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Zambach C, Pan J, Gerward S, Fedorowski A, Smith JG, Engström G, Hamrefors V. The relationships between the plasma metabolome and orthostatic blood pressure responses. Sci Rep 2023; 13:18244. [PMID: 37880314 PMCID: PMC10600108 DOI: 10.1038/s41598-023-44226-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
Whereas autonomic dysfunction and the metabolic syndrome are clinically associated, the relationships with the plasma metabolome is unknown. We explored the association between orthostatic blood pressure responses and 818 plasma metabolites in middle-aged subjects from the general population. We included 3803 out of 6251 subjects (mean age, 57 years; 52% women) from the Malmö sub-cohort of The Swedish CardioPulmonary bioImage Study with information on smoking habits, diabetes, antihypertensive drug treatment, anthropometrics, hemodynamic measurements and 818 plasma metabolites (mass-spectrometry). The associations between each metabolite and orthostatic systolic blood pressure responses were determined using multivariable linear regression analysis and p values were corrected using the Bonferroni method. Six amino acids, five vitamins, co-factors and carbohydrates, nine lipids and two xenobiotics were associated with orthostatic blood pressure after adjusting for age, gender and systolic blood pressure. After additional adjustments for BMI, diabetes, smoking and antihypertensive treatment, the association remained significant for six lipids, four amino acids and one xenobiotic. Twenty-two out of 818 plasma metabolites were associated with orthostatic blood pressure responses. Eleven metabolites, including lipids in the dihydrosphingomyelin and sphingosine pathways, were independently associated with orthostatic systolic blood pressure responses after additional adjustment for markers of cardio-metabolic disease.
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Affiliation(s)
- Christian Zambach
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden.
- Department of Internal Medicine, Skåne University Hospital, Lund, Sweden.
| | - Jingxue Pan
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Division of Child Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sofia Gerward
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
- The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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Lind M, Catrina SB, Ekberg NR, Gerward S, Halasa T, Hellman J, Hess D, Löndahl M, Qvist V, Bolinder J. Fast-Acting Insulin Aspart in Patients with Type 1 Diabetes in Real-World Clinical Practice: A Noninterventional, Retrospective Chart and Database Study. Diabetes Ther 2023:10.1007/s13300-023-01444-y. [PMID: 37450196 PMCID: PMC10363098 DOI: 10.1007/s13300-023-01444-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION This study utilized continuous glucose monitoring data to analyze the effects of switching to treatment with fast-acting insulin aspart (faster aspart) in adults with type 1 diabetes (T1D) in clinical practice. METHODS A noninterventional database review was conducted in Sweden among adults with T1D using multiple daily injection (MDI) regimens who had switched to treatment with faster aspart as part of basal-bolus treatment. Glycemic data were retrospectively collected during the 26 weeks before switching (baseline) and up to 32 weeks after switching (follow-up) to assess changes in time in glycemic range (TIR; 70-180 mg/dL), mean sensor glucose, glycated hemoglobin (HbA1c) levels, coefficient of variation, time in hyperglycemia (level 1, > 180 to ≤ 250 mg/dL; level 2, > 250 mg/dL), and time in hypoglycemia (level 1, ≥ 54 to < 70 mg/dL; level 2, < 54 mg/dL) (ClinicalTrials.gov Identifier NCT03895515). RESULTS Overall, 178 participants were included in the study cohort. The analysis population included 82 individuals (mean age 48.5 years) with adequate glucose sensor data. From baseline to follow-up, statistically significant improvements were reported for TIR (mean increase 3.3%-points [approximately 48 min/day]; p = 0.006) with clinically relevant improvement (≥ 5%) in 43% of participants. Statistically significant improvements from baseline were observed for mean sensor glucose levels, HbA1c levels, and time in hyperglycemia (levels 1 and 2), with no statistically significant changes in time spent in hypoglycemia. CONCLUSIONS Switching to faster aspart was associated with improvements in glycemic control without increasing hypoglycemia in adults with T1D using MDI in this real-world setting.
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Affiliation(s)
- Marcus Lind
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
- Specialist Medicine, Uddevalla and Department of Medicine, NU-Hospital Group, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sergiu-Bogdan Catrina
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, Stockholm, Sweden
| | - Neda R Ekberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, Stockholm, Sweden
| | | | | | - Jarl Hellman
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Magnus Löndahl
- Department of Endocrinology, Skane University Hospital, Lund, Sweden
| | - Veronica Qvist
- Ersta Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jan Bolinder
- Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
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Zambach C, Fedorowski A, Gerward S, Johansson M, Engström G, Hamrefors V. Subclinical atherosclerosis and risk factors in relation to autonomic indices in the general population. J Hypertens 2023; 41:759-767. [PMID: 36883449 PMCID: PMC10090316 DOI: 10.1097/hjh.0000000000003397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE Orthostatic hypotension and resting heart rate (RHR) are associated with cardiovascular disease (CVD). However, it is unknown how these factors relate to subclinical CVD. We examined the relationship between orthostatic blood pressure (BP) response, RHR and cardiovascular risk factors, including coronary artery calcification score (CACS) and arterial stiffness, in the general population. METHODS We included 5493 individuals (age 50-64 years; 46.6% men) from The Swedish CArdioPulmonary-bio-Image Study (SCAPIS). Anthropometric and haemodynamic data, biochemistry, CACS and carotid-femoral pulse wave velocity (PWV) were retrieved. Individuals were categorized into binary variables that manifest orthostatic hypotension and in quartiles of orthostatic BP responses and RHR, respectively. Differences across the various characteristics were tested using χ 2 for categorical variables and analysis of variance and Kruskal-Wallis test for continuous variables. RESULTS The mean (SD) SBP and DBP decrease upon standing was -3.8 (10.2) and -9.5 (6.4) mmHg, respectively. Manifest orthostatic hypotension (1.7% of the population) associated with age ( P = 0.021), systolic, diastolic and pulse pressure ( P < 0.001), CACS (<0.001), PWV ( P = 0.004), HbA1c ( P < 0.001) and glucose levels ( P = 0.035). Age ( P < 0.001), CACS ( P = 0.045) and PWV ( P < 0.001) differed according to systolic orthostatic BP, with the highest values seen in those with highest and lowest systolic orthostatic BP-responses. RHR was associated with PWV ( P < 0.001), SBP and DBP ( P < 0.001) as well as anthropometric parameters ( P < 0.001) but not CACS ( P = 0.137). CONCLUSION Subclinical abnormalities in cardiovascular autonomic function, such as impaired and exaggerated orthostatic BP response and increased resting heart rate, are associated with markers of increased cardiovascular risk in the general population.
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Affiliation(s)
- Christian Zambach
- Department of Clinical Sciences, Lund University, Malmö
- Department of Internal Medicine, Skåne University Hospital, Lund
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö
- Department of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institutet, Stockholm
| | - Sofia Gerward
- Department of Clinical Sciences, Lund University, Malmö
| | - Madeleine Johansson
- Department of Clinical Sciences, Lund University, Malmö
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | | | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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Sahlin D, Rezanezad B, Edvinsson ML, Bachus E, Melander O, Gerward S. Self-care Management Intervention in Heart Failure (SMART-HF): A Multicenter Randomized Controlled Trial. J Card Fail 2022; 28:3-12. [PMID: 34161807 PMCID: PMC7612444 DOI: 10.1016/j.cardfail.2021.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/30/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-care behavior is important in avoiding hospitalization for patients with heart failure (HF) and refers to those activities performed with the intention of improving or restoring health and well-being, as well as treating or preventing disease. The purpose was to study the effects of a home-based mobile device on self-care behavior and hospitalizations in a representative HF-population. METHODS AND RESULTS SMART-HF is a randomized controlled multicenter clinical trial, where patients were randomized 1:1 to receive standard care (control group [CG]) or intervention with a home-based tool designed to enhance self-care behavior (intervention group [IG]) and followed for 240 days. The tool educates the patient about HF, monitors objective and subjective symptoms and adjusts loop diuretics. The primary outcome is self-care as measured by the European Heart Failure Self-care behavior scale and the secondary outcome is HF related in-hospital days.A total of 124 patients were recruited and 118 were included in the analyses (CG: n = 60, IG: n = 58). The mean age was 79 years, 39% were female, and 45% had an ejection fraction of less than 40%. Self-care was significantly improved in the IG compared to the CG (median (interquartile range) (21.5 [13.25; 28] vs 26 [18; 29.75], p = 0.014). Patients in the IG spent significantly less time in the hospital admitted for HF (2.2 days less, relative risk 0.48, 95% confidence interval 0.32-0.74, P = .001). CONCLUSIONS The device significantly improved self-care behavior and reduced in-hospital days in a relevant HF population.
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Affiliation(s)
- Daniel Sahlin
- Department of Emergency and Internal Medicine, Skåne University Hospital, Skåne, Sweden
| | - Babak Rezanezad
- Department of Emergency and Internal Medicine, Skåne University Hospital, Skåne, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Marie-Louise Edvinsson
- Department of Emergency and Internal Medicine, Skåne University Hospital, Skåne, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Erasums Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Olle Melander
- Department of Emergency and Internal Medicine, Skåne University Hospital, Skåne, Sweden; Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Sofia Gerward
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
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Thelin J, Gerward S, Melander O. Low risk patients with acute atrial fibrillation and elevated high-sensitivity troponin do not have increased incidence of pathological stress tests. SCAND CARDIOVASC J 2021; 55:259-263. [PMID: 33988469 PMCID: PMC7612447 DOI: 10.1080/14017431.2021.1927171] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
OBJECTIVES Many patients with atrial fibrillation (AF) or atrial flutter (AFL) and rapid ventricular response (RVR) have elevated high-sensitivity troponin T (hsTnT) values. Elevated hsTnT is an independent risk marker for cardiovascular events and mortality. The aim was to examine if AF/AFL patients with RVR and elevated hsTnT have an increased incidence of pathological cardiac stress tests, indicating need of further evaluation for coronary artery disease (CAD). Design: We prospectively included 90 AF/AFL patients without known heart failure and CAD presenting with AF/AFL and RVR. Half of the patients had elevated hsTnT (cases) and half had levels below the 99th percentile (controls). All patients were discharged in sinus rhythm. After approximately one week in sinus rhythm a new hsTnT was analysed and the patients performed a bicycle exercise stress test within the 30 day follow-up. The primary endpoint was a pathological stress test confirmed by a pathological SPECT myocardial perfusion imaging or a coronary angiography. Results: None of the controls reached the primary endpoint. Two patients (4%) out of the 45 cases reached the primary endpoint (p = .49 vs controls), but only one was found to have significant CAD at subsequent coronary angiography. Conclusion: Patients with paroxysmal AF/AFL, without a history of CAD and heart failure, who present with a RVR and minor hsTnT elevations were not found to have an increased incidence of pathological stress tests compared to patients with hsTnT values below the 99th percentile.
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Affiliation(s)
- Johan Thelin
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Sofia Gerward
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
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Zambach C, Fedorowski A, Borné Y, Johnson LSB, Gerward S, Hamrefors V, Engström G. Cardiovascular risk factors and autonomic indices in relation to fatal and non-fatal coronary events. Open Heart 2021; 8:openhrt-2020-001445. [PMID: 33879505 PMCID: PMC8061811 DOI: 10.1136/openhrt-2020-001445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 09/11/2020] [Revised: 03/27/2021] [Accepted: 04/07/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Mortality caused by coronary artery disease has markedly decreased in recent years. However, a substantial proportion of patients suffering a coronary event (CE) die within the first day, most of them out of hospital. We aimed to investigate how established cardiovascular (CV) risk factors and CV autonomic indices associate with fatal versus non-fatal CEs in the population. METHODS 33 057 individuals (mean age; 45.6 years; 10 773 women) free of coronary artery disease at baseline were included. Baseline examination, including assessment of traditional CV risk factors and autonomic indices such as heart rate and orthostatic reaction, was performed during 1974-1992, after which the subjects were monitored for incident CV disease. The Lunn-McNeil competing risks approach with a prespecified multivariable model was used to assess differences in risks for fatal and non-fatal CEs in relation to baseline CV risk factors. RESULTS During follow-up period of 29.7 years, 5494 subjects (6.10/1000 person-years) had first CE; 1554 of these were fatal. Age, male gender, smoking, body mass index (BMI), blood pressure, pulse pressure and resting heart rate had stronger relationships with fatal CE than with non-fatal events. The effects of diabetes, serum cholesterol, antihypertensive treatment and orthostatic blood pressure responses were similar for fatal and non-fatal CE. CONCLUSIONS Several cardiovascular risk factors, such as smoking, high BMI, blood pressure and high resting heart rate, were preferentially associated with fatal compared with non-fatal CEs. These observations may require special attention in the overall efforts to further reduce coronary artery disease mortality.
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Affiliation(s)
- Christian Zambach
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Yan Borné
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Linda S B Johnson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Malmö, Sweden
| | - Sofia Gerward
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Lund University, Malmö, Sweden .,Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Lund University, Malmö, Sweden
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Sahlin D, Melander O, Gerward S. Selfcare management intervention in heart failure (SMART-HF) -a multicentre randomized controlled trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1126] [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
Clinical studies evaluating home-based interventions for heart failure (HF) patients are performed on patients that are too young, too often male and predominately have reduced ejection-fraction (EF). The Selfcare Management Intervention in Heart Failure (SMART-HF) study was designed to evaluate a digital intervention enhancing self-care behaviour in a more generalizable population. The aim was to see if the intervention could reduce in-hospital care due to HF.
Methods
SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne. Patients were randomized 1:1 to a control group (CG) receiving standard care or an intervention group (IG) who were equipped with the digital intervention. The intervention educates the patient about HF and supports the patient with medication and symptom monitoring, also notifying the patient in case of deterioration. The primary outcome was number of in-hospital days due to HF after 240 days follow-up.
Results
A total of 124 patients were randomized and 118 (CG: 60, IG: 58) were included in the analysis. The mean age was 79 years, 39% were women and 45% had EF <40%. The groups were well balanced at randomization. A total of 367 HF in-hospital days were registered among 33 patients, and patients in the IG lost on average 2.2 days fewer to HF-hospitalizations than patients in the CG, a reduction by 52%, p<0.001. An unadjusted Cox-regression to analyse the event-free survival yielded a hazard ratio = 0.50 (CI:0,24–0,96), p=0.046. The self-care behaviour was 21% better in the IG, p=0.014. The median system adherence was 85% after 240 days.
Conclusions
The intervention significantly reduced HF-related in-hospital days and improved event-free survival in a representative HF-population. The findings match previous published data from studies evaluating the same intervention.
Funding Acknowledgement
Type of funding source: None
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Sahlin D, Gerward S. An improvement in self-care behaviour in heart failure patients lead to better management of hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1127] [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
A common heart failure (HF) aetiology is hypertension (HTN), second only to ischemic heart disease and with a prevalence in the HF community of between 62% and 84%, depending on sex and ejection-fraction. Undertreated HTN leads to worse prognosis and resistant HTN is defined as blood pressure (BP) exceeding 140/90 mmHg, in spite of pharmacological treatment. Since one constituent of self-care behaviour is treatment adherence, we wished to study whether patients exposed to a digital intervention shown to improve self-care behaviour, would also display improved BP control.
Methods
SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne in southern Sweden, where patients in the intervention group (IG) were equipped with a digital home-based tool, designed to enhance self-care behaviour for HF-patients and the control group (CG) were subject to standard care. BP data was registered at baseline and after eight months of intervention and self-care behaviour was measured using the European Heart Failure Self-care Behaviour Scale (EHFScB). We used a Chi-square test to analyse whether there was an inter-group difference of prevalence of resistant HTN or a mean arterial pressure (MAP) outside the recommended range of 60 mmHg < MAP <100 mmHg.
Results
Out of the 118 patients included in the original analysis, 92 (78%) had complete BP measurements. At baseline there was no difference in self-care behaviour between the groups, with CG: 25 [17.5; 32] and IG: 24.5 [18; 30], p=0.61, and 28% of the CG patients and 24% of the IG population displayed resistant HTN, p=0.73. After eight months of intervention the IG had 21% (or 4.5 points) better self-care behaviour compared to the CG, p=0.014, and the fraction of patients with resistant HTN was 30% for the CG and 11% for the IG, p=0.027. There was also a significant effect on the fraction of patients having a MAP >100 mmHg, with 22% in the CG versus 16% in the IG having MAP >100 mmHg at baseline (p=0.39) and 19% in the CG versus 0% in the IG at follow-up (p=0.002).
Conclusions
There was a significant improvement in self-care behaviour and also a significant reduction in the number of patients with resistant hypertension and elevated mean arterial pressure after eight months of intervention.
Funding Acknowledgement
Type of funding source: None
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Nymberg VM, Bolmsjö BB, Wolff M, Calling S, Gerward S, Sandberg M. 'Having to learn this so late in our lives…' Swedish elderly patients' beliefs, experiences, attitudes and expectations of e-health in primary health care. Scand J Prim Health Care 2019; 37:41-52. [PMID: 30732519 PMCID: PMC6452815 DOI: 10.1080/02813432.2019.1570612] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The elderly are an increasing group and large consumers of care in Sweden. Development of mobile information technology shows promising results of interventions for prevention and treatment of chronic diseases. Exploring the elderly patients' beliefs, attitudes, experiences and expectations of e-health services helps us understand the factors that influence adherence to such tools in primary care. MATERIAL AND METHODS We conducted focus group interviews with 15 patients from three primary health care centers (PHCCs) in Southern Sweden. Data were analysed with thematic content analysis with codes and categories emerged from data during analysis. RESULTS We found one comprehensive theme: 'The elderly's ambivalence towards e-health: reluctant curiosity, a wish to join and need for information and learning support'. Eight categories emerged from the text during analysis: 'E-health - a solution for a non-existing problem?', 'The elderly's experiences of e-health', 'Lack of will, skills, self-trust or mistrust in the new technology', 'Organizational barriers', 'Wanting and needing to move forward', 'Concerns to be addressed for making e-health a good solution', 'Potential advantages with e-health versus ordinary health care' and 'Need for speed, access and correct comprehensive information'. CONCLUSIONS Elderly patients in Sweden described feelings of ambivalence towards e-health, raising concerns as accessibility to health care, mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly. Key points Exploring the elderly patients' beliefs, experiences, attitudes and expectations of the fast developing e-health services helps us understand the factors that influence adherence to such tools in primary care. Elderly patients in Sweden reported ambivalence and different experiences and attitudes towards e-health, raising concerns as accessibility to health care, costs and mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly.
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Affiliation(s)
- Veronica Milos Nymberg
- Department of Clinical Sciences, Lund University, Malmö, Sweden;
- Center for primary Health Care research Malmö, Malmö, Sweden;
- CONTACT Veronica Milos Nymberg Department of Clinical Sciences, Lund University, Malmö, Sweden; Centre for primary care research Malmö, Box 50332, 20213, Malmö, Sweden
| | - Beata Borgström Bolmsjö
- Department of Clinical Sciences, Lund University, Malmö, Sweden;
- Center for primary Health Care research Malmö, Malmö, Sweden;
| | - Moa Wolff
- Department of Clinical Sciences, Lund University, Malmö, Sweden;
- Center for primary Health Care research Malmö, Malmö, Sweden;
| | - Susanna Calling
- Department of Clinical Sciences, Lund University, Malmö, Sweden;
- Center for primary Health Care research Malmö, Malmö, Sweden;
| | - Sofia Gerward
- Department of Clinical Sciences, Lund University, Malmö, Sweden;
- Innovation Skåne, Lund, Sweden;
| | - Magnus Sandberg
- Department of Health Sciences, Lund University, Lund, Sweden
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Gerward S, Persson K, Midlöv P, Ekesbo R, Gullberg B, Hedblad B. Trends in out-of-hospital ischaemic heart disease deaths 1992 to 2003 in southern Sweden. Scand J Public Health 2012; 40:340-7. [DOI: 10.1177/1403494812449078] [Citation(s) in RCA: 4] [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
Aims: In western countries out-of-hospital ischaemic heart disease (IHD) deaths account for approximately 50–70% of all IHD deaths. The objective was to examine the trends in out-of-hospital IHD deaths in the Region of Skåne in southern Sweden, in different sex- and age-groups. Methods: All 14,347 persons (range 24–110 years) in Skåne who died out-of-hospital between 1992 and 2003 from IHD (I410–I414; I20–I25) as the underlying cause of death. Subjects with previous admission for IHD since 1970 were excluded. Data were retrieved from the Swedish National Cause of Death and Patient Register. Age-standardized IHD mortality rates and trends were calculated using Poisson regression analysis. Results: Age-standardized annual out-of-hospital IHD mortality rates from 1992–2003 decreased in men from 177±13 to 103±9/100,000 inhabitants (−4.7%; p<0.001) and in women from 142±11 to 96±9/100,000 (−2.7%; p<0.001). In men, the annual change in age-standardized IHD mortality rates were −5.3 % ( p<0.001), −4.0 % ( p<0.001) and −4.7 % ( p<0.001), respectively, in the age groups 20–64 years, 65–74 years and ≥75 years. Corresponding figures in women were −4.4 % ( p<0.001), −2.4 % ( p=0.003) and −2.5 % ( p<0.001). The proportion of IHD deaths occurring out-of-hospital was in these age groups 50%, 40% and 35% respectively. Conclusions: In Skåne, out-of-hospital mortality in IHD deaths decreased significantly between 1992 and 2003. The decrease is more pronounced in men than women, and at the end of the study period in 2003, rates were almost equal. The proportion of IHD deaths occurring outside hospital was higher in younger people than in older people.
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Affiliation(s)
- S. Gerward
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Lund University, Sweden
- Department of Clinical Sciences in Malmö, General Practice/Family Medicine, Sweden
| | | | | | | | - B. Gullberg
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Lund University, Sweden
| | - B. Hedblad
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Lund University, Sweden
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Ekesbo R, Midlöv P, Gerward S, Persson K, Nerbrand C, Johansson L. Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-a case report-based survey. BMC Fam Pract 2012; 13:34. [PMID: 22536853 PMCID: PMC3391982 DOI: 10.1186/1471-2296-13-34] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Accepted: 04/26/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. METHOD A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n=109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. RESULTS In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. CONCLUSION In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles.
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Affiliation(s)
- Rickard Ekesbo
- General Practice/Family Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- The R&D Department of Primary Care, Malmö, Region Skåne, Sweden
- Dalby Primary Health Care Centre, Skolgatan 1, S-240 10, Dalby, Sweden
| | - Patrik Midlöv
- General Practice/Family Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
- The R&D Department of Primary Care, Malmö, Region Skåne, Sweden
| | - Sofia Gerward
- Cardiovascular Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Kristin Persson
- General Practice/Family Medicine, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
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Gerward S, Tydén P, Engström G, Hedblad B. Marital status and occupation in relation to short-term case fatality after a first coronary event--a population based cohort. BMC Public Health 2010; 10:235. [PMID: 20459706 PMCID: PMC2874781 DOI: 10.1186/1471-2458-10-235] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 05/10/2010] [Indexed: 11/13/2022] Open
Abstract
Background Although marital status and low occupation level has been associated with mortality, the relationship with case fatality rates (CFR) after a coronary event (CE) is unclear. This study explored whether incidence of CE and short-term CFR differ between groups defined in terms of marital status and occupation, and if this could be explained by biological and life-style risk factors. Methods Population-based cohort study of 33,224 subjects (67% men), aged 27 to 61 years, without history of myocardial infarction, who were enrolled between 1974 and 1992. Incidence of CE, and CFR (death during the first day or within 28 days after CE, including out-of-hospital deaths) was examined over a mean follow-up of 21 years. Results A total of 3,035 men (6.0 per 1000 person-years) and 507 women (2.4 per 1000) suffered a first CE during follow-up. CFR (during the 1st day) was 29% in men and 23% in women. After risk factor adjustments, unmarried status in men, but not in women, was significantly associated with increased risk of suffering a CE [hazard ratios (HR) 1.10, 95% CI: 0.97-1.24; 1.42: 1.27-1.58 and 1.77: 1.31-2.40 for never married, divorced and widowed, respectively, compared to married]. Unmarried status, in both gender, was also related with an increased CFR (1st day), taking potential confounders into account (odds ratio (OR) 2.14, 95% CI: 1.63-2.81; 1.91: 1.50-2.43 and 1.49: 0.77-2.89 for never married, divorced and widowed, respectively, compared to married men. Corresponding figures for women was 2.32: 0.93-5.81; 1.87: 1.04-3.36 and 2.74: 1.03-7.28. No differences in CFR (1st day) were observed between occupational groups in neither gender. Conclusions In this population-based Swedish cohort, short-term CFR was significantly related to unmarried status in men and women. This relationship was not explained by biological-, life-style factors or occupational level.
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Affiliation(s)
- Sofia Gerward
- Department of Clinical Sciences in Malmö, Cardiovascular Epidemiology, Skåne University Hospital, Malmö, Sweden.
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Rosvall M, Gerward S, Engström G, Hedblad B. Income and short-term case fatality after myocardial infarction in the whole middle-aged population of Malmö, Sweden. Eur J Public Health 2008; 18:533-8. [PMID: 18621776 DOI: 10.1093/eurpub/ckn059] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are no previous studies investigating when and where those who die pre-hospitally after an AMI paid their last visit to medical care. METHODS AND RESULTS Incidence of AMI, pre-hospital and 28-day case fatality rates were monitored over 13 years of follow-up, in relation to sex-specific quartiles of annual income in all inhabitants aged 40-64 years in Malmö, Sweden. Both incidence and short-term case fatality were inversely related to income. In all, 60-70% of all deaths within 28 days after the AMI were pre-hospital deaths. As compared with the lowest income group, the highest income group had lower odds of pre-hospital death with an age- and time-to-event-adjusted odds ratio of 0.5 (95% CI 0.4-0.8) for men and 0.3 (95% CI 0.1-0.6) for women. On the other hand, while 72% of those in the lowest two income groups had paid a visit to the medical services during the three months before death, only 59% had done so in the two highest income groups (P < 0.05). CONCLUSIONS Poor socioeconomic circumstances increase the risk of pre-hospital death after an AMI. Of the pre-hospital deaths, the proportion who had visited the medical services during the 3 months preceding their AMI was higher among those from lower income groups. However, many of those suffering a pre-hospital death had visited clinics that normally do not treat coronary symptoms. If more patients were identified at an earlier stage this might increase the number of patients reaching hospital alive.
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Affiliation(s)
- Maria Rosvall
- Department of Clinical Sciences, Social Epidemiology, Lund University, Malmö University Hospital, Malmö, Sweden.
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Midlöv P, Ekesbo R, Johansson L, Gerward S, Persson K, Nerbrand C, Hedblad B. Barriers to adherence to hypertension guidelines among GPs in southern Sweden: a survey. Scand J Prim Health Care 2008; 26:154-9. [PMID: 18609250 PMCID: PMC3409603 DOI: 10.1080/02813430802202111] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [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] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate barriers to adherence to hypertension guidelines among publicly employed general practitioners (GPs). DESIGN Questionnaire-based survey distributed to GPs in 24 randomly selected primary care centres in the Region of Skåne in southern Sweden. SUBJECTS A total of 109 GPs received a self-administered questionnaire and 90 of them responded. MAIN OUTCOME MEASURES Use of risk assessment programmes. Reasons to postpone or abstain from pharmacological treatment for the management of hypertension. RESULTS Reported managing of high blood pressure (BP) varied. In all, 53% (95% CI 42-64%) of the GPs used risk assessment programmes and nine out of 10 acknowledged blood pressure target levels. Only one in 10 did not inform the patients about these levels. The range for immediate initiating pharmacological treatment was a systolic BP 140-220 (median 170) mmHg and diastolic BP 90-110 (median 100) mmHg. One-third (32%; 95% CI 22-42%) of the GPs postponed or abstained from pharmacological treatment of hypertension due to a patient's advanced age. No statistically significant associations were observed between GPs' gender, professional experience (i.e. in terms of specialist family medicine and by number of years in practice), and specific reasons to postpone or abstain from pharmacological treatment of hypertension. CONCLUSION These data suggest that GPs accept higher blood pressure levels than recommended in clinical guidelines. Old age of the patient seems to be an important barrier among GPs when considering pharmacological treatment for the management of hypertension.
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Affiliation(s)
- Patrik Midlöv
- Department of Clinical Sciences, Malmö-General Practice/Family Medicine, Lund University, Sweden.
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Gerward S, Tydén P, Hansen O, Engström G, Janzon L, Hedblad B. Survival rate 28 days after hospital admission with first myocardial infarction. Inverse relationship with socio-economic circumstances. J Intern Med 2006; 259:164-72. [PMID: 16420545 DOI: 10.1111/j.1365-2796.2005.01594.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study to what extent geographical differences of the mortality from ischaemic heart disease (IHD) can be accounted for by the 28-day case fatality rate (CFR) following first hospital admittance for acute myocardial infarction (MI) and whether the geographical pattern of survival has any relationship with socio-economic circumstances. DESIGN Register-based surveillance study. SETTING Seventeen residential areas in Malmö, Sweden. SUBJECTS All 5533 patients were admitted during 1986-1995 for a first acute MI at Malmö University Hospital. Main outcome measures. CFR is based on record linkage with national registers. Area-specific cardiovascular and socio-economic scores (SES) are based on previous cross-sectional studies. RESULTS In patients below 75 years of age, differences of the 28-day CFR accounted for 20-30% of the geographical variance in mortality from IHD. No corresponding association was found in older age groups. Patients from areas with low SES had the highest CFR, 23.8%. The odds ratios of fatal outcome for patients from areas with median and low SES (versus high SES) were 1.23 (95% CI: 1.01-1.50) and 1.25 (95% CI: 1.03-1.52), respectively (P for trend: 0.060). The strongest correlation was observed in men below 75 years of age (P for trend: 0.007). During the study period there was an improvement of the survival rate for patients from high and medium SES areas but no corresponding change for patients coming from areas having a low SES. CONCLUSIONS In patients below 75 years, geographical differences of the mortality from IHD were related to differences of the 28-day CFR following hospital admittance for a first MI. Rates of survival were inversely related to socio-economic circumstances in the patient's residential area.
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Affiliation(s)
- S Gerward
- Department of Clinical Sciences in Malmö, Epidemiological Research Group, Malmö University Hospital, Malmö, Sweden.
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