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- Bögl, Hans Peter, 1969-
(author)
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Atypical femoral fractures: Another brick in the wall : On aspects of healing, treatment strategies and surveillance
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Atypical femoral fractures are stress fractures of the femoral subtrochanteric and diaphyseal region. It is a common notion that these fractures heal poorly, if at all. In this thesis we show that patients with atypical femoral fractures have a good capacity to generate bone and therefore heal fractures. In daily practice, these patients have a higher risk for reoperation when compared with patients with a normal femoral fracture. However, this risk is less likely to be dependent on the type of fracture than other factors such as age, gender, comorbidities and survival. Using an implant that protects the fragile proximal femur, the risk for reoperations can be attenuated dramatically. An intramedullary nail with fixation of the femoral neck protects the femur from subsequent hip fractures – the most common complication in elderly patients with any type of femoral shaft fracture.Atypical femoral fractures are difficult to identify in the population. Erroneous diagnosis coding, poor reporting of adverse drug reactions and low accuracy of radiology reports make the identification and surveillance a difficult task. The Swedish Fracture Register has provided the option to register this special fracture since 2015. With its physician-based registration process, it enables researchers and treating physicians to identify and follow these rare fractures longitudinally.
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- Mohammad Ismail, Ahmad, 1993-
(author)
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The Association Between Beta-Blocker Therapy and Mortality in Hip Fracture Patients
- 2022
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Doctoral thesis (other academic/artistic)abstract
- Hip fractures have been a major concern within the healthcare systems for many years. National efforts have been done to improve the overall outcomes during the last decades. Despite this, the mortality rates one year after hip fracture surgery are as high as 27% and have remained high the past 15 years. Patients that suffer from hip fractures are often elderly and have several comorbidities. The orthopaedic trauma and subsequent emergency surgery impose an activation of the sympathetic nervous system mediated through the release of catecholamines. This causes a hyper-adrenergic state, which can be harmful if prolonged, or if the patient already has a strain caused by comorbidities forgoing the injury, especially on the cardiovascular system. This gave rise to the thought of blocking the adrenergic receptor activation in hip fracture patients as an effort to reduce the mortality rates.Papers I and II investigates the association between beta-blocker therapy and short-term mortality in hip fracture patients. In Paper I, (n=2443) patients operated in Orebro County between 2013 to 2017 were extracted from The National Quality Register for Hip Fractures (Rikshöft), to enable a more detailed review of the medical journals. The patients were divided into a betablocker cohort and a beta-blocker naive cohort. Results showed an 18% reduction in the risk of postoperative mortality within 90 days of surgery. In Paper II, all adults operated for traumatic hip fractures in Sweden between 2008 to 2017 were extracted from The National Quality Register for Hip Fractures and then cross-referenced with data from registers of The National Board of Health and Welfare. This resulted in a total of 134,915 patients eligible for analysis. The results demonstrated a 72% risk reduction in postoperative mortality within 30 days of surgery in the cohort with ongoing beta-blocker therapy.Paper III explored if the effect seen in Paper I-II remains up to one year using the same database as Paper II. The results demonstrated that the association between beta-blocker therapy and reduction in the risk of mortality,extending up to one year postoperatively, with the main effect seen during the first postoperative period.Paper IV investigates the interaction between the Revised Cardiac Risk Index and beta-blocker therapy related to 30-day post-operative mortality. This study concluded that all geriatric hip fracture patients could benefit from beta-blockers, but a more pronounced effect was seen in those with cardiac risk factors.
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- Bergström, Göran, 1964, et al.
(author)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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