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Shah SJ, Fine N, Garcia-Pavia P, Klein AL, Fernandes F, Weissman NJ, Maurer MS, Boman K, Gundapaneni B, Sultan MB, Elliott P. Effect of Tafamidis on Cardiac Function in Patients With Transthyretin Amyloid Cardiomyopathy: A Post Hoc Analysis of the ATTR-ACT Randomized Clinical Trial. JAMA Cardiol 2024; 9:25-34. [PMID: 37966817 PMCID: PMC10652219 DOI: 10.1001/jamacardio.2023.4147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/11/2023] [Indexed: 11/16/2023]
Abstract
Importance Tafamidis has been shown to improve survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared with placebo. However, its effect on cardiac function has not been fully characterized. Objective To examine the effect of tafamidis on cardiac function in patients with ATTR-CM. Design, Setting, and Participants This was an exploratory, post hoc analysis of the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), a multicenter, international, double-blind, placebo-controlled phase 3 randomized clinical trial conducted from December 2013 to February 2018. The ATTR-ACT included 48 sites in 13 counties and enrolled patients aged 18 to 90 years with ATTR-CM. Data were analyzed from July 2018 to September 2023. Intervention Patients were randomized to tafamidis meglumine, 80 mg or 20 mg, or placebo for 30 months. Main Outcomes and Measures Patients were categorized based on left ventricular (LV) ejection fraction at enrollment as having heart failure with preserved ejection fraction (≥50%), mildly reduced ejection fraction (41% to 49%), or reduced ejection fraction (≤40%). Changes from baseline to month 30 in LV ejection fraction, LV stroke volume, LV global longitudinal strain, and the ratio of early mitral inflow velocity to septal and lateral early diastolic mitral annular velocity (E/e') were compared in patients receiving tafamidis, 80 mg, vs placebo. Results A total of 441 patients were randomized in ATTR-ACT, and 436 patients had available echocardiographic data. Of 436 included patients, 393 (90.1%) were male, and the mean (SD) age was 74 (7) years. A total of 220 (50.5%), 119 (27.3%), and 97 (22.2%) had heart failure with preserved, mildly reduced, and reduced LV ejection fraction, respectively. Over 30 months, there was less pronounced worsening in 4 of the echocardiographic measures in patients receiving tafamidis, 80 mg (n = 176), vs placebo (n = 177) (least squares mean difference: LV stroke volume, 7.02 mL; 95% CI, 2.55-11.49; P = .002; LV global longitudinal strain, -1.02%; 95% CI, -1.73 to -0.31; P = .005; septal E/e', -3.11; 95% CI, -5.50 to -0.72; P = .01; lateral E/e', -2.35; 95% CI, -4.01 to -0.69; P = .006). Conclusions and Relevance Compared with placebo, tafamidis, 80 mg, attenuated the decline of LV systolic and diastolic function over 30 months in patients with ATTR-CM. Approximately half of patients had mildly reduced or reduced LV ejection fraction at enrollment, suggesting that ATTR-CM should be considered as a possible diagnosis in patients with heart failure regardless of underlying LV ejection fraction. Trial Registration ClinicalTrials.gov Identifier: NCT01994889.
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Affiliation(s)
- Sanjiv J. Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nowell Fine
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, CIBERCV and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Neil J. Weissman
- Medstar Health Research Institute, Georgetown University, Washington, DC
| | - Mathew S. Maurer
- Columbia University College of Physicians and Surgeons, New York City, New York
| | - Kurt Boman
- Research Unit, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Olofsson M, Lindmark K, Stålhammar J, Törnblom M, Lundberg A, Wikström G, Boman K. Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study. ESC Heart Fail 2022; 10:295-302. [PMID: 36208123 PMCID: PMC9871701 DOI: 10.1002/ehf2.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/21/2022] [Indexed: 01/29/2023] Open
Abstract
AIMS Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18-84 years) with HF in Sweden. METHODS Incidence of ≥2 HF diagnosis (ICD-10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010-2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality. RESULTS Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co-morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)-related management after diagnosis in primary care (13.6% vs. 6.5%; P < 0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P < 0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all-cause admissions per patient: 1.9 vs. 2.3; P < 0.0001; CVD-related admissions per patient: 1.8 vs. 2.1; P = 0.0004) or prescribed an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β-blocker (45.2% vs. 56.9%; P < 0.0001) or an ACEI/ARB plus a β-blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P < 0.0001). One-year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3-32.7%) out of 1797 patients. CONCLUSIONS Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work-up and subsequent treatment highlight the inequality of care in this vulnerable population.
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Affiliation(s)
- Mona Olofsson
- Research Unit, Medicine‐GeriatricSkellefteå County HospitalSkellefteåSweden,Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Krister Lindmark
- Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive MedicineUppsala UniversityUppsalaSweden
| | | | | | | | - Kurt Boman
- Research Unit, Medicine‐GeriatricSkellefteå County HospitalSkellefteåSweden,Department of Public Health and Clinical MedicineUmeå UniversityUmeåSweden
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Wachtell K, Julius S, Okin PM, Greve AM, Devereux RB, Oparil S, Kjeldsen SE, Boman K. Abstract P221: Cardiovascular Outcomes In Hypertensive Patients Who Discontinue Study Medication In A Large Outcome Trial. The Life Study. Hypertension 2022. [DOI: 10.1161/hyp.79.suppl_1.p221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Patient discontinuation of study medication during a hypertension outcome trial has implications for study power. We aimed to assess patient characteristics and outcomes in patients with hypertension and left ventricular hypertrophy (LVH) who discontinued the study drug but otherwise remained in the study until the end of follow-up.
Methods:
In patients who discontinued vs. those continuing, Cox proportional hazards models identified baseline variables that had a significant impact on the occurrence of the primary composite endpoint (cardiovascular death, stroke, and myocardial infarction) in 9,193 hypertensive patients and LVH in the LIFE study.
Results:
During a mean follow-up of 4.8 years, 3,281 patients (35.7%) discontinued one or more days, not counting death as a reason for discontinuation. The distribution of days to discontinuation was highly skewed towards the first part of the study; the 25
th
percentile was at day 161, and the median was at day 669. Reasons for discontinuation were a clinical adverse event (50%), a secondary study endpoint (19%), required study therapy (11%), withdrawal (2%), administrative (18%), and lost to follow-up (0.2%). Those who discontinued were older, more often male, had slightly lower body mass index, higher systolic and lower diastolic pressure, higher Framingham Risk Score (FRS), and more ECG LVH determined by either Cornell product or Sokolow-Lyon criteria. Patients randomized to losartan discontinued less than those randomized to atenolol. Multivariate analyses showed that older age, male gender, FRS, Sokolow-Lyon criteria, atenolol treatment as well as a history of pre-study myocardial infarction, cerebral vascular disease, peripheral vascular disease, and atrial fibrillation as well as lower levels of hemoglobin, higher serum creatinine and lower cholesterol independently predicted discontinuation.
Conclusions:
Patients discontinued during the first part of the study mainly due to a clinical adverse event. Patients who discontinued the study drug had, on average, more previous and concurrent cardiovascular disease than those who continued until the study ended. Thus, too high risk in an outcome study implies early drug discontinuation and thus reduction in the study power.
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Boman K, Lindmark K, Stålhammar J, Olofsson M, Costa-Scharplatz M, Fonseca AF, Johansson S, Heller V, Törnblom M, Wikström G. Healthcare resource utilisation and costs associated with a heart failure diagnosis: a retrospective, population-based cohort study in Sweden. BMJ Open 2021; 11:e053806. [PMID: 34667015 PMCID: PMC8527145 DOI: 10.1136/bmjopen-2021-053806] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden. DESIGN Retrospective, non-interventional cohort study. SETTING Two cohorts were identified from linked national health registers (cohort 1, 2005-2014) and electronic medical records (cohort 2, 2010-2012; primary/secondary care patients from Uppsala and Västerbotten). PARTICIPANTS Patients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included. OUTCOME MEASURES HRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists. RESULTS Total annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs. CONCLUSIONS HF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.
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Affiliation(s)
- Kurt Boman
- Research Unit, Medicine, Department of Public Health and Clinical Medicine, Umea University, Skellefteå, Sweden
| | - Krister Lindmark
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mona Olofsson
- Research Unit, Medicine, Department of Public Health and Clinical Medicine, Umea University, Skellefteå, Sweden
| | | | | | | | | | - Michael Törnblom
- Real-World & Analytics Solutions, IQVIA Solutions Sweden AB, Solna, Sweden
| | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden
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Lindmark K, Boman K, Stålhammar J, Olofsson M, Lahoz R, Studer R, Proudfoot C, Corda S, Fonseca AF, Costa-Scharplatz M, Levine A, Törnblom M, Castelo-Branco A, Kopsida E, Wikström G. Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Fail 2021; 8:2144-2153. [PMID: 33751806 PMCID: PMC8120394 DOI: 10.1002/ehf2.13296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden. Methods and results Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all‐cause mortality were evaluated. A time‐dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction‐based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient‐years of follow‐up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all‐cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all‐cause mortality increased approximately six‐fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities. Conclusions There is a strong association between recurrent HFHs and CV and all‐cause mortality, with the risk increasing progressively with each recurrent HFH.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine, Heart Centre, Umeå University Hospital, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, S-901 87, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | | | | | | | | | | | | | - Gerhard Wikström
- Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
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Hedman M, Boman K, Brännström M, Wennberg P. Clinical profile of rural community hospital inpatients in Sweden - a register study. Scand J Prim Health Care 2021; 39:92-100. [PMID: 33569976 PMCID: PMC7971215 DOI: 10.1080/02813432.2021.1882086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals. DESIGN Retrospective register study. SETTING Community and general hospitals in Västerbotten and Norrbotten counties, Sweden. PATIENTS Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014. OUTCOME MEASURES Age, sex, number of admissions, main, secondary and total number of diagnoses. RESULTS We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001). CONCLUSIONS Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.Key pointsThe patient characteristics at Swedish general practitioner-led rural community hospitals have not yet been reported. This study characterises inpatients in community hospitals compared to those referred to general hospitals.• Patients at community hospitals were predominantly older, with various medical conditions that would have led to a referral to general hospitals elsewhere in Sweden. • Compared to men, women were more likely to be admitted to community hospitals than to general hospitals, even after adjustment for age. To the best of our knowledge, this pattern has not been reported in other countries with community hospitals. • In both community hospitals and general hospitals, doctors assigned more diagnoses to men than to women.
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Affiliation(s)
- Mante Hedman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- CONTACT Mante Hedman Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Rapezzi C, Elliott P, Damy T, Nativi-Nicolau J, Berk JL, Velazquez EJ, Boman K, Gundapaneni B, Patterson TA, Schwartz JH, Sultan MB, Maurer MS. Efficacy of Tafamidis in Patients With Hereditary and Wild-Type Transthyretin Amyloid Cardiomyopathy: Further Analyses From ATTR-ACT. JACC Heart Fail 2020; 9:115-123. [PMID: 33309574 DOI: 10.1016/j.jchf.2020.09.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/02/2020] [Accepted: 09/18/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Tafamidis is an effective treatment for transthyretin amyloid cardiomyopathy (ATTR-CM), this study aimed to determine whether there is a differential effect between variant transthyretin amyloidosis (ATTRv) and wild-type transthyretin (ATTRwt). BACKGROUND ATTR-CM is a progressive, fatal disorder resulting from mutations in the ATTRv or the deposition of denatured ATTRwt. METHODS In pre-specified analyses from ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), baseline characteristics, all-cause mortality, and change from baseline to month 30 in 6-min walk test distance and Kansas City Cardiomyopathy Questionnaire Overall Summary score were compared in patients with ATTRwt and ATTRv. RESULTS There were 335 patients with ATTRwt (201 tafamidis, 134 placebo) and 106 with ATTRv (63 tafamidis, 43 placebo) enrolled in ATTR-ACT. Patients with ATTRwt (vs. ATTRv) had less advanced disease at baseline and a lower rate of disease progression over the study. The reduction in all-cause mortality with tafamidis compared with placebo was not different between ATTRwt (hazard ratio: 0.706 [95% confidence interval (CI): 0.474 to 1.052]; p = 0.0875) and ATTRv (hazard ratio: 0.690 [95% CI: 0.408 to 1.167]; p = 0.1667). Tafamidis was associated with a similar reduction (vs. placebo) in the decline in 6-min walk test distance in ATTRwt (mean ± SE difference from placebo, 77.14 ± 10.78; p < 0.0001) and ATTRv (79.61 ± 29.83 m; p = 0.008); and Kansas City Cardiomyopathy Questionnaire Overall Summary score in ATTRwt (12.72 ± 2.10; p < 0.0001) and ATTRv (18.18 ± 7.75; p = 0.019). CONCLUSIONS Pre-specified analyses from ATTR-ACT confirm the poor prognosis of untreated ATTRv-related cardiomyopathy compared with ATTRwt, but show the reduction in mortality and functional decline with tafamidis treatment is similar in both disease subtypes. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889).
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Affiliation(s)
- Claudio Rapezzi
- Cardiovascular Center, University of Ferrara, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy.
| | - Perry Elliott
- University College London and St. Bartholomew's Hospital, London, United Kingdom
| | - Thibaud Damy
- French Referral Center for Cardiac Amyloidosis, Amyloidosis Mondor Network, GRC Amyloid Research Institute and Department of Cardiology, all at APHP, CHU Henri Mondor, and INSERM U955, Clinical Investigation Center 006, and DHU ATVB all at Créteil, France
| | - Jose Nativi-Nicolau
- Department of Medicine, University of Utah Health Care, Salt Lake City, Utah, USA
| | - John L Berk
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eric J Velazquez
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kurt Boman
- Research Unit, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | | | | | | | - Mathew S Maurer
- Columbia University College of Physicians and Surgeons, New York, New York, USA
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Eriksson MA, Söderberg S, Nilsson TK, Eriksson M, Boman K, Jansson JH. Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men. Scand J Clin Lab Invest 2020; 80:303-308. [PMID: 32125188 DOI: 10.1080/00365513.2020.1731848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACEi) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACEi enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA-PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA-PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACEi. In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.
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Affiliation(s)
- Maria A Eriksson
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umea, Sweden
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umea, Sweden
| | - Torbjörn K Nilsson
- Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umea, Sweden
| | - Marie Eriksson
- Department of Statistics, USBE, Umeå University, Umea, Sweden
| | - Kurt Boman
- Research Unit Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
| | - Jan-Håkan Jansson
- Research Unit Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
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Greve AM, Bang CN, Boman K, Egstrup K, Kesäniemi YA, Ray S, Pedersen TR, Wachtell K. Relation of Lipid-Lowering Therapy to Need for Aortic Valve Replacement in Patients With Asymptomatic Mild to Moderate Aortic Stenosis. Am J Cardiol 2019; 124:1736-1740. [PMID: 31586530 DOI: 10.1016/j.amjcard.2019.08.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
Abstract
In this study, we aimed to determine if pretreatment low-density lipoprotein (LDL) levels and aortic stenosis (AS) severity alter the efficacy of lipid-lowering therapy on reducing aortic valve replacement (AVR). We used 1,687 patients with asymptomatic mild-to-moderate AS, who were randomly assigned (1:1) to 40/10 mg simvastatin/ezetimibe combination versus. placebo in the simvastatin and ezetimibe in aortic stenosis (SEAS) trial. Pretreatment LDL levels (>4 mmol/L) and peak aortic jet velocity (3 m/s) were used to partition study participants into 4 groups, which were followed for a primary endpoint of AVR. Cox regression with tests for interaction was used to study the effect of randomized treatment in each subgroup. During a median follow-up of 4.3 years (IQR 4.2 to 4.7 years; total 7,396 patient-years of follow-up), 478 (28%) patients underwent AVR and 146 (9%) died. A significant risk dependency was detected between simvastatin/ezetimibe combination, LDL levels and mild versus moderate AS on rates of AVR (p = 0.01 for interaction). In stratified analyses, randomized treatment, therefore, reduced the rate of AVR in patients with LDL levels >4 mmol and mild AS at baseline (HR 0.4; 95% CI: 0.2 to 0.9). There was no detectable effect of randomized treatment on the need for AVR in the 3 other participants subgroups. We conclude, that in a secondary analysis from a prospective randomized clinical trial, treatment with simvastatin/ezetimibe combination reduced the need for AVR in a subset of patients with mild AS and high pretreatment LDL levels (Unique identifier on clinicaltrials.gov: NCT00092677).
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Bang CN, Greve AM, Boman K, Egstrup K, Olsen MH, Kober L, Nienaber CA, Ray S, Rossebo AM, Nielsen OW, Willenheimer R, Wachtell K. P3779NT-proBNP adds incremental predictive information on incident atrial fibrillation in patients with asymptomatic aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Incident atrial fibrillation (AF) marks an adverse shift in the prognosis of patients with aortic stenosis (AS). Identifying risk factors for AF is therefore of paramount importance for timely intervention in patients with AS. In patients without AS, brain natriuretic peptides (BNP) is a well-established biomarker for left ventricular pressure overload on the pathway to heart failure and atrial fibrillation. However, a potential role of NT-proBNP to predict risk of new-onset AF in asymptomatic patients with mild to moderate AS is not well studied.
Methods
We included 1,434 patients with mild to moderate AS from the SEAS Study (Simvastatin and Ezetimibe in Aortic Stenosis) without AF or clinically overt heart failure at baseline. The primary endpoint for this substudy was time to incident AF, as determined by the first annual in-study 12-lead ECG with AF. Multivariable Cox model were adjusted for other important predictors of incident AF as selected by Bayesian statistics. Fine and Gray competing risk regression was used to evaluate the influence of all-cause mortality on selected predictor variables of incident AF.
Results
During a median follow-up of 4.3 years (range 0.1–6.9 years), incident AF occurred in 114 (6.1%) patients (13.8 per 1,000 person-years of follow-up), who at baseline were older (69±10 vs. 67±10 years, p<0.001), had larger systolic left atrial diameter (46±24 vs. 34±18 mm, p<0.001) and higher NT-proBNP level (286 [132; 613] vs. 154 [82; 297] pg/ml, p<0.001); but same left ventricular ejection fraction (66±6 mm vs. 67±6, p=0.4). In multivariable Cox regression, adjusted for age, circumferential end-systolic stress, left atrial volume and ECG PR interval, Ln(NT-proBNP) was associated with higher risk of new-onset AF (HR: 1.9 [95% CI: 1.6–2.3], p<0.001). Similar results were found when using Fine and Gray estimates with all-cause mortality (HR: 2.0 [95% CI: 1.7–2.4], p<0.001 (Figure, panel A). NT-proBNP level added incremental predictive information on incident AF over the other important, as selected by Bayesian statistics, predictor variables (C-index 0.81, p<0.001, Figure, panel B). There was no interaction with aortic valve area (p>0.05).
Figure 1
Conclusions
In patients with asymptomatic aortic stenosis and sinus rhythm at baseline, NT-proBNP levels were significantly higher in patients who subsequently developed AF. NT-proBNP significantly improved prognostic information of incident AF over other important predictor variables. This supports the notion that incident AF is a marker of left ventricular pressure overload and possibly a novel marker of timely intervention with aortic valve replacement.
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Affiliation(s)
- C N Bang
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - A M Greve
- Rigshospitalet - Copenhagen University Hospital, Clinical Biochemistry, Copenhagen, Denmark
| | - K Boman
- Skelleftea Hospital, Department of Medicine, Skeleftaa Laseratt, Umeå University Hospital, Skelleftea, Sweden
| | - K Egstrup
- Svendborg Hospital, Department of Medicine, Svendborg, Denmark
| | - M H Olsen
- Holbaek Hospital, Cardiology, Holbaek, Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | - C A Nienaber
- University Hospital Rostock, Cardiology, Rostock, Germany
| | - S Ray
- Manchester Academic Health Sciences Centre, Cardiology, Manchester, United Kingdom
| | - A M Rossebo
- Ulleval University Hospital, Cardiology, Oslo, Norway
| | - O W Nielsen
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | | | - K Wachtell
- Oslo University Hospital, Cardiology, Oslo, Norway
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11
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Lindmark K, Boman K, Olofsson M, Törnblom M, Levine A, Castelo-Branco A, Schlienger R, Bruce Wirta S, Stålhammar J, Wikström G. Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clin Epidemiol 2019; 11:231-244. [PMID: 30962724 PMCID: PMC6435223 DOI: 10.2147/clep.s170873] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden. Methods Adults with incident HF (≥2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Västerbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed. Results Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged ≥85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time). Conclusion The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.
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Affiliation(s)
- Krister Lindmark
- Department of Public Health and Clinical Medicine and Heart Centre, Umeå University Hospital, Umeå, Sweden,
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mona Olofsson
- Research Unit, Medicine-Geriatric, Skellefteå County Hospital, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Aaron Levine
- Real-World & Analytics Solutions, IQVIA, Solna, Sweden
| | | | - Raymond Schlienger
- Quantitative Safety & Epidemiology, Novartis Pharma AG, Basel, Switzerland
| | - Sara Bruce Wirta
- Global RWE Cardio-Metabolics, Novartis Sweden AB, Stockholm, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Gerhard Wikström
- Department for Medical Sciences, Uppsala University, Uppsala, Sweden
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12
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Wang A, Arver S, Boman K, Gerstein HC, Fu Lee S, Hess S, Rydén L, Mellbin LG. Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial. Eur J Prev Cardiol 2018; 26:847-854. [DOI: 10.1177/2047487318819142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Aims: Testosterone and its binding protein sex hormone-binding globulin have been associated with cardiovascular disease and dysglycaemia. However, information on the prognostic implication in patients at high cardiovascular risk with dysglycaemia is inconsistent. The study objective was to determine whether testosterone and/or sex hormone-binding globulin predict cardiovascular events or death in dysglycaemic patients. Methods: Dysglycaemic males at high cardiovascular risk ( n = 5553) who participated in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial and provided baseline blood samples were studied. Testosterone and sex hormone-binding globulin were measured at baseline and used to estimate free testosterone. Low levels of total and free testosterone were defined as ≤300 ng/dl and ≤7 ng/dl, respectively. Patients were followed for six years for cardiovascular events (defined as the composite of cardiovascular death, non-fatal myocardial infarction or stroke) and all-cause mortality. Results: The mean total and free testosterone levels were 416.6 ng/dl and 8.4 ng/dl, and low levels were present in 13% and 37% of the patients. The median sex hormone-binding globulin level was 35 nmol/l. In Cox regression models adjusted for age, previous diseases and pharmacological treatment, neither total nor free testosterone predicted cardiovascular events. However, a one-standard-deviation increase in sex hormone-binding globulin predicted both cardiovascular events (hazard ratio 1.07; 95% confidence interval 1.00–1.14; p = 0.03) and all-cause mortality (hazard ratio 1.13; 95% confidence interval 1.06–1.21; p < 0.01). Conclusion: Sex hormone-binding globulin, but not total testosterone, predicts cardiovascular disease and all-cause mortality in dysglycaemic males at high cardiovascular risk.
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Affiliation(s)
- Anne Wang
- Department of Medicine Solna, Karolinska Institutet, Sweden
| | - Stefan Arver
- Department of Medicine Huddinge, Karolinska Institutet, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences, Canada
- Department of Medicine, McMaster University, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences, Canada
| | - Sibylle Hess
- Translational Medicine and Early Development, Biomarkers and Clinical Bioanalyses, Sanofi-Aventis Deutschland GmbH, Germany
| | - Lars Rydén
- Department of Medicine Solna, Karolinska Institutet, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Sweden
| | - Linda G Mellbin
- Department of Medicine Solna, Karolinska Institutet, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Sweden
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13
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Brännström M, Jansson JH, Boman K, Nilsson TK. Endothelial Haemostatic Factors May Be Associated with Mortality in Patients on Long-term Anticoagulant Treatment. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1649784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThe aim of the present study was to test if long-term mortality could be predicted by endothelial derived haemostatic variables in a population with high morbidity due to thromboembolic disease. Plasma samples were drawn from 212 out-patients treated with oral anticoagulants, at the beginning of the study, and analyzed for mass concentration of tissue plasminogen activator (tPA) and its inhibitor (PAI-1), and von Willebrand factor. In the course of 3.8-year follow-up 45 patients died, including 38 vascular deaths. We found that all-cause mortality was significantly associated with increased levels of vWF and tPA. For vascular mortality there was a significant association with all three haemostatic variables (tPA, PAI-1, vWF). For vWF there was a 3-fold increase in total and vascular mortality in the highest quartile compared to the lowest quartile. There were 27 vascular deaths in the group of patients with a tPA-value above the median compared to 11 in those with a tPA below the median. In multivariate Cox regression analysis (including: age, sex, smoking habits, body mass index, diabetes mellitus, hypertension, tPA, PAI-1, and vWF), vWF and smoking were independently significantly associated with all-cause mortality, and tPA and age with vascular mortality. Endothelial derived haemostatic variables are predictors of total and vascular mortality in patients treated with oral anticoagulants.
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Affiliation(s)
- Mats Brännström
- The Department of Medicine, Skellefteå Hospital, Umeå, Sweden
| | | | - Kurt Boman
- The Department of Medicine, Skellefteå Hospital, Umeå, Sweden
| | - Torbjörn K Nilsson
- The Department of Clinical Chemistry, Umeå University Hospital, Umeå, Sweden
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14
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Hodges GW, Bang CN, Forman JL, Olsen MH, Boman K, Ray S, Kesäniemi YA, Eugen-Olsen J, Greve AM, Jeppesen JL, Wachtell K. Effect of simvastatin and ezetimibe on suPAR levels and outcomes. Atherosclerosis 2018; 272:129-136. [PMID: 29602140 DOI: 10.1016/j.atherosclerosis.2018.03.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/27/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory marker associated with cardiovascular disease. Statins lower both low-density lipoprotein (LDL)-cholesterol and C-reactive protein (CRP), resulting in improved outcomes. However, whether lipid-lowering therapy also lowers suPAR levels is unknown. METHODS We investigated whether treatment with Simvastatin 40 mg and Ezetimibe 10 mg lowered plasma suPAR levels in 1838 patients with mild-moderate, asymptomatic aortic stenosis, included in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, using a pattern mixture model. A 1-year Cox analysis, adjusted for established cardiovascular risk factors, allocation to study treatment, peak aortic valve velocity and baseline suPAR, was performed to evaluate relationships between change in suPAR with all-cause mortality and the composite endpoint of major cardiovascular events (MCE) composed of ischemic cardiovascular events (ICE) and aortic valve related events (AVE). RESULTS After 4.3 years of follow-up, suPAR levels had increased by 9.2% (95% confidence interval [CI]: 7.0%-11.5%) in the placebo group, but only by 4.1% (1.9%-6.2%) in the group with lipid-lowering treatment (p<0.001). In a multivariate 1-year analysis, 1-year suPAR was strongly associated with all-cause mortality, hazard ratio (HR) = 2.05 (1.17-3.61); MCE 1.40 (1.01-1.92); and AVE 1.42 (1.02-1.99) (all p<0.042) for each doubling of suPAR; but was not associated with ICE. CONCLUSIONS Simvastatin and Ezetimibe treatment impeded the progression of the time-related increase in plasma suPAR levels. Year-1 suPAR was associated with all-cause mortality, MCE, and AVE irrespective of baseline levels (SEAS study: NCT00092677).
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Affiliation(s)
- Gethin W Hodges
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Denmark.
| | - Casper N Bang
- The Danish Heart Foundation, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, Denmark; Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Denmark
| | - Kurt Boman
- Research Unit, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Simon Ray
- Department of Cardiology, University Hospitals of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Y Antero Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen L Jeppesen
- Department of Medicine Glostrup, Amager Hvidvore Hospital Glostrup, University of Copenhagen, Denmark
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15
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Hägglund L, Boman K, Brännström M. A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nurs Open 2018; 5:176-185. [PMID: 29599993 PMCID: PMC5867290 DOI: 10.1002/nop2.127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 12/29/2017] [Indexed: 01/25/2023] Open
Abstract
Aims and objectives This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older. Background Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF. Design A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (N = 25) or control (N = 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self‐rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (N = 10) in the Tai Chi training group. Results No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow‐up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort. Conclusion Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.
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Affiliation(s)
| | - Kurt Boman
- Department of Medicine-Geriatric Skellefteå County Hospital Skellefteå Sweden.,Department of Public Health and Clinical Medicine Umeå University Umeå Sweden
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16
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Greve AM, Bang CN, Boman K, Egstrup K, Forman JL, Kesäniemi YA, Ray S, Pedersen TR, Best P, Rajamannan NM, Wachtell K. Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study). Am J Cardiol 2018; 121:739-745. [PMID: 29361285 DOI: 10.1016/j.amjcard.2017.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 01/28/2023]
Abstract
Observational studies indicate that low-density lipoprotein (LDL) cholesterol acts as a primary contributor to an active process leading to aortic stenosis (AS) development. However, randomized clinical trials have failed to demonstrate an effect of lipid lowering on impeding AS progression. This study explored if pretreatment LDL levels and AS severity altered the efficacy of lipid-lowering therapy. The study goal was evaluated in the analysis of surviving patients with baseline data in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial of 1,873 asymptomatic patients with mild-to-moderate AS. Serially measured peak aortic jet velocity was the primary effect estimate. Linear mixed model analysis adjusted by baseline peak jet velocity and pretreatment LDL levels was used to assess effect modifications of treatment. Data were available in 1,579 (84%) patients. In adjusted analyses, lower baseline peak aortic jet velocity and higher pretreatment LDL levels increased the effect of randomized treatment (p = 0.04 for interaction). As such, treatment impeded progression of AS in the highest quartile of LDL among patients with mild AS at baseline (0.06 m/s per year slower progression vs placebo in peak aortic jet velocity, 95% confidence interval 0.01 to 0.11, p = 0.03), but not in the 3 other quartiles of LDL. Conversely, among patients with moderate AS, there was no detectable effect of treatment in any of the pretreatment LDL quartiles (all p ≥0.14). In conclusion, in a non-prespecified post hoc analysis, the efficacy of lipid-lowering therapy on impeding AS progression increased with higher pretreatment LDL and lower peak aortic jet velocity (SEAS study: NCT00092677).
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Affiliation(s)
- Anders M Greve
- Department of clinical biochemistry, Rigshospitalet University Hospital, Copenhagen, Denmark.
| | - Casper N Bang
- Department of Cardiology, Zealand University Hospital-Roskilde, Roskilde, Denmark
| | - Kurt Boman
- Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Skelleftå, Sweden
| | | | - Julie L Forman
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Y Antero Kesäniemi
- Institute of Clinical Medicine, Department of Medicine, University of Oulu and Clinical Research center, Oulu University Hospital, Oulu, Finland
| | - Simon Ray
- Manchester Academic Health Sciences Centre, University Hospitals of South Manchester, Manchester, United Kingdom
| | - Terje R Pedersen
- Center for Preventive medicine, Oslo University Hospital, Ullevål and University of Oslo, Oslo, Norway
| | - Patricia Best
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Nalini M Rajamannan
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota; Most Sacred Heart of Jesus Cardiology and Valvular Institute, Sheboygan, Wisconsin
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17
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Årestedt K, Alvariza A, Boman K, Öhlén J, Goliath I, Håkanson C, Fürst CJ, Brännström M. Symptom Relief and Palliative Care during the Last Week of Life among Patients with Heart Failure: A National Register Study. J Palliat Med 2018; 21:361-367. [DOI: 10.1089/jpm.2017.0125] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalens Hospital, Stockholm, Sweden
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Sweden
- Institution of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Joakim Öhlén
- Centre for Person-Centred Care and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ida Goliath
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Håkanson
- Department of Health Care Sciences and Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Carl Johan Fürst
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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18
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Boman K, Thormark Fröst F, Bergman ACR, Olofsson M. NTproBNP and ST2 as predictors for all-cause and cardiovascular mortality in elderly patients with symptoms suggestive for heart failure. Biomarkers 2018; 23:373-379. [PMID: 29355441 DOI: 10.1080/1354750x.2018.1431692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND A new biomarker, suppression of tumorigenicity 2 (ST2) has been introduced as a marker for fibrosis and hypertrophy. Its clinical value in comparison with N-terminal pro-hormone of brain natriuretic peptide /Amino-terminal pro-B-type natriuretic peptide (NTproBNP) in predicting mortality in elderly patients with symptoms of heart failure (HF) is still unclear. AIM To evaluate the prognostic value for all-cause- and cardiovascular mortality of ST2 or NTproBNP and the combination of these biomarkers. PATIENTS AND METHODS One hundred seventy patients patients with clinical symptoms of HF (77 (45%) were with verified HF) were recruited from one selected primary health care center (PHC) in Sweden and echocardiography was performed in all patients. Blood samples were obtained from 159 patients and stored frozen at -70 °C. NTproBNP was analyzed at a central core laboratory using a clinically available immunoassay.ST2 was analyzed with Critical Diagnostics Presage ST2 ELISA immunoassay. RESULTS We studied 159 patients (mean age 77 ± 8.3 years, 70% women). During ten years of follow up 78 patients had died, out of which 50 deaths were for cardiovascular reasons. Continuous NTproBNP and ST2 were both significantly associated with all-cause mortality (1.0001; 1.00001-1.0002, p = 0.04 and 1.03; 1.003-1.06, p = 0.03), NTproBNP but not ST2 remained significant for cardiovascular mortality after adjustments (1.0001; 1.00001-1.0002, p = 0.03 and 1.01; 0.77-1.06, p = 0.53), respectively. NTproBNP above median (>328 ng/L) compared to below median was significantly associated with all-cause mortality(HR: 4.0; CI :2.46-6.61; p < 0.001) and cardiovascular mortality (HR: 6.1; CI: 3.11-11.95; p < 0.001). Corresponding analysis for ST2 above median (25.6 ng/L) was not significantly associated neither with all-cause mortality (HR; 1.4; CI: 0.89-2.77) nor cardiovascular mortality (HR: 1.3; CI: 0.73-2.23) and no significant interaction of NTproBNP and ST2 (OR: 1.1; CI: 0.42-3.12) was found. CONCLUSION In elderly patients with symptoms of heart failure ST2 was not superior to NTproBNP to predict all cause or cardiovascular mortality. Furthermore, it is unclear if the combination of ST2 and NTproBNP will improve long-term prognostication beyond what is achieved by NTproBNP alone.
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Affiliation(s)
- Kurt Boman
- a Research Unit, Department of Medicine , Skellefteå Hospital , Skellefteå , Sweden.,b Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Finn Thormark Fröst
- c Department of Clinical Chemistry , Karolinska University Hospital , Stockholm , Sweden
| | | | - Mona Olofsson
- a Research Unit, Department of Medicine , Skellefteå Hospital , Skellefteå , Sweden
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19
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Hodges GW, Bang CN, Eugen-Olsen J, Olsen MH, Boman K, Ray S, Kesäniemi AY, Jeppesen JL, Wachtell K. SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis. Open Heart 2018; 5:e000743. [PMID: 29387432 PMCID: PMC5786924 DOI: 10.1136/openhrt-2017-000743] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/30/2017] [Accepted: 12/20/2017] [Indexed: 12/25/2022] Open
Abstract
Background We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery. Methods Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period. Results Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively. Conclusion Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted. Trial registration number NCT00092677; Post-results.
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Affiliation(s)
- Gethin W Hodges
- Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Casper N Bang
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Jesper Eugen-Olsen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, Holbæk, Denmark.,Centre for Individualized Medicine in Arterial Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Kurt Boman
- Research Unit, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Simon Ray
- Department of Cardiology, University Hospitals of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Antero Y Kesäniemi
- Research Institute of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jørgen L Jeppesen
- Department of Medicine, Amager Hvidovre Hospital Glostrup, University of Copenhagen, Copenhagen, Denmark
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Jansson JH, Jern S, Nilsson T, Tjärnlund A, Boman K, Ladenvall P, Johansson L, Jern C. Tissue-type Plasminogen Activator –7,351C/T Enhancer Polymorphism Is Associated with a First Myocardial Infarction. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612951] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryWe recently identified a polymorphic Sp1 binding site in an enhancer at the tissue-type plasminogen activator (tPA) locus (tPA –7,351C/T), which was associated with vascular tPA release. Subjects homozygous for the –7,351C allele had twice the tPA release rate compared to subjects carrying the –7,351T allele. In this study we tested the hypothesis that the tPA –7,351C/T polymorphism is associated with myocardial infarction (MI). In a population-based prospective nested case-control study within northern Sweden, genotypes were determined among 61 MI cases and 120 controls. In a multivariate model, the tPA –7,351C/T polymorphism (OR 2.68 for T allele carriers; 95% CI 1.31– 5.50), tPA antigen (OR 1.16; 95% CI 1.07–1.25) and apo A-I (OR, 0.997; 95% CI 0.995–0.999) were independently associated with a first MI. These findings suggest that genetic markers of local tPA release and circulating steady-state tPA levels carry independent prognostic information.
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21
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Jansson JH, Boman K, Nilsson T, Stegmayr B, Hallmans G, Johansson L. Prospective Study on Soluble Thrombomodulin and von Willebrand Factor and the Risk of Ischemic and Hemorrhagic Stroke. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612975] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryThe aim of the present study was to examine if soluble thrombomodulin (sTM) and von Willebrand factor (VWF) could predict a first-ever ischemic or hemorrhagic stroke.This study was an incident case-referent study from within a population-based cohort in northern Sweden. Up to 1996 about 44,000 subjects had been screened and stroke cases were classified according to the WHO MONICA criteria. A first-ever stroke occurred in 108 cases. A total of 216 controls were selected from the same cohort.This prospective study found no association with sTM or VWF and the development of a first-ever ischemic stroke (n = 87) in the logistic regression model. For the hemorrhagic stroke cases (n = 18), the multivariate logistic regression model revealed a significant negative association with sTM. When dichotomized, the upper level (>17.3 µg/L) of sTM, as compared with the lower level (<17.3 µg/L), showed one fifth of the risk for hemorrhagic stroke (OR, 0.18; CI, 0.05 to 0.69). No significant association was found for VWF. We suggest that the novel finding of an inverse relation between sTM and hemorrhagic stroke should be investigated in a larger study.
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22
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Jansson JH, Nyhlén K, Nilsson T, Boman K. Improved Fibrinolysis after one Year of Treatment with Enalapril in Men and Women with Uncomplicated Myocardial Infarction. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1612991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryTo study long-term effects of enalapril on mass concentrations of tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI-1), tPA/PAI-1-complex and von Willebrand factor (vWF) in both genders with uncomplicated myocardial infarction.More than three months after an uncomplicated myocardial infarction 82 survivors (46 males, 36 females) were randomised to enalapril/placebo. PAI-1, tPA, tPA/PAI-1-complex and vWF were measured after two weeks, six and 12 months following randomisation. PAI-1 decreased significantly in both genders in the enalapril-treated group after two weeks, with a maximum decrease at six months (mean reduction: 31% equal to 9.8 µg X L–1, CI: 5.2 to 14.5 µg X L–1, p = 0.0001) and remained significantly lower at 12 months. Mass concentration of tPA decreased significantly (mean reduction; 1.81 µg X L–1, CI: 0.903 to 2.708 µg X L–1, p <0.001) after two weeks treatment in both genders but returned to baseline values at 12 months. The tPA/PAI-1-complex decreased and was significantly lower (mean reduction 0.96 µg X L–1, CI: 0.36 to 1.56 µg X L–1, p = 0.003) in the enalapril group after two weeks and six months (p = 0.037). No decrease of vWF was seen in the enalapril group.Enalapril treatment up to one year depressed mass concentrations of PAI-1 and transiently tPA and tPA/PAI-1 complex indicating an improvement of the fibrinolytic balance in both genders with uncomplicated myocardial infarction.
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23
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Boman K, Olofsson M, Bergman ACR, Brännström M. Anaemia, but not iron deficiency, is associated with clinical symptoms and quality of life in patients with severe heart failure and palliative home care: A substudy of the PREFER trial. Eur J Intern Med 2017; 46:35-40. [PMID: 28899603 DOI: 10.1016/j.ejim.2017.08.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 08/23/2017] [Accepted: 08/30/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND To explore the relationships between anaemia or iron deficiency (ID) and symptoms, quality of life (QoL), morbidity, and mortality. METHODS A post-hoc, non-prespecified, explorative substudy of the prospective randomized PREFER trial. One centre study of outpatients with severe HF and palliative need managed with advanced home care. Associations between anaemia, ID, and the Edmonton Symptom Assessment Scale (ESAS), Euro QoL (EQ-5D), Kansas City Cardiomyopathy Questions (KCCQ) were examined only at baseline but at 6months for morbidity and mortality. RESULTS Seventy-two patients (51 males, 21 females), aged 79.2±9.1years. Thirty-nine patients (54%) had anaemia and 34 had ID (47%). Anaemia was correlated to depression (r=0.37; p=0.001), anxiety (r=0.25; p=0.04), and reduced well-being (r=0.26; p=0.03) in the ESAS; mobility (r=0.33; p=0.005), pain/discomfort (r=0.27; p=0.02), and visual analogue scale of health state (r=-0.28; p=0.02) in the EQ-5D; and physical limitation (r=-0.27; p=0.02), symptom stability; (r=-0.43; p<0.001); (r=-0.25; p=0.033), social limitation;(r=-0.26; p=0.03), overall summary score; (r=-0.24, p=0.046) and clinical summary score; (r=-0.27; p=0.02) in the KCCQ. ID did not correlate to any assessment item. Anaemia was univariably associated with any hospitalization (OR: 3.0; CI: 1.05-8.50, p=0.04), but not to mortality. ID was not significantly associated with any hospitalization or mortality. CONCLUSION Anaemia, but not ID, was associated although weakly with symptoms and QoL in patients with advanced HF and palliative home care.
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Affiliation(s)
- Kurt Boman
- Research Unit, Department of Medicine, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Mona Olofsson
- Research Unit, Department of Medicine, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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24
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Bang CN, Greve AM, Rossebø AB, Ray S, Egstrup K, Boman K, Nienaber C, Okin PM, Devereux RB, Wachtell K. Antihypertensive Treatment With β-Blockade in Patients With Asymptomatic Aortic Stenosis and Association With Cardiovascular Events. J Am Heart Assoc 2017; 6:JAHA.117.006709. [PMID: 29180457 PMCID: PMC5779004 DOI: 10.1161/jaha.117.006709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Patients with aortic stenosis (AS) often have concomitant hypertension. Antihypertensive treatment with a β‐blocker (Bbl) is frequently avoided because of fear of depression of left ventricular function. However, it remains unclear whether antihypertensive treatment with a Bbl is associated with increased risk of cardiovascular events in patients with asymptomatic mild to moderate AS. Methods and Results We did a post hoc analysis of 1873 asymptomatic patients with mild to moderate AS and preserved left ventricular ejection fraction in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. Propensity‐matched Cox regression and competing risk analyses were used to assess risk ratios for all‐cause mortality, sudden cardiac death, and cardiovascular death. A total of 932 (50%) patients received Bbl at baseline. During a median follow‐up of 4.3±0.9 years, 545 underwent aortic valve replacement, and 205 died; of those, 101 were cardiovascular deaths, including 40 sudden cardiovascular deaths. In adjusted analyses, Bbl use was associated with lower risk of all‐cause mortality (hazard ratio 0.5, 95% confidence interval 0.3‐0.7, P<0.001), cardiovascular death (hazard ratio 0.4, 95% confidence interval 0.2‐0.7, P<0.001), and sudden cardiac death (hazard ratio 0.2, 95% confidence interval 0.1‐0.6, P=0.004). This was confirmed in competing risk analyses (all P<0.004). No interaction was detected with AS severity (all P>0.1). Conclusions In post hoc analyses Bbl therapy did not increase the risk of all‐cause mortality, sudden cardiac death, or cardiovascular death in patients with asymptomatic mild to moderate AS. A prospective study may be warranted to determine if Bbl therapy is in fact beneficial. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00092677.
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Affiliation(s)
- Casper N Bang
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark .,Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Anders M Greve
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | - Simon Ray
- Department of Cardiology, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Kenneth Egstrup
- Department of Cardiology, Odense University Hospital, Svendborg, Denmark
| | - Kurt Boman
- Institution of Public Health and Clinical Medicine, Medicine Skellefteå, Umeå University, Skellefteå, Sweden
| | | | - Peter M Okin
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Kristian Wachtell
- Department of Medicine, Weill Cornell Medicine, New York, NY.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
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25
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Weinehall L, Hellsten G, Boman K, Hallmans G. Prevention of cardiovascular disease in Sweden: The Norsjö community intervention programme—Motives, methods and intervention components. Scand J Public Health 2017. [DOI: 10.1177/14034948010290021401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: When epidemiologic data on cardiovascular disease (CVD) mortality rates in different Swedish regions were published in the early 1980s, there was great concern about the high CVD incidence in the northernmost counties of Sweden, namely Västerbotten and Norrbotten. This paper describe the development of a Northern Sweden community intervention programme for the prevention of CVD. Methods: As there were no Swedish prototypes, the programme was designed by drawing on experiences from other community interventions. One unique emphasis of the Norsjö intervention programme was to combine a population strategy with efforts to contact each person individually when they became 30, 40, 50, and 60 years of age (the primary care approach). Using the primary care system as part of the community intervention, systematic risk factor screening and counselling by family medicine providers were carried out at the same time as the community intervention programme invoked other efforts to raise public awareness. Results: During the first 10 years of the programme >90% of those invited participated in the individual health screening and counselling. A new food labelling system was introduced in the grocery stores, which after a few years became the official Swedish food labelling system. Sales statistics regarding dairy products showed a significant turnover of low fat products. According to public opinion, the health screening and counselling were reported to be the most infl uential factors supporting lifestyle changes. Conclusions: It was possible in Norsjö to create a local health promotion collaboration between healthcare providers, grocery stores, schools, municipal authorities, and the public in order to develop a Swedish model for community intervention. The different programme components were well received by the public.
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Affiliation(s)
- L. Weinehall
- Epidemiology, Department of Public Health and Clinical
Medicine, UmeÅ University, UmeÅ, Sweden,
| | - G. Hellsten
- Norsjö Primary Health Care Centre, Norsjö, Sweden
| | - K. Boman
- Medicine Department of Public Health and Clinical Medicine,
UmeÅ University, UmeÅ, Sweden
| | - G. Hallmans
- Nutritional Research, Department of Public Health and
Clinical Medicine, UmeÅ University, UmeÅ, Sweden
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Minners J, Rossebo A, Greve A, Ray S, Boman K, Gohlke-Baerwolf C, Neumann F, Wachtell K, Jander N. P2620Sudden death in primarily asymptomatic patients with aortic valve stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Olofsson M, Boman K. P4232Iron deficiency predicted hospitalizations in elderly patients with symptoms of heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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28
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Talabani N, Ängerud KH, Boman K, Brännström M. Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study. BMJ Support Palliat Care 2017; 10:e9. [PMID: 28689185 DOI: 10.1136/bmjspcare-2016-001226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 05/27/2017] [Accepted: 05/31/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home. METHOD Interviews were conducted with 12 patients with severe HF (New York Heart Association class IIIâ€"IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis. RESULTS Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities. CONCLUSIONS: Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population. TRIAL REGISTRATION NUMBER NCT01304381; Results.
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Affiliation(s)
- Naghada Talabani
- Department of Cardiology M82, Karolinska University Hospital, Stockholm, Sweden
| | | | - Kurt Boman
- Research Unit Skellefteå, Department of Medicine, Umeå University, Skellefteå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,The Arctic Research Centre, Umeå University, Umeå, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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Rautio A, Boman K, Gerstein HC, Hernestål-Boman J, Lee SF, Olofsson M, Mellbin LG. The effect of basal insulin glargine on the fibrinolytic system and von Willebrand factor in people with dysglycaemia and high risk for cardiovascular events: Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial. Diab Vasc Dis Res 2017; 14:345-352. [PMID: 28403644 DOI: 10.1177/1479164117703034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Fibrinolytic factors, plasminogen activator inhibitor-1, tissue plasminogen activator, tissue plasminogen activator/plasminogen activator-complex and the haemostatic factor von Willebrand factor are known markers of cardiovascular disease. Their plasma levels are adversely affected in patients with dysglycaemia, and glucose normalization with insulin glargine might improve the levels of these factors. METHODS Prespecified Swedish substudy of the Outcome Reduction with an Initial Glargine Intervention trial (ClinicalTrials.gov number, NCT00069784). Tissue plasminogen activator activity, tissue plasminogen activator antigen, plasminogen activator inhibitor-1 antigen, tissue plasminogen activator/plasminogen activator inhibitor-1 complex and von Willebrand factor were analysed at study start, after 2 years and at the end of the study (median follow-up of 6.2 years). RESULTS Of 129 patients (mean age of 64 ± 7 years, females: 19%), 68 (53%) and 61 (47%) were randomized to the insulin glargine and standard care group, respectively. Allocation to insulin glargine did not significantly affect the studied fibrinolytic markers or von Willebrand factor compared to standard care. Likewise, there were no significant differences in plasminogen activator inhibitor-1, tissue plasminogen activator antigen and von Willebrand factor. During the whole study period, the within-group analysis revealed a curvilinear pattern and significant changes for tissue plasminogen activator/plasminogen activator inhibitor-1 complex, tissue plasminogen activator antigen and von Willebrand factor in the insulin glargine but not in the standard care group. CONCLUSION In people with dysglycaemia and other cardiovascular risk factors, basal insulin does not improve the levels of markers of fibrinolysis or von Willebrand factor compared to standard glucose-lowering treatments.
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Affiliation(s)
- Aslak Rautio
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 2 Department of Medicine, Sunderby Hospital, Luleå, Sweden
| | - Kurt Boman
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Hertzel C Gerstein
- 4 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Jenny Hernestål-Boman
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Shun Fu Lee
- 4 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON, Canada
| | - Mona Olofsson
- 1 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- 3 Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Linda Garcia Mellbin
- 5 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Ängerud KH, Boman K, Brännström M. Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scand J Caring Sci 2017; 32:346-353. [PMID: 28543624 DOI: 10.1111/scs.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care. OBJECTIVE To describe family members' perceptions of quality of HF care in an outpatient setting. METHODS A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV. RESULTS Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members. CONCLUSION Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.
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Affiliation(s)
| | - Kurt Boman
- Research Unit Skellefteå, Department of Medicine, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden.,The Arctic Research Centre, Umeå University, Umeå, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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31
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Lønnebakken MT, De Simone G, Saeed S, Boman K, Rossebø AB, Bahlmann E, Gohlke-Bärwolf C, Gerdts E. Impact of stroke volume on cardiovascular risk during progression of aortic valve stenosis. Heart 2017; 103:1443-1448. [DOI: 10.1136/heartjnl-2016-310917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/21/2017] [Accepted: 03/29/2017] [Indexed: 11/04/2022] Open
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Winkvist A, Klingberg S, Nilsson LM, Wennberg M, Renström F, Hallmans G, Boman K, Johansson I. Longitudinal 10-year changes in dietary intake and associations with cardio-metabolic risk factors in the Northern Sweden Health and Disease Study. Nutr J 2017; 16:20. [PMID: 28351404 PMCID: PMC5370464 DOI: 10.1186/s12937-017-0241-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 03/19/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Dietary risks today constitute the largest proportion of disability-adjusted life years (DALYs) globally and in Sweden. An increasing number of people today consume highly processed foods high in saturated fat, refined sugar and salt and low in dietary fiber, vitamins and minerals. It is important that dietary trends over time are monitored to predict changes in disease risk. METHODS In total, 15,995 individuals with two visits 10 (±1) years apart in the population-based Västerbotten Intervention Programme 1996-2014 were included. Dietary intake was captured with a 64-item food frequency questionnaire. Percent changes in intake of dietary components, Healthy Diet Score and Dietary Inflammatory Index were calculated and related to body mass index (BMI), serum cholesterol and triglyceride levels and blood pressure at the second visit in multivariable regression analyses. RESULTS For both sexes, on group level, proportion of energy intake (E%) from carbohydrates and sucrose decreased (largest carbohydrate decrease among 40 year-olds) and E% protein and total fat as well as saturated and poly-unsaturated fatty acids (PUFA) increased (highest protein increase among 30 year-olds and highest fat increase among 60 year-olds) over the 10-year period. Also, E% trans-fatty acids decreased. On individual basis, for both sexes decreases in intake of cholesterol and trans-fatty acids were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). For men, increases in intake of whole grain and Healthy Diet Score were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). Also for men, decreases in intake of trans-fatty acids and increases in Healthy Diet Score were associated with lower systolic blood pressure at second visit (P = 0.002 and P < 0.000). For women, increases in intake of PUFA and Healthy Diet Score were associated with lower BMI at second visit (P = 0.01 and P < 0.05). Surprisingly, increases in intake of sucrose among women were associated with lower BMI at second visit (P = 0.02). CONCLUSIONS In this large population-based sample, dietary changes over 10 years towards less carbohydrates and more protein and fat were noted. Individual changes towards the Nordic dietary recommendations were associated with healthier cardio-metabolic risk factor profile at second visit.
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Affiliation(s)
- Anna Winkvist
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
- Department of Internal Medicine and Clinical Nutrition, Sahlgenska Academy, University of Gothenburg, Box 459, SE-405 30 Gothenburg, Sweden
| | - Sofia Klingberg
- Section for Epidemiology and Social Medicine (EPSO), Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Frida Renström
- Department of Biobank Research, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Lund University, Malmö, Sweden
| | - Göran Hallmans
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Research Unit, Medicine-geriatric clinic Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Ingegerd Johansson
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
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Persson SE, Boman K, Wanhainen A, Carlberg B, Arnerlöv C. Decreasing prevalence of abdominal aortic aneurysm and changes in cardiovascular risk factors. J Vasc Surg 2017; 65:651-658. [DOI: 10.1016/j.jvs.2016.08.091] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/24/2016] [Indexed: 12/11/2022]
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Karlström P, Johansson P, Dahlström U, Boman K, Alehagen U. The impact of time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. Results from the UPSTEP study. Int J Cardiol 2017; 236:315-320. [PMID: 28268084 DOI: 10.1016/j.ijcard.2017.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a life-threatening condition and optimal handling is necessary to reduce risk of therapy failure. The impact of the duration of HF diagnosis on HF outcome has not previously been examined. The objectives of this study were (I) to evaluate the impact of patient age on clinical outcomes, (II) to evaluate the impact of duration of the HF disease on outcomes, and (III) to evaluate the impact of age and HF duration on B-type Natriuretic Peptide (BNP) concentration in a population of HF patients. METHODS AND RESULTS In the UPSTEP (Use of PeptideS in Tailoring hEart failure Project) study we retrospectively evaluated how age and HF duration affected HF outcome. HF duration was divided into <1year, 1-5years and >5years. A multivariate Cox proportional hazard regression analysis showed that HF duration influenced outcome more than age, even when adjusted for comorbidities(<1year versus >5years: HR 1.65; 95% CI 1.28-2.14; P<0.0002) on HF mortality and hospitalisations. The influence of age on BNP showed increased BNP as age increased. However, there was a significant effect on BNP concentration when comparing HF duration of less than one year to HF duration to more than five years, even when adjusted for age. CONCLUSIONS Patients with longer HF duration had significantly worse outcome compared to those with short HF duration, even when adjusted for patient age and comorbidities. Age did not influence outcome but had an impact on BNP concentration; however, BNP concentration increased as HF duration increased.
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Affiliation(s)
- Patric Karlström
- Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
| | - Peter Johansson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kurt Boman
- Research unit Skellefteå Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Urban Alehagen
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Norberg EB, Löfgren B, Boman K, Wennberg P, Brännström M. A client-centred programme focusing energy conservation for people with heart failure. Scand J Occup Ther 2017; 24:455-467. [PMID: 28052703 DOI: 10.1080/11038128.2016.1272631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIM The purpose of this study was to describe clients and occupational therapists (OTs) experiences of a home-based programme focusing energy conservation strategies (ECS) for clients with chronic heart failure (CHF). METHODS The programme, based on occupational therapy intervention process model (OTIPM), was led by two OTs in primary health care. Five clients' self-reported activities of daily living (ADL), fatigue, depression, goal achievements and use of ECS. Furthermore, both clients and OTs were individually interviewed. RESULTS The clients reported mild depression, severe fatigue and both increased and decreased independence in ADL. Most goals were achieved, and multiple ECS were used. Clients perceived that they worked collaboratively with the OTs and gained professional support to enhance daily activities. The OTs experienced knowledge and structure and found benefits from the programme, but doubted the possibility of using it in clinical practice. CONCLUSIONS This study, despite having few participants, indicates that both the OTs and the clients experienced that the specialized programme gave structure to the OTs work, provided knowledge about CHF and valuable energy conservation strategies. The programme supported the OTs in working in a more comprehensive client-centred way. However, its feasibility needs to be further evaluated.
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Affiliation(s)
- Eva-Britt Norberg
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Britta Löfgren
- a Department of Community Medicine and Rehabilitation , Occupational Therapy, Umeå University, Umeå , Sweden
| | - Kurt Boman
- b Department of Public Health and Clinical Medicine , Research Unit, Medcine Skellefteå, Umeå University , Skellefteå , Sweden
| | - Patrik Wennberg
- c Department of Public Health and Clinical Medicine , Family Medicine, Umeå University , Umeå , Sweden
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Hodges GW, Bang CN, Eugen-Olsen J, Olsen MH, Boman K, Ray S, Gohlke-Bärwolf C, Kesäniemi YA, Jeppesen JL, Wachtell K. SuPAR Predicts Cardiovascular Events and Mortality in Patients With Asymptomatic Aortic Stenosis. Can J Cardiol 2016; 32:1462-1469. [DOI: 10.1016/j.cjca.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 11/17/2022] Open
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Hägglund L, Boman K, Olofsson M, Brulin C. Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare. Eur J Cardiovasc Nurs 2016; 6:208-15. [PMID: 17092775 DOI: 10.1016/j.ejcnurse.2006.09.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 09/19/2006] [Accepted: 09/22/2006] [Indexed: 11/30/2022]
Abstract
Background Patients with heart failure (HF) in primary healthcare are in many respects not comparable to those in specialized care and the knowledge about different patient groups with and without HF is limited. Aims To compare fatigue and health-related quality of life (Hr-QoL) when adjusting for age, gender and social provision in patients with confirmed HF ( n=49) to a group of patients with symptoms indicating HF but without HF (NHF, n=59) and to an age-and sex-matched control-group ( n=40). Method A questionnaire including the Multidimensional Fatigue Inventory, the SF-36, and the Social Provisions Scale was used. Results The average age in all groups was 78 years. Patients in the HF and NHF groups reported worse physical QoL and more general and physical fatigue than the control group. HF patients had worse general health than the NHF group. Conclusion Elderly patients in primary healthcare with confirmed heart failure and patients with symptoms similar to heart failure perceived they had a significantly worse physical QoL and more general and physical fatigue than an age- and sex-matched control group. The similarities between the patient groups indicate the importance of the symptom experience for Hr-QoL.
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Affiliation(s)
- Lena Hägglund
- Department of Nursing, Umeå University, S-90187, Umeå, Sweden.
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Jansson JH, Boman K, Messner T. Trends in blood pressure, lipids, lipoproteins and glucose metabolism in the Northern Sweden MONICA project 1986 - 99. Scand J Public Health 2016; 61:43-50. [PMID: 14660247 DOI: 10.1080/14034950310001397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aim: The authors present an analysis of time trends in blood pressure, hypertension, and lipids in the adult population of Northern Sweden over the period 1986 - 99. Method: Four population surveys were undertaken with new and independent cohorts, 25 - 64 years old. Results: Small changes in blood pressure were observed during the study period with increased systolic blood pressure in men and decreased diastolic blood pressure in women. The proportion with high blood pressure was found to be constant over time and only 50% were prescribed antihypertensive drugs and of these only a minority were normotensive. Total serum cholesterol decreased from 6.4 to 5.7 mmol/l in men and from 6.3 to 5.7 mmol/l in women over the study period, and this was accompanied by an increase in HDL cholesterol by about 10% in both sexes. The proportion with high cholesterol decreased from 41% to 26%. Triglycerides increased between 1986 and 1990 and no further changes were found in the following surveys. Conclusion: In the Northern Sweden MONICA population total cholesterol has declined and HDL cholesterol has increased during the past 13 years and small changes in blood pressure have been observed for both men and women.
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Affiliation(s)
- Jan-Håkan Jansson
- Department of Medicine, Skellefteå Hospital University of Umeå, Sweden.
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Brännström M, Ekman I, Norberg A, Boman K, Strandberg G. Living with Severe Chronic Heart Failure in Palliative Advanced Home Care. Eur J Cardiovasc Nurs 2016; 5:295-302. [PMID: 16546447 DOI: 10.1016/j.ejcnurse.2006.01.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2006] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Living with severe chronic heart failure (CHF) in palliative care has been little studied. AIM The aim of this study is to illuminate meaning of living with severe CHF in palliative advanced home care through patients' narratives. METHODS Narrative interviews were conducted with 4 patients, tape-recorded and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. RESULTS Meaning of living with severe CHF in palliative advanced home care emerged as 'knocking on death's door' although surviving. The course of the illness forces one to live a 'roller coaster life,' with an ongoing oscillation between ups and downs. Making it through the downs breeds a kind of confidence in one's ability to survive and the will to live is strong. Being offered a safety belt in the 'roller coaster' by the palliative advanced home care team evokes feelings of security. CONCLUSIONS Meaning of living with severe CHF in palliative advanced home care is on one hand, being aware of one's imminent death, on the other hand, making it through the downs i.e. surviving life-threatening conditions, breed confidence in also surviving the current down. Being constructively dependent on palliative advanced home care facilitates everyday life at home.
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Mancusi C, Gerdts E, de Simone G, Midtbø H, Lønnebakken MT, Boman K, Wachtell K, Dahlöf B, Devereux RB. Higher pulse pressure/stroke volume index is associated with impaired outcome in hypertensive patients with left ventricular hypertrophy the LIFE study. Blood Press 2016; 26:150-155. [PMID: 27710139 DOI: 10.1080/08037051.2016.1243009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We tested the prognostic impact of a marker of arterial stiffness, pulse pressure/stroke volume index (PP/SVi), in patients with hypertension and left ventricular (LV) hypertrophy. We used data from 866 patients randomized to losartan or atenolol-based antihypertensive treatment, over a median of 4.8 years, in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. The association of PP/SVi with outcomes was tested in Cox regression analyses and reported as hazard ratio (HR) and 95% confidence intervals (CI). In multivariate regression, reduction of PP/SVi was independently associated with male gender, reduction in systolic blood pressure (BP) and relative wall thickness and with an increase in left ventricular ejection fraction (all p < .05). After adjusting for confounders, higher baseline PP/SVi predicted a 38% higher hazard of combined major fatal and non-fatal cardiovascular events (95% CI 1.04-1.84), and higher hazard of cardiovascular mortality (HR 2.35 (95% CI 1.59-3.48) and stroke (HR 1.45 (95% CI 1.06-1.99) (all p < .05). Higher PP/SVi also predicts higher rate of hospitalization for HF (HR 2.15 (95% CI 1.48-3.12) and a 52% higher hazard of all-cause mortality (95% CI 1.10-2.09) (both p < .05). In hypertensive patients with electrocardiographic LV hypertrophy, higher PP/SVi was associated with increased cardiovascular morbidity and mortality.
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Affiliation(s)
- Costantino Mancusi
- a Department of Clinical Science , University of Bergen , Bergen , Norway.,b Hypertension Research Center, Federico II University Hospital , Napoli , Italy.,c Department of Translational Medical Sciences , Federico II University Hospital , Naples , Italy
| | - Eva Gerdts
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | - Giovanni de Simone
- b Hypertension Research Center, Federico II University Hospital , Napoli , Italy.,c Department of Translational Medical Sciences , Federico II University Hospital , Naples , Italy
| | - Helga Midtbø
- a Department of Clinical Science , University of Bergen , Bergen , Norway
| | | | - Kurt Boman
- d Department of Medicine, Skeleftaa Hospital , University of Umeaa , Skelleftaa , Sweden
| | - Kristian Wachtell
- e Department of Cardiology , Gentofte Hospital , Copenhagen , Denmark
| | - Björn Dahlöf
- f Department of Medicine , Sahlgrenska University Hospital/Östra , Göteborg , Sweden
| | - Richard B Devereux
- g Division of Cardiology , Weill Medical College of Cornell University , New York , NY , USA
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Ängerud KH, Boman K, Ekman I, Brännström M. Areas for quality improvements in heart failure care: quality of care from the patient's perspective. Scand J Caring Sci 2016; 31:830-838. [DOI: 10.1111/scs.12404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Karin H. Ängerud
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
| | - Kurt Boman
- Research Unit Skellefteå; Department of Medicine; Umeå University; Umeå Sweden
- Department of Public Health and Clinical Medicine; Umeå University; Umeå Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
| | - Margareta Brännström
- Department of Nursing; Umeå University; Umeå Sweden
- The Arctic Research Centre; Umeå University; Umeå Sweden
- Centre for Person-Centred Care; University of Gothenburg (GPCC); Gothenburg Sweden
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Norberg M, Stenlund H, Lindahl B, Boman K, Weinehall L. Contribution of Swedish moist snuff to the metabolic syndrome: A wolf in sheep's clothing? Scand J Public Health 2016; 34:576-83. [PMID: 17132590 DOI: 10.1080/14034940600665143] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between several lifestyle factors and MetSy, with a focus on the possible role of smokeless tobacco in the form of Swedish moist snuff (snus). Methods: A population-based longitudinal cohort study within the Västerbotten Intervention Programme in Northern Sweden. All inhabitants at the ages of 30, 40, 50, and 60 are invited to participate in a health survey that includes a questionnaire on psychosocial conditions and lifestyle and measurement of biological variables. Individuals examined in 1990—94 (n=24,230) and who also returned for follow-up after 10 years were included (total of 16,492 individuals: 46.6% men and 53.4% women). Regression analyses were performed. MetSy was the outcome and analyses were adjusted for age, sex, alcohol abuse, and family history of CVD and diabetes. Results: Ten-year development of MetSy was associated with high-dose consumption of snus at baseline (OR 1.6 [95% CI 1.26—2.15]), low education (2.2 [1.92—2.63]), physical inactivity (1.5 [1.22—1.73]) and former smoking (1.2 [1.06—1.38]). Snus was associated with separate components of MetSy, including triglycerides (1.6, 1.30—1.95), obesity (1.7 [1.36—2.18]) but not hypertension, dysglycemia and low HDL cholesterol. Conclusions: MetSy is independently associated with high consumption of snus, even when controlling for smoking status. The finding is of public health interest in societies with widespread use of snus. More research is needed to better understand the mechanisms underlying this effect.
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Affiliation(s)
- Margareta Norberg
- Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden.
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Wennberg P, Lindahl B, Hallmans G, Messner T, Weinehall L, Johansson L, Boman K, Jansson JH. The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction. ACTA ACUST UNITED AC 2016; 13:924-30. [PMID: 17143124 DOI: 10.1097/01.hjr.0000239470.49003.c3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction. DESIGN We used a prospective incident case-referent study design nested in Västerbotten Intervention Program and the Northern Sweden MONICA study. METHODS Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents. RESULTS Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20-2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50-0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50-0.98) or high (OR 0.67; 95% CI, 0.42-1.08) versus low occupational physical activity. CONCLUSIONS We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker.
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Björck L, Rosengren A, Winkvist A, Capewell S, Adiels M, Bandosz P, Critchley J, Boman K, Guzman-Castillo M, O’Flaherty M, Johansson I. Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study. PLoS One 2016; 11:e0160474. [PMID: 27490257 PMCID: PMC4973910 DOI: 10.1371/journal.pone.0160474] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/20/2016] [Indexed: 12/05/2022] Open
Abstract
Objective In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. Methods We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. Results In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. Conclusion CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- * E-mail:
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Piotr Bandosz
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Julia Critchley
- St George's, University of London, Population Health Research Institute, Cranmer Terrace, London, United Kingdom
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Martin O’Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
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Burström M, Boman K, Strandberg G, Brulin C. Manliga patienter med hjärtsvikt och deras erfarenhet av att vara trygga och otrygga. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/010740830702700306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brännström M, Brulin C, Norberg A, Boman K, Strandberg G. Being a Palliative Nurse for Persons with Severe Congestive Heart Failure in Advanced Homecare. Eur J Cardiovasc Nurs 2016; 4:314-23. [PMID: 15946901 DOI: 10.1016/j.ejcnurse.2005.04.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Revised: 04/01/2005] [Accepted: 04/11/2005] [Indexed: 10/25/2022]
Abstract
Advanced homecare for persons with congestive heart failure is a ‘new’ challenge for palliative nurses. The aim of this study is to illuminate the meaning of being a palliative nurse for persons with severe congestive heart failure in advanced homecare. Narrative interviews with 11 nurses were conducted, tape-recorded, and transcribed verbatim. A phenomenological-hermeneutic method was used to interpret the text. One meaning of being a palliative nurse is being firmly rooted and guided by the values of palliative culture. Being adaptable to the patient's way of life carries great weight. On one hand nurses live out this value, facilitating for the patients to live their everydaylife as good as possible. Being a facilitator is revealed as difficult, challenging, but overall positive. On the other hand nurses get into a tight corner when values of palliative culture clash and do not correspond with the nurses interpretation of what is good for the person with congestive heart failure. Being in such a tight corner is revealed as frustrating and giving rise to feelings of inadequacy. Thus, it seems important to reflect critical on the values of palliative culture.
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Ekman I, Boman K, Olofsson M, Aires N, Swedberg K. Gender Makes a Difference in the Description of Dyspnoea in Patients with Chronic Heart Failure. Eur J Cardiovasc Nurs 2016; 4:117-21. [PMID: 15904882 DOI: 10.1016/j.ejcnurse.2004.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 10/11/2004] [Accepted: 10/21/2004] [Indexed: 10/25/2022]
Abstract
Background: Dyspnoea is a common symptom of chronic heart failure (CHF). In the community setting, patients with CHF are most often women. Aim: To examine the impact of gender on the description of dyspnoea and to explore which clinical variables support a diagnosis of CHF. Methods: From four primary health care centres, 158 patients with CHF were included. Patients were examined with echocardiography and a cardiologist assessed the diagnosis of CHF. The patients filled in a questionnaire containing 11 descriptors of dyspnoea. Results: A diagnosis of CHF was confirmed in 87 (55%) patients (47 males and 40 females). One descriptor, I feel that I am suffocating, was significantly scored higher in CHF patients ( p=0.014) as compared to non-CHF patients. Three descriptors, My breath does not go in all the way ( p=0.006), I feel that I am suffocating ( p=0.040), and I cannot get enough air ( p=0.0327) were significantly scored higher among men with CHF, compared to no descriptor among women with CHF. Being male (OR=2.7; CI: 1.3–5.6, p=0.008), having diabetes (OR=5.6; CI: 1.7–18.2, p=0.004), IHD (OR=3.3; CI: 1.3–8.5, p=0.014), and a borderline significance for age (OR=1.04; CI: 0.99–1.08, p=0.058) predicted a confirmed diagnosis of CHF. Conclusion: Three descriptors of dyspnoea were associated with CHF among men, whereas no such association was found among women. Our results suggest that gender is an important factor and should—together with age, underlying heart disease, and diabetes—be taken into account when symptoms are evaluated in the diagnosis of CHF in primary care.
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Affiliation(s)
- Inger Ekman
- Faculty of Health and Caring Sciences, Institute of Nursing, The Sahlgrenska Academy at Göteborg University, Box 457, Göteborg SE 405 30, Sweden.
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Rautio A, Boman K, Eriksson JW, Svensson MK. Markers of fibrinolysis may predict development of lower extremity arterial disease in patients with diabetes: A longitudinal prospective cohort study with 10 years of follow-up. Diab Vasc Dis Res 2016; 13:183-91. [PMID: 26818227 DOI: 10.1177/1479164115618516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A previous cross-sectional study suggested that tissue plasminogen activator-activity might be an early marker of asymptomatic lower extremity arterial disease, but the long-term relationship is unknown. SUBJECTS AND METHODS This study included 96 diabetic (48 type 1/48 type 2) and 62 non-diabetic subjects aged 30-70 years without previously known lower extremity arterial disease (age: 50.3 ± 9.3 years, gender: M/W 47.5/52.5% and body mass index: 26.6 ± 4.5 kg/m(2)). The relationships between asymptomatic lower extremity arterial disease and fibrinolytic markers (tissue plasminogen activator-activity, tissue plasminogen activator-mass, plasminogen activator inhibitor-1 activity) at baseline and after 10 years were assessed by logistic regression analysis adjusting for age, hypertension, statin treatment, HbA1c, triglycerides and low-density lipoprotein cholesterol as fixed covariates. RESULTS The tissue plasminogen activator-activity at baseline and at the 10-year follow-up significantly predicted the presence of sign(s) of lower extremity arterial disease (odds ratio = 1.78, 95% confidence interval: 1.02-3.10, p = 0.043 and odds ratio = 1.78, 95% confidence interval: 1.12-2.23, p = 0.014, respectively). In addition, tissue plasminogen activator-mass at the 10-year follow-up was associated with signs of lower extremity arterial disease (odds ratio = 1.07, 95% confidence interval: 1.00-1.15, p = 0.046). Baseline age, hypertension and HbA1c were independently associated with sign(s) of lower extremity arterial disease at 10 years (odds ratio = 1.09, 95% confidence interval: 1.04-1.14, p = < 0.001; odds ratio = 3.68, 95% confidence interval: 1.67-8.12, p = 0.001 and odds ratio = 1.54, 95% confidence interval: 1.21-1.95, p = < 0.001, respectively). CONCLUSION This long-term study supports previous findings of a significant association between asymptomatic lower extremity arterial disease and tissue plasminogen activator-activity. Thus, tissue plasminogen activator-activity may be an early marker of lower extremity arterial disease although the mechanism of this relationship remains unclear.
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Affiliation(s)
- Aslak Rautio
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Department of Medicine, Sunderby Hospital, Luleå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Research Unit, Skellefteå Hospital, Skellefteå, Sweden
| | - Jan W Eriksson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Maria K Svensson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Blyme A, Asferg C, Nielsen OW, Boman K, Gohlke-Bärwolf C, Wachtell K, Olsen MH. Increased hsCRP is associated with higher risk of aortic valve replacement in patients with aortic stenosis. SCAND CARDIOVASC J 2016; 50:138-45. [PMID: 26911132 DOI: 10.3109/14017431.2016.1151928] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective To investigate relations between inflammation and aortic valve stenosis (AS) by measuring high-sensitivity C-reactive protein, at baseline (hsCRP0) and after 1 year (hsCRP1) and exploring associations with aortic valve replacement (AVR). Design We examined 1423 patients from the Simvastatin and Ezetimibe in Aortic Stenosis study. Results During first year of treatment, hsCRP was reduced both in patients later receiving AVR (2.3 [0.9-4.9] to 1.8 [0.8-5.4] mg/l, p < 0.001) and not receiving AVR (1.90 [0.90-4.10] to 1.3 [0.6-2.9] mg/l, p < 0.001). In Cox-regression analyses, hsCRP1 predicted later AVR (HR = 1.17, p < 0.001) independently of hsCRP0 (HR = 0.96, p = 0.33), aortic valve area (AVA) and other risk factors. A higher rate of AVR was observed in the group with high hsCRP0 and an increase during the first year (AVRhighCRP0CRP1inc = 47.3% versus AVRhighCRP0CRP1dec = 27.5%, p < 0.01). The prognostic benefit of a 1-year reduction in hsCRP was larger in patients with high versus low hsCRP0 eliminating the difference in incidence of AVR between high versus low hsCRP0 (AVRhighCRP0CRP1dec = 27.5% versus AVRlowCRP0CRP1dec = 25.8%, p = 0.66) in patients with reduced hsCRP during the first year. Conclusions High hsCRP1 or an increase in hsCRP during the first year of follow-up predicted later AVR independently of AVA, age, gender and other risk factors, although no significant improvement in C-statistics was observed.
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Affiliation(s)
- Adam Blyme
- a Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark
| | - Camilla Asferg
- a Department of Cardiology , Glostrup Hospital, University of Copenhagen , Glostrup , Denmark
| | - Olav W Nielsen
- b Department of Cardiology , Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Kurt Boman
- c Research Unit, Skelelfteå , Institution of Public Health and Clinical Medicine, Umeå University , Umeå , Sweden
| | | | - Kristian Wachtell
- e Oslo University Hospital, Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology, Section Cardiology Intervention , Unit Ullevål , Oslo , Norway
| | - Michael H Olsen
- f Centre for Individualized Medicine in Arterial Diseases (CIMA) , Odense University Hospital, University of Southern Denmark , Denmark ;,g Medical Research Council Unit on Hypertension and Cardiovascular Disease; Hypertension in Africa Research Team (HART) , North-West University , Potchefstroom, South Africa
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50
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Sahlen KG, Boman K, Brännström M. A cost-effectiveness study of person-centered integrated heart failure and palliative home care: Based on a randomized controlled trial. Palliat Med 2016; 30:296-302. [PMID: 26603186 DOI: 10.1177/0269216315618544] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion. AIM To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care. DESIGN A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients' responses to the EQ-5D quality of life instrument. SETTING/PARTICIPANTS Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital. RESULTS EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs. CONCLUSION The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
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Affiliation(s)
- Klas-Göran Sahlen
- Department of Nursing, Umeå University, Umeå, Sweden Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden Research Unit, Department of Medicine, Umeå University, Skellefteå, Sweden
| | - Margareta Brännström
- Department of Nursing, Umeå University, Umeå, Sweden The Arctic Research Centre, Umeå University, Umeå, Sweden
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