-
In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 64:2, s. 171-5
-
Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Goteborg and to identify implications for public access defibrillation (PAD). METHODS: Ambulance run reports for the years 1994-2002 were studied retrospectively and manually to establish the location of the cardiac arrest. RESULTS: The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims' homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners' offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. CONCLUSION: Among patients suffering from out-of-hospital cardiac arrest in Goteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.
|
|
| 10. |
|
|
| 11. |
- Etminani, Farzaneh, 1984-, et al.
(author)
-
Randomised, siteless study to compare systematic atrial fibrillation screening using enrichment by a risk prediction model with standard care in a Swedish population aged ≥ 65 years : CONSIDERING-AF study design
- 2024
-
In: BMJ Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 14:1
-
Journal article (peer-reviewed)abstract
- INTRODUCTION: Atrial fibrillation (AF) is the most common arrhythmia and confers an increased risk of mortality, stroke, heart failure and cognitive decline. There is growing interest in AF screening; however, the most suitable population and device for AF detection remains to be elucidated. Here, we present the design of the CONSIDERING-AF (deteCtiON and Stroke preventIon by moDEl scRreenING for Atrial Fibrillation) study. METHODS AND ANALYSIS: CONSIDERING-AF is a randomised, controlled, siteless, non-blinded diagnostic superiority trial with four parallel groups and a primary endpoint of identifying AF during a 6-month study period set in Region Halland, Sweden. In each group, 740 individuals aged≥65 years will be included. The primary objective is to compare the intervention of AF screening enrichment using a risk prediction model (RPM), followed by 14 days of a continuous ECG patch, with no intervention (standard care). Primary outcome is defined as the incident AF recorded in the Region Halland Information Database after 6 months as compared with standard care. Secondary endpoints include the difference in incident AF between groups enriched or not by the RPM, with and without an invitation to 14 days of continuous ECG recording, and the proportions of oral anticoagulation treatment in the four groups. ETHICS AND DISSEMINATION: This study has ethical approval from the Swedish Ethical Review Authority. Results will be published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: NCT05838781. © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
|
|
| 12. |
|
|
| 13. |
- Herlitz, Johan, 1949, et al.
(author)
-
Association between interval between call for ambulance and return of spontaneous circulation and survival in out-of-hospital cardiac arrest
- 2006
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 71:1, s. 40-6
-
Journal article (peer-reviewed)abstract
- AIM: To describe the association between the interval between the call for ambulance and return of spontaneous circulation (ROSC) and survival in out-of-hospital cardiac arrest. PATIENTS: All patients suffering an out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started, included in the Swedish Cardiac Arrest Registry (SCAR) for whom information about the time of calling for an ambulance and the time of ROSC was available. RESULTS: Among 26,192 patients who were included in SCAR and were not witnessed by the ambulance crew, information about the time of call for an ambulance and the time of ROSC was available in 4847 patients (19%). There was a very strong relationship between the interval between call for an ambulance and ROSC and survival to one month. If the interval was less than or equal to 5 min, 47% survived to one month. If the interval exceeded 30 min, only 5% (n = 35) survived to one month. The vast majority of the latter survivors had a shockable rhythm either on admission of the rescue team or at some time during resuscitation. CONCLUSION: Among patients who have ROSC after an out-of-hospital cardiac arrest, there is a very strong association between the interval between the call for ambulance and ROSC and survival to one month. However, even if this delay is very long (> 30 min after calling for an ambulance), a small percentage will ultimately survive; they are mainly patients who at some time during resuscitation have a shockable rhythm. The overall percentage of patients for whom CPR continued for more than 30 min who are alive one month later can be assumed to be extremely low.
|
|
| 14. |
- Herlitz, Johan, 1949, et al.
(author)
-
Can we define patients with no chance of survival after out-of-hospital cardiac arrest?
- 2004
-
In: Heart. - : BMJ. - 1468-201X .- 1355-6037. ; 90:10, s. 1114-8
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate whether subgroups of patients with no chance of survival can be defined among patients with out-of-hospital cardiac arrest. PATIENTS: Patients in the Swedish cardiac arrest registry who fulfilled the following criteria were surveyed: cardiopulmonary resuscitation (CPR) was attempted; the arrest was not crew witnessed; and patients were found in a non-shockable rhythm. SETTING: Various ambulance organisations in Sweden. DESIGN: Prospective observational study. RESULTS: Among the 16,712 patients who fulfilled the inclusion criteria, the following factors were independently associated with a lower chance of survival one month after cardiac arrest: no bystander CPR; non-witnessed cardiac arrest; cardiac arrest occurring at home; increasing interval between call for and arrival of the ambulance; and increasing age. When these factors were considered simultaneously two groups with no survivors were defined. In both groups patients were found in a non-shockable rhythm, no bystander CPR was attempted, the arrest was non-witnessed, the arrest took place at home. In one group the interval between call for and arrival of ambulance exceeded 12 minutes. In the other group patients were older than 80 years and the interval between call for and arrival of the ambulance exceeded eight minutes. CONCLUSION: Among patients who had an out-of-hospital cardiac arrest and were found in a non-shockable rhythm the following factors were associated with a low chance of survival: no bystander CPR, non-witnessed cardiac arrest, the arrest took place at home, increasing interval between call for and arrival of ambulance, and increasing age. When these factors were considered simultaneously, groups with no survivors could be defined. In such groups the ambulance crew may refrain from starting CPR.
|
|
| 15. |
- Herlitz, Johan, 1949, et al.
(author)
-
Changes in demographic factors and mortality after out-of-hospital cardiac arrest in Sweden
- 2005
-
In: Coron Artery Dis. - : Ovid Technologies (Wolters Kluwer Health). - 0954-6928 .- 1473-5830. ; 16:1, s. 51-7
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To describe changes between 1992 and 2003 in age, sex, factors at resuscitation and survival among patients suffering from out-of-hospital cardiac arrest in Sweden. METHODS: This was a prospective observational study including various ambulance organizations in Sweden. Patients suffering from out-of-hospital cardiac arrest between 1992 and 2003 included in the Swedish Cardiac Arrest Registry were followed for survival to 1 month. RESULTS: In all 19 791 cases took part in the survey. There was a slight increase in mean age from 68 to 70 years (P = 0.025) and an increase of females from 29 to 32% (P = 0.0001). There was a change in witnessed status (P < 0.0001) with an increase in crew-witnessed cases and a decrease in non-witnessed cases. There was a decrease in cases of a cardiac etiology from 75 to 61% (P < 0.0001) and a decrease in the percentage found in ventricular fibrillation from 36 to 25% (P < 0.0001). When crew-witnessed cases were excluded the proportion receiving bystander cardiopulmonary resuscitation (CPR) increased from 30 to 42% (P < 0.0001). There was a slight increase in the overall proportion of patients hospitalized alive from 16 to 20% (P = 0.032). There was no significant change in the overall proportion of survivors at 1 month after cardiac arrest (4.5% in 1992 and 5.0% in 2003). CONCLUSIONS: Among patients suffering from out-of-hospital cardiac arrest in Sweden some changes took place. The most important ones were a decrease in the proportion of patients found in ventricular fibrillation and an increase in the proportion of patients receiving bystander CPR. The proportion of patients admitted alive to hospital increased moderately, whereas the proportion of patients alive after 1 month remained unchanged.
|
|
| 16. |
- Herlitz, Johan, 1949, et al.
(author)
-
Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden
- 2005
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 64:1, s. 37-40
-
Journal article (peer-reviewed)abstract
- AIM: To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden. METHODS: Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990-2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants). RESULTS: In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2-58.1). CONCLUSION: Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.
|
|
| 17. |
- Herlitz, Johan, 1949, et al.
(author)
-
Characteristics and outcome amongst young adults suffering from out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation is attempted
- 2006
-
In: J Intern Med. - : Wiley. - 0954-6820 .- 1365-2796. ; 260:5, s. 435-41
-
Journal article (peer-reviewed)abstract
- OBJECTIVES: Amongst patients suffering from out-of-hospital cardiac arrest, young adults represent a minority. However, these victims suffer from the catastrophe when they are in a very active phase of life and have a long life expectancy. This survey aims to describe young adults in Sweden who suffer from out-of-hospital cardiac arrest and in whom cardiopulmonary resuscitation (CPR) is attempted in terms of characteristics and outcome. DESIGN: Prospective and descriptive design. SUBJECTS AND METHODS: Young adults (18-35 years) who suffered from out-of-hospital cardiac arrest in whom CPR was attempted and who were included in the Swedish Cardiac Arrest Registry between 1990 and 2004. MAIN OUTCOME MEASURES: Survival to 1 month. RESULTS: In all, 1105 young adults (3.1% of all the patients in the registry) were included, of which 29% were females, 51% were nonwitnessed and 15% had a cardiac aetiology. Only 17% were found in ventricular fibrillation, 53% received bystander CPR. The overall survival to 1 month was 6.3%. High survival was found amongst patients found in ventricular fibrillation (20.8%) and those with a cardiac aetiology (14.8%). Ventricular fibrillation at the arrival of the rescue team remained an independent predictor of an increased chance of survival (odds ratio: 7.43; 95% confidence interval: 3.44-16.65). CONCLUSION: Amongst young adults suffering from out-of-hospital cardiac arrest and in whom CPR was attempted, a minority survived to 1 month. Subgroups with a higher survival could be defined (patients found in ventricular fibrillation and patients in whom there was a cardiac aetiology). However, only one independent predictor of an increased chance of survival could be demonstrated, i.e. ventricular fibrillation at the arrival of the rescue team.
|
|
| 18. |
- Herlitz, Johan, 1949, et al.
(author)
-
Characteristics and outcome in out-of-hospital cardiac arrest when patients are found in a non-shockable rhythm
- 2008
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 76:1, s. 31-36
-
Journal article (peer-reviewed)abstract
- AIM: To define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA) who were found in a non-shockable rhythm. PATIENTS: All the patients included in the Swedish OHCA registry between 1990 and 2005 in whom resuscitation was attempted, who were found in a non-shockable rhythm and where either the OHCA was witnessed by a bystander or was not witnessed. RESULTS: In all, 22,465 patients fulfilled the inclusion criteria. Their mean age was 67 years, 32% were women, 57% were witnessed, 64% had a cardiac aetiology, 71% occurred at home and 34% received bystander cardiopulmonary resuscitation (CPR). Survival to 1 month was 1.3%. The following were independently associated with an increased chance of survival: 1/Decreasing age, 2/Witnessed arrest, 3/Bystander CPR, 4/Cardiac arrest outside home, 5/Shorter ambulance response time and 6/Need for defibrillatory shock. If these six criteria were fulfilled (age and ambulance response time below the median), survival to 1 month increased to 12.6%. If no criteria were fulfilled, survival was 0.15%. CONCLUSION: The overall survival among patients with an OHCA found in a non-shockable rhythm is very low (1.3%). Six factors associated with survival can be defined. When they are taken into account, survival varies between 12.6 and 0.15%.
|
|
| 19. |
- Herlitz, Johan, 1949, et al.
(author)
-
Decrease in the occurrence of ventricular fibrillation as the initially observed arrhythmia after out-of-hospital cardiac arrest during 11 years in Sweden
- 2004
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 60:3, s. 283-90
-
Journal article (peer-reviewed)abstract
- AIM: To describe the change in the occurrence of ventricular fibrillation as initially observed arrhythmia among patients suffering from out-of-hospital cardiac arrest in Sweden. PATIENTS: All patients included in the Swedish cardiac arrest registry between 1991 until 2001. The registry covers 85% of the population in Sweden. METHODS: All patients with bystander witnessed out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1991 and 2001 from the same ambulance organisation each year were included in the survey. RESULTS: Over 11 years, among patients in Sweden with a bystander witnessed out-of-hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was attempted (n = 9666), the occurrence of ventricular fibrillation as the initially obseved arrhythmia decreased from 45% in 1991 to 28% in 2001 (P < 0.0001) if the arrest occurred at home, and from 57% to 41% if the arrest occurred outside home (P < 0.0001). This was found despite the fact that the proportion who received bystander CPR increased from 29% in 1991 to 39% in 2001 if the arrest occurred at home (P < 0.0001) and from 54% to 60% if the arrest occurred outside home (NS). There was a significant increase in age among patients with out-of-hospital cardiac arrest at home, no change in the estimated interval between collapse and call but an increase in the interval between call and arrival of the ambulance among patients with out-of-hospital cardiac arrest outside home. CONCLUSION: During 11 years in Sweden, there was a marked decrease in the proportion of patients found in ventricular fibrillation among patients with a bystander witnessed cardiac arrest regardless whether the arrest occurred at home or outside home. A modest increase in age and interval between call for, and arrival of, the ambulance was associated with these findings.
|
|
| 20. |
- Herlitz, Johan, 1949, et al.
(author)
-
Factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in a national perspective in Sweden
- 2005
-
In: Am Heart J. - St. Louis, Mo. : Elsevier BV. - 1097-6744 .- 0002-8703. ; 149:1, s. 61-6
-
Journal article (peer-reviewed)abstract
- AIM: To describe factors associated with an increased chance of survival among patients suffering from an out-of-hospital cardiac arrest in Sweden. PATIENTS AND METHODS: All patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom cardiopulmonary resuscitation (CPR) was attempted and who were registered in the Swedish Cardiac Arrest Registry. This registry covers about 85% of the Swedish population and has been running since 1990. RESULTS: In all, 33,453 patients, 71% of whom had a cardiac etiology, were included in the survey. The following were independent predictors for an increased chance of survival in order of magnitude: (1) patients found in ventricular fibrillation (odds ratio [OR] 5.3, 95% confidence limits [CL] 4.2-6.8), (2) the interval between call for and arrival of the ambulance less than or equal to the median (OR 3.6, 95% CL 2.9-4.6), (3) cardiac arrest occurred outside the home (OR 2.2, 95% CL 1.9-2.7), (4) cardiac arrest was witnessed (OR 2.0, 95% CL 1.6-2.7), (5) bystanders performing CPR before the arrival of the ambulance (OR 2.0, 95% CL 1.7-2.4), and (6) age less than or equal to the median (OR 1.6, 95% CL 1.4-2.0). When none of these factors were present, survival to 1 m was 0.4%; when all factors were present, survival was 23.8%. CONCLUSION: Among patients suffering from an out-of-hospital cardiac arrest, which were not crew witnessed, in Sweden and in whom CPR was attempted, 6 factors for an increased chance of survival could be defined. These include (1) initial rhythm, (2) delay to arrival of the rescue team, (3) place of arrest, (4) witnessed status, (5) bystander CPR, and (6) age.
|
|
| 21. |
- Herlitz, Johan, 1949, et al.
(author)
-
Is female sex associated with increased survival after out-of-hospital cardiac arrest?
- 2004
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 60:2, s. 197-203
-
Journal article (peer-reviewed)abstract
- AIM: To evaluate survival after out-of-hospital cardiac arrest in relation to sex. METHODS: All patients with out-of-hospital cardiac arrest included in the Swedish Cardiac Arrest Registry between 1990 and 2000 in whom cardiopulmonary resuscitation (CPR) was attempted and who did not have a crew witnessed arrest were included. The registry covers 85% of the inhabitants of Sweden (approximately 8 million inhabitants). P-values were adjusted to differences in age. Survival was defined as patients being hospitalised alive and being alive one month after cardiac arrest. In all, 23,797 patients participated in the survey of which 27.9% were women. RESULTS: Among women 16.4% were hospitalised alive versus 13.2% among men ( P<0.001). After one month 3.0% among women were alive versus 3.4% among men (NS). In a multivariate analysis considering differences in age and various factors at resuscitation female sex was an independent predictor for patients being hospitalised alive (odds ratio 1.66; 95% confidence limits 1.49-1.84) and for being alive after one month (odds ratio 1.27; 95% confidence limits 1.03-1.56). Women differed from men as they were older ( P<0.001 ), had a lower prevalence of witnessed cardiac arrest ( P=0.01), a lower occurrence of bystander CPR (P<0.001), a lower occurrence of ventricular fibrillation as initial arrhythmia (P<0.001) and a lower occurrence of cardiac disease judged to be the cause of cardiac arrest ( P<0.0001 ). On the other hand they had a cardiac arrest at home more frequently ( P<0.001 ). CONCLUSION: Among patients suffering out-of-hospital cardiac arrest in Sweden which was not crew witnessed and in whom resuscitation efforts were attempted, female sex was associated with an increased survival.
|
|
| 22. |
- Herlitz, Johan, 1949, et al.
(author)
-
Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest
- 2006
-
In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 70:3, s. 404-9
-
Journal article (peer-reviewed)abstract
- AIM: To explore the rate of survival to hospital discharge among patients who were brought to hospital alive after an out-of-hospital cardiac arrest in different hospitals in Sweden. PATIENTS AND METHODS: All patients who had suffered an out-of-hospital cardiac arrest which was not witnessed by the ambulance crew, in whom cardiopulmonary resuscitation (CPR) was started and who had a palpable pulse on admission to hospital were evaluated for inclusion. Each participating ambulance organisation and its corresponding hospital(s) required at least 50 patients fulfilling these criteria. RESULTS: Three thousand eight hundred and fifty three patients who were brought to hospital by 21 different ambulance organisations fulfilled the inclusion criteria. The number of patients rescued by each ambulance organisation varied between 55 and 900. The survival rate, defined as alive 1 month after cardiac arrest, varied from 14% to 42%. When correcting for dissimilarities in characteristics and factors of the resuscitation, the adjusted odds ratio for survival to 1 month among patients brought to hospital alive in the three ambulance organisations with the highest survival versus the three with the lowest survival was 2.63 (95% CI: 1.77-3.88). CONCLUSION: There is a marked variability between hospitals in the rate of 1-month survival among patients who were alive on hospital admission after an out-of-hospital cardiac arrest. One possible contributory factor is the standard of post-resuscitation care.
|
|
| 23. |
|
|
| 24. |
|
|
| 25. |
- Hessulf, Fredrik, 1986, et al.
(author)
-
Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases.
- 2017
-
In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754.
-
Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVE: In-hospital cardiac arrest (IHCA) constitutes a major contributor to cardiovascular mortality. The aim of the present study was to investigate factors of importance to 30-day survival after IHCA in Sweden.METHODS: A retrospective register study based on the Swedish Register of Cardiopulmonary Resuscitation (SRCPR) 2006-2015. Sixty-six of 73 hospitals in Sweden participated. The inclusion criterion was a confirmed cardiac arrest in which resuscitation was attempted among patients aged >18years.RESULTS: In all, 18,069 patients were included, 39% of whom were women. The median age was 75years. Thirty-day survival was 28.3%, 93% with a CPC score of 1-2. One-year survival was 25.0%. Overall IHCA incidence in Sweden was 1.7 per 1000 hospital admissions. Several factors were found to be associated with 30-day survival in a multivariable analysis. They included cardiac arrest (CA) at working days during the daytime (08-20) compared with weekends and night-time (20-08) (OR 1.51 95% CI 1.39-1.64), monitored CA (OR 2.18 95% CI 1.99-2.38), witnessed CA (OR 2.87 95% CI 2.48-3.32) and if the first recorded rhythm was ventricular fibrillation/tachycardia, especially in combination with myocardial ischemia/infarction as the assumed aetiology of the CA (OR for interaction 4.40 95% CI 3.54-5.46).CONCLUSION: 30-day survival after IHCA is associated with the time of the event, the aetiology of the CA and the degree of monitoring and this should influence decisions regarding the appropriate level of monitoring and care.
|
|
| 26. |
|
|
| 27. |
- Hessulf, Fredrik, 1986, et al.
(author)
-
Predicting survival and neurological outcome in out-of-hospital cardiac arrest using machine learning: the SCARS model
- 2023
-
In: eBioMedicine. - : Elsevier BV. - 2352-3964. ; 89
-
Journal article (peer-reviewed)abstract
- Background: A prediction model that estimates survival and neurological outcome in out-of-hospital cardiac arrest patients has the potential to improve clinical management in emergency rooms.Methods: We used the Swedish Registry for Cardiopulmonary Resuscitation to study all out-of-hospital cardiac arrest (OHCA) cases in Sweden from 2010 to 2020. We had 393 candidate predictors describing the circumstances at cardiac arrest, critical time intervals, patient demographics, initial presentation, spatiotemporal data, socioeconomic status, medications, and comorbidities before arrest. To develop, evaluate and test an array of prediction models, we created stratified (on the outcome measure) random samples of our study population. We created a training set (60% of data), evaluation set (20% of data), and test set (20% of data). We assessed the 30-day survival and cerebral performance category (CPC) score at discharge using several machine learning frameworks with hyperparameter tuning. Parsimonious models with the top 1 to 20 strongest predictors were tested. We calibrated the decision threshold to assess the cut-off yielding 95% sensitivity for survival. The final model was deployed as a web application.Findings: We included 55,615 cases of OHCA. Initial presentation, prehospital interventions, and critical time intervals variables were the most important. At a sensitivity of 95%, specificity was 89%, positive predictive value 52%, and negative predictive value 99% in test data to predict 30-day survival. The area under the receiver characteristic curve was 0.97 in test data using all 393 predictors or only the ten most important predictors. The final model showed excellent calibration. The web application allowed for near-instantaneous survival calculations.Interpretation: Thirty-day survival and neurological outcome in OHCA can rapidly and reliably be estimated during ongoing cardiopulmonary resuscitation in the emergency room using a machine learning model incorporating widely available variables.
|
|
| 28. |
- Hessulf, Fredrik, 1986, et al.
(author)
-
Temporal variation in survival following in-hospital cardiac arrest in Sweden.
- 2023
-
In: International journal of cardiology. - 0167-5273 .- 1874-1754. ; 381, s. 112-119
-
Journal article (peer-reviewed)abstract
- The aim of the study was to investigate what characterizes IHCAs that take place during the "day" (Monday-Friday 7am-3pm), "evening" (Monday-Friday 3pm-9pm) and "night" (Monday-Friday 9pm-7am and Saturday-Sunday 12am- 11.59pm).We used the Swedish Registry for CPR (SRCR) to study 26,595 patients from January 1, 2008 to December 31, 2019. Adult patients ≥18years with a IHCA where resuscitation was initiated were included. Uni- and multivariable logistic regression was used to investigate associations between temporal factors and survival to 30days.30-day survival and Return of Spontaneous Circulation (ROSC) was 36.8% and 67.9% following CA during the day and decreased during the evening (32.0% and 66.3%) and night (26.2% and 60.2%) (p<0.001 and p=0.028). When comparing the survival rates between the day and the night, survival decreased more (change in relative survival rates) in small (<99 beds) compared to large (<400) hospitals (35.9% vs 25%), in non-academic vs academic hospitals (33.5% vs 22%) and on non-Electro Cardiogram (ECG)-monitored wards vs ECG-monitored wards (46.2% vs 20.9%) (p<0.001 for all). IHCAs that took place during the day (adjusted Odds Ratio (aOR) 1.47 95% CI 1.35-1.60), in academic hospitals (aOR 1.14 95% CI 1.02-1.27) and in large (>400 beds) hospitals (aOR 1.31 95% CI 1.10-1.55) were independently associated with an increased chance of survival.Patients suffering an IHCA have an increased chance of survival during the day vs the evening vs night, and the difference in survival is even more pronounced when cared for at smaller, non-academic hospitals, general wards and wards without ECG-monitoring capacity.
|
|
| 29. |
- Lindgren, Johan, et al.
(author)
-
Biochemistry and adaptive colouration of an exceptionally preserved juvenile fossil sea turtle
- 2017
-
In: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 7:1
-
Journal article (peer-reviewed)abstract
- The holotype (MHM-K2) of the Eocene cheloniine Tasbacka danica is arguably one of the best preserved juvenile fossil sea turtles on record. Notwithstanding compactional flattening, the specimen is virtually intact, comprising a fully articulated skeleton exposed in dorsal view. MHM-K2 also preserves, with great fidelity, soft tissue traces visible as a sharply delineated carbon film around the bones and marginal scutes along the edge of the carapace. Here we show that the extraordinary preservation of the type of T. danica goes beyond gross morphology to include ultrastructural details and labile molecular components of the once-living animal. Haemoglobin-derived compounds, eumelanic pigments and proteinaceous materials retaining the immunological characteristics of sauropsid-specific β-keratin and tropomyosin were detected in tissues containing remnant melanosomes and decayed keratin plates. The preserved organics represent condensed remains of the cornified epidermis and, likely also, deeper anatomical features, and provide direct chemical evidence that adaptive melanism - a biological means used by extant sea turtle hatchlings to elevate metabolic and growth rates - had evolved 54 million years ago. © 2017 The Author(s).
|
|
| 30. |
- Lindgren, Johan, et al.
(author)
-
Interpreting melanin-based coloration through deep time : A critical Review
- 2015
-
In: Proceedings of the Royal Society of London. Biological Sciences. - : Royal Society of London. - 0962-8452 .- 1471-2954. ; 282:1813
-
Research review (peer-reviewed)abstract
- Colour, derived primarily from melanin and/or carotenoid pigments, is integral to many aspects of behaviour in living vertebrates, including social signalling, sexual display and crypsis. Thus, identifying biochromes in extinct animals can shed light on the acquisition and evolution of these biological traits. Both eumelanin and melanin-containing cellular organelles (melanosomes) are preserved in fossils, but recognizing traces of ancient melanin-based coloration is fraught with interpretative ambiguity, especially when observations are based on morphological evidence alone. Assigning microbodies (or, more often reported, their ‘mouldic impressions’) as melanosome traces without adequately excluding a bacterial origin is also problematic because microbes are pervasive and intimately involved in organismal degradation. Additionally, some forms synthesize melanin. In this review, we survey both vertebrate and microbial melanization, and explore the conflicts influencing assessment of microbodies preserved in association with ancient animal soft tissues.We discuss the types of data used to interpret fossil melanosomes and evaluate whether these are sufficient for definitive diagnosis. Finally, we outline an integrated morphological and geochemical approach for detecting endogenous pigment remains and associated microstructures in multimillion-year-old fossils.
|
|
| 31. |
- Lundin, Andreas, et al.
(author)
-
Drug therapy in cardiac arrest : a review of the literature
- 2016
-
In: European heart journal. Cardiovascular pharmacotherapy. - : Oxford University Press (OUP). - 2055-6845 .- 2055-6837. ; 2:1, s. 54-75
-
Journal article (peer-reviewed)abstract
- The aim of this study was to review the literature on human studies of drug therapy in cardiac arrest during the last 25 years. In May 2015, a systematic literature search was performed in PubMed, Embase, the Cochrane Library, and CRD databases. Prospective interventional and observational studies evaluating a specified drug therapy in human cardiac arrest reporting a clinical endpoint [i.e. return of spontaneous circulation (ROSC) or survival] and published in English 1990 or later were included, whereas animal studies, case series and reports, studies of drug administration, drug pharmacology, non-specified drug therapies, preventive drug therapy, drug administration after ROSC, studies with primarily physiological endpoints, and studies of traumatic cardiac arrest were excluded. The literature search identified a total of 8936 articles. Eighty-eight articles met our inclusion criteria and were included in the review. We identified no human study in which drug therapy, compared with placebo, improved long-term survival. Regarding adrenaline and amiodarone, the drugs currently recommended in cardiac arrest, two prospective randomized placebo-controlled trials, were identified for adrenaline, and one for amiodarone, but they were all underpowered to detect differences in survival to hospital discharge. Of all reviewed studies, only one recent prospective study demonstrated improved neurological outcome with one therapy over another using a combination of vasopressin, steroids, and adrenaline as the intervention compared with standard adrenaline administration. The evidence base for drug therapy in cardiac arrest is scarce. However, many human studies on drug therapy in cardiac arrest have not been powered to identify differences in important clinical outcomes such as survival to hospital discharge and favourable neurological outcome. Efforts are needed to initiate large multicentre prospective randomized clinical trials to evaluate both currently recommended and future drug therapies.
|
|
| 32. |
- Lyth, Johan, 1980-, et al.
(author)
-
Cost-effectiveness of population screening for atrial fibrillation : the STROKESTOP study
- 2023
-
In: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 3:3, s. 196-204
-
Journal article (peer-reviewed)abstract
- Aims Previous studies on the cost-effectiveness of screening for atrial fibrillation (AF) are based on assumptions of long-term clinical effects. The STROKESTOP study, which randomised 27 975 persons aged 75/76 years into a screening invitation group and a control group, has a median follow-up time of 6.9 years. The aim of this study was to estimate the cost-effectiveness of population-based screening for AF using clinical outcomes. Methods and results The analysis is based on a Markov cohort model. The prevalence of AF, the use of oral anticoagulation, clinical event data, and all-cause mortality were taken from the STROKESTOP study. The cost for clinical events, age-specific utilities, utility decrement due to stroke, and stroke death was taken from the literature. Uncertainty in the model was considered in a probabilistic sensitivity analysis. Per 1000 individuals invited to the screening, there were 77 gained life years and 65 gained quality-adjusted life years. The incremental cost was euro1.77 million lower in the screening invitation group. Gained quality-adjusted life years to a lower cost means that the screening strategy was dominant. The result from 10 000 Monte Carlo simulations showed that the AF screening strategy was cost-effective in 99.2% and cost-saving in 92.7% of the simulations. In the base-case scenario, screening of 1000 individuals resulted in 10.6 [95% confidence interval (CI): -22.5 to 1.4] fewer strokes (8.4 ischaemic and 2.2 haemorrhagic strokes), 1.0 (95% CI: -1.9 to 4.1) more cases of systemic embolism, and 2.9 (95% CI: -18.2 to 13.1) fewer bleedings associated with hospitalization. Conclusion Based on the STROKESTOP study, this analysis shows that a broad AF screening strategy in an elderly population is cost-effective. Efforts should be made to increase screening participation.
|
|
| 33. |
|
|
| 34. |
- Thorén, Anna, et al.
(author)
-
Rapid response team activation prior to in-hospital cardiac arrest: Areas for improvements based on a national cohort study
- 2023
-
In: Resuscitation. - 0300-9572 .- 1873-1570. ; 193
-
Journal article (peer-reviewed)abstract
- Introduction: Rapid response teams (RRTs) are designed to improve the "chain of prevention" of in-hospital cardiac arrest (IHCA). We studied the 30-day survival of patients reviewed by RRTs within 24 hours prior to IHCA, as compared to patients not reviewed by RRTs.Methods: A nationwide cohort study based on the Swedish Registry of Cardiopulmonary Resuscitation, between January 1st, 2014, and December 31st, 2021. An explorative, hypothesis-generating additional in-depth data collection from medical records was performed in a small subgroup of general ward patients reviewed by RRTs.Results: In all, 12,915 IHCA patients were included. RRT-reviewed patients (n = 2,058) had a lower unadjusted 30-day survival (25% vs 33%, p < 0.001), a propensity score based Odds ratio for 30-day survival of 0.92 (95% Confidence interval 0.90-0.94, p < 0.001) and were more likely to have a respiratory cause of IHCA (22% vs 15%, p < 0.001). In the subgroup (n = 82), respiratory distress was the most common RRT trigger, and 24% of the RRT reviews were delayed. Patient transfer to a higher level of care was associated with a higher 30-day survival rate (20% vs 2%, p < 0.001).Conclusion: IHCA preceded by RRT review is associated with a lower 30-day survival rate and a greater likelihood of a respiratory cause of cardiac arrest. In the small explorative subgroup, respiratory distress was the most common RRT trigger and delayed RRT activation was frequent. Early detection of respiratory abnormalities and timely interventions may have a potential to improve outcomes in RRT-reviewed patients and prevent further progress into IHCA.
|
|
| 35. |
- Aronsson, Mattias, et al.
(author)
-
Cost-effectiveness of mass screening for untreated atrial fibrillation using intermittent ECG recording
- 2015
-
In: Europace. - : Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY. - 1099-5129 .- 1532-2092. ; 17:7, s. 1023-1029
-
Journal article (peer-reviewed)abstract
- Aims The aim of this study was to estimate the cost-effectiveness of 2 weeks of intermittent screening for asymptomatic atrial fibrillation (AF) in 75/76-year-old individuals. Methods and results The cost-effectiveness analysis of screening in 75-year-old individuals was based on a lifelong decision analytic Markov model. In this model, 1000 hypothetical individuals, who matched the population of the STROKESTOP study, were simulated. The population was analysed for different parameters such as prevalence, AF status, treatment with oral anticoagulation, stroke risk, utility, and costs. In the base-case scenario, screening of 1000 individuals resulted in 263 fewer patient-years with undetected AF. This implies eight fewer strokes, 11 more life-years, and 12 more quality-adjusted life years (QALYs) per 1000 screened individuals. The screening implies an incremental cost of (sic)50 012, resulting in a cost of (sic)4313 per gained QALY and (sic)6583 per avoided stroke. Conclusions With the use of a decision analytic simulation model, it has been shown that screening for asymptomatic AF in 75/76-year-old individuals is cost-effective.
|
|
| 36. |
- Aronsson, Mattias, 1989-, et al.
(author)
-
Designing an optimal screening program for unknown atrial fibrillation : a cost-effectiveness analysis.
- 2017
-
In: Europace. - Oxford : Oxford University Press. - 1099-5129 .- 1532-2092. ; 19:10, s. 1650-1656
-
Journal article (peer-reviewed)abstract
- Aims: The primary objective of this study was to use computer simulations to suggest an optimal age for initiation of screening for unknown atrial fibrillation and to evaluate if repeated screening will add value.Methods and results: In the absence of relevant clinical studies, this analysis was based on a simulation model. More than two billion different designs of screening programs for unknown atrial fibrillation were simulated and analysed. Data from the published scientific literature and registries were used to construct the model and estimate lifelong effects and costs. Costs and effects generated by 2 147 483 648 different screening designs were calculated and compared. Program designs that implied worse clinical outcome and were less cost-effective compared to other programs were excluded from the analysis. Seven program designs were identified, and considered to be cost effective depending on what the health-care decision makers are ready to pay for gaining a quality-adjusted life-year (QALY). Screening at the age of 75 implied the lowest cost per gained QALY (€4 800/QALY).Conclusion: In conclusion, examining the results of more than two billion simulated screening program designs for unknown atrial fibrillation, seven designs were deemed cost-effective depending on how much we are prepared to pay for gaining QALYs. Our results showed that repeated screening for atrial fibrillation implied additional health benefits to a reasonable cost compared to one-off screening.
|
|
| 37. |
- Atterman, Adriano, et al.
(author)
-
Net benefit of oral anticoagulants in patients with atrial fibrillation and active cancer : a nationwide cohort study
- 2020
-
In: Europace. - : Oxford University Press. - 1099-5129 .- 1532-2092. ; 22:1, s. 58-65
-
Journal article (peer-reviewed)abstract
- Aims: To estimate the net cerebrovascular benefit of prophylactic treatment with oral anticoagulants (OACs) in patients with atrial fibrillation (AF) and active cancer.Methods and results: We included all Swedish patients who had been diagnosed with AF in a hospital or in a hospital-associated outpatient unit between 1 July 2005 and 1 October 2017. Patients with active cancer (n = 22 596) and without cancer (n = 440 848) were propensity score matched for the likelihood of receiving OACs at baseline. At baseline, 38.3% of cancer patients with AF and high stroke risk according to CHA2DS2-VASc score received OACs. There was a net benefit of OACs, assessed by the composite outcome of ischaemic stroke, extracranial arterial thromboembolism, all major bleedings, and death, both among patients with active cancer [hazard ratio (HR): 0.81, confidence interval (CI): 0.78-0.85] and among patients without cancer (HR: 0.81, CI: 0.80-0.82). When limiting follow-up to 1 year to minimize the effects of possible treatment cross-over and additionally accounting for death as a competing risk in cancer patients, a net cerebrovascular benefit regarding ischaemic stroke or intracranial bleeding was observed for OACs [subhazard ratio (sHR): 0.67, CI: 0.55-0.83]. A net cerebrovascular benefit was also seen for non-vitamin K antagonist OACs over warfarin after competing risk analyses in cancer patients (sHR: 0.65, CI: 0.48-0.88).Conclusion: Patients with AF and active cancer benefit from OAC treatment.
|
|
| 38. |
- Aune, S, et al.
(author)
-
Improvement in the hospital organisation of CPR training and outcome after cardiac arrest in Sweden during a 10-year period
- 2011
-
In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 82:4, s. 431-435
-
Journal article (peer-reviewed)abstract
- Aim To describe (a) changes in the organisation of training in cardiopulmonary resuscitation (CPR) and the treatment of cardiac arrest in hospital in Sweden and (b) the clinical achievement, i.e. survival and cerebral function, among survivors after in-hospital cardiac arrest (IHCA) in Sweden. Methods Aspects of CPR training among health care providers (HCPs) and treatment of IHCA in Sweden were evaluated in 3 national surveys (1999, 2003 and 2008). Patients with IHCA are recorded in a National Register covering two thirds of Swedish hospitals. Results The proportion of hospitals with a CPR coordinator increased from 45% in 1999 to 93% in 2008. The majority of co-ordinators are nurses. The proportions of hospitals with local guidelines for acceptable delays from cardiac arrest to the start of CPR and defibrillation increased from 48% in 1999 to 88% in 2008. The proportion of hospitals using local defibrillation outside intensive care units prior to arrival of rescue team increased from 55% in 1999 to 86% in 2008. During the past 4 years in Sweden, survival to hospital discharge has been 29%. Among survivors, 93% have a cerebral performance category (CPC) score of I or II, indicating acceptable cerebral function. Conclusion During the last 10 years, there was a marked improvement in CPR training and treatment of IHCA in Sweden. During the past 4 years, survival after IHCA is high and the majority of survivors have acceptable cerebral function.
|
|
| 39. |
- Axelsson, Christer, et al.
(author)
-
Outcome after out-of-hospital cardiac arrest witnessed by EMS : changes over time and factors of importance for outcome in Sweden.
- 2012
-
In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 83:10, s. 1253-1258
-
Journal article (peer-reviewed)abstract
- Background Among patients who survive after out-of-hospital cardiac arrest (OHCA), a large proportion are recruited from cases witnessed by the Emergency Medical Service (EMS), since the conditions for success are most optimal in this subset. Aim To evaluate outcome after EMS-witnessed OHCA in a 20-year perspective in Sweden, with the emphasis on changes over time and factors of importance. Methods All patients included in the Swedish Cardiac Arrest Register from 1990 to 2009 were included. Results There were 48,349 patients and 13.5% of them were EMS witnessed. There was a successive increase in EMS-witnessed OHCA from 8.5% in 1992 to 16.9% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, the survival to one month increased from 13.9% in 1992 to 21.8% in 2009 (p for trend < 0.0001). Among EMS-witnessed OHCA, 51% were found in ventricular fibrillation, which was higher than in bystander-witnessed OHCA, despite a lower proportion with a presumed cardiac aetiology in the EMS-witnessed group. Among EMS-witnessed OHCA overall, 16.0% survived to one month, which was significantly higher than among bystander-witnessed OHCA. Independent predictors of a favourable outcome were: (1) initial rhythm ventricular fibrillation; (2) cardiac aetiology; (3) OHCA outside home and (4) decreasing age. Conclusion In Sweden, in a 20-year perspective, there was a successive increase in the proportion of EMS-witnessed OHCA. Among these patients, survival to one month increased over time. EMS-witnessed OHCA had a higher survival than bystander-witnessed OHCA. Independent predictors of an increased chance of survival were initial rhythm, aetiology, place and age.
|
|
| 40. |
- Bjerva, Johannes, et al.
(author)
-
Anticipatory Looking in Infants and Adults
- 2011
-
In: Proceedings of EyeTrackBehavior 2011.
-
Conference paper (other academic/artistic)abstract
- Infant language acquisition research faces the challenge of dealing with subjects who are unable to provide spoken answers to research questions. To obtain comprehensible data from such subjects eye tracking is a suitable research tool, as the infants’ gaze can be interpreted as behavioural responses. The purpose of the current study was to investigate the amount of training necessary for participants to learn an audio-visual contingency and present anticipatory looking behaviour in response to an auditory stimulus. Infants (n=22) and adults (n=16) were presented with training sequences, every fourth of which was followed by a test sequence. Training sequences contained implicit audio-visual contingencies consisting of a syllable (/da/ or /ga/) followed by an image appearing on the left/right side of the screen. Test sequences were identical to training sequences except that no image appeared. The latency in time to first fixation towards the non-target area during test sequences was used as a measurement of whether the participants had grasped the contingency. Infants were found to present anticipatory looking behaviour after 24 training trials. Adults were found to present anticipatory looking behaviour after 28-36 training trials. In future research a more interactive experiment design will be employed in order to individualise the amount of training, which will increase the time span available for testing.
|
|
| 41. |
- Bjerva, Johannes, et al.
(author)
-
Preceding non-linguistic stimuli affect categorisation of Swedish plosives
- 2012
-
In: Journal of the Acoustical Society of America. - : Acoustical Society of America (ASA). - 0001-4966 .- 1520-8524. ; 131:4
-
Journal article (peer-reviewed)abstract
- Speech perception is highly context-dependent. Sounds preceding speech stimuli affect how listeners categorise the stimuli, regardless of whether the context consists of speech or non-speech. This effect is acoustically contrastive; a preceding context with high-frequency acoustic energy tends to skew categorisation towards speech sounds possessing lower-frequency acoustic energy and vice versa (Mann, 1980; Holt, Lotto, Kluender, 2000; Holt, 2005). Partially replicating Holt's study from 2005, the present study investigates the effect of non-linguistic contexts in different frequency bands on speech categorisation. Adult participants (n=15) were exposed to Swedish syllables from a speech continuum ranging from /da/ to /ga/ varying in the onset frequencies of the second and third formants in equal steps. Contexts preceding the speech stimuli consisted of sequences of sine tones distributed in different frequency bands: high, mid and low. Participants were asked to categorise the syllables as /da/ or /ga/. As hypothesised, high frequency contexts shift the category boundary towards /da/, while lower frequency contexts shift the boundary towards /ga/, compared to the mid frequency context.
|
|
| 42. |
- Brandes, Axel, et al.
(author)
-
Consumer-Led Screening for Atrial Fibrillation : Frontier Review of the AF-SCREEN International Collaboration
- 2022
-
In: Circulation. - 0009-7322 .- 1524-4539. ; 146:19, s. 1461-1474
-
Research review (peer-reviewed)abstract
- The technological evolution and widespread availability of wearables and handheld ECG devices capable of screening for atrial fibrillation (AF), and their promotion directly to consumers, has focused attention of health care professionals and patient organizations on consumer-led AF screening. In this Frontiers review, members of the AF-SCREEN International Collaboration provide a critical appraisal of this rapidly evolving field to increase awareness of the complexities and uncertainties surrounding consumer-led AF screening. Although there are numerous commercially available devices directly marketed to consumers for AF monitoring and identification of unrecognized AF, health care professional-led randomized controlled studies using multiple ECG recordings or continuous ECG monitoring to detect AF have failed to demonstrate a significant reduction in stroke. Although it remains uncertain if consumer-led AF screening reduces stroke, it could increase early diagnosis of AF and facilitate an integrated approach, including appropriate anticoagulation, rate or rhythm management, and risk factor modification to reduce complications. Companies marketing AF screening devices should report the accuracy and performance of their products in high- and low-risk populations and avoid claims about clinical outcomes unless improvement is demonstrated in randomized clinical trials. Generally, the diagnostic yield of AF screening increases with the number, duration, and temporal dispersion of screening sessions, but the prognostic importance may be less than for AF detected by single-time point screening, which is largely permanent, persistent, or high-burden paroxysmal AF. Consumer-initiated ECG recordings suggesting possible AF always require confirmation by a health care professional experienced in ECG reading, whereas suspicion of AF on the basis of photoplethysmography must be confirmed with an ECG. Consumer-led AF screening is unlikely to be cost-effective for stroke prevention in the predominantly young, early adopters of this technology. Studies in older people at higher stroke risk are required to demonstrate both effectiveness and cost-effectiveness. The direct interaction between companies and consumers creates new regulatory gaps in relation to data privacy and the registration of consumer apps and devices. Although several barriers for optimal use of consumer-led screening exist, results of large, ongoing trials, powered to detect clinical outcomes, are required before health care professionals should support widespread adoption of consumer-led AF screening.
|
|
| 43. |
- De La Garza, Randolph Glenn, et al.
(author)
-
An ancestral hard-shelled sea turtle with a mosaic of soft skin and scutes
- 2022
-
In: Scientific Reports. - : Nature Research. - 2045-2322. ; 12:1
-
Journal article (peer-reviewed)abstract
- The transition from terrestrial to marine environments by secondarily aquatic tetrapods necessitates a suite of adaptive changes associated with life in the sea, e.g., the scaleless skin in adult individuals of the extant leatherback turtle. A partial, yet exceptionally preserved hard-shelled (Pan-Cheloniidae) sea turtle with extensive soft-tissue remains, including epidermal scutes and a virtually complete flipper outline, was recently recovered from the Eocene Fur Formation of Denmark. Examination of the fossilized limb tissue revealed an originally soft, wrinkly skin devoid of scales, together with organic residues that contain remnant eumelanin pigment and inferred epidermal transformation products. Notably, this stem cheloniid—unlike its scaly living descendants—combined scaleless limbs with a bony carapace covered in scutes. Our findings show that the adaptive transition to neritic waters by the ancestral pan-chelonioids was more complex than hitherto appreciated, and included at least one evolutionary lineage with a mosaic of integumental features not seen in any living turtle. © 2022, The Author(s).
|
|
| 44. |
|
|
| 45. |
- Engdahl, Henrik, et al.
(author)
-
Statistical Data for Free-floating Car Sharing versusPublic Transport
- 2017
-
Conference paper (peer-reviewed)abstract
- Free-floating car sharing is a form of car rental used by people for short periods of time where the cars canbe picked up and returned anywhere within a given area. In this paper, we have collected free-floating carsharing data, for electric as well as fossil fueled cars, and data for alternative trips using cycling, walking andpublic transport for the cities of Amsterdam, Berlin, Denver, Madrid, San Diego and Seattle. From this data,free-floating car sharing seems to be a compliment to other type of transports, including public transports,bicycling and walking, and not a competitor.
|
|
| 46. |
- Engdahl, Johan, et al.
(author)
-
Acoustic analysis of adults imitating infants : a cross-linguistic perspective
- 2012
-
In: Journal of the Acoustical Society of America. - : Acoustical Society of America (ASA). - 0001-4966 .- 1520-8524. ; 131:4
-
Journal article (peer-reviewed)abstract
- The present study investigates adult imitations of infant vocalizations in a cross-linguistic perspective. Japanese-learning and Swedish-learning infants were recorded at ages 16-21 and 78-79 weeks. Vowel-like utterances (n=210) were selected from the recordings and presented to Japanese (n=3) and Swedish (n=3) adults. The adults were asked to imitate what they heard, simulating a spontaneous feedback situation between caregiver and infant. Formant data (F1 and F2) was extracted from all utterances and validated by comparing original and formant re-synthesized utterances. The data was normalized for fundamental frequency and time, and the accumulated spectral difference was calculated between each infant utterance and each imitation of that utterance. The mean spectral difference was calculated and compared, grouped by native language of infant and adult, as well as age of the infant. Preliminary results show smaller spectral difference in the imitations of older infants compared to imitations of the younger group, regardless of infant and adult native language. This may be explained by the increasing stability and more speech-like quality of infants' vocalizations as they grow older (and thus have been exposed to their native language for a longer period of time), making their utterances easier for adults to imitate.
|
|
| 47. |
- Engdahl, J, et al.
(author)
-
Can we define patients with no and those with some chance of survival when found in asystole out of hospital?
- 2000
-
In: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 86:6, s. 610-614
-
Journal article (peer-reviewed)abstract
- We describe the epidemiology, prognosis, and circumstances at resuscitation among a consecutive population of patients with out-of-hospital cardiac arrest (OHCA) with asystole as the arrhythmia first recorded by the Emergency Medical Service (EMS), and identify factors associated with survival. We included all patients in the municipality of Göteborg, regardless of age and etiology, who experienced an OHCA between 1981 and 1997. There were a total of 4,662 cardiac arrests attended by the EMS during the study period. Of these, 1,635 (35%) were judged as having asystole as the first-recorded arrhythmia: 156 of these patients (10%) were admitted alive to hospital, and 32 (2%) were discharged alive. Survivors were younger (median age 58 vs 68 years) and had a witnessed cardiac arrest more often than nonsurvivors (78% vs 50%). Survivors also had shorter intervals from collapse to arrival of ambulance (3.5 vs 6 minutes) and the mobile coronary care unit (MCCU) (5 vs 10 min), and they received atropine less often on scene. There were also a greater proportion of survivors with noncardiac etiologies of cardiac arrest (48% vs 27%). Survivors to discharge also displayed higher degrees of consciousness on arrival to the emergency department in comparison to nonsurvivors. Multivariate analysis among all patients with asystole indicated age (p = 0.01) and witnessed arrest (p = 0.03) as independent predictors of an increased chance of survival. Multivariate analysis among witnessed arrests indicated short time to arrival of the MCCU (p < 0.001) and no treatment with atropine (p = 0.05) as independent predictors of survival. Fifty-five percent of patients discharged alive had none or small neurologic deficits (cerebral performance categories 1 or 2). No patients > 70 years old with unwitnessed arrests (n = 211) survived to discharge.
|
|
| 48. |
- Engdahl, J, et al.
(author)
-
Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology.
- 2003
-
In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 57:1, s. 33-41
-
Journal article (peer-reviewed)abstract
- AIM: To describe the epidemiology for out of hospital cardiac arrest of a non-cardiac aetiology. PATIENTS: All patients suffering from out of hospital cardiac arrest in whom resuscitation efforts were attempted in the community of Göteborg between 1981 and 2000. METHODS: Between October 1, 1980 and October 1, 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed up to discharge from hospital. RESULTS: In all, 5415 patients participated in the evaluation. Among them 1360 arrests (25%) were judged to be of a non-cardiac aetiology. Among these 24% were caused by a surgical cause or accident, 20% by obstructive pulmonary disease, 13% by drug abuse and the remaining 43% by 'another cause'. Of the patients with out of hospital cardiac arrest of a non-cardiac aetiology 4.0% survived to discharge from hospital as compared with 10.1% of the patients with a cardiac aetiology (P<0.0001). In the various subgroups survival was highest in those with drug abuse (6.8%) and lowest in those with 'another cause' (4.2%). Cerebral performance categories (CPC) score at hospital discharge tended to be worse among survivors from an arrest of non-cardiac than cardiac aetiology. Patients with a cardiac arrest of a non-cardiac aetiology differed from the remaining patients by being younger, including more women, less frequently having a witnessed arrest and less frequently being found in ventricular fibrillation/tachycardia. When simultaneously considering age, sex, witnessed status, presence of bystander cardiopulmonary resuscitation (CPR) and initial arrhythmia, the aetiology (non-cardiac vs. cardiac aetiology) was not an independent predictor of survival. CONCLUSION: Among patients with out of hospital cardiac arrest in whom resuscitation was attempted 25% were judged to be of a non-cardiac aetiology. These patients had a lower survival than patients with a cardiac arrest of cardiac aetiology. However, this was mainly explained by a lower occurrence of ventricular fibrillation and witnessed cardiac arrest.
|
|
| 49. |
- Engdahl, J, et al.
(author)
-
Factors affecting short and long term prognosis among 1069 patients with out-of-hospital cardiac arrest and pulseless electrical activity
- 2001
-
In: Resuscitation. - : Elsevier Ireland Ltd. - 0300-9572 .- 1873-1570. ; 51:1, s. 17-25
-
Journal article (peer-reviewed)abstract
- Aims: To describe the epidemiology, resuscitation factors and prognosis among a consecutive population of patients suffering from out-of-hospital cardiac arrest (OHCA) where pulseless electrical activity (PEA) was the first arrhythmia recorded on emergency medical services (EMS) arrival. Methods: Analysis of data collected prospectively on all patients regardless of age succumbing to OHCA during 1980–1997 in the community of Gothenburg where EMS initiated resuscitative measures. Results: 4662 patients with OHCA were attended by the EMS during the study period. Of these, 1069 (23%) were judged as having PEA as the first recorded arrhythmia; 158 (15%) of these were admitted alive to hospital and 26 (2.4%) were discharged alive. Survivors to discharge had a significantly larger share of bystander cardiopulmonary resuscitation (CPR) (28 vs. 8%, P=0.008), significantly higher levels of consciousness (8% awake vs. 0%, P<0.001) and higher median systolic blood pressure (145 vs. 106 mmHg, P<0.001) on arrival at hospital. No patient with unwitnessed cardiac arrest and PEA over 80 years old survived. Conclusion: Survival among patients suffering from OHCA and PEA is poor, especially among the elderly unwitnessed cases and those who do not receive bystander CPR. The latter seems to be of utmost importance among these patients.
|
|
| 50. |
- Engdahl, Johan, 1968, et al.
(author)
-
Geographic and socio-demographic differences in uptake of population-based screening for atrial fibrillation: The STROKESTOP I study
- 2016
-
In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 222, s. 430-435
-
Journal article (peer-reviewed)abstract
- BACKGROUND: The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-demographic differences are expected to affect screening uptake. Geographic differences may provide further insights leading to targeted interventions for improved uptake. The objective of this study was to evaluate geographic and socio-demographic differences in uptake of AF screening in the population-based study STROKESTOP I. METHODS: STROKESTOP was carried out in two Swedish counties with a total population of 2.3 million inhabitants. Half of the residents aged 75-76years were randomized to the screening arm: invitation to clinical examination followed by ambulant ECG recording. Information on each invited person's residential parish (n=157) was used. On parish-level, aggregated data for the participants and non-participants, respectively, were obtained with respect to socioeconomic variables: educational level, disposable income, immigrant and marital status. Geo-maps displaying participation ratios were estimated by hierarchical Bayes methods. RESULTS: The overall participation rate was similar in men and women but lower in Stockholm, 47.6% (5665/11,903) than in Halland, 61.2% (1495/2443). Participation was clearly associated with the socioeconomic variables. Participation not taking into account socioeconomy varied more markedly across the parishes in the Stockholm county (range: 0.65-1.26) than in the Halland county (0.94-1.27). After adjustment for socioeconomic variables, a geographic variation remained in Stockholm, but not in Halland. CONCLUSION: Participation in AF screening varied according to socioeconomic conditions. Geographic variation in participation was marked in the Stockholm county, with only one screening clinic. Geo-mapping of participation yielded useful information needed to intervene for improved screening uptake.
|
|
