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Stenestrand, Ulf
Publications (10 of 171) Show all publications
Aspberg, S., Stenestrand, U., Koster, M. & Kahan, T. (2013). Large differences between patients with acute myocardial infarction included in two Swedish health registers. Scandinavian Journal of Public Health, 41(6), 637-643
Open this publication in new window or tab >>Large differences between patients with acute myocardial infarction included in two Swedish health registers
2013 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 41, no 6, p. 637-643Article in journal (Refereed) Published
Abstract [en]

Background: Acute myocardial infarction (MI) is a leading cause for morbidity and mortality in Sweden. We aimed to compare patients with an acute MI included in the Register of information and knowledge about Swedish heart intensive care admissions (RIKS-HIA, now included in the register Swedeheart) and in the Swedish statistics of acute myocardial infarctions (S-AMI). Methods: Population based register study including RIKS-HIA, S-AMI, the National patient register and the Cause of death register. Odds ratios were determined by logistic regression analysis. Results: From 2001 to 2007, 114,311 cases in RIKS-HIA and 198,693 cases in S-AMI were included with a discharge diagnosis of an acute MI. Linkage was possible for 110,958 cases. These cases were younger, more often males, had fewer concomitant diseases and were more often treated with invasive coronary artery procedures than patients included in S-AMI only. There were substantial regional differences in proportions of patients reported to RIKS-HIA. Conclusions: Approximately half of all patients with an acute MI were included in RIKS-HIA. They represented a relatively more healthy population than patients included in S-AMI only. S-AMI covered almost all patients with an acute MI but had limited information about the patients. Used in combination, these two registers can give better prerequisites for improved quality of care of all patients with acute coronary syndromes.

Place, publisher, year, edition, pages
SAGE Publications (UK and US), 2013
Keyword
Age, comorbidity, coronary care unit, myocardial infarction, register, sex
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-102790 (URN)10.1177/1403494813483936 (DOI)000327542500013 ()
Note

Funding Agencies|Karolinska Institutet||

Available from: 2014-01-07 Created: 2013-12-26 Last updated: 2017-12-06
Janszky, I., Ahnve, S., Mukamal, K. J., Gautam, S., Wallentin, L. & Stenestrand, U. (2012). Daylight saving time shifts and incidence of acute myocardial infarction - Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA). Sleep Medicine, 13(3), 237-242
Open this publication in new window or tab >>Daylight saving time shifts and incidence of acute myocardial infarction - Swedish Register of Information and Knowledge About Swedish Heart Intensive Care Admissions (RIKS-HIA)
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2012 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 13, no 3, p. 237-242Article in journal (Refereed) Published
Abstract [en]

Background: Daylight saving time shifts can be looked upon as large-scale natural experiments to study the effects of acute minor sleep deprivation and circadian rhythm disturbances. Limited evidence suggests that these shifts have a short-term influence on the risk of acute myocardial infarction (AMI), but confirmation of this finding and its variation in magnitude between individuals is not clear. less thanbrgreater than less thanbrgreater thanMethods: To identify AMI incidence on specific dates, we used the Register of Information and Knowledge about Swedish Heart Intensive Care Admission, a national register of coronary care unit admissions in Sweden. We compared AMI incidence on the first seven days after the transition with mean incidence during control periods. To assess effect modification, we calculated the incidence ratios in strata defined by patient characteristics. less thanbrgreater than less thanbrgreater thanResults: Overall, we found an elevated incidence ratio of 1.039 (95% confidence interval, 1.003-1.075) for the first week after the spring clock shift forward. The higher risk tended to be more pronounced among individuals taking cardiac medications and having low cholesterol and triglycerides. There was no statistically significant change in AMI incidence following the autumn shift. Patients with hyperlipidemia and those taking statins and calcium-channel blockers tended to have a lower incidence than expected. Smokers did not ever have a higher incidence. less thanbrgreater than less thanbrgreater thanConclusions: Our data suggest that even modest sleep deprivation and disturbances in the sleep-wake cycle might increase the risk of AMI across the population. Confirmation of subgroups at higher risk may suggest preventative strategies to mitigate this risk.

Place, publisher, year, edition, pages
Elsevier, 2012
Keyword
Daylight saving time, Circadian rhythm, Sleep deprivation, Myocardial infarction, Sleep, Chronobiology, Circadian Misalignment
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76618 (URN)10.1016/j.sleep.2011.07.019 (DOI)000301695600004 ()
Note
Funding Agencies|Swedish Council of Working Life and Social Research||Karolinska Institute Foundation||Ansgarius Foundation||Available from: 2012-04-13 Created: 2012-04-13 Last updated: 2017-12-07
Szummer, K., Lundman, P., Jacobson, S. H., Schon, S., Lindback, J., Stenestrand, U., . . . Jernberg, T. (2011). Association between statin treatment and outcome in relation to renal function in survivors of myocardial infarction. KIDNEY INTERNATIONAL, 79(9), 997-1004
Open this publication in new window or tab >>Association between statin treatment and outcome in relation to renal function in survivors of myocardial infarction
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2011 (English)In: KIDNEY INTERNATIONAL, ISSN 0085-2538, Vol. 79, no 9, p. 997-1004Article in journal (Refereed) Published
Abstract [en]

As statins are recommended at discharge to all patients following myocardial infarction (MI), we studied their use and efficacy in renal disease by analyzing the data, in the nationwide SWEDEHEART registry, of 42,814 consecutive survivors of MI with available creatinine/dialysis data but without statin therapy on admission. The estimated glomerular filtration rate (eGFR) was determined by the Modification of Diet in Renal Disease Study formula and the patients classified into the five traditional stages of kidney disease. The 1-year survival in relation to prescription of statin at discharge was assessed in a Cox regression analysis adjusted by a propensity score that described each individuals likelihood of being treated with a statin, established by 36 baseline characteristics and in-hospital therapies. Statin use at discharge decreased with increased renal impairment from 81% in eGFR stage 1 to 31% in eGFR stage 5. After adjusting for the propensity score and discharge medication, statin use was associated with a significant reduction in overall risk of death (hazard ratio 0.63), with a statistically significant interaction between statin therapy and the stage of renal function. Thus, statin use at discharge was associated with improved 1-year survival of patients in stages 2-4 (mild-to-severe) of renal insufficiency. This effect appears attenuated in those with stage 5 renal failure.

Place, publisher, year, edition, pages
Nature Publishing Group, 2011
Keyword
myocardial infarction, prognosis, renal dysfunction, statin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67965 (URN)10.1038/ki.2010.524 (DOI)000289514400009 ()
Available from: 2011-05-04 Created: 2011-05-04 Last updated: 2011-05-11
Persson, J., Lindback, J., Hofman-Bang, C., Lagerqvist, B., Stenestrand, U. & Samnegard, A. (2011). Efficacy and safety of clopidogrel after PCI with stenting in patients on oral anticoagulants with acute coronary syndrome. EUROINTERVENTION, 6(9), 1046-1052
Open this publication in new window or tab >>Efficacy and safety of clopidogrel after PCI with stenting in patients on oral anticoagulants with acute coronary syndrome
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2011 (English)In: EUROINTERVENTION, ISSN 1774-024X, Vol. 6, no 9, p. 1046-1052Article in journal (Refereed) Published
Abstract [en]

Aims: To evaluate crude cardiovascular risk in patients with acute coronary syndrome (ACS) who are on oral anticoagulants (OAC) after percutaneous coronary intervention with stents (PCI-S) and also to evaluate if the patients on OAC after PCI-S benefit from clopidogrel. less thanbrgreater than less thanbrgreater thanMethods and results: Data from RIKS-HIA and SCAAR on patients admitted to coronary care units 1997 to 2005, undergoing PCI-S (n=27,972), were evaluated. OAC were prescribed to 4.2% (n=1,183) of the patients and they had higher crude 1-year mortality than the non-OAC group, (3.6% [n=421 vs. 1.5% [n= 413], p=0.008), but after adjusting for pre-treatment patient characteristics there were no significant difference in 1-year mortality (adjusted risk ratio [adj. RR] 0.82 [95% CI 0.58-1.16]). Of patients on OAC, 56% (n=659) were also on clopidogrel at discharge. Incidence of death or myocardial infarction (MI) within one year did not differ between the clopidogrel and non-clopidogrel group, adj. RR 0.93 (95% Cl 0.65-1.34). Triple therapy (OAC, clopidogrel plus aspirin) was associated with four times higher risk of any bleeding than OAC plus aspirin, adj. RR 4.27 (95% Cl 1.2-15.1) but a lower incidence of death or MI than OAC plus clopidogrel adj. RR 0.63 (95% Cl 0.40-0.99) less thanbrgreater than less thanbrgreater thanConclusions: Patients discharged on OAC after PCI-S in ACS have higher crude 1-year mortality than patients not on OAC, largely explained by age and comorbidities. Adding clopidogrel is not associated with lower incidence of death or MI at one year. Triple therapy is associated with higher risk of any bleeding than OAC plus aspirin but lower risk of death or MI than OAC plus clopidogrel.

Place, publisher, year, edition, pages
EUROPA EDITION, 5, RUE SAINT-PANTALEON, BP 61508, TOULOUSE CEDEX 6, 31015, FRANCE, 2011
Keyword
Pharmacology, angioplasty, bleeding, safety
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70513 (URN)10.4244/EIJV6I9A183 (DOI)000294136300007 ()
Note

Funding Agencies|Filip Lundbergs foundation/Eirs 50-years foundation||Anders Otto Swords foundation/Ulrika Eklunds foundatio||Swedish Health Authorities||

Available from: 2011-09-12 Created: 2011-09-12 Last updated: 2014-10-22
Lawesson, S., Tödt, T., Alfredsson, J., Janzon, M., Stenestrand, U. & Swahn, E. (2011). Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Heart, 97(4), 308-314
Open this publication in new window or tab >>Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
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2011 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, no 4, p. 308-314Article in journal (Refereed) Published
Abstract [en]

Objective To evaluate if female gender is associated with renal insufficiency in patients with ST-elevation myocardial infarction (STEMI) and if there is a gender difference in the prognostic importance of renal insufficiency in STEMI. Design Single-centre observational study. Setting One tertiary cardiac centre. Patients All consecutive patients with STEMI planned for primary percutaneous coronary intervention in one Swedish county in 2005 (98 women and 176 men). Main outcome measures Logistic regression analyses were conducted to evaluate the predictors of renal insufficiency, associations between estimated glomerular filtration rate (eGFR) and outcome in each gender and a possible interaction between gender and eGFR regarding outcome. Results Renal insufficiency was defined as eGFR less than 60 ml/min per 1.73 m(2). 67% of women had renal insufficiency compared with 26% of men, OR 5.06 (95% CI 2.66 to 9.59) after multivariable adjustment. In women each 10 ml/min per 1.73 m 2 increment of eGFR was associated with a 63% risk reduction for 1-year mortality, OR 0.37 (95% CI 0.15 to 0.89). No such association was found in men, OR 1.05 (95% CI 0.63 to 1.76). A trend towards a significant interaction between gender and eGFR regarding 1-year mortality was found, OR 2.05 (95% CI 0.93 to 4.50). Conclusions A considerable gender difference in the prevalence of renal insufficiency in STEMI was found and renal insufficiency seemed to be a more important prognostic marker in women. These results are important as previous STEMI studies have shown higher multivariable adjusted mortality in women than in men but renal function has seldom been taken into consideration.

Place, publisher, year, edition, pages
BMJ Publishing Group; 1999, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65947 (URN)10.1136/hrt.2010.194282 (DOI)000286459400008 ()
Note
Original Publication: Sofia Lawesson, Tim Tödt, Joakim Alfredsson, Magnus Janzon, Ulf Stenestrand and Eva Swahn, Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention, 2011, HEART, (97), 4, 308-314. http://dx.doi.org/10.1136/hrt.2010.194282 Copyright: BMJ Publishing Group; 1999 http://group.bmj.com/ Available from: 2011-02-28 Created: 2011-02-28 Last updated: 2017-12-11Bibliographically approved
Ludvigsson, J. F., James, S., Askling, J., Stenestrand, U. & Ingelsson, E. (2011). Nationwide Cohort Study of Risk of Ischemic Heart Disease in Patients With Celiac Disease. CIRCULATION, 123(5), 483-U239
Open this publication in new window or tab >>Nationwide Cohort Study of Risk of Ischemic Heart Disease in Patients With Celiac Disease
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2011 (English)In: CIRCULATION, ISSN 0009-7322, Vol. 123, no 5, p. 483-U239Article in journal (Refereed) Published
Abstract [en]

Background-Studies on ischemic heart disease (IHD) incidence in individuals with celiac disease (CD) are contradictory and do not take small intestinal pathology into account. Methods and Results-In this Swedish population-based cohort study, we examined the risk of IHD in patients with CD based on small intestinal histopathology. We defined IHD as death or incident disease in myocardial infarction or angina pectoris in Swedish national registers. In 2006 to 2008, we collected duodenal/jejunal biopsy data on CD (equal to villous atrophy; Marsh 3; n = 28 190 unique individuals) and inflammation without villous atrophy (Marsh 1 to 2; n = 12 598) from all 28 pathology departments in Sweden. A third cohort consisted of 3658 individuals with normal mucosa but positive CD serology (Marsh 0, latent CD). We found an increased risk of incident IHD in patients undergoing small intestinal biopsy that was independent of small intestinal histopathology (CD: hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.11 to 1.28; 991 events; inflammation: HR, 1.28; 95% CI, 1.19 to 1.39; 809 events; and latent CD: HR, 1.14; 95% CI, 0.87 to 1.50; 62 events). Celiac disease (HR, 1.22; 95% CI, 1.06 to 1.40) and inflammation (HR, 1.32; 95% CI, 1.14 to 1.52) were both associated with death resulting from IHD, whereas latent CD was not (HR, 0.71; 95% CI, 0.34 to 1.50). Conclusions-Individuals with CD or small intestinal inflammation are at increased risk of incident IHD. We were unable to show a positive association between latent CD and incident IHD.

Place, publisher, year, edition, pages
American Heart Association Inc, 2011
Keyword
myocardial infarction, angina, celiac disease, cohort studies, epidemiology, glutens
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-66143 (URN)10.1161/CIRCULATIONAHA.110.965624 (DOI)000287021300011 ()
Available from: 2011-03-04 Created: 2011-03-04 Last updated: 2011-03-04
Höglund, J., Stenestrand, U., Tödt, T. & Johansson, I. (2011). The effect of early mobilisation for patient undergoing coronary angiography; A pilot study with focus on vascular complications and back pain. European Journal of Cardiovascular Nursing, 10(2), 130-136
Open this publication in new window or tab >>The effect of early mobilisation for patient undergoing coronary angiography; A pilot study with focus on vascular complications and back pain
2011 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 10, no 2, p. 130-136Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The optimal length of bed rest after femoral coronary angiography is still unknown. Short immobilisation could cause puncture site complications due to the modern antiplatelet therapy used, while long immobilisation time increases the risk of back pain for the patient. PURPOSE: To assess the safety, as well as perceived comfort, of early mobilisation after coronary angiography with femoral approach. METHODS: A randomised, single centre pilot trial with 104 coronary angiography patients (including 58 patients with non ST-elevation acute coronary syndrome) assigned to a post-procedural bed rest time for either 1.5 or 5h. The primary endpoint was any incidence of vascular complication. Patients' discomfort was measured as self-perceived grade of pain in the back. RESULTS: The presence of haematomas >/=5cm was 5.8% in the short immobilisation group vs. 3.8% in the control group (ns). There was a significantly lower rate of perceived back pain in the short immobilisation group, compared to the controls, at the time of mobilisation, which remained significant also after 2h of mobilisation. CONCLUSION: Early ambulation after coronary angiography is safe, without affecting the incidence of vascular complications, and decreases the patients' pain, both during and after the bed rest.

Place, publisher, year, edition, pages
London, UK: Sage Publications, 2011
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-66438 (URN)10.1016/j.ejcnurse.2010.05.005 (DOI)000291774700009 ()20620118 (PubMedID)
Available from: 2011-03-16 Created: 2011-03-15 Last updated: 2017-12-11Bibliographically approved
Huynh, T., Birkhead, J., Huber, K., OLoughlin, J., Stenestrand, U., Weston, C., . . . Danchin, N. (2011). The Pre-Hospital Fibrinolysis Experience in Europe and North America and Implications for Wider Dissemination. JACC-CARDIOVASCULAR INTERVENTIONS, 4(8), 877-883
Open this publication in new window or tab >>The Pre-Hospital Fibrinolysis Experience in Europe and North America and Implications for Wider Dissemination
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2011 (English)In: JACC-CARDIOVASCULAR INTERVENTIONS, ISSN 1936-8798, Vol. 4, no 8, p. 877-883Article in journal (Refereed) Published
Abstract [en]

Objectives The primary objective of this report was to describe the infrastructures and processes of selected European and North American pre-hospital fibrinolysis (PHL) programs. A secondary objective is to report the outcome data of the PHL programs surveyed. less thanbrgreater than less thanbrgreater thanBackground Despite its benefit in reducing mortality in patients with ST-segment elevation myocardial infarction, PHL remained underused in North America. Examination of existing programs may provide insights to help address barriers to the implementation of PHL. less thanbrgreater than less thanbrgreater thanMethods The leading investigators of PHL research projects/national registries were invited to respond to a survey on the organization and outcomes of their affiliated PHL programs. less thanbrgreater than less thanbrgreater thanResults PHL was successfully deployed in a wide range of geographic territories (Europe: France, Sweden, Vienna, England, and Wales; North America: Houston, Edmonton, and Nova Scotia) and was delivered by healthcare professionals of varying expertise. In-hospital major adverse outcomes were rare with mortality of 3% to 6%, reinfarction of 2% to 5%, and stroke of andlt;2%. less thanbrgreater than less thanbrgreater thanConclusions Combining formal protocols for PHL for some patients with direct transportation of others to a percutaneous coronary intervention hospital for primary percutaneous coronary intervention would allow for tailored reperfusion therapy for patients with ST-segment elevation myocardial infarction. Insights from a variety of international settings may promote widespread use of PHL and increase timely coronary reperfusion worldwide.

Place, publisher, year, edition, pages
Elsevier, 2011
Keyword
acute myocardial infarction, electrocardiogram, fibrinolysis, percutaneous coronary intervention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-70510 (URN)10.1016/j.jcin.2011.05.013 (DOI)000294147500008 ()
Note
Funding Agencies|Association for the Promotion of Research in Arteriosclerosis, Thrombosis, and Vascular Biology||Aventis||Pfizer||Servier||Caisse Nationale dassurancc-maladie (National Health Insurance system)||Boehringer Ingelheim||AstraZeneca||Sanofi-Aventis||Eli Lilly||Portola||Abbott||Medtronic||Tier 1 Canada Research Chair in Health Services Research||Heart and Stroke Foundation of Ontario||Bristol-Myers Squibb||GlaxoSmithKline||Menarini||Merck-Serono||MSD-Schering-Plough||Merck-Schering-Plough||Novartis||Medicines Company||Available from: 2011-09-12 Created: 2011-09-12 Last updated: 2011-09-12
Koutouzis, M., Rosengren, A., Bjork, L., Albertsson, P., Grip, L., Matejka, G., . . . Johanson, P. (2010). Acute coronary syndromes in nonagenarians in Sweden. A report from the register of Information and Knowledge about Swedish Seart Intensive care Admissions (RIKS-HIA) in EUROPEAN HEART JOURNAL, vol 31, issue , pp 308-308. In: EUROPEAN HEART JOURNAL (pp. 308-308). Oxford University Press, 31
Open this publication in new window or tab >>Acute coronary syndromes in nonagenarians in Sweden. A report from the register of Information and Knowledge about Swedish Seart Intensive care Admissions (RIKS-HIA) in EUROPEAN HEART JOURNAL, vol 31, issue , pp 308-308
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2010 (English)In: EUROPEAN HEART JOURNAL, Oxford University Press , 2010, Vol. 31, p. 308-308Conference paper, Published paper (Refereed)
Abstract [en]

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Place, publisher, year, edition, pages
Oxford University Press, 2010
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67381 (URN)000281531902037 ()
Available from: 2011-04-11 Created: 2011-04-11 Last updated: 2011-04-27
Henriksson, M., Damant, J., K Fitzpatrick, N., Abrams, K., Hingorani, A. D., Stenestrand, U., . . . Hemingway, H. (2010). Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery. BRITISH MEDICAL JOURNAL, 340
Open this publication in new window or tab >>Assessing the cost effectiveness of using prognostic biomarkers with decision models: case study in prioritising patients waiting for coronary artery surgery
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2010 (English)In: BRITISH MEDICAL JOURNAL, ISSN 0959-535X, Vol. 340Article in journal (Refereed) Published
Abstract [en]

Objective To determine the effectiveness and cost effectiveness of using information from circulating biomarkers to inform the prioritisation process of patients with stable angina awaiting coronary artery bypass graft surgery. Design Decision analytical model comparing four prioritisation strategies without biomarkers (no formal prioritisation, two urgency scores, and a risk score) and three strategies based on a risk score using biomarkers: a routinely assessed biomarker (estimated glomerular filtration rate), a novel biomarker (C reactive protein), or both. The order in which to perform coronary artery bypass grafting in a cohort of patients was determined by each prioritisation strategy, and mean lifetime costs and quality adjusted life years (QALYs) were compared. Data sources Swedish Coronary Angiography and Angioplasty Registry (9935 patients with stable angina awaiting coronary artery bypass grafting and then followed up for cardiovascular events after the procedure for 3.8 years), and meta-analyses of prognostic effects (relative risks) of biomarkers. Results The observed risk of cardiovascular events while on the waiting list for coronary artery bypass grafting was 3 per 10 000 patients per day within the first 90 days (184 events in 9935 patients). Using a cost effectiveness threshold of 20 pound 000-30 pound 000 ((sic)22 000-(sic)33 000; $32 000-$48 000) per additional QALY, a prioritisation strategy using a risk score with estimated glomerular filtration rate was the most cost effective strategy (cost per additional QALY was andlt;410 pound compared with the Ontario urgency score). The impact on population health of implementing this strategy was 800 QALYs per 100 000 patients at an additional cost of 245 pound 000 to the National Health Service. The prioritisation strategy using a risk score with C reactive protein was associated with lower QALYs and higher costs compared with a risk score using estimated glomerular filtration rate. Conclusion Evaluating the cost effectiveness of prognostic biomarkers is important even when effects at an individual level are small. Formal prioritisation of patients awaiting coronary artery bypass grafting using a routinely assessed biomarker (estimated glomerular filtration rate) along with simple, routinely collected clinical information was cost effective. Prioritisation strategies based on the prognostic information conferred by C reactive protein, which is not currently measured in this context, or a combination of C reactive protein and estimated glomerular filtration rate, is unlikely to be cost effective. The widespread practice of using only implicit or informal means of clinically ordering the waiting list may be harmful and should be replaced with formal prioritisation approaches.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53837 (URN)10.1136/bmj.b5606 (DOI)000273951200002 ()
Available from: 2010-02-05 Created: 2010-02-05 Last updated: 2014-11-14
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