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Yndigegn T, Lindahl B, Mars K, Alfredsson J, Benatar J, Brandin L, Erlinge D, Hallen O, Held C, Hjalmarsson P, Johansson P, Karlström P, Kellerth T, Marandi T, Ravn-Fischer A, Sundström J, Östlund O, Hofmann R, Jernberg T. Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. N Engl J Med 2024; 390:1372-1381. [PMID: 38587241 DOI: 10.1056/nejmoa2401479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Most trials that have shown a benefit of beta-blocker treatment after myocardial infarction included patients with large myocardial infarctions and were conducted in an era before modern biomarker-based diagnosis of myocardial infarction and treatment with percutaneous coronary intervention, antithrombotic agents, high-intensity statins, and renin-angiotensin-aldosterone system antagonists. METHODS In a parallel-group, open-label trial performed at 45 centers in Sweden, Estonia, and New Zealand, we randomly assigned patients with an acute myocardial infarction who had undergone coronary angiography and had a left ventricular ejection fraction of at least 50% to receive either long-term treatment with a beta-blocker (metoprolol or bisoprolol) or no beta-blocker treatment. The primary end point was a composite of death from any cause or new myocardial infarction. RESULTS From September 2017 through May 2023, a total of 5020 patients were enrolled (95.4% of whom were from Sweden). The median follow-up was 3.5 years (interquartile range, 2.2 to 4.7). A primary end-point event occurred in 199 of 2508 patients (7.9%) in the beta-blocker group and in 208 of 2512 patients (8.3%) in the no-beta-blocker group (hazard ratio, 0.96; 95% confidence interval, 0.79 to 1.16; P = 0.64). Beta-blocker treatment did not appear to lead to a lower cumulative incidence of the secondary end points (death from any cause, 3.9% in the beta-blocker group and 4.1% in the no-beta-blocker group; death from cardiovascular causes, 1.5% and 1.3%, respectively; myocardial infarction, 4.5% and 4.7%; hospitalization for atrial fibrillation, 1.1% and 1.4%; and hospitalization for heart failure, 0.8% and 0.9%). With regard to safety end points, hospitalization for bradycardia, second- or third-degree atrioventricular block, hypotension, syncope, or implantation of a pacemaker occurred in 3.4% of the patients in the beta-blocker group and in 3.2% of those in the no-beta-blocker group; hospitalization for asthma or chronic obstructive pulmonary disease in 0.6% and 0.6%, respectively; and hospitalization for stroke in 1.4% and 1.8%. CONCLUSIONS Among patients with acute myocardial infarction who underwent early coronary angiography and had a preserved left ventricular ejection fraction (≥50%), long-term beta-blocker treatment did not lead to a lower risk of the composite primary end point of death from any cause or new myocardial infarction than no beta-blocker use. (Funded by the Swedish Research Council and others; REDUCE-AMI ClinicalTrials.gov number, NCT03278509.).
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Affiliation(s)
- Troels Yndigegn
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Bertil Lindahl
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Katarina Mars
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Joakim Alfredsson
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Jocelyne Benatar
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Lisa Brandin
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - David Erlinge
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Ola Hallen
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Claes Held
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Patrik Hjalmarsson
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Pelle Johansson
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Patric Karlström
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Thomas Kellerth
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Toomas Marandi
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Annica Ravn-Fischer
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Johan Sundström
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Ollie Östlund
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Robin Hofmann
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
| | - Tomas Jernberg
- From the Department of Cardiology, Clinical Sciences, Lund University, and Skåne University Hospital, Lund (T.Y., D.E.), the Department of Medical Sciences, Uppsala University (B.L., C.H., J.S.), and Uppsala Clinical Research Center (B.L., C.H., O.Ö.), Uppsala, the Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset (K.M., R.H.), the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet (P.H., T.J.), and the Heart and Lung Patients Association (P.J.), Stockholm, the Departments of Cardiology (J.A.) and Health, Medicine, and Caring Sciences (J.A., P.K.), Linköping University, Linköping, the Division of Cardiology, Skaraborgs Sjukhus, Skövde (L.B.), the Division of Cardiology and Emergency Medicine, Centralsjukhuset Karlstad, Karlstad (O.H., T.K.), the Department of Internal Medicine, Ryhov County Hospital, Jönköping (P.K.), and the Department of Cardiology, Sahlgrenska University Hospital, and the Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska Academy University of Gothenburg, Gothenburg (A.R.-F.) - all in Sweden; Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand (J.B.); the Department of Cardiology, Institute of Clinical Medicine, University of Tartu, Tartu, and the Center of Cardiology, North Estonia Medical Center, Tallinn - both in Estonia (T.M.); and the George Institute for Global Health, University of New South Wales, Sydney (J.S.)
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