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Pettersen TR, Schjøtt J, Allore H, Bendz B, Borregaard B, Fridlund B, Hadjistavropoulos HD, Larsen AI, Nordrehaug JE, Rasmussen TB, Rotevatn S, Valaker I, Wentzel-Larsen T, Norekvål TM. Discharge Information About Adverse Drug Reactions Indicates Lower Self-Reported Adverse Drug Reactions and Fewer Concerns in Patients After Percutaneous Coronary Intervention. Heart Lung Circ 2024; 33:350-361. [PMID: 38238118 DOI: 10.1016/j.hlc.2023.12.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 04/07/2024]
Abstract
AIM There are discrepancies between the information patients desire about adverse drug reactions (ADRs) and the information they receive from healthcare providers; this is an impediment to shared decision-making. This study aimed to establish whether patients received information about ADRs resulting from prescribed pharmacotherapy, before hospital discharge, after percutaneous coronary intervention (PCI) and to determine whether receiving information about ADRs was associated with incidence of self-reported ADRs or concerns related to prescribed pharmacotherapy. METHODS CONCARDPCI, a prospective multicentre cohort study including 3,417 consecutive patients after PCI, was conducted at seven high-volume referral PCI centres in two Nordic countries. Clinical data were collected from patients' medical records and national quality registries. Patient-reported outcome measures were registered 2 months (T1), 6 months (T2), and 12 months (T3) after discharge. Covariate-adjusted logistic regression yielded adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS At discharge, 38% of participants had been informed about potential ADRs. For these patients, the incidence of self-reported ADRs was significantly lower at T1 (aOR 0.61, 95% CI 0.50-0.74; p<0.001), T2 (aOR 0.60, 95% CI 0.49-0.74; p<0.001), and T3 (aOR 0.57, 95% CI 0.46-0.71; p<0.001). Those who were not informed reported higher levels of concern about prescribed pharmacotherapy at all measuring points (p<0.001 for all comparisons). Those living alone (aOR 0.73, 95% CI 0.57-0.92; p=0.008), who were female (aOR 0.57, 95% CI 0.44-0.72; p<0.001), and with three or more versus no comorbidities (aOR 0.61, 95% CI 0.44-0.84; p=0.002) were less likely to receive information. CONCLUSION A substantial proportion of patients were not informed about potential ADRs from prescribed pharmacotherapy after PCI. Patients informed about ADRs had lower incidences of self-reported ADRs and fewer concerns about prescribed pharmacotherapy.
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Affiliation(s)
| | - Jan Schjøtt
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | | | - Alf Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | | | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Campus Førde, Norway
| | | | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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2
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Titlestad I, Haugarvoll K, Solvang SEH, Norekvål TM, Skogseth RE, Andreassen OA, Årsland D, Neerland BE, Nordrehaug JE, Tell GS, Giil LM. Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records. Age Ageing 2024; 53:afae006. [PMID: 38342753 PMCID: PMC10859244 DOI: 10.1093/ageing/afae006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND In-hospital delirium is associated with adverse outcomes and is underdiagnosed, limiting research and clinical follow-up. OBJECTIVE To compare the incidence of in-hospital delirium determined by chart-based review of electronic medical records (D-CBR) with delirium discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments and delirium triggers between D-CBR and D-DD. METHOD The community-based cohort included 2,115 participants in the Hordaland Health Study born between 1925 and 1927. Between 2018 and 2022, we retrospectively reviewed hospital electronic medical records from baseline (1997-99) until death prior to 2023. D-DD and D-CBR were validated using The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria for delirium. RESULTS Of the 2,115 participants, 638 had in-hospital delirium. The incidence rate (IR) of D-CBR was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas the IR by D-DD was 3.4 [2.8, 4.2]. The IR ratio was 9.14 (P < 0.001). Patients who received pharmacological treatment for delirium (n = 121, odds ratio (OR) 3.4, [2.1, 5.4], P < 0.001), who were affected by acute memory impairment (n = 149, OR 2.8, [1.8, 4.5], P < 0.001), or change in perception (n = 137, OR 2.9, [1.8, 4.6] P < 0.001) had higher odds for D-DD. In contrast, post-operative cases (OR 0.2, [0.1, 0.4], P < 0.001) had lower odds for D-DD. CONCLUSION Underdiagnosis of in-hospital delirium was a major issue in our study, especially in less severe delirium cases. Our findings emphasise the need for integrating systematic delirium diagnostics and documentation into hospital admission and discharge routines.
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Affiliation(s)
- Irit Titlestad
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Kristoffer Haugarvoll
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Stein-Erik H Solvang
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ragnhild E Skogseth
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dag Årsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bjørn Erik Neerland
- Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lasse M Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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3
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Giil LM, Hanseth S, Bojovic O, Nordrehaug JE, Ueland PM, Meyer K, Tell GS. The inverse association between the apolipoprotein E ε4 allele and C-reactive protein levels is stronger in persons with obesity and diabetes. Scand J Immunol 2024; 99:e13323. [PMID: 37801334 DOI: 10.1111/sji.13323] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND C-reactive protein (CRP) is lower in patients who carry the apolipoprotein E epsilon 4 allele variant (APOEε4) of the APOE gene. This could however be explained by other factors observed in APOEε4 carriers, such as lower body mass index (BMI), possibly less diabetes and more use of statins, all associated with CRP concentrations. OBJECTIVES To assess the association between CRP and APOEε4 stratified by BMI, statin use and diabetes. METHODS We included 2700 community-dwelling older adults from the Hordaland health study with genotyping of the APOE gene by a one-step polymerase chain reaction and CRP measured using immuno-MALDI-TOF MS. Differences in CRP concentrations by APOE (ε4 vs no ε4) were assessed using the Mann-Whitney U tests, also stratified by statin use, diabetes and BMI categories. Finally, we performed linear regression with log (CRP) as the outcome and APOEε4 together with statin use, diabetes, BMI and their respective interactions. RESULTS CRP was higher in APOEε4 carriers irrespective of BMI, diabetes and statin use. In APOEε4 non-carriers, CRP was elevated with diabetes and obesity as expected. However, this was attenuated or even reversed in APOEε4 carriers. Such differences were not observed for statin use. CONCLUSIONS Statin use, obesity or diabetes did not confound the known association between the APOEε4 allele and lower CRP. Our data suggest that CRP is less responsive to inflammatory cues involved in diabetes and obesity in APOEε4 carriers. Epidemiological studies should take note of these relationships, as CRP, APOEε4, diabetes and obesity are both linked to neurodegenerative and cardiovascular disease.
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Affiliation(s)
- Lasse Melvaer Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Silja Hanseth
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Ognjen Bojovic
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | | | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Laupsa-Borge J, Grytten E, Bohov P, Bjørndal B, Strand E, Skorve J, Nordrehaug JE, Berge RK, Rostrup E, Mellgren G, Dankel SN, Nygård OK. Sex-specific responses in glucose-insulin homeostasis and lipoprotein-lipid components after high-dose supplementation with marine n-3 PUFAs in abdominal obesity: a randomized double-blind crossover study. Front Nutr 2023; 10:1020678. [PMID: 37404855 PMCID: PMC10315503 DOI: 10.3389/fnut.2023.1020678] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 06/01/2023] [Indexed: 07/06/2023] Open
Abstract
Background Clinical studies on effects of marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFAs), mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), and the plant-derived omega-6 (n-6) PUFA linoleic acid (LA) on lipoprotein-lipid components and glucose-insulin homeostasis have shown conflicting results, which may partly be explained by differential responses in females and males. However, we have lacked data on sexual dimorphism in the response of cardiometabolic risk markers following increased consumption of n-3 or n-6 PUFAs. Objective To explore sex-specific responses after n-3 (EPA + DHA) or n-6 (LA) PUFA supplementation on circulating lipoprotein subfractions, standard lipids, apolipoproteins, fatty acids in red blood cell membranes, and markers of glycemic control/insulin sensitivity among people with abdominal obesity. Methods This was a randomized double-blind crossover study with two 7-week intervention periods separated by a 9-week washout phase. Females (n = 16) were supplemented with 3 g/d of EPA + DHA (fish oil) or 15 g/d of LA (safflower oil), while males (n = 23) received a dose of 4 g/d of EPA + DHA or 20 g/d of LA. In fasting blood samples, we measured lipoprotein particle subclasses, standard lipids, apolipoproteins, fatty acid profiles, and markers of glycemic control/insulin sensitivity. Results The between-sex difference in relative change scores was significant after n-3 for total high-density lipoproteins (females/males: -11%*/-3.3%, p = 0.036; *: significant within-sex change), high-density lipoprotein particle size (+2.1%*/-0.1%, p = 0.045), and arachidonic acid (-8.3%*/-12%*, p = 0.012), and after n-6 for total (+37%*/+2.1%, p = 0.041) and small very-low-density lipoproteins (+97%*/+14%, p = 0.021), and lipoprotein (a) (-16%*/+0.1%, p = 0.028). Circulating markers of glucose-insulin homeostasis differed significantly after n-3 for glucose (females/males: -2.1%/+3.9%*, p = 0.029), insulin (-31%*/+16%, p < 0.001), insulin C-peptide (-12%*/+13%*, p = 0.001), homeostasis model assessment of insulin resistance index 2 (-12%*/+14%*, p = 0.001) and insulin sensitivity index 2 (+14%*/-12%*, p = 0.001), and quantitative insulin sensitivity check index (+4.9%*/-3.4%*, p < 0.001). Conclusion We found sex-specific responses after high-dose n-3 (but not n-6) supplementation in circulating markers of glycemic control/insulin sensitivity, which improved in females but worsened in males. This may partly be related to the sex differences we observed in several components of the lipoprotein-lipid profile following the n-3 intervention. Clinical trial registration https://clinicaltrials.gov/, identifier [NCT02647333].
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Affiliation(s)
- Johnny Laupsa-Borge
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elise Grytten
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elin Strand
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rolf K. Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Simon N. Dankel
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Mohn Research Center for Diabetes Precision Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar K. Nygård
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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5
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Nilsen DWT, Røysland M, Ueland T, Aukrust P, Michelsen AE, Staines H, Barvik S, Kontny F, Nordrehaug JE, Bonarjee VVS. The Effect of Protease-Activated Receptor-1 (PAR-1) Inhibition on Endothelial-Related Biomarkers in Patients with Coronary Artery Disease. Thromb Haemost 2022; 123:510-521. [PMID: 36588289 PMCID: PMC10113036 DOI: 10.1055/s-0042-1760256] [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: 01/03/2023]
Abstract
BACKGROUND Vorapaxar has been shown to reduce cardiovascular mortality in post-myocardial infarction (MI) patients. Pharmacodynamic biomarker research related to protease-activated receptor-1 (PAR-1) inhibition with vorapaxar in humans has short follow-up (FU) duration and is mainly focused on platelets rather than endothelial cells. AIM This article assesses systemic changes in endothelial-related biomarkers during vorapaxar treatment compared with placebo at 30 days' FU and beyond, in patients with coronary heart disease. METHODS Local substudy patients in Norway were included consecutively from two randomized controlled trials; post-MI subjects from TRA2P-TIMI 50 and non-ST-segment elevation MI (NSTEMI) patients from TRACER. Aliquots of citrated blood were stored at -80°C. Angiopoietin-2, angiopoietin-like 4, vascular endothelial growth factor, intercellular adhesion molecule-1, vascular cell adhesion molecule-1, E-selectin, von Willebrand factor, thrombomodulin, and plasminogen activator inhibitor-1 and -2 were measured at 1-month FU and at study completion (median 2.3 years for pooled patients). RESULTS A total of 265 consecutive patients (age median 62.0, males 83%) were included. Biomarkers were available at both FUs in 221 subjects. In the total population, angiopoietin-2 increased in patients on vorapaxar as compared with placebo at 1-month FU (p = 0.034). Angiopoietin-like 4 increased (p = 0.028) and plasminogen activator inhibitor-2 decreased (p = 0.025) in favor of vorapaxar at final FU. In post-MI subjects, a short-term increase in E-selectin favoring vorapaxar was observed, p = 0.029. Also, a short-term increase in von Willebrand factor (p = 0.032) favoring vorapaxar was noted in NSTEMI patients. CONCLUSION Significant endothelial biomarker changes during PAR-1 inhibition were observed in post-MI and NSTEMI patients.
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Affiliation(s)
- Dennis W T Nilsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Michelle Røysland
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Thor Ueland
- Department of Clinical Medicine, Thrombosis Research Center, UiT - The Arctic University of Norway, Tromsø, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Annika E Michelsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Harry Staines
- Sigma Statistical Services, Balmullo, United Kingdom of Great Britain and Northern Ireland
| | - Ståle Barvik
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Frederic Kontny
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Drammen Heart Center, Drammen, Norway
| | - Jan Erik Nordrehaug
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Morken I, Ponitz V, Brugger-Andersen T, Aareskjold O, Aadnanes L, Melberg T, Bru E, Nordrehaug JE. Short- and long-term quality of life after electrical cardioversion of atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2754] [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: 11/14/2022] Open
Abstract
Abstract
Background
Electrical cardioversion (ECV) of atrial fibrillation (AF) is known to be effective in restoring sinus rhythm. However, limited and contradictory data exist on the impact of ECV on short- and long-term quality of life outcomes.
Purpose
To examine the impact of ECV on short- and long-term quality of life in patients with AF.
Methods
This was a prospective cohort study of consecutive patients with AF referred for outpatient electrical cardioversion at a university hospital in Norway. Recruitment started March 2017, and ended December 2019. Baseline demographics, clinical characteristics, and procedure details were obtained from medical records. Quality of life was measured with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire before electrical cardioversion (baseline), and at three and 12 months after ECV.
Results
Two hundred and ninety-five patients underwent ECV and completed follow-up questionnaires at three months (n-259) and at 12 months (n=258). The median age was 68 years (range 37–86 years) and 79% were men. The mean left ventricular ejection fraction obtained by echocardiography was 51% (±9.2). The mean body mass index score was 28±4.8. Immediate success of electric cardioversion was 91%. Recurrence of AF after successful ECV was 36% within three months. Twenty-two percent of the patient underwent new ECV before three months, and 25% of the patients had persistent AF at three months. The overall mean AFEQT score at baseline was 62.9±21.4, and the domain-specific scores were as follows: symptoms, 72.3±23.1; daily activities, 52±26.6; treatment concerns, 71.1±22.4; and treatment satisfaction, 59.9±25.2. There were significant improvements in the overall mean AFEQT score at three months, 70.8±20.8, (p<0.01) and at 12 months, 72.3±20.8 (p<0.01) compared with baseline values. There were also significant improvement (p<0.01) in all AFQET subscales at three and 12 months. Daily activity scores and treatment satisfactions scores demonstrated highest improvement in mean score with a 10% increase from baseline to three months and 13% increase from baseline to 12 months. Sub-analyses revealed that patients with persistent AF within three months were significantly dissatisfied with treatment (p<0.01) and reported lower activity level (p<0.01) compared with the rest of the sample.
Conclusions
Results indicate both significant improvement in short- and long-term quality of life for patients after electrical cardioversion, in particular when sinus-rythm was maintained.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Stavanger University Hospital
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Affiliation(s)
- I Morken
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - V Ponitz
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - T Brugger-Andersen
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - O Aareskjold
- University of Stavanger, department of health studies , Stavanger , Norway
| | - L Aadnanes
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - T Melberg
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - E Bru
- University of Stavanger, department of health studies , Stavanger , Norway
| | - J E Nordrehaug
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
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7
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Pettersen T, Schjott J, Allore H, Bendz B, Borregaard B, Fridlund B, Hadjistavropoulos HD, Larsen AI, Nordrehaug JE, Rasmussen TB, Rotevatn S, Valaker I, Wentzel-Larsen T, Norekval TM. Informing patients about potential adverse drug reactions after percutaneous coronary intervention reduces the occurrence of self-reported adverse drug reactions. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2736] [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: 11/13/2022] Open
Abstract
Abstract
Background
Healthcare providers are commonly reluctant to inform patients about potential adverse drug reactions (ADRs) from prescribed therapy to avoid increasing the incidence of ADRs through the nocebo effect. However, patients need information on all aspects of prescribed therapy to facilitate informed decision-making and take ownership of their care.
Purpose
To describe wether patients received information about potential ADRs from prescribed therapy before hospital discharge after percutaneous coronary intervention (PCI). Furthermore, to determine whether receiving information about ADRs is associated with incidence of self-reported ADRs.
Methods
CONCARDPCI is a prospective multicentre cohort study including 3417 patients after PCI. The study was conducted between June 2017 and May 2020 at seven large referral PCI centres in Norway and Denmark. Clinical data were collected from patients' medical records. Socio-demographic characteristics were obtained by self-report during index hospitalization after PCI. Two questions from the Heart Continuity of Care Questionnaire were used to determine if information about potential ADRs was received before hospital discharge. De novo created questions were used to determine if patients reported ADRs from prescribed therapy. Questionnaires were distributed two (T1), six (T2), and twelve months (T3) after hospital discharge to assess the incidence of self-reported ADRs in a longitudinal perspective. Logistic regression was utilised to scrutinize the aims, reported as odds ratios (ORs) with 95% confidence intervals (CIs).
Results
Patients were predominantly men (78%), with a mean age of 66 years (SD 11, range 20–96 years), and married or living with a partner (75%). Stable coronary artery disease was the most frequent cause of admission for PCI (30%). Before hospital discharge, 59% were informed of potential ADRs from prescribed therapy and 50% were informed what to do if ADRs occurred. The incidence of self-reported ADRs were significantly lower for those who were informed of potential ADRs compared to those who were not informed at T1 (OR 0.54, CI: 0.45–0.65, p<0.001), T2 (OR 0.56, CI: 0.46–0.70, p<0.001) and T3 (OR 0.51, CI: 0.42–0.67, p<0.001) (Figure 1). After controlling for socio-demographic and clinical variables, the incidence of self-reported ADRs were similar at T1 (OR 0.58, CI: 0.47–0.71, p<0.001), T2 (OR 0.56, CI: 0.46–0.70, p<0.001) and T3 (OR 0.53, CI: 0.42–0.66, p<0.001). Those less likely to receive information about ADRs were living alone (OR 0.75, CI: 0.59–0.97; p=0.029), women (OR 0.58, CI: 0.45–0.75, p<0.001) and those with three or more comorbidities (OR 0.68, CI: 0.47–0.98, p=0.029) compared to their counterparts.
Conclusion
Our study showed that informing patients about potential ADRs after PCI reduces the occurrence of self-reported ADRs. Information about potential ADRs should be provided regardless of cohabitation status, sex and comorbidities.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Western Norway Health Authority
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Affiliation(s)
- T Pettersen
- Haukeland Universityhospital, Department of Heart Disease , Bergen , Norway
| | - J Schjott
- Haukeland University Hospital, Department of Medical Biochemistry and Pharmacology , Bergen , Norway
| | - H Allore
- Yale School of Medicine, Department of Internal Medicine , New Haven , United States of America
| | - B Bendz
- Oslo University Hospital, Department of Cardiology , Oslo , Norway
| | - B Borregaard
- Odense University Hospital, Department of Cardiology , Odense , Denmark
| | - B Fridlund
- Linnaeus University, Centre of Interprofessional Cooperation within Emergency care (CICE) , Vaxjo , Sweden
| | | | - A I Larsen
- Stavanger University Hospital, Department of Cardiology , Stavanger , Norway
| | - J E Nordrehaug
- University of Bergen, Department of Clinical Science , Bergen , Norway
| | - T B Rasmussen
- Gentofte University Hospital, Department of Cardiology , Gentofte , Denmark
| | - S Rotevatn
- Haukeland Universityhospital, Department of Heart Disease , Bergen , Norway
| | - I Valaker
- Western Norway University of Applied Sciences, Faculty of Health and Social Sciences , Førde , Norway
| | - T Wentzel-Larsen
- Haukeland University Hospital, Centre for Clinical Research , Bergen , Norway
| | - T M Norekval
- Haukeland Universityhospital, Department of Heart Disease , Bergen , Norway
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Pettersen TR, Schjøtt J, Allore HG, Bendz B, Borregaard B, Fridlund B, Larsen AI, Nordrehaug JE, Rotevatn S, Wentzel-Larsen T, Norekvål TM. Perceptions of generic medicines and medication adherence after percutaneous coronary intervention: a prospective multicentre cohort study. BMJ Open 2022; 12:e061689. [PMID: 36127123 PMCID: PMC9490600 DOI: 10.1136/bmjopen-2022-061689] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To determine patient perceptions of generic medicines 2 and 6 months after percutaneous coronary intervention (PCI), and to determine whether these perceptions moderate medication adherence. DESIGN Prospective multicentre cohort study with repeated measures of perceptions of generic medicines and medication adherence. SETTING The CONCARDPCI study conducted at seven large referral PCI centres in Norway and Denmark between June 2017 and May 2020. PARTICIPANTS A total of 3417 adults (78% men), using both generic and brand name medicines, with a mean age of 66 years (SD 11) who underwent PCI were followed up 2 and 6 months after discharge from hospital. MAIN OUTCOME MEASURES Perceptions of generic medicines were the main outcome. The secondary outcome was medication adherence. RESULTS Perceptions of generic medicines were significantly more negative at 2 than at 6 months (1.10, 95% CI 0.41 to 1.79, p=0.002). Female sex (-4.21, 95% CI -6.75 to -1.71, p=0.001), older age (-0.12, 95% CI -0.23 to -0.02, p=0.020), lower education level (overall p<0.001), ethnicity (overall p=0.002), Norwegian nationality (10.27, 95% CI 8.19 to 12.40, p<0.001) and reduced self-reported health status (0.19, 95% CI 0.09 to 0.41, p=0.003) were significantly associated with negative perceptions of generic medicines. There was no evidence to suggest that perceptions of generic medicines moderate the association between sociodemographic and clinical variables and medication adherence (p≥0.077 for all covariates). Moreover, self-reported medication adherence was high, with 99% scoring at or above the Medication Adherence Report Scale midpoint at both time points. There were no substantial correlations between negative perceptions of generic medicines and medication non-adherence at 2 months (r=0.041, 95% CI 0.002 to 0.081, p=0.037) or 6 months (r=0.038, 95% CI -0.005 to 0.081, p=0.057). CONCLUSIONS Mistrust and uncertainty about the safety and efficacy of generic medicines remains in a sizeable proportion of patients after PCI. This applies especially to those of lower socioeconomic status, older age, female sex, immigrants and those with poorer mental health. However, this study demonstrated a shift towards more positive perceptions of generic medicines in the longer term.
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Affiliation(s)
- Trond Røed Pettersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Jan Schjøtt
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Heather G Allore
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Oslo, Norway
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense Universitetshospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Kalmar, Sweden
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Centre for Child and Adolescent Mental Health Eastern and Southern Norway, Oslo, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
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Eriksen E, Herstad J, Pertiwi KR, Tuseth V, Nordrehaug JE, Bleie Ø, van der Wal AC. Thrombus characteristics evaluated by acute optical coherence tomography in ST elevation myocardial Infarction. PLoS One 2022; 17:e0266634. [PMID: 35404941 PMCID: PMC9000063 DOI: 10.1371/journal.pone.0266634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
Abstract
Aims ST elevation myocardial infarction (STEMI) is caused by an occlusive thrombosis of a coronary artery. We wanted to assess if the thrombus can be characterized according to erythrocyte content and age using intravascular optical coherence tomography (OCT) in a clinical setting. Methods and results We performed manual thrombus aspiration in 66 STEMI patients. OCT was done of the thrombus remnants after aspiration. A light intensity ratio was measured through the thrombus. Forty two of the aspirates had thrombus which could be analyzed histomorphologically for analysis of erythrocyte and platelet content, and to determine the age of thrombus as fresh, lytic or organized. There were 11 red, 21 white and 10 mixed thrombi. Furthermore, 36 aspirates had elements of fresh, 7 of lytic and 8 of organized thrombi. There was no correlation between colour and age. OCT appearance could not predict erythrocyte or platelet content. The light intensity ratios were not significantly different in fresh, lytic or organized thrombi. Conclusion OCT could not differentiate between red and white thrombi, nor determine thrombus age.
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Affiliation(s)
- Erlend Eriksen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- * E-mail:
| | - Jon Herstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kartika Ratna Pertiwi
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vegard Tuseth
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Allard C. van der Wal
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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10
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Packer EJS, Solholm A, Omdal TR, Stangeland L, Zhang L, Mongstad A, Urban M, Wentzel-Larsen T, Haaverstad R, Slettom G, Nordrehaug JE, Grong K, Tuseth V. Effects of Add-On Left Ventricular Assist Device to Extracorporeal Membrane Oxygenation During Refractory Cardiac Arrest in a Porcine Model. ASAIO J 2022; 68:531-540. [PMID: 34294641 DOI: 10.1097/mat.0000000000001528] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study evaluated the effects of extracorporeal membrane oxygenation (ECMO) in combination with a percutaneous adjunctive left ventricular assist device (LVAD) in a porcine model during 60 minutes of refractory cardiac arrest (CA). Twenty-four anesthetized swine were randomly allocated into three groups given different modes of circulatory assist: group 1: ECMO 72 ml/kg/min and LVAD; group 2: ECMO 36 ml/kg/min and LVAD; and group 3: ECMO 72 ml/kg/min. During CA and extracorporeal cardiopulmonary resuscitation (ECPR), mean left ventricular pressure (mLVP) was lower in group 1 (p = 0.013) and in group 2 (p = 0.003) versus group 3. Mean aortic pressure (mAP) and coronary perfusion pressure (CPP) were higher in group 1 compared with the other groups. In group 3, mean pulmonary artery flow (mPAf) was lower versus group 1 (p = 0.003) and group 2 (p = 0.039). If the return of spontaneous circulation (ROSC) was achieved after defibrillation, up to 180 minutes of unsupported observation followed. All subjects in groups 1 and 3, and 5 subjects in group 2 had ROSC. All subjects in group 1, five in group 2 and four in group 3 had sustained cardiac function after 3 hours of spontaneous circulation. Subjects that did not achieve ROSC or maintained cardiac function post-ROSC had lower mAP (p < 0.001), CPP (p = 0.002), and mPAf (p = 0.004) during CA and ECPR. Add-on LVAD may improve hemodynamics compared with ECMO alone during refractory CA but could not substitute reduced ECMO flow. Increased mAP and CPP could be related to ROSC rate and sustained cardiac function. Increased mLVP was related to poor post-ROSC cardiac function.
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Affiliation(s)
- Erik J S Packer
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Atle Solholm
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tom Roar Omdal
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lodve Stangeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Liqun Zhang
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Arve Mongstad
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Malte Urban
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tore Wentzel-Larsen
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
- Centre for Violence and Traumatic Stress Studies Oslo, Oslo, Norway
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Grete Slettom
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Ketil Grong
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Vegard Tuseth
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
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11
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Nordrehaug JE. Hyperkalaemia as a differential diagnosis in chest pain. Tidsskr Nor Laegeforen 2022; 142:22-0154. [PMID: 35324117 DOI: 10.4045/tidsskr.22.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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12
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Mølstad PM, Nordrehaug JE, Steigen TK, Wilsgaard T, Wiseth R, Rotevatn S, Mannsverk J, Larsen T, Larsby KE, Skarstad SÅ, Fosse EØ, Dahl-Eriksen Ø, Bønaa KH. Drug-eluting versus bare metal stents in saphenous vein grafts compared to native coronary vessels. The NORSTENT study. Cardiology 2021; 147:14-22. [PMID: 34879374 DOI: 10.1159/000521085] [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: 09/14/2021] [Accepted: 11/06/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug-eluting stents (DES) reduce target lesion revascularization (TLR) with no effect on mortality or myocardial infarction (MI) compared to bare metal stents (BMS) in native vessels. Randomized stent studies in saphenous vein grafts (SVG) are few and the reported effects are ambiguous. The NORSTENT study is the first to randomize lesions to percutaneous coronary intervention (PCI) in native vessels and SVG. AIMS To compare rate of mortality, MI and TLR across stent and vessel types. METHODS In this substudy 6087 patients with a single lesion in native vessels and 164 in SVG, were followed for 5 years. RESULTS MI was more frequent in SVG (subdistributional hazard ratio (SHR) 4.95 (3.75 - 6.54, p<0.001), but not affected by stent type. In the first 500 days DES reduced TLR in native vessels (SHR 0.21 ( 0.15 - 0.30)p<0.001) and SVG (SHR 0.18 (0.04 - 0.80) p=0.02). Thereafter DES and BMS were equivalent in native vessels, but DES had a higher TLR rate than BMS in SVG (SHR 3.31 (1.23 - 8.94) p=0.02). After 5 years the TLR rate was still significantly lower for DES in native vessels (3.2 % versus 7.8 %, p<0.001) but not in SVG (21.4 % vs 18. 4%). CONCLUSION In SVG no difference in TLR between DES and BMS was observed after 5 years in contrast to persistent benefit in native vessels. The high rate of TLR and myocardial infarction in SVG makes treatment of native vessels a preference whenever feasible and better treatment options for SVG are warranted. .
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Affiliation(s)
| | | | - Terje K Steigen
- Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jan Mannsverk
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Tommy Larsen
- Cardiological Department, Akershus University Clinic Gardermoen, Jessheim, Norway
| | | | | | - Eivind Øygard Fosse
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Kaare Harald Bønaa
- Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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13
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Pettersen T, Schjott J, Allore H, Bendz B, Borregaard B, Fridlund B, Larsen AI, Nordrehaug JE, Rotevatn S, Wentzel-Larsen T, Norekvaal TM. Perceptions of efficacy and safety of generic medicines in patients after percutaneous coronary intervention. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3020] [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
Generic medicines are bioequivalents to brand-name medicines, and compelling evidence for the safety and efficacy of generic medicines exists. However, negative perceptions about generic medicines can potentially reduce adherence to prescribed therapy and thereby efficacy of the treatment.
Purpose
To describe patients' perceptions of generic medicines after percutaneous coronary intervention (PCI), and to investigate the association between perceptions and sociodemographic and clinical factors. Furthermore, we sought to investigate if these perceptions change over time.
Methods
CONCARDPCI is a large-scale prospective multicentre cohort study on 3251 patients after PCI. The study was conducted between June 2017 and May 2020 at seven large referral PCI centres in Norway and Denmark. Clinical data, including invasive procedures and patient characteristics, were collected from the patients' medical records. Sociodemographic characteristics were obtained by self-report during index hospitalization after PCI. Postal or electronic questionnaires comprising questions regarding perceptions of generic medicines were distributed two (T1) and six (T2) months after discharge from hospital to included patients. The time intervals ensured that a sufficient amount of time had passed so that refill of prescriptions was necessary. To investigate perceptions of generic medicines and the associations with sociodemographic and clinical characteristics, logistic regression analysis was performed.
Results
Most patients were men (78%), married or living with a partner (75%), elderly (mean age 66 years, SD11, range 20–96 years), and 28% were admitted to hospital due to non-ST-segment elevation myocardial infarction. At T1, 70% perceived generic medicines to be as effective, safe (68%), produce the same side effects (64%), and contain the same active ingredients as brand-name medicines (64%). Perceptions of generic medicines were similar at T2. No significant associations were found with age, marital status, living alone, taking ≥5 medications, or participation in cardiac rehabilitation. However, Danish patients (p<0.001), those with a higher education level (college/university≥4 years) (p=0.01), total household income >83,000 Euro (p=0.007), female gender (p<0.001), and history of coronary artery disease (p=0.048) had more positive perceptions of generic medicines.
Conclusion
Approximately one third of the patients had negative perceptions of generic medicines after PCI, and these negative perceptions do not seem to change substantially during the first six months after PCI. As negative perceptions of generic medicines have been found to be a barrier to medication adherence, improving patients' knowledge and confidence in generic medicines after PCI may be pivotal to reach treatment goals set forth by the 2018 ESC/EACTS Guidelines on myocardial revascularization.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Western Norway Health Authority
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Affiliation(s)
- T Pettersen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - J Schjott
- Haukeland University Hospital, Department of Medical Biochemistry and Pharmacology, Bergen, Norway
| | - H Allore
- Yale School of Medicine, Department of Internal Medicine, New Haven, United States of America
| | - B Bendz
- Oslo University Hospital, Department of Cardiology, Oslo, Norway
| | - B Borregaard
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - B Fridlund
- Linnaeus University, Centre of Interprofessional Cooperation within Emergency care (CICE), Vaxjo, Sweden
| | - A I Larsen
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - J E Nordrehaug
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - S Rotevatn
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - T Wentzel-Larsen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - T M Norekvaal
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
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14
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Grytten E, Laupsa-Borge J, Bohov P, Bjørndal B, Strand E, Skorve J, Nordrehaug JE, Berge RK, Rostrup E, Mellgren G, Dankel SN, Nygård OK. Changes in lipoprotein particle subclasses, standard lipids, and apolipoproteins after supplementation with n-3 or n-6 PUFAs in abdominal obesity: A randomized double-blind crossover study. Clin Nutr 2021; 40:2556-2575. [PMID: 33933722 DOI: 10.1016/j.clnu.2021.03.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Marine-derived omega-3 (n-3) polyunsaturated fatty acids (PUFAs), mainly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), lower circulating levels of triacylglycerols (TAGs), and the plant-derived omega-6 (n-6) PUFA linoleic acid (LA) may reduce cholesterol levels. Clinical studies on effects of these dietary or supplemental PUFAs on other blood fat fractions are few and have shown conflicting results. This study aimed to determine effects of high-dose supplemental n-3 (EPA + DHA) and n-6 (LA) PUFAs from high-quality oils on circulating lipoprotein subfractions and standard lipids (primary outcomes), as well as apolipoproteins, fatty acids, and glycemic control (secondary outcomes), in females and males with abdominal obesity. METHODS This was a randomized double-blind crossover study with two 7-wk intervention periods separated by a 9-wk washout phase. Females (n = 16) were supplemented with 3 g/d of EPA + DHA (TAG fish oil) or 15 g/d of LA (safflower oil), while males (n = 23) received a dose of 4 g/d of EPA + DHA or 20 g/d of LA. In fasting blood samples, we investigated lipoprotein particle subclasses by nuclear magnetic resonance spectroscopy, as well as standard lipids, apolipoproteins, fatty acid profiles, and glucose and insulin. Data were analyzed by linear mixed-effects modeling with 'subjects' as the random factor. RESULTS The difference between interventions in relative change scores was among the lipoprotein subfractions significant for total very-low-density lipoproteins (VLDLs) (n-3 vs. n-6: -38%∗ vs. +16%, p < 0.001; ∗: significant within-treatment change score), large VLDLs (-58%∗ vs. -0.91%, p < 0.001), small VLDLs (-57%∗ vs. +41%∗, p < 0.001), total low-density lipoproteins (LDLs) (+5.8%∗ vs. -4.3%∗, p = 0.002), large LDLs (+23%∗ vs. -2.1%, p = 0.004), total high-density lipoproteins (HDLs) (-6.0%∗ vs. +3.7%, p < 0.001), large HDLs (+11%∗ vs. -5.3%, p = 0.001), medium HDLs (-24%∗ vs. +6.2%, p = 0.030), and small HDLs (-9.9%∗ vs. +9.6%∗, p = 0.002), and among standard lipids for TAGs (-16%∗ vs. -2.6%, p = 0.014), non-esterified fatty acids (-19%∗ vs. +5.5%, p = 0.033), and total cholesterol (-0.28% vs. -4.4%∗, p = 0.042). A differential response in relative change scores was also found for apolipoprotein (apo)B (+0.40% vs. -6.0%∗, p = 0.008), apoA-II (-6.0%∗ vs. +1.5%, p = 0.001), apoC-II (-11%∗ vs. -1.7%, p = 0.025), and apoE (+3.3% vs. -3.8%, p = 0.028). CONCLUSIONS High-dose supplementation of high-quality oils with n-3 (EPA + DHA) or n-6 (LA) PUFAs was followed by reductions in primarily TAG- or cholesterol-related markers, respectively. The responses after both interventions point to changes in the lipoprotein-lipid-apolipoprotein profile that have been associated with reduced cardiometabolic risk, also among people with TAG or LDL-C levels within the normal range. REGISTRATION Registered under ClinicalTrials.gov Identifier: NCT02647333. CLINICAL TRIAL REGISTRATION Registered at https://clinicaltrials.gov/ct2/show/NCT02647333.
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Affiliation(s)
- Elise Grytten
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Johnny Laupsa-Borge
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Pavol Bohov
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Elin Strand
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Jan Erik Nordrehaug
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Rolf K Berge
- Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Gunnar Mellgren
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Simon N Dankel
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
| | - Ottar K Nygård
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway; Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, 5020 Bergen, Norway.
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15
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Erlinge D, Maehara A, Ben-Yehuda O, Bøtker HE, Maeng M, Kjøller-Hansen L, Engstrøm T, Matsumura M, Crowley A, Dressler O, Mintz GS, Fröbert O, Persson J, Wiseth R, Larsen AI, Okkels Jensen L, Nordrehaug JE, Bleie Ø, Omerovic E, Held C, James SK, Ali ZA, Muller JE, Stone GW. Identification of vulnerable plaques and patients by intracoronary near-infrared spectroscopy and ultrasound (PROSPECT II): a prospective natural history study. Lancet 2021; 397:985-995. [PMID: 33714389 DOI: 10.1016/s0140-6736(21)00249-x] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [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: 11/11/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) and intravascular ultrasound are promising imaging modalities to identify non-obstructive plaques likely to cause coronary-related events. We aimed to assess whether combined NIRS and intravascular ultrasound can identify high-risk plaques and patients that are at risk for future major adverse cardiac events (MACEs). METHODS PROSPECT II is an investigator-sponsored, multicentre, prospective natural history study done at 14 university hospitals and two community hospitals in Denmark, Norway, and Sweden. We recruited patients of any age with recent (within past 4 weeks) myocardial infarction. After treatment of all flow-limiting coronary lesions, three-vessel imaging was done with a combined NIRS and intravascular ultrasound catheter. Untreated lesions (also known as non-culprit lesions) were identified by intravascular ultrasound and their lipid content was assessed by NIRS. The primary outcome was the covariate-adjusted rate of MACEs (the composite of cardiac death, myocardial infarction, unstable angina, or progressive angina) arising from untreated non-culprit lesions during follow-up. The relations between plaques with high lipid content, large plaque burden, and small lumen areas and patient-level and lesion-level events were determined. This trial is registered with ClinicalTrials.gov, NCT02171065. FINDINGS Between June 10, 2014, and Dec 20, 2017, 3629 non-culprit lesions were characterised in 898 patients (153 [17%] women, 745 [83%] men; median age 63 [IQR 55-70] years). Median follow-up was 3·7 (IQR 3·0-4·4) years. Adverse events within 4 years occurred in 112 (13·2%, 95% CI 11·0-15·6) of 898 patients, with 66 (8·0%, 95% CI 6·2-10·0) arising from 78 untreated non-culprit lesions (mean baseline angiographic diameter stenosis 46·9% [SD 15·9]). Highly lipidic lesions (851 [24%] of 3500 lesions, present in 520 [59%] of 884 patients) were an independent predictor of patient-level non-culprit lesion-related MACEs (adjusted odds ratio 2·27, 95% CI 1·25-4·13) and non-culprit lesion-specific MACEs (7·83, 4·12-14·89). Large plaque burden (787 [22%] of 3629 lesions, present in 530 [59%] of 898 patients) was also an independent predictor of non-culprit lesion-related MACEs. Lesions with both large plaque burden by intravascular ultrasound and large lipid-rich cores by NIRS had a 4-year non-culprit lesion-related MACE rate of 7·0% (95% CI 4·0-10·0). Patients in whom one or more such lesions were identified had a 4-year non-culprit lesion-related MACE rate of 13·2% (95% CI 9·4-17·6). INTERPRETATION Combined NIRS and intravascular ultrasound detects angiographically non-obstructive lesions with a high lipid content and large plaque burden that are at increased risk for future adverse cardiac outcomes. FUNDING Abbott Vascular, Infraredx, and The Medicines Company.
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Affiliation(s)
| | - Akiko Maehara
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | - Ori Ben-Yehuda
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA; University of California San Diego, San Diego, CA, USA
| | | | | | | | | | | | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY, USA
| | - Ole Fröbert
- Faculty of Health, Örebro University, Sweden
| | - Jonas Persson
- Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Rune Wiseth
- St Olavs Hospital, Trondheim University Hospital, Norway
| | | | | | | | | | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Claes Held
- Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Stefan K James
- Uppsala University and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Ziad A Ali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; Cardiovascular Research Foundation, New York, NY, USA
| | | | - Gregg W Stone
- Cardiovascular Research Foundation, New York, NY, USA; The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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16
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Mølstad P, Nordrehaug JE, Steigen T, Wilsgaard T, Wiseth R, Bønaa KH. Analyses of Increased Mortality in New and Known Diabetes in Patients with Coronary Disease Enrolled in the NORSTENT Randomized Study. Cardiology 2021; 146:295-303. [PMID: 33691304 DOI: 10.1159/000513514] [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: 09/28/2020] [Accepted: 11/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND NORSTENT trial randomized 9,013 patients to percutaneous coronary intervention with drug-eluting stents (DES) or bare-metal stents (BMS) with a 5-year follow-up. Among the patients, 5,512 had measured either fasting glucose level or percent glycated hemoglobin (HbA1c) at the index procedure. That cohort constitutes the present study population analyzing mortality and evaluating treatment heterogeneity of randomized stent in diabetic versus nondiabetic subgroups. RESULTS The cohort consisted of 4,174 (75.7%) patients without diabetes, 716 (13.0%) with known diabetes, and 622 (11.3%) with no diabetes in history but elevated fasting glucose level >7.0 mmol/L or HbA1c >6.5% and therefore defined as new diabetes. Patients with known diabetes had a significantly increased all-cause (hazard ratio [HR] 1.99, 95% CI 1.51-2.62, p < 0.001), cardiac (subhazard ratio [SHR] 2.47, 95% CI 1.55-3.93, p < 0.001), and noncardiac (SHR 1.74, 95% CI 1.23-2.44, p = 0.002) mortality after adjustment for baseline variables. In the follow-up of 5 years, patients with new diabetes, however, had a marginally increased all-cause (HR 1.40, 95% CI 1.01-1.93, p = 0.043) and significantly increased noncardiac mortality (SHR 1.52, 95% CI 1.06-2.20, p = 0.025), but no increase in cardiac mortality (SHR 1.06, 95% CI 0.53-2.12, p = 0.86) after the same adjustment. The majority of the mortality was cardiac in the first 1-2 years after intervention; thereafter, noncardiac mortality dominated. However, the time period for when noncardiac mortality became the dominating cause varied considerably and significantly between the groups. There was no heterogeneity in mortality in response to randomized stent between diabetics and nondiabetics. CONCLUSION Known diabetes has increased cardiac and noncardiac mortality in contrast to new diabetes which is only associated with increased noncardiac mortality during the 5-year follow-up. Diabetic and nondiabetic patients have the same response to the treatment with BMS or DES.
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Affiliation(s)
- Per Mølstad
- Department of Cardiology, LHL Clinics Gardermoen, Jessheim, Norway,
| | | | - Terje Steigen
- University Hospital of North Norway and UiT The Arctic University of Norway, Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olavs University Hospital, and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kaare H Bønaa
- Clinic of Cardiology, St. Olavs University Hospital, and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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17
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Packer EJS, Slettom G, Solholm A, Omdal TR, Stangeland L, Zhang L, Mongstad A, Løland K, Haaverstad R, Grong K, Nordrehaug JE, Tuseth V. Balanced Biventricular Assist Versus Extracorporeal Membrane Oxygenation in Cardiac Arrest. ASAIO J 2021; 66:1110-1119. [PMID: 33136598 DOI: 10.1097/mat.0000000000001146] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Mechanical assist devices in refractory cardiac arrest are increasingly employed. We compared the hemodynamics and organ perfusion during cardiac arrest with either veno-arterial extracorporeal membrane oxygenation (ECMO) or biventricular assisted circulation combining left- and right-sided impeller devices (BiPella) in an acute experimental setting. Twenty pigs were randomized in two equal groups receiving circulatory support either by ECMO or by BiPella during 40 minutes of ventricular fibrillation (VF) followed by three attempts of cardioversion, and if successful, 60 minute observation with spontaneous, unsupported circulation. Hemodynamic variables were continuously recorded. Tissue perfusion was evaluated by fluorescent microsphere injections. Cardiac function was visualized by intracardiac echocardiography. During VF device output, carotid flow, kidney perfusion, mean aortic pressure (AOPmean), and mean left ventricular pressure (LVPmean) were all significantly higher in the ECMO group, and serum-lactate values were lower compared with the BiPella group. No difference in myocardial or cerebral perfusion was observed between groups. In 15 animals with sustained cardiac function for 60 minutes after return of spontaneous circulation, left ventricular subendocardial blood flow rate averaged 0.59 ± 0.05 ml/min/gm during VF compared with 0.31 ± 0.07 ml/min/gm in five animals with circulatory collapse (p = 0.005). Corresponding values for the midmyocardium was 0.91 ± 0.06 vs. 0.65 ± 0.15 ml/min/gm (p = 0.085). Both BiPella and ECMO could sustain vital organ function. ECMO provided a more optimal systemic circulatory support related to near physiologic output. Myocardial tissue perfusion and sustained cardiac function were related to coronary perfusion pressure during VF, irrespective of mode of circulatory support.
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Affiliation(s)
- Erik J S Packer
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Grete Slettom
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Atle Solholm
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tom Roar Omdal
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Arve Mongstad
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Løland
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science
| | | | | | - Vegard Tuseth
- From the Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
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18
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Skaar E, Øksnes A, Eide LSP, Norekvål TM, Ranhoff AH, Nordrehaug JE, Forman DE, Schoenenberger AW, Hufthammer KO, Kuiper KKJ, Bleie Ø, Packer EJS, Langørgen J, Haaverstad R, Schaufel MA. Baseline frailty status and outcomes important for shared decision-making in older adults receiving transcatheter aortic valve implantation, a prospective observational study. Aging Clin Exp Res 2021; 33:345-352. [PMID: 32193850 PMCID: PMC7914240 DOI: 10.1007/s40520-020-01525-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 02/07/2023]
Abstract
AIMS The objective of this study was to examine baseline frailty status (including cognitive deficits) and important clinical outcomes, to inform shared decision-making in older adults receiving transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS We conducted a prospective, observational study of 82 TAVI patients, recruited 2013 to 2015, with 2-year follow-up. Mean age was 83 years (standard deviation (SD) 4.7). Eighteen percent of the patients were frail, as assessed with an 8-item frailty scale. Fifteen patients (18%) had a Mini-Mental Status Examination (MMSE) score below 24 points at baseline, indicating cognitive impairment or dementia and five patients had an MMSE below 20 points. Mean New York Heart Association (NYHA) class at baseline and 6 months was 2.5 (SD 0.6) and 1.4 (SD 0.6), (p < 0.001). There was no change in mean Nottingham Extended Activities of Daily Living (NEADL) scale between baseline and 6 months, 54.2 (SD 11.5) and 54.5 (SD 10.3) points, respectively, mean difference 0.3 (p = 0.7). At 2 years, six patients (7%) had died, four (5%, n = 79) lived in a nursing home, four (5%) suffered from disabling stroke, and six (7%) contracted infective endocarditis. CONCLUSIONS TAVI patients had improvement in symptoms and maintenance of activity of daily living at 6 months. They had low mortality and most patients lived in their own home 2 years after TAVI. Complications like death, stroke, and endocarditis occurred. Some patients had cognitive impairment before the procedure which might influence decision-making. Our findings may be used to develop pre-TAVI decision aids.
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19
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Hellton KH, Cummings J, Vik-Mo AO, Nordrehaug JE, Aarsland D, Selbaek G, Giil LM. The Truth behind the Zeros: A New Approach to Principal Component Analysis of the Neuropsychiatric Inventory. Multivariate Behav Res 2021; 56:70-85. [PMID: 32329370 PMCID: PMC8867488 DOI: 10.1080/00273171.2020.1736976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Psychiatric syndromes in dementia are often derived from the Neuropsychiatric Inventory (NPI) using principal component analysis (PCA). The validity of this statistical approach can be questioned, since the excessive proportion of zeros and skewness of NPI items may distort the estimated relations between the items. We propose a novel version of PCA, ZIBP-PCA, where a zero-inflated bivariate Poisson (ZIBP) distribution models the pairwise covariance between the NPI items. We compared the performance of the method to classical PCA under zero-inflation using simulations, and in two dementia-cohorts (N = 830, N = 1349). Simulations showed that component loadings from PCA were biased due to zero-inflation, while the loadings of ZIBP-PCA remained unaffected. ZIBP-PCA obtained a simpler component structure of "psychosis," "mood" and "agitation" in both dementia-cohorts, compared to PCA. The principal components from ZIBP-PCA had component loadings as follows: First, the component interpreted as "psychosis" was loaded by the items delusions and hallucinations. Second, the "mood" component was loaded by depression and anxiety. Finally, the "agitation" component was loaded by irritability and aggression. In conclusion, PCA is not equipped to handle zero-inflation. Using the NPI, PCA fails to identify components with a valid interpretation, while ZIBP-PCA estimates simple and interpretable components to characterize the psychopathology of dementia.
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Affiliation(s)
| | - Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA
| | - Audun Osland Vik-Mo
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, London, United Kingdom
| | - Geir Selbaek
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Toensberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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20
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Bjørnestad EØ, Olset H, Dhar I, Løland K, Pedersen EKR, Svingen GFT, Svardal A, Berge RK, Ueland PM, Tell GS, Nilsen DWT, Nordrehaug JE, Nygaard E, Nygård O. Circulating trimethyllysine and risk of acute myocardial infarction in patients with suspected stable coronary heart disease. J Intern Med 2020; 288:446-456. [PMID: 32270523 DOI: 10.1111/joim.13067] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 12/20/2022]
Abstract
BACKGROUND The carnitine precursor trimethyllysine (TML) is associated with progression of atherosclerosis, possibly through a relationship with trimethylamine-N-oxide (TMAO). Riboflavin is a cofactor in TMAO synthesis. We examined prospective relationships of circulating TML and TMAO with acute myocardial infarction (AMI) and potential effect modifications by riboflavin status. METHODS By Cox modelling, risk associations were examined amongst 4098 patients (71.8% men) with suspected stable angina pectoris. Subgroup analyses were performed according to median plasma riboflavin. RESULTS During a median follow-up of 4.9 years, 336 (8.2%) patients experienced an AMI. The age- and sex-adjusted hazard ratio (HR) (95% CI) comparing the 4th vs. 1st TML quartile was 2.19 (1.56-3.09). Multivariable adjustment for traditional cardiovascular risk factors and indices of renal function only slightly attenuated the risk estimates [HR (95% CI) 1.79 (1.23-2.59)], which were particularly strong amongst patients with riboflavin levels above the median (Pint = 0.035). Plasma TML and TMAO were strongly correlated (rs = 0.41; P < 0.001); however, plasma TMAO was not associated with AMI risk in adjusted analyses [HR (95% CI) 0.81 (0.58-1.14)]. No interaction between TML and TMAO was observed. CONCLUSION Amongst patients with suspected stable angina pectoris, plasma TML, but not TMAO, independently predicted risk of AMI. Our results motivate further research on metabolic processes determining TML levels and their potential associations with cardiovascular disease. We did not adjust for multiple comparisons, and the subgroup analyses should be interpreted with caution.
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Affiliation(s)
- E Ø Bjørnestad
- From the, Departments of, Department of, Medicine, Stavanger University Hospital, Stavanger, Norway
| | - H Olset
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - I Dhar
- Department of, Clinical Science, University of Bergen, Bergen, Norway
| | - K Løland
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - E K R Pedersen
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - G F T Svingen
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - A Svardal
- Department of, Clinical Science, University of Bergen, Bergen, Norway
| | - R K Berge
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of, Clinical Science, University of Bergen, Bergen, Norway
| | - P M Ueland
- Department of, Clinical Science, University of Bergen, Bergen, Norway
| | - G S Tell
- Department of, Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - D W T Nilsen
- Department of, Clinical Science, University of Bergen, Bergen, Norway.,Department of, Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - J E Nordrehaug
- Department of, Clinical Science, University of Bergen, Bergen, Norway
| | - E Nygaard
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - O Nygård
- Department of, Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of, Clinical Science, University of Bergen, Bergen, Norway
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21
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Dhar I, Siddique S, R Pedersen E, F T Svingen G, Lysne V, Olsen T, Nilsen DW, Nordrehaug JE, Midttun Ø, M Ueland P, S Tell G, K Nygård O. Lipid parameters and vitamin A modify cardiovascular risk prediction by plasma neopterin. Heart 2020; 106:1073-1079. [PMID: 32398245 DOI: 10.1136/heartjnl-2019-316165] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Oxidised cholesterol metabolites are linked to increased production of the active vitamin A (Vit-A) form and monocyte/macrophage activation, which may be reflected by neopterin, a marker of both interferon-γ-mediated immune activation and coronary artery disease risk. We examined the influence of serum lipid parameters and Vit-A on the risk association between neopterin and incident acute myocardial infarction (AMI). METHODS We included 4130 patients with suspected stable angina pectoris (SAP), of whom 80% received lipid-lowering treatment with statins. Risk associations between plasma neopterin and AMI are given as HRs per SD increase in log-transformed neopterin. RESULTS During a median follow-up of 7.5 years, 530 (12.8%) patients experienced an AMI. In age-adjusted and sex-adjusted analysis, plasma neopterin was positively associated with incident AMI (HR (95% CI) per SD: 1.26 (1.17 to 1.35)). However, the estimates were most pronounced in patients with serum low-density lipoprotein cholesterol (LDL-C) or apolipoprotein (apo) B100 below-median (HR (95% CI) per SD: 1.35 (1.24 to 1.48) and 1.42 (1.27 to 1.58), respectively; both pinteraction ≤0.03). We also observed a particularly strong risk association in those with above-median Vit-A (HR (95% CI) per SD: 1.32 (1.21 to 1.44); pinteraction=0.03). The estimates were slightly modified after multivariable adjustment. CONCLUSIONS In patients with suspected SAP, the majority of whom receiving statin therapy, high plasma neopterin was associated with increased risk of AMI particularly among those with low LDL-C and apoB100 or high Vit-A levels. The particularly strong relationship of plasma neopterin with residual cardiovascular risk in patients with low lipid levels should be further investigated.
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Affiliation(s)
- Indu Dhar
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Sumia Siddique
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Eva R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Gard F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Vegard Lysne
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Olsen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Dennis W Nilsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar K Nygård
- Centre for Nutrition, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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22
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Berge RK, Cacabelos D, Señarís R, Nordrehaug JE, Nygård O, Skorve J, Bjørndal B. Hepatic steatosis induced in C57BL/6 mice by a non-ß oxidizable fatty acid analogue is associated with reduced plasma kynurenine metabolites and a modified hepatic NAD +/NADH ratio. Lipids Health Dis 2020; 19:94. [PMID: 32410680 PMCID: PMC7227213 DOI: 10.1186/s12944-020-01271-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/29/2020] [Indexed: 01/14/2023] Open
Abstract
Background Non-alcoholic fatty liver disease is often associated with obesity, insulin resistance, dyslipidemia, and the metabolic syndrome in addition to mitochondrial dysfunction and nicotinamide adenine dinucleotide (NAD+) deficiency. The aim of this study was to investigate how inhibition of mitochondrial fatty acid oxidation using the compound tetradecylthiopropionic acid (TTP) would affect hepatic triacylglycerol level and plasma levels of kynurenine (Kyn) metabolites and nicotinamide. Methods 12 C57BL/6 mice were fed a control diet, or an intervention diet supplemented with 0.9% (w/w) tetradecylthiopropionic acid for 14 days. Blood and liver samples were collected, enzyme activities and gene expression were analyzed in liver, in addition to fatty acid composition. Metabolites in the tryptophan/kynurenine pathway and total antioxidant status were measured in plasma. Results Dietary treatment with tetradecylthiopropionic acid for 2 weeks induced fatty liver accompanied by decreased mitochondrial fatty acid oxidation. The liver content of the oxidized form of NAD+ was increased, as well as the ratio of NAD+/NADH, and these changes were associated by increased hepatic mRNA levels of NAD synthetase and nicotinamide mononucleotide adenyltransferase-3. The downstream metabolites of kynurenine were reduced in plasma whereas the plasma nicotinamide content was increased. Some effects on inflammation and oxidative stress was observed in the liver, while the plasma antioxidant capacity was increased. This was accompanied by a reduced plasma ratio of kynurenine/tryptophan. In addition, a significant decrease in the inflammation-related arachidonic fatty acid in liver was observed. Conclusion Fatty liver induced by short-time treatment with tetradecylthiopropionic acid decreased the levels of kynurenine metabolites but increased the plasma levels of NAD+ and nicotinamide. These changes are most likely not associated with increased inflammation and oxidative stress. Most probably the increase of NAD+ and nicotinamide are generated through the Preiss Handler pathway and/or salvage pathway and not through the de novo pathway. The take home message is that non-alcoholic fatty liver disease is associated with the metabolic syndrome in addition to mitochondrial dysfunction and nicotinamide adenine dinucleotide (NAD+) deficiency. Inducing fatty liver in mice by inhibition of fatty acid oxidation resulted in a concomitant change in kynurenine metabolites increasing the plasma levels of nicotinamides and the hepatic NAD+/NADH ratio, probably without affecting the de novo pathway of kynurenines.
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Affiliation(s)
- Rolf K Berge
- Department of Clinical Science, University of Bergen, Bergen, Norway. .,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | - Daniel Cacabelos
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Rosa Señarís
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Stavanger University Hospital, Stavanger, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,KG Jebsen Centre for Diabetes Research, University of Bergen, Bergen, Norway
| | - Jon Skorve
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bodil Bjørndal
- Department of Clinical Science, University of Bergen, Bergen, Norway
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23
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Butt N, Bache-Mathiesen LK, Ushakova A, Nordrehaug JE, Jensen SE, Munk PS, Danchin N, Dubois-Rande JL, Hansen HS, Paganelli F, Corvoisier PL, Firat H, Erlinge D, Atar D, Larsen AI. Pentraxin 3 in primary percutaneous coronary intervention for ST elevation myocardial infarction is associated with early irreversible myocardial damage : Kinetic profile, relationship to interleukin 6 and infarct size. Eur Heart J Acute Cardiovasc Care 2020; 9:302-312. [PMID: 32403934 PMCID: PMC7549329 DOI: 10.1177/2048872620923641] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The inflammatory marker long pentraxin 3 (PTX3) has been shown to be a strong
predictor of 30-day and one-year mortality after acute myocardial
infarction. The aim of this study was to evaluate the kinetic profile of
PTX3 and its relationship with interleukin 6 (IL-6), high-sensitive
C-reactive protein (hs-CRP) and infarct size. Methods PTX3, IL-6 and hs-CRP were measured at predefined time points, at baseline
(before percutaneous coronary intervention (PCI)), at 12 and 72 hours after
PCI in 161 patients with first-time ST elevation myocardial infarction
(STEMI). Results PTX3 and IL-6 levels increased in the early phase, followed
by a gradual decrease between 12 and 72 hours. There were statistically
significant correlations between PTX3 and IL-6 in general, for all time
points and for changes over time (0–72 hours). In a linear
mixed model, PTX3 predicted IL-6 (p < 0.001). PTX3 is
also correlated with hs-CRP in general, and at each time point post PCI,
except at baseline. PTX3, IL-6 and hs-CRP were all significantly correlated
with infarct size in general, and at the peak time point for maximum
troponin I. In addition, there was a modest correlation between IL-6 levels
at baseline and infarct size at 72 hours after PCI
(ρ = 0.23, p = 0.006). Conclusions PTX3 had a similar kinetic profile to IL-6, with an early increase and
decline, and was statistically significantly correlated with markers of
infarct size in STEMI patients post primary PCI. Baseline levels of IL-6
only predicted infarct size at 72 hours post PCI.
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Affiliation(s)
- Noreen Butt
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
| | - L K Bache-Mathiesen
- Department of Research, Section of Biostatistics Stavanger, University Hospital, Norway
| | - A Ushakova
- Department of Research, Section of Biostatistics Stavanger, University Hospital, Norway
| | - J E Nordrehaug
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
| | - S E Jensen
- Cardiology, Aalborg University Hospital, Denmark
| | - P S Munk
- Department of Cardiology, Sørlandet Hospital, Norway
| | - N Danchin
- Cardiology, Hôpital Européen Georges Pompidou, Université Paris Descartes, France
| | - J L Dubois-Rande
- Cardiology and Clinical Investigation Center, University Hospital Henri Mondor, France
| | | | | | - P Le Corvoisier
- Cardiology and Clinical Investigation Center, University Hospital Henri Mondor, France
| | | | | | - D Atar
- Department of Cardiology, Oslo University Hospital Ullevål and University of Oslo, Norway
| | - A I Larsen
- Department of Clinical Science, University of Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Norway
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Lund A, Nordrehaug JE, Slettom G, Solvang SEH, Pedersen EK, Midttun Ø, Ulvik A, Ueland PM, Nygård O, Giil LM. Correction: Plasma kynurenines and prognosis in patients with heart failure. PLoS One 2020; 15:e0230056. [PMID: 32109260 PMCID: PMC7046265 DOI: 10.1371/journal.pone.0230056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0227365.].
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Mølstad P, Nordrehaug JE, Steigen T, Giil LM, Wilsgaard T, Wiseth R, Bønaa KH. The Effect of Drug-Eluting Stents on Target Lesion Revascularization in Native Coronary Arteries: Results from the NORSTENT Randomized Study. Cardiology 2020; 145:333-341. [PMID: 32097932 DOI: 10.1159/000506042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/17/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The NORSTENT trial randomized 9,013 patients to percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) or bare-metal stent (BMS) with 5-year follow-up. No difference was found in the composite primary outcome of death from any cause and nonfatal spontaneous myocardial infarction after a median of 5 years of follow-up. Secondary outcomes included repeat revascularizations, which were reduced by DES. We report the occurrence of target lesion revascularization (TLR) in time and across demographic and clinical subgroups in patients with lesions in native coronary arteries (n = 8,782). RESULTS Clinically driven TLR was performed on 488 (5.6%) of the 8,782 patients during 5 years of follow-up. Male gender, older age, visible thrombus in the lesion, and larger stent diameter were associated with less TLR; multivessel disease and longer stents were associated with a higher risk of TLR. There was a substantial and highly significant reduction of the risk of any TLR after 5 years in the DES group (hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.36-0.52], p < 0.001). The effect of DES on TLR was limited in time to the first 2 years in the study with no evidence of a later rebound effect. The reduction in TLR after DES insertion was consistent across subgroups defined by gender, age, diabetes status, renal function, and lesion and stent characteristics. The number needed to treat with DES (vs. BMS) to prevent 1 TLR ranged from 4 to 110 across clinically relevant subgroups. CONCLUSION DES have a time-limited effect on the rate of TLR, but with a substantial and highly significant reduction in the first 2 years after the procedure. This effect was found to be consistent across all important clinical subgroups.
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Affiliation(s)
- Per Mølstad
- Department of Cardiology, LHL Clinics Gardermoen, Jessheim, Norway,
| | | | - Terje Steigen
- University Hospital of North Norway and UiT The Arctic University of Norway, Tromsø, Norway
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Rune Wiseth
- Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kaare H Bønaa
- Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Valaker I, Fridlund B, Wentzel-Larsen T, Nordrehaug JE, Rotevatn S, Råholm MB, Norekvål TM. Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention. BMC Health Serv Res 2020; 20:71. [PMID: 32005235 PMCID: PMC6993348 DOI: 10.1186/s12913-020-4908-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
AIMS Complexity of care in patients with coronary artery disease is increasing, due to ageing, improved treatment, and more specialised care. Patients receive care from various healthcare providers in many settings. Still, few studies have evaluated continuity of care across primary and secondary care levels for patients after percutaneous coronary intervention (PCI). This study aimed to determine multifaceted aspects of continuity of care and associations with socio-demographic characteristics, self-reported health, clinical characteristics and follow-up services for patients after PCI. METHODS This multi-centre prospective cohort study collected data at baseline and two-month follow-up from medical records, national registries and patient self-reports. Univariable and hierarchical regressions were performed using the Heart Continuity of Care Questionnaire total score as the dependent variable. RESULTS In total, 1695 patients were included at baseline, and 1318 (78%) completed the two-month follow-up. Patients stated not being adequately informed about lifestyle changes, medication and follow-up care. Those experiencing poorer health status after PCI scored significantly worse on continuity of care. Patients with ST-segment elevation myocardial infarction scored significantly better on informational and management continuity than those with other cardiac diagnoses. The regression analyses showed significantly better continuity (P ≤ 0.034) in patients who were male, received written information from hospital, were transferred to another hospital before discharge, received follow-up from their general practitioner or had sufficient consultation time after discharge from hospital. CONCLUSION Risk factors for sub-optimal continuity were identified. These factors are important to patients, healthcare providers and policy makers. Action should be taken to educate patients, reconcile discharge plans and organise post-discharge services. Designing pathways with an interdisciplinary approach and shared responsibility between healthcare settings is recommended.
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Affiliation(s)
- Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Centre for Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, 351 95 Växjö, Sweden
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Haukelandsveien 28, 5009 Bergen, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1, 0484 Oslo, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O box 7804, 5020 Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Norwegian Registry for Invasive Cardiology, 5021 Bergen, Norway
| | - Maj-Britt Råholm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
| | - Tone M. Norekvål
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O box 7804, 5020 Bergen, Norway
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Lund A, Nordrehaug JE, Slettom G, Solvang SEH, Pedersen EKR, Midttun Ø, Ulvik A, Ueland PM, Nygård O, Giil LM. Plasma kynurenines and prognosis in patients with heart failure. PLoS One 2020; 15:e0227365. [PMID: 31923223 PMCID: PMC6953806 DOI: 10.1371/journal.pone.0227365] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 06/17/2019] [Accepted: 12/17/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Metabolites of the kynurenine pathway (mKP) relate to important aspects of heart failure pathophysiology, such as inflammation, energy-homeostasis, apoptosis, and oxidative stress. We aimed to investigate whether mKP predict mortality in patients with heart failure. METHODS The study included 202 patients with heart failure (73.8% with coronary artery disease (CAD)), propensity score matched to 384 controls without heart disease, and 807 controls with CAD (71%). All underwent coronary angiography and ventriculography at baseline. Plasma mKP, pyridoxal 5'phosphate (PLP) and CRP were measured at baseline. Case-control differences were assessed by logistic regression and survival by Cox regression, adjusted for age, gender, smoking, diabetes, ejection fraction, PLP, eGFR and CRP. Effect measures are reported per standard deviation increments. RESULTS Higher plasma levels of kynurenine, 3- hydroxykynurenine (HK), quinolinic acid (QA), the kynurenine-tryptophan-ratio (KTR) and the ratio of HK to xanthurenic acid (HK/XA) were detected in heart failure compared to both control groups. The mortality rate per 1000 person-years was 55.5 in patients with heart failure, 14.6 in controls without heart disease and 22.2 in CAD controls. QA [HR 1.80, p = 0.013], HK [HR 1.77, p = 0.005], HK/XA [HR 1.67, p < 0.001] and KTR [HR 1.55, p = 0.009] were associated with increased mortality in patients with heart failure, while XA [HR 0.68-0.80, p = 0.013-0.037] were associated with lower mortality in all groups. HK and HK/XA had weak associations with increased mortality in CAD-controls. CONCLUSION Elevated plasma levels of mKP and metabolite ratios are associated with increased mortality, independent of CAD, in patients with heart failure.
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Affiliation(s)
- Anders Lund
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Grete Slettom
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stein-Erik Hafstad Solvang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Eva Kristine Ringdal Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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Ervik AO, Solvang SEH, Nordrehaug JE, Ueland PM, Midttun Ø, Hildre A, McCann A, Nygård O, Aarsland D, Giil LM. The Associations Between Cognitive Prognosis and Kynurenines Are Modified by the Apolipoprotein ε4 Allele Variant in Patients With Dementia. Int J Tryptophan Res 2019; 12:1178646919885637. [PMID: 31798303 PMCID: PMC6859685 DOI: 10.1177/1178646919885637] [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: 10/02/2019] [Accepted: 10/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background: The apolipoprotein E ε4 gene variant (APOEε4) confers considerable risk for
dementia and affects neuroinflammation, brain metabolism, and synaptic
function. The kynurenine pathway (KP) gives rise to neuroactive metabolites,
which have inflammatory, redox, and excitotoxic effects in the brain. Aim: To assess whether the presence of at least one APOEε4 allele modifies the
association between kynurenines and the cognitive prognosis. Methods: A total of 152 patients with sera for metabolite measurements and APOE
genotype were included from the Dementia Study of Western
Norway. The participants had mild Alzheimer disease and Lewy body dementia.
Apolipoprotein E ε4 gene variant allele status was classified as one or more
ε4 versus any other. Mini-Mental State Examination (MMSE) was measured at
baseline and for 5 consecutive years. Mann-Whitney U tests
and linear mixed-effects models were used for statistical analysis. Results: There were no significant differences in serum concentrations of tryptophan
and kynurenine according to the presence or absence of APOEε4. High serum
concentrations of kynurenic acid, quinolinic acid, and picolinic acid, and a
higher kynurenine-to-tryptophan ratio, were all associated with more
cognitive decline in patients without APOEε4 compared to those with the
APOEε4 allele (P-value of the interactions < .05). Conclusions: Kynurenic acid, quinolinic acid, picolinic acid, and the
kynurenine-to-tryptophan ratio were associated with a significant increase
in cognitive decline when the APOEε4 variant was absent, whereas there was a
relatively less decline when the APOEε4 variant was present.
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Affiliation(s)
- Arne Olav Ervik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Stein-Erik Hafstad Solvang
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | | | - Audun Hildre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Ottar Nygård
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College London, London, UK
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
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Hildre AS, Solvang SEH, Aarsland D, Midtun Ø, McCann A, Ervik AO, Nygård O, Ueland PM, Nordrehaug JE, Giil LM. Components of the choline oxidation pathway modify the association between the apolipoprotein ε4 gene variant and cognitive decline in patients with dementia. Brain Res 2019; 1726:146519. [PMID: 31654640 DOI: 10.1016/j.brainres.2019.146519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 07/03/2019] [Revised: 10/12/2019] [Accepted: 10/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Metabolites involved in one-carbon metabolism (OCM) may predict cognitive prognosis in dementia. The link between OCM, apolipoprotein E (APOE), and DNA methylation creates a biologically plausible mechanism of interaction. AIM To assess OCM metabolites as predictors of 5-year cognitive prognosis in patients with mild dementia, and in subgroups defined by the APOEε4 allele variant. METHODS We followed one-hundred and fifty-two patients with mild dementia (86 with Alzheimer's disease, 66 with Lewy body dementia, including 90 with at least one APOEε4 allele) for 5 years with annual Mini-Mental State Examinations (MMSE). Total homocysteine, methionine, choline, betaine, dimethylglycine, sarcosine, folate, cobalamin and pyridoxal 5'-phoshate were measured in serum at baseline. We used linear mixed models to assess metabolite-MMSE associations, including 3-way interactions between metabolites, time, and APOEε4. False-discovery rate adjusted p-values (Q-values) are reported. RESULTS Metabolite concentrations were not different in patients with dementia according to the presence of APOEε4. Overall, serum concentration of total homocysteine was inversely associated with MMSE performance, while betaine was positively associated with MMSE (Q < 0.05), but neither was associated with MMSE decline. Serum concentrations of betaine, dimethylglycine and sarcosine, however, were associated with slower MMSE decline in patients with APOEε4, but with faster MMSE decline in patients without the allele (all 3-way interactions: Q < 0.05). CONCLUSION Components of the choline oxidation pathway are associated with a better cognitive prognosis in APOEε4 carriers and a worse cognitive prognosis in non-carriers. Further research investigating targeted metabolic interventions according to APOE allele status is warranted.
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Affiliation(s)
| | - Stein-Erik Hafstad Solvang
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | | | | | - Arne Olav Ervik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ottar Nygård
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
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30
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Packer E, Slettom G, Solholm A, Omdal TR, Stangeland L, Zhang L, Mongstad A, Løland K, Haaverstad R, Grong K, Nordrehaug JE, Tuseth V. TCT-811 Balanced Biventricular Assist Versus Extracorporeal Membrane Oxygenation in Cardiac Arrest. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.956] [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: 11/27/2022]
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Solvang SEH, Nordrehaug JE, Aarsland D, Lange J, Ueland PM, McCann A, Midttun Ø, Tell GS, Giil LM. Kynurenines, Neuropsychiatric Symptoms, and Cognitive Prognosis in Patients with Mild Dementia. Int J Tryptophan Res 2019; 12:1178646919877883. [PMID: 31632053 PMCID: PMC6769202 DOI: 10.1177/1178646919877883] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 08/23/2019] [Accepted: 08/31/2019] [Indexed: 01/13/2023] Open
Abstract
Introduction: Circulating tryptophan (Trp) and its downstream metabolites, the kynurenines,
are potentially neuroactive. Consequently, they could be associated with
neuropsychiatric symptoms and cognitive prognosis in patients with
dementia. Objective: The objective of this study was to assess associations between circulating
kynurenines, cognitive prognosis, and neuropsychiatric symptoms. Methods: We measured baseline serum Trp, neopterin, pyridoxal 5′-phosphate (PLP), and
9 kynurenines in 155 patients with mild dementia (90 with Alzheimer’s
disease, 65 with Lewy body dementia). The ratios between kynurenine and Trp
and kynurenic acid (KA) to kynurenine (KKR) were calculated. The Mini-Mental
State Examination (MMSE) and the Neuropsychiatric Inventory (NPI) were
administered at baseline and annually over 5 years. Associations between
baseline metabolite concentrations with MMSE and the NPI total score were
assessed using a generalized structural equation model (mixed-effects
multiprocess model), adjusted for age, sex, current smoking, glomerular
filtration rate, and PLP. Post hoc associations between KKRs and individual
NPI items were assessed using logistic mixed-effects models. False discovery
rate (0.05)–adjusted P values (Q values)
are reported. Results: Kynurenine had a nonlinear quadratic relationship with the intercept of the
MMSE scores over 5 years (Q < 0.05), but not with the
slope of MMSE decline. Kynurenine was associated with a higher NPI total
score over time (Q < 0.001). Post hoc, both KKR and KA
were associated with more hallucinations (Q < 0.05). Conclusions: Kynurenine has a complex relationship with cognition, where both low and high
levels were associated with poor cognitive performance. A higher KKR
indicated risk for neuropsychiatric symptoms, especially hallucinations.
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Affiliation(s)
- Stein-Erik Hafstad Solvang
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | - Johannes Lange
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway.,Centre for Organelle Research (CORE), University of Stavanger, Stavanger, Norway
| | | | | | | | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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Skaar E, Eide LSP, Norekvål TM, Ranhoff AH, Nordrehaug JE, Forman DE, Schoenenberger AW, Hufthammer KO, Kuiper KKJ, Bleie Ø, Packer EJS, Langørgen J, Haaverstad R, Schaufel MA. A novel geriatric assessment frailty score predicts 2-year mortality after transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2019; 5:153-160. [PMID: 30256921 PMCID: PMC6440438 DOI: 10.1093/ehjqcco/qcy044] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 12/12/2022]
Abstract
Aims Established surgical scores have limitations in delineating risk among candidates for transcatheter aortic valve implantation (TAVI). Assessment of frailty might help to estimate the mortality risk and identify patients likely to benefit from treatment. The aim of the study was to develop a frailty score to guide the decision for TAVI. Methods and results We conducted a prospective observational study in patients ≥70 years referred for TAVI during 2011–15. A Heart Team had declined the patients for open heart surgery due to high risk but accepted them for TAVI. Prior to the procedure, a geriatric assessment (GA) was performed. Based on this, an 8-element frailty score with a 0–9 (least frail–most frail) scale was developed. A total of 142 patients, 54% women, mean age 83 (standard deviation 4) years, with severe and symptomatic aortic stenosis were assessed. All-cause 2 year mortality was 11%. The novel GA frailty score predicted 2-year mortality in Cox analyses, also when adjusted for age, gender, and logistic EuroSCORE [hazard ratio (HR) 1.75, 95% confidence interval (CI): 1.28–2.42, P < 0.001]. A receiver operating characteristic (ROC) curve analysis indicated that a GA frailty score cut-off at ≥4 predicted 2-year mortality with a specificity of 80% (95% CI: 73–86%) and a sensitivity of 60% (95% CI: 36–80%). The area under the curve was 0.81 (95% CI 0.71–0.90). Conclusion A novel 8-element GA frailty score identified gradations in survival in patients declined for open heart surgery. Patients with higher GA frailty scores had significantly higher 2-year mortality after TAVI.
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Affiliation(s)
- Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway.,Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Leslie Sofia Pareja Eide
- Institute of Health and Social Science, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tone Merete Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Anette Hylen Ranhoff
- Department of Clinical Science, University of Bergen, Norway.,Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Daniel Edward Forman
- Department of Medicine, Section of Geriatric Cardiology, Divisions of Geriatrics and the Heart and vascular Institute, University of Pittsburgh, Pittsburg, Pennsylvania, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | | | | | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Norway
| | - Margrethe Aase Schaufel
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.,Research Unit for General Practice, Uni Research Health, Bergen, Norway
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Valaker I, Fridlund B, Wentzel-Larsen T, Hadjistavropoulos H, Nordrehaug JE, Rotevatn S, Råholm MB, Norekvål TM. Adaptation and psychometric properties of the Norwegian version of the heart continuity of care questionnaire (HCCQ). BMC Med Res Methodol 2019; 19:62. [PMID: 30885143 PMCID: PMC6423885 DOI: 10.1186/s12874-019-0706-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/30/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background Continuity of cardiac care after hospital discharge is a priority, especially as healthcare systems become increasingly complex and fragmented. There are few available instruments to measure continuity of cardiac care, especially from the patient perspective. The aim of this study was (1) to translate and adapt the Heart Continuity of Care Questionnaire (HCCQ) to conditions in Norway, and (2) to determine its psychometric properties in self-report format administered to patients after percutaneous coronary intervention (PCI). Methods The HCCQ was first translated into Norwegian from the original English version, following a widely used cross-cultural adaptation process. Data were collected before hospital discharge and in a follow-up after 2 months. To assess psychometric properties, a confirmatory factor analysis (CFA) was performed and three aspects of construct validity were evaluated: structural validity, hypotheses testing and cross-cultural validation. Internal consistency of the HCCQ subscales was calculated using Cronbach’s alpha, while intra-class correlation (ICC) was used to assess test-retest reliability. Additionally, socio-demographic and patient-reported data were collected to correlate with HCCQ scores. Results Of those included at baseline, 436 (76%) completed the questionnaires after 2 months. CFA suggested that the fit of the HCCQ data to a 3-factor model was modest (RMSEA = 0.11, CFI = 0.90, TLI = 0.90). However, convergent validity was satisfactory, based on existing research. Internal consistency was good, as indicated by its Cronbach’s alphas: total continuity of care (0.95); informational (0.93), relational (0.87), and management (0.89) continuity. The ICC for the total HCCQ score was 0.80 (95% CI [0.71, 0.87] p < 0.001). As indicated by negative care experiences (rated as 1 or 2 on the five-point scale), patients seemed to have limited knowledge about medical treatment, lifestyle modification and follow-up after PCI. Participation in cardiac rehabilitation and longer consultations with the general practitioner after hospital discharge were positively correlated with better continuity of care. Conclusions Implementation of the HCCQ will likely support healthcare providers and researchers in identifying problem areas of continuity of cardiac care and in evaluating interventions aimed at improving continuity of care.
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Affiliation(s)
- Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.,Centre for Child and Adolescent Mental Health, Eastern and Southern, Oslo, Norway.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | | | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Norwegian Registry for Invasive Cardiology, Bergen, Norway
| | - Maj-Britt Råholm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway
| | - Tone M Norekvål
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Førde, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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Giil LM, Solvang SEH, Giil MM, Hellton KH, Skogseth RE, Vik-Mo AO, Hortobágyi T, Aarsland D, Nordrehaug JE. Serum Potassium Is Associated with Cognitive Decline in Patients with Lewy Body Dementia. J Alzheimers Dis 2019; 68:239-253. [PMID: 30775974 DOI: 10.3233/jad-181131] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epidemiological studies link serum potassium (K+) to cognitive performance, but whether cognitive prognosis in dementia is related to K+ levels is unknown. OBJECTIVE To determine if K+ levels predict cognitive prognosis in dementia and if this varies according to diagnosis or neuropathological findings. METHODS This longitudinal cohort study recruited 183 patients with mild Alzheimer's disease or Lewy body dementia (LBD). Serum K+ and eGFR were measured at baseline and medications which could affect K+ registered. The Mini-Mental State Examination (MMSE) was measured annually over 5 years, and mortality registered. Association between K+ and √(30 -MMSE) was estimated overall, and according to diagnosis (joint model). Associations between MMSE-decline and K+ were assessed in two subgroups with neuropathological examination (linear regression) or repeated measurements of K+ over 3 years (mixed model). RESULTS Serum K+ at baseline was associated with more errors on MMSE over time (Estimate 0.18, p = 0.003), more so in LBD (p = 0.048). The overall association and LBD interaction were only significant in the 122 patients not using K+ relevant medication. Repeated K+ measures indicated that the association with MMSE errors over time was due to a between-person effect (p < 0.05, n = 57). The association between the annual MMSE decline was stronger in patients with autopsy confirmed LBD and more α-synuclein pathology (all: p < 0.05, n = 41). CONCLUSION Higher serum K+ predicts poorer cognitive prognosis in demented patients not using medications which affect K+, likely a between-person effect seen mainly in LBD.
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Affiliation(s)
- Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Institute of Clinical Sciences, University of Bergen, Norway
| | - Stein-Erik Hafstad Solvang
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Institute of Clinical Sciences, University of Bergen, Norway
| | | | | | - Ragnhild Eide Skogseth
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Institute of Clinical Medicine, University of Bergen, Norway
| | - Audun Osland Vik-Mo
- Institute of Clinical Sciences, University of Bergen, Norway.,Center for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | - Tibor Hortobágyi
- MTA-DE Cerebrovascular and Neurodegenerative Research Group, University of Debrecen, Debrecen, Hungary.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK
| | - Dag Aarsland
- Center for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK
| | - Jan Erik Nordrehaug
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Institute of Clinical Sciences, University of Bergen, Norway
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Solvang SEH, Nordrehaug JE, Tell GS, Nygård O, McCann A, Ueland PM, Midttun Ø, Meyer K, Vedeler CA, Aarsland D, Refsum H, Smith AD, Giil LM. The kynurenine pathway and cognitive performance in community-dwelling older adults. The Hordaland Health Study. Brain Behav Immun 2019; 75:155-162. [PMID: 30675874 DOI: 10.1016/j.bbi.2018.10.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [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: 05/30/2018] [Revised: 09/17/2018] [Accepted: 10/23/2018] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Tryptophan, its downstream metabolites in the kynurenine pathway and neopterin have been associated with inflammation and dementia. We aimed to study the associations between plasma levels of these metabolites and cognitive function in community-dwelling, older adults. METHODS This cross-sectional study included 2174 participants aged 70-72 years of the community-based Hordaland Health Study. Tryptophan, kynurenine, neopterin and eight downstream kynurenines were measured in plasma. Kendrick Object Learning Test (KOLT), Digit Symbol Test (DST) and the Controlled Oral Word Association Test (COWAT) were all outcomes in standardized Zellner's regression. The Wald test of a composite linear hypothesis of an association with each metabolite was adjusted by the Bonferroni method. Age, body mass index, C-reactive protein, depressive symptoms, diabetes, education, glomerular filtration rate, hypertension, previous myocardial infarction, prior stroke, pyridoxal 5'phosphate, sex and smoking were considered as potential confounders. RESULTS Higher levels of the kynurenine-to-tryptophan ratio (KTR) and neopterin were significantly associated with poorer, overall cognitive performance (p < 0.002). Specifically, KTR was negatively associated with KOLT (β -0.08, p = 0.001) and COWAT (β -0.08, p = 0.001), but not with DST (β -0.03, p = 0.160). This pattern was also seen for neopterin (KOLT: β -0.07; p = 0.001; COWAT: β -0.06, p = 0.010; DST: β -0.01, p = 0.800). The associations were not confounded by the examined variables. No significant associations were found between the eight downstream kynurenines and cognition. CONCLUSION Higher KTR and neopterin levels, biomarkers of cellular immune activation, were associated with reduced cognitive performance, implying an association between the innate immune system, memory, and language.
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Affiliation(s)
- Stein-Erik Hafstad Solvang
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway; Institute of Clinical Science, University of Bergen, Norway.
| | - Jan Erik Nordrehaug
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway; Institute of Clinical Science, University of Bergen, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Ottar Nygård
- Institute of Clinical Science, University of Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | | | | | | | - Dag Aarsland
- Department of Old Age Psychiatry, King's College University, London, UK
| | - Helga Refsum
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway; Department of Pharmacology, University of Oxford, UK
| | - A David Smith
- Department of Pharmacology, University of Oxford, UK
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway; Institute of Clinical Science, University of Bergen, Norway
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36
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Eide LS, Ranhoff AH, Lauck S, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Nordrehaug JE, Norekvål TM. Indwelling urinary catheters, aortic valve treatment and delirium: a prospective cohort study. BMJ Open 2018; 8:e021708. [PMID: 30389757 PMCID: PMC6224736 DOI: 10.1136/bmjopen-2018-021708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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] [Received: 01/19/2018] [Revised: 05/23/2018] [Accepted: 10/05/2018] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES To determine whether an association exists between delirium and length of time indwelling urine catheters (IUC) are used in octogenarian patients treated with surgical aortic valve treatment (SAVR) or transcatheter aortic valve implantation (TAVI). DESIGN Prospective cohort study. SETTING Tertiary university hospital covering the western region of Norway. PARTICIPANTS Octogenarian patients undergoing elective SAVR or TAVI and willing to participate in the study were eligible. Patients unable to speak Norwegian were excluded. Between 2011 and 2013, 143 consecutive patients were included, and data from 136 of them are presented. PRIMARY OUTCOME Delirium. RESULTS Logistic regression analysis shows that lower cognitive function was positively associated with delirium (OR 0.86, CI 0.74 to 0.99, p=0.047). Besides, the interaction term in the model shows that IUC use and delirium differed between SAVR and TAVI patients (p=0.04). The difference corresponded to a weaker association between hours of IUC use and delirium for SAVR (OR 1.01, CI: 0.99 to 1.03, p=0.54) compared with that for TAVI (OR 1.04, CI: 1.01 to 1.08, p=0.004). CONCLUSIONS The association between IUC use and delirium is stronger for octogenarian patients treated with TAVI than for patients who received SAVR. Our results revealed a previously unknown association between the number of hours an IUC is used and postoperative delirium in octogenarian patients treated with TAVI.
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Affiliation(s)
- Leslie Sp Eide
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Kavli Research Center for Geriatrics and Dementia, Haraldsplass Hospital, Bergen, Norway
| | - Sandra Lauck
- Centre for Heart Valve Innovation, St. Paul's Hospital, Vancouver, Canada
- University of British Columbia, Vancouver, Canada
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Tone Merete Norekvål
- Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Schartum-Hansen H, Seifert R, Svingen GFT, Ueland PM, Pedersen ER, Nordrehaug JE, Nilsen DWT, Dahr I, Nygaard ON. P627Cyclic variations of C-reactive protein levels. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - R Seifert
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - G F T Svingen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - P M Ueland
- University of Bergen, Department of Clinical Science, Bergen, Norway
| | - E R Pedersen
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
| | - J E Nordrehaug
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - D W T Nilsen
- Stavanger University Hospital, Department of Cardiology, Stavanger, Norway
| | - I Dahr
- University of Bergen, Department of Clinical Science, Bergen, Norway
| | - O N Nygaard
- Haukeland University Hospital, Department of Heart Disease, Bergen, Norway
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Pettersen TR, Fridlund B, Bendz B, Nordrehaug JE, Rotevatn S, Schjøtt J, Norekvål TM. Challenges adhering to a medication regimen following first-time percutaneous coronary intervention: A patient perspective. Int J Nurs Stud 2018; 88:16-24. [PMID: 30165236 DOI: 10.1016/j.ijnurstu.2018.07.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [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: 02/12/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Percutaneous coronary intervention is the most common therapeutic intervention for patients with narrowed coronary arteries due to coronary artery disease. Although it is known that patients with coronary artery disease often do not adhere to their medication regimen, little is known about what patients undergoing percutaneous coronary interventions find challenging in adhering to their medication regimen after hospital discharge. OBJECTIVES To explore patients' experiences in adhering to medications following early post-discharge after first-time percutaneous coronary intervention. DESIGN An abductive qualitative approach was used to conduct in-depth interviews of patients undergoing first-time percutaneous coronary intervention. SETTINGS Participants were recruited from a single tertiary university hospital, which services a large geographical area in western Norway. Patients fulfilling the inclusion criteria were identified through the Norwegian Registry for Invasive Cardiology. PARTICIPANTS Participants were patients aged 18 years or older who had their first percutaneous coronary intervention six to nine months earlier, were living at home at the time of study inclusion, and were prescribed dual antiplatelet therapy. Patients who were cognitively impaired, had previously undergone cardiac surgery, and/or were prescribed anticoagulation therapy with warfarin or novel oral anticoagulants were excluded. Purposeful sampling was used to include patients of different gender, age, and geographic settings. Twenty-two patients (12 men) were interviewed between December 2016 and April 2017. METHODS Face-to-face semi-structured interviews were conducted, guided by a set of predetermined open-ended questions to gather patient experiences on factors relating to medication adherence or non-adherence. Transcribed interviews were analysed by qualitative content analysis. FINDINGS Patients failed to adhere to their medication regimen for several reasons; intentional and unintentional reasons, multifaceted side effects from heart medications, scepticism towards generic drugs, lack of information regarding seriousness of disease after percutaneous coronary intervention, psychological impact of living with coronary artery disease, and these interacted. There were patients who felt that the medication information they received from physicians and nurses was uninformative and inadequate. Side effects from heart medications were common, ranging from minor ones to more disabling side effects, such as severe muscle and joint pain and fatigue. Patients found well established medication taking routines and aids to be necessary, and these improved adherence. CONCLUSION Patients undergoing first-time percutaneous coronary intervention face multiple, interacting challenges in trying to adhere to prescribed medications following discharge. This study highlights the need for a more structured follow-up care in order to improve medication adherence and to maximise their self-care abilities.
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Affiliation(s)
- Trond R Pettersen
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, 351 95 Växjö, Sweden.
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, Blindern, 0318 Oslo, Norway.
| | - Jan Erik Nordrehaug
- Department of Cardiology, Stavanger University Hospital, P.O. Box 8100, 4068 Stavanger, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
| | - Jan Schjøtt
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
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Giil LM, Aarsland D, Hellton K, Lund A, Heidecke H, Schulze-Forster K, Riemekasten G, Vik-Mo AO, Kristoffersen EK, Vedeler CA, Nordrehaug JE. Antibodies to Multiple Receptors are Associated with Neuropsychiatric Symptoms and Mortality in Alzheimer’s Disease: A Longitudinal Study. J Alzheimers Dis 2018; 64:761-774. [DOI: 10.3233/jad-170882] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Lasse M. Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | | | - Anders Lund
- Department of Clinical Science, University of Bergen, Norway
| | | | | | - Gabriela Riemekasten
- Department of Rheumatology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Audun Osland Vik-Mo
- Department of Clinical Science, University of Bergen, Norway
- Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
| | - Einar K. Kristoffersen
- Department of Clinical Science, University of Bergen, Norway
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Christian A. Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Zuo H, Nygård O, Ueland PM, Vollset SE, Svingen GFT, Pedersen ER, Midttun Ø, Meyer K, Nordrehaug JE, Nilsen DWT, Tell GS. Association of plasma neopterin with risk of an inpatient hospital diagnosis of atrial fibrillation: results from two prospective cohort studies. J Intern Med 2018; 283:578-587. [PMID: 29573355 DOI: 10.1111/joim.12748] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Link between inflammation and atrial fibrillation (AF) has been increasingly recognized. Neopterin, a biomarker of cellular immune activation, may be associated with incident AF. OBJECTIVE To investigate the association between plasma neopterin levels and risk of an inpatient hospital diagnosis of AF, and to evaluate a joint association of neopterin and a nonspecific inflammatory marker C-reactive protein (CRP) in two prospective cohorts. METHODS We performed a prospective analysis from a community-based cohort (the Hordaland Health Study (HUSK), n = 6891), and validated the findings in a cohort of patients with suspected stable angina pectoris (the Western Norway Coronary Angiography Cohort (WECAC), n = 2022). RESULTS In both cohorts, higher plasma levels of neopterin were associated with an increased risk of incident AF after adjustment for age, sex, body mass index, current smoking, diabetes, hypertension and renal function. The multivariable-adjusted hazard ratio (HR) (95% CI) per one SD increment of log-transformed neopterin was 1.20 (1.10-1.32) in HUSK and 1.26 (1.09-1.44) in WECAC. Additional adjustment for CRP did not materially affect the risk association for neopterin. The highest risk of AF was found among individuals with both neopterin and CRP levels above the median (HR: 1.54; 95% CI: 1.16-2.05 in HUSK and HR: 1.67; 95% CI: 1.11-2.52 in WECAC). CONCLUSIONS Our findings indicate an association of plasma neopterin with risk of an inpatient hospital diagnosis of AF, which remains after adjustment for traditional risk factors as well as for CRP. This study highlights a role of cellular immune activation, in addition to inflammation, in AF pathogenesis.
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Affiliation(s)
- H Zuo
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - O Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - P M Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - S E Vollset
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,The Norwegian Institute of Public Health, Bergen, Norway
| | - G F T Svingen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - E R Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | | | - J E Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - D W T Nilsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - G S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Department of Non-communicable Diseases, Norwegian Institute of Public Health, Bergen, Norway
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Giil LM, Vedeler CA, Kristoffersen EK, Nordrehaug JE, Heidecke H, Dechend R, Schulze-Forster K, Muller DN, von Goetze VS, Cabral-Marques O, Riemekasten G, Vogelsang P, Nygaard S, Lund A, Aarsland D. Antibodies to Signaling Molecules and Receptors in Alzheimer's Disease are Associated with Psychomotor Slowing, Depression, and Poor Visuospatial Function. J Alzheimers Dis 2018; 59:929-939. [PMID: 28697567 DOI: 10.3233/jad-170245] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is associated with several antibodies as well as signaling molecules and receptors. These may be detrimental in the presence of a disrupted blood-brain barrier (BBB). OBJECTIVE To investigate whether the levels of antibodies toward 33 signaling molecules involved in neurotransmitter, vascular, and immune functions were associated with AD and, within the AD group; cognitive function and mood. METHODS Antibodies in sera from patients with mild AD [(n = 91) defined as a Mini-Mental State Examination ≥ 20 or a Clinical Dementia Rating Scale≤1] and healthy controls (n = 102) were measured with enzyme-linked immunosorbent assays. Levels in AD and controls were compared by Mann-Whitney test. In the AD group, associations between antibodies and psychometric test scores were analyzed by robust regression. The false discovery threshold was set to 0.05. RESULTS Antibodies to serotonin receptors [5-HT2AR (effect size (r) = 0.21, p = 0.004), 5-HT2CR (r = 0.25, p = 0.0005) and 5-HT7R (r = 0.21, p = 0.003)], vascular endothelial growth factor receptor 1 [VEGFR1 (r = 0.29, p < 0.001)] and immune-receptors (Stabilin-1 (r = 0.23, p = 0.001) and C5aR1 (r = 0.21, p = 0.004) were higher in AD. Psychomotor speed was associated with D1R-abs (β 0.49, p < 0.001), depression with ETAR-abs (β 0.31, p < 0.001), and visuospatial function with 5-HT1AR-abs (β 0.27, p = 0.004) despite similar antibody levels compared to controls. CONCLUSIONS Antibody levels to VEGFR1, serotonergic receptors, and receptors in the immune system were increased in AD. Antibodies at similar levels as in controls were associated cognitive dysfunction and depression in AD.
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Affiliation(s)
- Lasse M Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Christian A Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Einar K Kristoffersen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Ralf Dechend
- Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbruck Center for Molecular Medicine, Berlin, Germany.,HELIOS-Klinikum Berlin, Berlin, Germany
| | | | - Dominik N Muller
- Experimental and Clinical Research Center, Charité Medical Faculty and the Max-Delbruck Center for Molecular Medicine, Berlin, Germany.,Max-Delbruck Center for Molecular Medicine, Berlin, Germany
| | | | | | - Gabriela Riemekasten
- Department of Rheumatology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Petra Vogelsang
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Staale Nygaard
- Research Group for Biomedical Informatics, University of Oslo, Oslo, Norway
| | - Anders Lund
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College, UK.,Centre for Age-Related Diseases (SESAM), Stavanger University Hospital, Norway
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Jia X, Heiberg E, Ripa M, Engblom H, Arheden H, Clemmensen P, Erlinge D, Halvorsen S, Larsen AI, Nordrehaug JE, Jensen SE, Atar D, Birnbaum Y. ST CHANGES IN ELECTROCARDIOGRAPHIC LEADS V4-V6 IN PATIENTS WITH INFERIOR MYOCARDIAL INFARCTION PREDICT EXTENT AND DISTRIBUTION OF ISCHEMIC INJURY AS EVALUATED BY CARDIAC MAGNETIC RESONANCE: ANALYSIS FROM THE MITOCARE STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30784-8] [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: 10/17/2022]
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Degerud E, Nygård O, de Vogel S, Hoff R, Svingen GFT, Pedersen ER, Nilsen DWT, Nordrehaug JE, Midttun Ø, Ueland PM, Dierkes J. Plasma 25-Hydroxyvitamin D and Mortality in Patients With Suspected Stable Angina Pectoris. J Clin Endocrinol Metab 2018; 103:1161-1170. [PMID: 29325121 DOI: 10.1210/jc.2017-02328] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/04/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT AND OBJECTIVE Vitamin D status may affect cardiovascular disease (CVD) development and survival. We studied the relationship between concentrations of the circulating biomarker 25-hydroxyvitamin D (25OHD) and all-cause and cardiovascular mortality risk. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURES 25OHD, the sum of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2, was analyzed in plasma samples from 4114 white patients suspected of having stable angina pectoris and was adjusted for seasonal variation. Hazard ratios (HRs) for all-cause and cardiovascular mortality were estimated by using multivariable Cox models with 25OHD as the main exposure variable, with adjustment for study site, age, sex, smoking, body mass index, estimated glomerular filtration rate, and systolic blood pressure. RESULTS A total of 895 (21.8%) deaths, including 407 (9.9%) from CVD causes, occurred during a mean ± standard deviation follow-up of 11.9 ± 3.0 years. Compared with the first 25OHD quartile, HRs in the second, third, and fourth quartiles were 0.64 [95% confidence interval (CI), 0.54 to 0.77], 0.56 (95% CI, 0.46 to 0.67), and 0.56 (95% CI, 0.46 to 0.67) for all-cause mortality and 0.70 (95% CI, 0.53 to 0.91), 0.60 (95% CI, 0.45 to 0.79), and 0.57 (95% CI, 0.43 to 0.75) for cardiovascular mortality, respectively. Threshold analysis demonstrated increased all-cause and CVD mortality in patients with 25OHD concentrations below ∼42.5 nmol/L. Moreover, analysis suggested increased all-cause mortality at concentrations >100 nmol/L. CONCLUSION Plasma 25OHD concentrations were inversely associated with cardiovascular mortality and nonlinearly (U-shaped) associated with all-cause mortality.
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Affiliation(s)
- Eirik Degerud
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Ottar Nygård
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Stefan de Vogel
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rune Hoff
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Gard Frodahl Tveitevåg Svingen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Eva Ringdal Pedersen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Dennis Winston Trygve Nilsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway
| | - Jutta Dierkes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Vogelsang P, Giil LM, Lund A, Vedeler CA, Parkar AP, Nordrehaug JE, Kristoffersen EK. Reduced glucose transporter-1 in brain derived circulating endothelial cells in mild Alzheimer's disease patients. Brain Res 2017; 1678:304-309. [PMID: 29102777 DOI: 10.1016/j.brainres.2017.10.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/11/2017] [Accepted: 10/29/2017] [Indexed: 12/11/2022]
Abstract
Patients with Alzheimer's disease (AD) have blood-brain barrier (BBB) dysfunction. Methods to study cells of the BBB in vivo would facilitate analyses of neurovascular damage in early AD. Thus, we conducted a pilot study to investigate if brain-derived endothelial cells (BDCECs) could be identified from a cell population of circulating endothelial cells (CECs). Peripheral blood was sampled from early AD patients (n = 9), patients with vascular diseases (myocardial infarction (n = 8) and ischemic stroke (n = 8)), and healthy controls (n = 8). We enumerated CD34+/CD146+/CD45- cells (CECs) and Glucose transporter-1 (Glut1+ CECs (BDCECs)) by flow cytometry. We found that BDCECs formed a separate, aggregate cell population. Glut1 expression on BDCECs, measured by the median fluorescence intensity, was significantly decreased in patients with AD compared to both the healthy controls and patients with myocardial infarction ((p < .05, Kruskal-Wallis, Dunn's post hoc test). We found no significant differences in cell numbers. Our study shows that isolation of BDCECs offers a promising non-invasive tool to investigate cells derived from the BBB. Downregulation of Glut1 at the mild stages of AD suggests that agents that increase Glut1 levels may be therapeutic candidates to improve energy availability to the brain.
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Affiliation(s)
- Petra Vogelsang
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Lasse Melvaer Giil
- Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Anders Lund
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Christian A Vedeler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Anagha P Parkar
- Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Einar K Kristoffersen
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
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Lund A, Giil LM, Slettom G, Nygaard O, Heidecke H, Nordrehaug JE. Antibodies to receptors are associated with biomarkers of inflammation and myocardial damage in heart failure. Int J Cardiol 2017; 250:253-259. [PMID: 29046223 DOI: 10.1016/j.ijcard.2017.10.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/03/2017] [Accepted: 10/02/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Naturally occurring antibodies are linked to inflammation, tissue injury and apoptosis, processes also linked to heart failure. Associations between antibodies, inflammation and myocardial damage, have not been elucidated in heart failure. OBJECTIVE We investigated if 25 antibodies to receptors expressed in the cardiovascular system were associated with troponin-T, biomarkers of inflammation and clinical measures of disease severity, in patients with heart failure. METHODS Antibodies in sera from patients (n=191) with ischemic (n=155) or non-ischemic (n=36) heart failure were measured with full-receptor sandwich enzyme-linked immunosorbent assays. All patients underwent coronary angiography with determination of left ventricular ejection fraction (LVEF) and left ventricular end-diastolic pressure (LVEDP). Measured biomarkers included troponin-T, C-reactive protein, erythrocyte sedimentation rate, fibrinogen and neopterin. RESULTS Stabilin-1-antibodies correlated with troponin-T (β 0.23 p=0.008), soluble endoglin-antibodies with erythrocyte sedimentation rate (β 0.19, p=0.007) and fibrinogen (β 0.28, p<0.001). Platelet-derived growth factor subunit β-antibodies were associated with neopterin (β 0.17, p=0.002). All antibodies were correlated (R 0.26 to 0.91) and formed 4 principal components (PCs). Patients with high CRP and high PC2 had higher NYHA class and patients with high troponin-T and high PC1 had lower LVEDP (interactions, all p<0.05). CONCLUSION Antibodies to receptors are correlated and are associated with biomarkers of inflammation and myocardial damage, which further modifies their association with disease severity in heart failure. Their functional activity and immunological function, remain undecided.
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Affiliation(s)
- Anders Lund
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Lasse Melvaer Giil
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Grete Slettom
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Ottar Nygaard
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Jan Erik Nordrehaug
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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Oterhals K, Haaverstad R, Nordrehaug JE, Eide GE, Norekvål TM. Self-reported health status, treatment decision and survival in asymptomatic and symptomatic patients with aortic stenosis in a Western Norway population undergoing conservative treatment: a cross-sectional study with 18 months follow-up. BMJ Open 2017; 7:e016489. [PMID: 28827255 PMCID: PMC5629730 DOI: 10.1136/bmjopen-2017-016489] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Received: 02/17/2017] [Revised: 07/05/2017] [Accepted: 07/19/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes. DESIGN A cross-sectional survey with an 18-month follow-up. SETTING One tertiary university hospital in Western Norway. PARTICIPANTS In all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measures were symptoms and self-reported health status. Secondary outcomes were treatment decision and patient survival after 18 months. RESULTS A total of 136 patients with mean (SD) age 79 (12) years, 52% men responded. Among conservatively treated patients 77% were symptomatic. The symptom most frequently experienced was dyspnoea. Symptomatic patients reported worse physical and mental health compared with asymptomatic patients (effect size 1.24 and 0.74, respectively). In addition, symptomatic patients reported significantly higher levels of anxiety and depression compared with asymptomatic patients. However, symptom status did not correlate with haemodynamic severity of AS. After 18 months, 117 (86%) were still alive, 20% had undergone surgical aortic valve replacement (AVR) and 7% transcatheter aortic valve implantation (TAVI). When adjusting for age, gender, symptomatic status, severity of AS and European system for cardiac operative risk evaluation (EuroSCORE), patients with severe AS had more than sixfold chance of being scheduled for AVR or TAVI compared with those with moderate AS (HR 6.3, 95% CI 1.9 to 21.2, p=0.003). Patients with EuroSCORE ≥11 had less chance for undergoing AVR or TAVI compared with those with EuroSCORE ≤5 (HR 0.06, 95% CI 0.01 to 0.46, p=0.007). CONCLUSIONS Symptoms affected both physical and mental health in conservatively treated patients with AS. Many patients with symptomatic severe AS are not scheduled for surgery, despite the recommendations in current guidelines. The referral practice for AVR is a path for further investigation.
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Affiliation(s)
- Kjersti Oterhals
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Geir Egil Eide
- Department of Research and Development, Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Butt N, Bache-Mathiesen LK, Nordrehaug JE, Tuseth V, Munk PS, Bonarjee V, Hall TS, Jensen SE, Halvorsen S, Firat H, Atar D, Larsen AI. Administration of the Mitochondrial Permeability Transition Pore Inhibitor, TRO40303, prior to Primary Percutaneous Coronary Intervention, Does Not Affect the Levels of Pro-Inflammatory Cytokines or Acute-Phase Proteins. Cardiology 2017. [DOI: 10.1159/000475460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objectives: In the MITOCARE study, reperfusion injury was not prevented after administration of the mitochondrial permeability transition pore (mPTP) opening inhibitor, TRO40303, in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). The effects of TRO40303 on pro-inflammatory cytokines and acute-phase proteins were assessed. Methods: STEMI patients (n = 163, mean age 62 years) with chest pain within 6 h before admission for pPCI were randomized to intravenous bolus of TRO40303 (n = 83) or placebo (n = 80) prior to reperfusion. We tested whether the groups differed in levels of IL-1β, IL-6, IL-10, TNF, and high-sensitive C-reactive protein at various time points (0, 12, and 72 h) after PCI. Further, potential differences between groups in the change of biomarker levels between 0 and 72 h, 0 and 12 h, and 12 and 72 h were tested. Results: There were no statistically significant differences between the two groups, neither in levels of pro-inflammatory cytokines nor in levels of acute-phase proteins, and there were no statistically significant differences in the change of biomarker levels between the groups considering the time intervals from 0 to 72 h, from 0 to 12 h, and from 12 to 72 h. Conclusion: The administration of the mPTP, TRO40303, prior to reperfusion does not alter the pharmacokinetics of pro-inflammatory cytokines or acute-phase proteins during the first 72 h after PCI.
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Valaker I, Norekvål TM, Råholm MB, Nordrehaug JE, Rotevatn S, Fridlund B. Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings. Eur J Cardiovasc Nurs 2017; 16:444-452. [PMID: 28111970 PMCID: PMC5458873 DOI: 10.1177/1474515117690298] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 12/12/2022]
Abstract
Background: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI. Aim: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge. Methods: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6–8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis. Findings: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments. Conclusions and implications: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.
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Affiliation(s)
- Irene Valaker
- 1 Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
| | - Tone M Norekvål
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,3 Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maj-Britt Råholm
- 1 Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
| | - Jan Erik Nordrehaug
- 3 Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,4 Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Svein Rotevatn
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,5 Norwegian Registry for Invasive Cardiology, Bergen, Norway
| | - Bengt Fridlund
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,6 School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Veum VL, Laupsa-Borge J, Eng Ø, Rostrup E, Larsen TH, Nordrehaug JE, Nygård OK, Sagen JV, Gudbrandsen OA, Dankel SN, Mellgren G. Visceral adiposity and metabolic syndrome after very high-fat and low-fat isocaloric diets: a randomized controlled trial. Am J Clin Nutr 2017; 105:85-99. [PMID: 27903520 DOI: 10.3945/ajcn.115.123463] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 09/22/2015] [Accepted: 10/28/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Different aspects of dietary pattern, including macronutrient and food profiles, may affect visceral fat mass and metabolic syndrome. OBJECTIVE We hypothesized that consuming energy primarily from carbohydrate or fat in diets with similar food profiles would differentially affect the ability to reverse visceral adiposity and metabolic syndrome. DESIGN Forty-six men (aged 30-50 y) with body mass index (in kg/m2) >29 and waist circumference >98 cm were randomly assigned to a very high-fat, low-carbohydrate (VHFLC; 73% of energy fat and 10% of energy carbohydrate) or low-fat, high-carbohydrate (LFHC; 30% of energy fat and 53% of energy carbohydrate) diet for 12 wk. The diets were equal in energy (8750 kJ/d), protein (17% of energy), and food profile, emphasizing low-processed, lower-glycemic foods. Fat mass was quantified with computed tomography imaging. RESULTS Recorded intake of carbohydrate and total and saturated fat in the LFHC and VHFLC groups were 51% and 11% of energy, 29% and 71% of energy, and 12% and 34% of energy, respectively, with no difference in protein and polyunsaturated fatty acids. Mean energy intake decreased by 22% and 14% in the LFHC and VHFLC groups. The diets similarly reduced waist circumference (11-13 cm), abdominal subcutaneous fat mass (1650-1850 cm3), visceral fat mass (1350-1650 cm3), and total body weight (11-12 kg). Both groups improved dyslipidemia, with reduced circulating triglycerides, but showed differential responses in total and low-density lipoprotein cholesterol (decreased in LFHC group only), and high-density lipoprotein cholesterol (increased in VHFLC group only). The groups showed similar reductions in insulin, insulin C-peptide, glycated hemoglobin, and homeostasis model assessment of insulin resistance. Notably, improvements in circulating metabolic markers in the VHFLC group mainly were observed first after 8 wk, in contrast to more acute and gradual effects in the LFHC group. CONCLUSIONS Consuming energy primarily as carbohydrate or fat for 3 mo did not differentially influence visceral fat and metabolic syndrome in a low-processed, lower-glycemic dietary context. Our data do not support the idea that dietary fat per se promotes ectopic adiposity and cardiometabolic syndrome in humans. This study was registered at clinicaltrials.gov as NCT01750021.
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Affiliation(s)
- Vivian L Veum
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | - Johnny Laupsa-Borge
- Department of Clinical Science.,Hormone Laboratory and.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Espen Rostrup
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Terje H Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Ottar K Nygård
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jørn V Sagen
- Department of Clinical Science.,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | | | - Simon N Dankel
- Department of Clinical Science, .,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
| | - Gunnar Mellgren
- Department of Clinical Science, .,KG Jebsen Centre for Diabetes Research, Department of Clinical Science, and.,Hormone Laboratory and
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Eide LSP, Ranhoff AH, Fridlund B, Haaverstad R, Hufthammer KO, Kuiper KKJ, Nordrehaug JE, Norekvål TM. Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: a prospective cohort study. BMJ Open 2016; 6:e012683. [PMID: 27707832 PMCID: PMC5073576 DOI: 10.1136/bmjopen-2016-012683] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission. DESIGN Prospective cohort study of patients undergoing elective SAVR or TAVI. SETTING Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway. PARTICIPANTS Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries. RESULTS Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (non-delirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. CONCLUSIONS Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.
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Affiliation(s)
- Leslie S P Eide
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anette H Ranhoff
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bengt Fridlund
- School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Karel K J Kuiper
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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