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  • 1. Aronsson, B
    et al.
    Perk, J
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Clinical Physiology.
    Norlén, S
    Hedbäck, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Resuming domestic activities after myocardial infarction: a study in female patients2000In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 7, p. 39-44Article in journal (Refereed)
  • 2.
    Eriksson, Andreas
    et al.
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Hedbäck, Bo
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Cardiology UHL.
    Whiss, Per A.
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Monitoring platelet inhibiting treatment in coronary heart disease by static platelet adhesion2007Conference paper (Other academic)
  • 3.
    Eriksson, Andreas
    et al.
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lindahl, Tomas
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Chemistry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Chemistry.
    Hedbäck, Bo
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Whiss, Per
    Linköping University, Department of Medical and Health Sciences, Pharmacology. Linköping University, Faculty of Health Sciences.
    Static platelet adhesion, flow cytometry and serum TXB2 levels for monitoring platelet inhibiting treatment with ASA and clopidogrel in coronary artery disease: a randomised cross-over study2009In: Journal of Translational Medicine, ISSN 1479-5876, E-ISSN 1479-5876, Vol. 7, no 42Article in journal (Refereed)
    Abstract [en]

    Background: Despite the use of anti-platelet agents such as acetylsalicylic acid (ASA) and clopidogrel in coronary heart disease, some patients continue to suffer from atherothrombosis. This has stimulated development of platelet function assays to monitor treatment effects. However, it is still not recommended to change treatment based on results from platelet function assays. This study aimed to evaluate the capacity of a static platelet adhesion assay to detect platelet inhibiting effects of ASA and clopidogrel. The adhesion assay measures several aspects of platelet adhesion simultaneously, which increases the probability of finding conditions sensitive for anti-platelet treatment. Methods: With a randomised cross-over design we evaluated the anti-platelet effects of ASA combined with clopidogrel as well as monotherapy with either drug alone in 29 patients with a recent acute coronary syndrome. Also, 29 matched healthy controls were included to evaluate intra-individual variability over time. Platelet function was measured by flow cytometry, serum thromboxane B-2 (TXB2)-levels and by static platelet adhesion to different protein surfaces. The results were subjected to Principal Component Analysis followed by ANOVA, t-tests and linear regression analysis. Results: The majority of platelet adhesion measures were reproducible in controls over time denoting that the assay can monitor platelet activity. Adenosine 5-diphosphate (ADP)-induced platelet adhesion decreased significantly upon treatment with clopidogrel compared to ASA. Flow cytometric measurements showed the same pattern (r(2) = 0.49). In opposite, TXB2-levels decreased with ASA compared to clopidogrel. Serum TXB2 and ADP-induced platelet activation could both be regarded as direct measures of the pharmacodynamic effects of ASA and clopidogrel respectively. Indirect pharmacodynamic measures such as adhesion to albumin induced by various soluble activators as well as SFLLRN-induced activation measured by flow cytometry were lower for clopidogrel compared to ASA. Furthermore, adhesion to collagen was lower for ASA and clopidogrel combined compared with either drug alone. Conclusion: The indirect pharmacodynamic measures of the effects of ASA and clopidogrel might be used together with ADP-induced activation and serum TXB2 for evaluation of anti-platelet treatment. This should be further evaluated in future clinical studies where screening opportunities with the adhesion assay will be optimised towards increased sensitivity to anti-platelet treatment.

  • 4.
    Hedbäck, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Erhardt, Leif
    Kard klin Malmö.
    Brandström, Hans
    Hälsov Gråbo Visby.
    Lingfors, Hans
    Boda VC Habo.
    Israelsson, Bo
    Kard klin Malmö.
    Nilsson, Peter
    Klin fo-center Malmö.
    Sjöberg, Gunilla
    Med klin Danderyd.
    Kvalitetssäkring av sekundärprevention vid kranskärlssjukdom. Pågående projekt skapar möjligheter till förbättrad behandling.2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, p. 4846-4852Article in journal (Other academic)
  • 5.
    Hedbäck, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nilsson, Peter
    Brandström, Hans
    Lingfors, Hans
    Erhardt, Leif
    Israelsson, Bo
    Sjöberg, Gunilla
    Gender differences in secondary prevention of coronary heart disease: Reasons to worry or not?2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Objective - To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. Design - Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). Setting - Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. Subjects - A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n=9135) and 12 months (n=4802) of follow-up. The proportion of female patients (25%) did not differ between visits. Main outcome measures - Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. Results - No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p<0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. Conclusions - In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.

  • 6.
    Hedbäck, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Perk, Joep
    Hörnblad, Mikael
    Ohlsson, Ulf
    Cardiac rehabilitation after coronary artery bypass surgery: 10-Year results on mortality, morbidity and readmissions to hospital2001In: Journal of Cardiovascular Risk, ISSN 1350-6277, E-ISSN 1473-5652, Vol. 8, no 3, p. 153-158Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate the long-term secondary preventive effect of a comprehensive rehabilitation programme after coronary artery bypass grafting (CABG). Methods: The study group included 49 consecutive patients who underwent bypass surgery and were then offered a rehabilitation programme consisting of education in risk-factor control, a physical training programme and regular follow-up at a post-CABG clinic. The control group (n = 98), consisting of two well-matched CABG patients for each study patient, was offered the usual care with no access to a cardiac rehabilitation programme. The two groups were followed for 10 years and the results regarding cardiovascular mortality, morbidity, total cardiac events and readmissions to hospital were compared. Results: The total mortality (study group 8.2%, control group 20.4%) and cardiovascular mortality (8.2 versus 15.3%) after 10 years did not differ significantly between the groups. In the study group, nine patients (18.4%) had 10 cardiac events (four cardiovascular deaths, five non-fatal myocardial infarctions and one CABG) compared to 34 patients (34.7%, P < 0.05) suffering 46 (P < 0.01) cardiac events (15 cardiovascular deaths, 18 non-fatal myocardial infarctions, eight CABG, five coronary angioplasties) in the control group. The number of readmissions to hospital (2.1 versus 3.5 per patient) and length of admissions (11 versus 26 days per patient) was significantly lower in the study group (P < 0.01). Conclusion: A comprehensive cardiac rehabilitation programme offered to patients after coronary artery bypass surgery will improve the long-term prognosis and reduce the need for hospital care.

  • 7. Norrman, S
    et al.
    Stegmayr, B
    Eriksson, M
    Hedbäck, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Burell, G
    Brulin, C
    Depressive mood after a cardiac event: Gender inequality and participation in rehabilitation programme2004In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 3, no 4, p. 295-302Article in journal (Refereed)
    Abstract [en]

    Depressive mood after a cardiac event is common with serious consequences for the patient. To compare gender in depressive mood during the first year after a cardiac event and to evaluate the effect of participating in a multidimensional secondary prevention program on depressive mood. 166 men and 54 women, <73 years, consecutively answered a questionnaire concerning depressive mood at 2 weeks, 6 weeks, 5 months and 1 year after discharge after a cardiac event. At 2 weeks, each patient met a nurse, and was informed about the disease and received individual support about lifestyle changes. Of those invited to participate in a secondary prevention program, 127 patients accepted, and 93 declined participation. At each of the four follow-ups, women had significantly higher depression scores than men. Depressive mood in both women and men was significantly reduced at 6 weeks. Thereafter, it increased to the 2-week level in women and to above the 2-week level in men. No differences were seen in patients participating or not in secondary prevention programs. Women had higher depressive mood scores than men and secondary prevention programs failed to improve depressive mood in both women and men. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

  • 8.
    Rydén, Mireille
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Hedbäck, Bo
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Jonasson, Lena
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Does Stress Reduction Change the Levels of Cortisol Secretion in Patients With Coronary Artery Disease?2009In: JOURNAL OF CARDIOPULMONARY REHABILITATION AND PREVENTION, ISSN 1932-7501, Vol. 29, no 5, p. 314-317Article in journal (Refereed)
    Abstract [en]

    PURPOSE: It has been shown that behavioral therapy has effects on Stress behavior in patients with coronary artery disease Salivary cortisol measurements are widely used to assess psychological stress, stress reactivity or both The aim of this study was to investigate whether improved stress behavior in type A patients with coronary artery disease involved changes in cortisol secretion pattern METHODS: Twenty-four male patients were identified as type A individuals and completed a 12-month cognitive-behavioral stress management program Stress behavior was evaluated by using a validated questionnaire Morning and evening salivary cortisol levels were measured over 3 consecutive clays at baseline and after 12 months. RESULTS: Although the patients showed a significant improvement in psychosocial well-being after 12 months, their basal cortisol levels of diurnal rhythm of cortisol did not change There was no Correlation between stress score and cortisol levels CONCLUSIONS. The value of salivary cortisol as both a stress marker and a new cardiovasular risk factor has been discussed but the data from this small Pilot Study raise the question of its utility as a stress marker in cardiac rehabilitation

  • 9.
    Stagmo, M.
    et al.
    Department of Cardiology, University Hospital, Malmö, Sweden, Department of Cardiology, University Hospital, S-205 02 Malmö, Sweden.
    Israelsson, B.
    Department of Cardiology, University Hospital, Malmö, Sweden.
    Brandstrom, H.
    Brandström, H., Gråbo Health Centre, Visby, Sweden.
    Hedbäck, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Lingfors, H.
    Primary Health Care Centre, Habo, Sweden.
    Nilsson, P.
    Department of Medicine, University Hospital, Malmö, Sweden.
    Erhardt, L.
    Department of Cardiology, University Hospital, Malmö, Sweden.
    The Swedish national programme for quality control of secondary prevention of coronary artery disease - Results after one year2004In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 11, no 1, p. 18-24Article, review/survey (Refereed)
    Abstract [en]

    Background: Guidelines for the prevention of coronary artery disease (CAD) have been developed both in Europe and in the USA. However, several surveys have shown that these guidelines are poorly implemented in clinical practice. Design/methods: The Swedish Quality Control Programme on Secondary Prevention of CAD includes patients after myocardial infarction, or having undergone coronary artery surgery or percutaneous coronary intervention. Fifty of Sweden's 79 hospital districts are currently participating. Patients are asked to send report-cards regarding risk factor management to a central registry after discharge from hospital, at a 3-6 month visit and then yearly for 5 years. Results: Results based on data from 1 year after the index event show that a majority of patients reach targets for serum cholesterol (70%), and low-density lipoprotein (LDL)-cholesterol (71%). Mean value for total cholesterol is 4.6 (± SD 0.9) mmol/l, LDL-cholesterol 2.7 (± SD 0.8) mmol/l. Blood pressure targets are less often achieved, with 58% reaching the European Society of Cardiology target for systolic (< 140 mmHg) and 81% for diastolic (< 90 mmHg) blood pressure. A large proportion of patients are prescribed preventive drugs: aspirin (96%), beta-blockers (78%) and lipid-lowering drugs (83%). Conclusions: The Swedish Quality Control Programme is one of the first attempts to assess implementation of guidelines on a national level based on patient participation. It is hoped that shared care programmes and increased patient involvement with feedback on achieved treatment goals in relation to guidelines will improve outcomes in patients with CAD. © 2004 The European Society of Cardiology.

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