liu.seSearch for publications in DiVA
Change search
Refine search result
123 51 - 100 of 139
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 51.
    Henriksson, Martin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Nordlund, Anders
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    A comparison of EQ-5D and SF-6D utilities2003In: iHEA 2003, San Francisco. Muntlig posterpresentation,2003, 2003Conference paper (Refereed)
  • 52.
    James, Stefan K
    et al.
    Uppsala University, Sweden.
    Storey, Robert F
    University of Sheffield, UK.
    Cannon, Christopher
    Brigham and Women's Hospital, Boston, USA.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nicoloau, Jose C
    University of Sao Paulo, Brazil.
    Parasuraman, Bhash
    Astra Zeneca, Wilmington, USA.
    Mellström, Carl
    Astra Zeneca, Södertälje, Sweden.
    Henriksson, Martin
    Astra Zeneca, Södertälje, Sweden.
    Health economic evalatuion of ticagrelor compared to generic clopidogrel in patients with acute coronary syndromes (ACS) intended for non-invasive management based on the PLATO trial2013Conference paper (Refereed)
  • 53.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Antitrombotisk behandling prehospitalt vid primär PCI2007In: IX Svenska Kardiovaskulära Vårmötet,2007, 2007Conference paper (Other academic)
  • 54.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Bröstsmärtor på akuten, akut koronart syndorm. Vad ska göras, när?2006In: Nationellt Akutläkarmöte i Linköping,2006, 2006Conference paper (Other academic)
  • 55.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Den kostnadseffektiva revaskulariseringen, finns den?2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
  • 56.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    EUROTRANSFER and beyond - There is still a rationale for facilitation!2007In: ACS Network Workshop,2007, 2007Conference paper (Refereed)
  • 57.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Grunder i hälsoekonomi. Exempel från kardiologin.2007In: Nationella fortbildningsdagar i kardiologi.,2007, 2007Conference paper (Refereed)
    Abstract [sv]

      

  • 58.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    How to Organize Networks for Invasive Treatment of STEMI: Linköping Experience2010In: Mechanical reperfusion for STEMI: from randomized trials to clinical practice / [ed] Giuseppe De Luca, Alexandra Lansky, Informa Healthcare, 2010, p. 41-49Chapter in book (Other academic)
  • 59.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Hälsoekonomiska effekter - fokus på nya antikoagulantia.2012Conference paper (Refereed)
  • 60.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Hälsoekonomiska och sjukvårdsrelaterade synpunkter vid antitrombotisk behandling vid kranskärlssjukdom2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
  • 61.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Implementing the guidelines at a local (national) level. Workshop sessions.2011Conference paper (Refereed)
  • 62.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Novel Strategies for the Management of STEMI2007In: Kardiologen, US som ett led i vår utmärkelse Center of Excellence Europé 2007 möte med läkare från Holland,2007, 2007Conference paper (Other academic)
  • 63.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Prehospital treatment - the role of thrombolytics, GPIIb/IIIa antagonists och thienopyridines?2007In: 1st Pan-European STEMI Network Symposium,2007, 2007Conference paper (Other academic)
  • 64.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Primary angioplasty: The paradox of an intervention that improves outcome and reduces cost.2011Conference paper (Refereed)
  • 65.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    STEMI - Primär PCI Östgötamodellen. Uppbyggnad och resultat.2006In: Nationellt Thoraxmöte i Linköping,2006, 2006Conference paper (Other academic)
  • 66.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    STEMI 2010 - bästa behandling? Moderator på symposium2010Conference paper (Refereed)
  • 67.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    STEMI treatment in the real world: Learning from RIKS-HIA and EuroTransfer2007In: PACS. Progress in Acute Coronary Syndromes,2007, 2007Conference paper (Refereed)
  • 68.
    Janzon, Magnus
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Treatment strategies in unstable coronary artery disease: economic and quality of life evaluations2003Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    During the past few decades two treatment strategies have evolved for patients with unstable coronary artery disease (UCAD). The non-invasive strategy uses clinical investigations and non-invasive stress tests to identify patients who need diagnostic catheterisation. The early invasive strategy uses coronary catheterisation as the diagnostic instrument. The new technologies have consequences not only for the clinical endpoints of death or myocardial infarction (MI), but also in terms of health-related quality of life and costs. The economic evaluations are of great importance due to the high incidence of the disease and high short-term costs of the invasive strategy. The early costly intervention may prevent later complications and thereby partly or completely offset the higher initial treatment costs. Even if longterm costs remain higher, they can be justified by improved survival or quality of life. Such clinical effects in the long-term follow-up need to be seen in relation to the cost of the strategy. In a prospective Scandinavian multi centre trial we examined 3489 patients with UCAD. The purpose of this thesis was to study the treatment strategies in UCAD with respect to cost-effectiveness and patients' health-related quality of life. This purpose was divided into four aims:

    The first aim was to evaluate the cost-effectiveness of extended treatment with the low-molecular-weight heparin dalteparin. 2267 patients were randomised. The incremental cost-effectiveness ratio for administering dalteparin treatment for one month was SEK 30,300 per avoided death or MI. Since the resources for early intervention are limited in many countries, extended dalteparin treatment for up to one month is a cost-effective bridge to invasive intervention.

    The second aim was to evaluate the short-term costs and cost-effectiveness of the invasive strategy compared to the non-invasive strategy. A total of 2457 patients were randomised. The results were analysed in a societal perspective. The difference in mean total costs after one year was SEK 23,900 (p < 0.001), favouring the non-invasive strategy. The incremental cost-effectiveness ratio for choosing the invasive instead of the non-invasive strategy was SEK 645,000 per avoided death or MI. The high cost at the beginning of the invasive strategy was substantial. For policy discussions concerning implementing the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.

    The third aim was to evaluate the patients' health-related quality of life with respect to the strategies. We used two questionnaires, the generic Short Form 36 (SF-36) and the disease-specific Angina Pectoris Quality of Life Questionnaire (APQLQ), at randomisation and after three, six and 12 months of followup. The invasively treated group showed a significantly better health-related quality of life at the threeand six-month follow-ups (p < 0.01) than the non-invasively treated group. These differences remained at the 12-month follow-up. The disease-specific quality of life results were similar.

    The fourth aim was to evaluate the long-term cost-effectiveness and cost-utility of these strategies. Results were analysed in both a societal and a health care provider perspective. The difference in mean total cost SEK 11,400 was not statistically significant. The estimated cost per quality adjusted life year (QALY) gained for the invasive strategy, based on within trial results and projected life expectancy, was SEK 22,900. These results were consistent in most subgroups. The estimated cost per life year gained was SEK 57,700. Compared to other accepted treatments in the cardiovascular field, the cost per QALY gained is very low.

    In summary, this thesis shows that the early invasive treatment strategy for patients with UCAD promotes health-related quality of life and is highly cost-effective when compared to many other interventions in the cardiovascular field and should therefore be recommended.

    List of papers
    1. Cost effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery disease: results from the FRISC II trial
    Open this publication in new window or tab >>Cost effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery disease: results from the FRISC II trial
    2003 (English)In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, no 3, p. 287-292Article in journal (Refereed) Published
    Abstract [en]

    Background: In unstable coronary artery disease short term treatment with low molecular weight heparin in addition to aspirin has been shown to be effective.

    Objective: To assess the cost effectiveness of extended treatment with dalteparin in patients managed with a non-invasive treatment strategy.

    Design: Prospective, randomised, multicentre study.

    Setting: 58 centres in Sweden, Denmark, and Norway, of which 16 were interventional.

    Patients: After at least five days’ treatment with open label dalteparin, 2267 patients were randomised to continue double blind treatment with either subcutaneous dalteparin twice daily or placebo for three months. The patients’ use of health service resources was recorded prospectively.

    Main outcome measure: Death/myocardial infarction.

    Results: After one month into the double blind period there was a 47% relative reduction in death or myocardial infarction in the dalteparin group compared with the placebo group (p = 0.002). There was a non-significant mean cost difference, favouring the placebo group, of 849 Swedish crowns (SEK) per patient (equivalent to £58). The incremental cost effectiveness ratio for giving dalteparin treatment for one month was SEK 30 300 (range −78 000 to 139 000) (£2060, range −£5300 to £9400) per avoided death or myocardial infarct. At three months, the decrease in death or myocardial infarction was not significant, precluding cost effectiveness analyses.

    Conclusions: There is a marginal and non-significant increase in costs for one month of extended dalteparin treatment compared with placebo. Extended dalteparin treatment lowers the risk of death or myocardial infarction in patients with unstable coronary artery disease. While in many countries the resources for early intervention are limited, extended dalteparin treatment up to one month is a cost effective bridge to invasive intervention.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26280 (URN)10.1136/heart.89.3.287 (DOI)10794 (Local ID)10794 (Archive number)10794 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Cost-effectiveness of an invasive strategy in unstable coronary artery disease: results from the FRISC II invasive trial
    Open this publication in new window or tab >>Cost-effectiveness of an invasive strategy in unstable coronary artery disease: results from the FRISC II invasive trial
    2002 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 1, p. 31-40Article in journal (Refereed) Published
    Abstract [en]

    Aims The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs.

    Methods and Results A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1·7% absolute reduction in deaths and a 3·7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3·9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P<0·001). The incermental cost-effective ratio for choosing the invasive instead of the non-invasive strategy is SEK 1 404 000 per avoided death and SEK 645 000 per avoided death or myocardial infarction

    Conclusion The high cost at the beginning of the invasive strategy is substantial. The clinical results of the FRISC II study provided evidence that the invasive strategy reduces the rate of death and myocardial infarction in patients with unstable coronary artery disease. For policy discussions concerning whether or not to implement the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.

    Keywords
    Unstable angina, non-Q wave myocardial infarction, unstable coronary artery disease, costs, cost-effectiveness, revascularization
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-26279 (URN)10.1053/euhj.2001.2695 (DOI)10793 (Local ID)10793 (Archive number)10793 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Invasive treatment in unstable coronary artery disease promotes health-related quality of life: results from the FRISC II trial
    Open this publication in new window or tab >>Invasive treatment in unstable coronary artery disease promotes health-related quality of life: results from the FRISC II trial
    2004 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 1, p. 114-121Article in journal (Refereed) Published
    Abstract [en]

    Background

    Treatment strategies, either invasive or noninvasive, for patients with unstable coronary artery disease still vary. There are no published studies comparing the strategies for health-related quality of life.

    Methods

    A total of 2457 patients with unstable coronary artery disease were randomized. We prospectively recorded the patients' health-related quality of life using 2 questionnaires, the generic Medical Outcomes Study Short Form 36 (SF-36) and the disease-specific Angina Pectoris Quality of Life Questionnaire (APQLQ), at randomization and after 3, 6, and 12 months of follow-up.

    Results

    There was a high response rate (92%) at randomization, with 2251 respondents. The invasively treated group showed a significantly better quality of life in all 8 scales and both component scores at the 3- and 6-month follow-up (P <.01) than the noninvasively treated group. These differences remained at the 12-month follow-up, with significance in 7 of the scales and in the physical component score. The disease-specific quality of life results were similar until the 6-month follow-up. At randomization, the unstable population showed a remarkably lower quality of life in all 8 scales and the component scores compared with an age- and sex-matched normative population.

    Conclusions

    Patients receiving early invasive intervention after an unstable episode had substantial improvement in health-related quality of life until the 1-year follow-up, compared with patients receiving noninvasive treatment. Health-related quality of life in an unstable coronary artery disease population is remarkably lower than in a matched normative population.

    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-23965 (URN)10.1016/j.ahj.2003.11.026 (DOI)3515 (Local ID)3515 (Archive number)3515 (OAI)
    Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
    4. Long-term cost-effectiveness of invasive strategy in patients with unstable coronary artery disease: results from the FRISC II invasive trial
    Open this publication in new window or tab >>Long-term cost-effectiveness of invasive strategy in patients with unstable coronary artery disease: results from the FRISC II invasive trial
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background The use of coronary catheterisation and revascularisation in unstable coronary artery disease (UCAD) varies, which could have important consequences for patients as well as for health care costs. Our objective was to examine the total two-year costs and the long-term cost-effectiveness and cost-utility of these strategies.

    Methods All 2457 patients in the FRISC II invasive trial, randomised to an early invasive strategy with coronary catheterisation and revascularisation if appropriate or to a non-invasive strategy with coronary catheterisation only for recurrent ischemic symptoms or a positive stress test, were included in the economic evaluation. The patients' use of health services as well as productivity losses were recorded prospectively. Health state scores were obtained five times during the two-year follow-up. Health effects and costs appearing after two years were modelled.

    Findings The mean total cost was Swedish kronor (SEK) 11 386 (£ 850) higher in the invasive group. 1bis difference was not statistically significant. The estimated cost per quality adjusted life year (QALY) gained for the invasive strategy, based on within trial results and projected life expectancy, was SEK 22 873 (£ 1 707). These results were consistent in most subgroups. The estimated cost per life year gained was SEK 57 651 (£ 4 302). If costs for added life years were included, the cost per QALY was SEK 78 077 (£ 5 827) for invasive strategy.

    Interpretation Invasive strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction was shown to be highly cost-effective in the long term.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-84650 (URN)
    Available from: 2012-10-16 Created: 2012-10-16 Last updated: 2013-09-11Bibliographically approved
  • 69.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Våra rutinbehaldningar - hur kostnadseffektiva är de? fokus på trombocythämmare.2012Conference paper (Refereed)
  • 70.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Aasa, Mikael
    Lyth, Johan
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Svensson, Leif
    Herlitz, Johan
    Grip, Lars
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Cost and effectiveness comparison of very early treatment with primary percutaneous coronary intervention facilitated with abciximab or thrombolytic therapy for acute ST-elevation myocardial infarction2007In: ACC,2007, 2007Conference paper (Other academic)
  • 71.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Hasvold, Pål
    AstraZeneca Nordic-Baltic, Södertälje, Sweden.
    Hjelm, Hans
    Nyköping Hospital, Nyköping, Sweden.
    Thuresson, Marcus
    Statisticon AB, Uppsala, Sweden.
    Jernberg, Tomas
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm, Sweden.
    Long-term resource use patterns and healthcare costs after myocardial infarction in a clinical practice setting - results from a contemporary nationwide registry study2016In: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, Vol. 2, p. 291-298Article in journal (Refereed)
    Abstract [en]

    Aims Long-term contemporary nationwide data on resource use and healthcare costs after myocardial infarction (MI) in a clinical practice setting are not widely studied, and the aim of this study was to investigate resource use patterns and healthcare costs in patients with MI in a nationwide clinical practice setting.

    Methods and results This retrospective cohort study included all patients identified in the compulsory Swedish nationwide patient register with a diagnosis of MI between 1 July 2006 and 30 June 2011. Cardiovascular hospitalization and outpatient visits data from the patient register were combined with data from the cause of death register and the drug utilization register. For a subset of patients, data were also available from a primary care register. Healthcare resource use patterns and annual costs [reported in 2014 euros (€) converted from Swedish kronor (SEK) using the exchange rate €1 = SEK 9.33)] were estimated for the year prior to the occurrence of MI as well as for a maximum follow-up period of 6 years post-MI. The study included 97 252 patients with a diagnosis of MI with a total number of 285 351 observation years. The majority of healthcare consumption occurred within the first year of MI where patients were on average hospitalized 1.55 times, made 1.08 outpatient care visits, and 3.80 primary care visits. In the long term, for the majority of resource use categories, average consumption was higher in the years after MI compared with the year prior to MI. Healthcare costs at 6 years of follow-up were approximately €20 000 of which €12 460 occurred in the first year, and the major part was attributed to hospitalizations.

    Conclusion For patients with 6 years of follow-up after MI, healthcare costs were approximately €20 000. The major part of costs occurred in the first year after MI and was driven by hospitalizations

  • 72.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Henriksson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Quality of life in unstable angina - Individual and public preferences differ in levels but are similar when measuring changes over time2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, p. 730-730Conference paper (Other academic)
  • 73.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Henriksson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Quality of life in unstable angina. Individual and public preferences differ in levels but are similar when measuring changes over time2002In: ISTAHC-konferens, Berlin, juni 2002,2002, 2002Conference paper (Refereed)
  • 74.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    James, S
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden.
    Cannon, C P
    ] Brigham & Womens Hosp, Thrombolysis Myocardial Infarct TIMI Study Grp, Boston, MA 02115 USA Harvard Univ, Sch Med, Boston, MA USA .
    Storey, R F
    Univ Sheffield, Dept Cardiovasc Sci, Sheffield, S Yorkshire, England.
    Mellström, C
    AstraZeneca R&D, Molndal, Sweden.
    Nicolau, J C
    Univ Sao Paulo Med Sch, Heart Inst InCor, Sao Paulo, Brazil.
    Wallentin, L
    Uppsala Univ, Dept Med Sci, Uppsala, Sweden Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden.
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. AstraZeneca Nord Balt, Sodertalje, Sweden.
    Health economic analysis of ticagrelor in patients with acute coronary syndromes intended for non-invasive therapy2015In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, no 2, p. 119-25Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management.

    METHODS: A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12 months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems.

    RESULTS: Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of €467, €551, €739 and €574, respectively. The cost per QALY gained with ticagrelor was €2747, €3395, €4419 and €4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability.

    CONCLUSIONS: Treatment of patients with ACS scheduled for 12 months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel.

    TRIAL REGISTRATION NUMBER: NCT000391872.

  • 75.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cast-comparison of early invasive versus non-invasive treatment in unstable coronary artery disease - A six months follow-up from the FRISC II invasive trial2000In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 35, no 2, p. 358A-358AConference paper (Other academic)
  • 76.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Comment concerning 'Cost-effectiveness of an invasive strategy in unstable coronary artery disease' - Reply2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 20, p. 1634-1635Article in journal (Other academic)
  • 77.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Cost effectiveness of extended treatment with low molecular weight heparin (dalteparin) in unstable coronary artery disease: results from the FRISC II trial2003In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 89, no 3, p. 287-292Article in journal (Refereed)
    Abstract [en]

    Background: In unstable coronary artery disease short term treatment with low molecular weight heparin in addition to aspirin has been shown to be effective.

    Objective: To assess the cost effectiveness of extended treatment with dalteparin in patients managed with a non-invasive treatment strategy.

    Design: Prospective, randomised, multicentre study.

    Setting: 58 centres in Sweden, Denmark, and Norway, of which 16 were interventional.

    Patients: After at least five days’ treatment with open label dalteparin, 2267 patients were randomised to continue double blind treatment with either subcutaneous dalteparin twice daily or placebo for three months. The patients’ use of health service resources was recorded prospectively.

    Main outcome measure: Death/myocardial infarction.

    Results: After one month into the double blind period there was a 47% relative reduction in death or myocardial infarction in the dalteparin group compared with the placebo group (p = 0.002). There was a non-significant mean cost difference, favouring the placebo group, of 849 Swedish crowns (SEK) per patient (equivalent to £58). The incremental cost effectiveness ratio for giving dalteparin treatment for one month was SEK 30 300 (range −78 000 to 139 000) (£2060, range −£5300 to £9400) per avoided death or myocardial infarct. At three months, the decrease in death or myocardial infarction was not significant, precluding cost effectiveness analyses.

    Conclusions: There is a marginal and non-significant increase in costs for one month of extended dalteparin treatment compared with placebo. Extended dalteparin treatment lowers the risk of death or myocardial infarction in patients with unstable coronary artery disease. While in many countries the resources for early intervention are limited, extended dalteparin treatment up to one month is a cost effective bridge to invasive intervention.

  • 78.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Cost-effectiveness of an invasive strategy in unstable coronary artery disease: results from the FRISC II invasive trial2002In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 23, no 1, p. 31-40Article in journal (Refereed)
    Abstract [en]

    Aims The utilization and timing of revascularization in unstable coronary artery disease varies, which could have important consequences for patients and for treatment costs. The FRISC II invasive trial compared an early invasive strategy vs a non-invasive strategy with respect to the composite end-point of death and myocardial infarction as well as costs.

    Methods and Results A total of 2457 patients, median age 66 years, comprising 70% men, were randomized. We prospectively recorded the patients' use of the health service. The results were analysed in a societal perspective. There was a significant 1·7% absolute reduction in deaths and a 3·7% absolute reduction in deaths and myocardial infarctions in the invasive compared to the non-invasive group after 12 months. During the initial hospitalization a patient in the invasive group spent on average 3·9 more days in hospital than a patient in the non-invasive group. Opposite results were found for rehospitalizations. The difference in mean total costs is SEK 23 876 (P<0·001). The incermental cost-effective ratio for choosing the invasive instead of the non-invasive strategy is SEK 1 404 000 per avoided death and SEK 645 000 per avoided death or myocardial infarction

    Conclusion The high cost at the beginning of the invasive strategy is substantial. The clinical results of the FRISC II study provided evidence that the invasive strategy reduces the rate of death and myocardial infarction in patients with unstable coronary artery disease. For policy discussions concerning whether or not to implement the invasive strategy, these positive results should be balanced against the cost-consequences of the strategy.

  • 79.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cost-effectiveness of early invasive treatment in unstable coronary artery disease: A one-year follow-up from the FRISC II invasive trial2001In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 37, no 2, p. 376A-376AConference paper (Other academic)
  • 80.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Invasive treatment in non ST elevation acute coronary syndorme promotes long-term health related quality of life - results from the FRISC II trial2007In: ACC, New Orleans, LA,2007, 2007Conference paper (Other academic)
  • 81.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Swahn, Eva
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Invasive treatment in unstable coronary artery disease promotes health-related quality of life: results from the FRISC II trial2004In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 148, no 1, p. 114-121Article in journal (Refereed)
    Abstract [en]

    Background

    Treatment strategies, either invasive or noninvasive, for patients with unstable coronary artery disease still vary. There are no published studies comparing the strategies for health-related quality of life.

    Methods

    A total of 2457 patients with unstable coronary artery disease were randomized. We prospectively recorded the patients' health-related quality of life using 2 questionnaires, the generic Medical Outcomes Study Short Form 36 (SF-36) and the disease-specific Angina Pectoris Quality of Life Questionnaire (APQLQ), at randomization and after 3, 6, and 12 months of follow-up.

    Results

    There was a high response rate (92%) at randomization, with 2251 respondents. The invasively treated group showed a significantly better quality of life in all 8 scales and both component scores at the 3- and 6-month follow-up (P <.01) than the noninvasively treated group. These differences remained at the 12-month follow-up, with significance in 7 of the scales and in the physical component score. The disease-specific quality of life results were similar until the 6-month follow-up. At randomization, the unstable population showed a remarkably lower quality of life in all 8 scales and the component scores compared with an age- and sex-matched normative population.

    Conclusions

    Patients receiving early invasive intervention after an unstable episode had substantial improvement in health-related quality of life until the 1-year follow-up, compared with patients receiving noninvasive treatment. Health-related quality of life in an unstable coronary artery disease population is remarkably lower than in a matched normative population.

  • 82.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Quality of life in unstable coronary artery disease - A comparison of early invasive versus non-invasive treatment. Six months follow-up from the FRISC II invasive trial2000In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 35, no 2, p. 357A-358AConference paper (Other academic)
  • 83.
    Janzon, Magnus
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Swahn, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Quality of life one year after invasive intervention in unstable coronary artery disease: Results from the FRISC II invasive trial2001In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 37, no 2, p. 360A-360AConference paper (Other academic)
  • 84.
    Janzon, Magnus
    et al.
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Swahn, Ewa
    Linköping University, Department of Medicine and Care, Cardiology. Linköping University, Faculty of Health Sciences.
    Long-term cost-effectiveness of invasive strategy in patients with unstable coronary artery disease: results from the FRISC II invasive trialManuscript (preprint) (Other academic)
    Abstract [en]

    Background The use of coronary catheterisation and revascularisation in unstable coronary artery disease (UCAD) varies, which could have important consequences for patients as well as for health care costs. Our objective was to examine the total two-year costs and the long-term cost-effectiveness and cost-utility of these strategies.

    Methods All 2457 patients in the FRISC II invasive trial, randomised to an early invasive strategy with coronary catheterisation and revascularisation if appropriate or to a non-invasive strategy with coronary catheterisation only for recurrent ischemic symptoms or a positive stress test, were included in the economic evaluation. The patients' use of health services as well as productivity losses were recorded prospectively. Health state scores were obtained five times during the two-year follow-up. Health effects and costs appearing after two years were modelled.

    Findings The mean total cost was Swedish kronor (SEK) 11 386 (£ 850) higher in the invasive group. 1bis difference was not statistically significant. The estimated cost per quality adjusted life year (QALY) gained for the invasive strategy, based on within trial results and projected life expectancy, was SEK 22 873 (£ 1 707). These results were consistent in most subgroups. The estimated cost per life year gained was SEK 57 651 (£ 4 302). If costs for added life years were included, the cost per QALY was SEK 78 077 (£ 5 827) for invasive strategy.

    Interpretation Invasive strategy in patients with unstable angina or non-ST-segment elevation myocardial infarction was shown to be highly cost-effective in the long term.

  • 85.
    Janzon, Magnus
    et al.
    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.
    Nikolic, Elisabet
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Henriksson, Martin
    Department om Health Economics, AstraZeneca Södertälje.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hauch, Ole
    AstraZeneca LP, Wilmington, DE, USA.
    Mark, DB
    Duke Clinical Research Institute, Duke University Medical Center, USA.
    Cowper, P.
    Duke Clinical Research Institute, Duke University Medical Center, USA.
    Kaul, P.
    Duke Clinical Research Institute, Duke University Medical Center, USA.
    Harrington, RA.
    Duke Clinical Research Institute, Duke University Medical Center, USA.
    Horrow, J.
    AstraZeneca LP, Wilmington, DE, USA.
    Wallentin, Lars
    Uppsala Clinical Research Centre, Uppsala University.
    Health Economics in the PLATelet Inhibition and Patient Outcomes (PLATO) Randomized Trial: Report on Within Trial Resource Use Patterns2010Conference paper (Refereed)
  • 86. Jeppsson, Anders
    et al.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    SWEDEHEART - symposium.2011Conference paper (Refereed)
  • 87.
    Jernberg, Tomas
    et al.
    Karolinska Univ Hosp, Dept Cardiol, Karolinska Inst, Dept Med, S-14186 Stockholm, Sweden.
    Hasvold, Pål
    AstraZeneca NordicBalt, Sodertalje, Sweden.
    Henriksson, Martin
    AstraZeneca NordicBalt, Sodertalje, Sweden.
    Hjelm, Hans
    Nykoping Hosp, Nykoping, Sweden.
    Thuresson, Marcus
    Statisticon AB, S-75322 Uppsala, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective.2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 19, p. 1163-1170Article in journal (Refereed)
    Abstract [en]

    AIMS: Long-term disease progression following myocardial infarction (MI) is not well understood. We examined the risk of subsequent cardiovascular events in patients discharged after MI in Sweden.

    METHODS AND RESULTS: This was a retrospective, cohort study linking morbidity, mortality, and medication data from Swedish national registries. Of 108 315 patients admitted to hospital with a primary MI between 1 July 2006 and 30 June 2011 (index MI), 97 254 (89.8%) were alive 1 week after discharge and included in this study. The primary composite endpoint of risk for non-fatal MI, non-fatal stroke, or cardiovascular death was estimated for the first 365 days post-index MI and Day 366 to study completion. Risk and risk factors were assessed by Kaplan-Meier analysis and Cox proportional hazards modelling, respectively. Composite endpoint risk was 18.3% during the first 365 days post-index MI. Age [60-69 vs. <60 years: HR (95% CI): 1.37 (1.30-1.45); 70-79 vs. <60 years: 2.13 (2.03-2.24); >80 vs. <60 years: 3.96 (3.78-4.15)], prior MI [1.44 (1.40-1.49)], stroke [1.49 (1.44-1.54)], diabetes [1.37 (1.34-1.40)], heart failure [1.57 (1.53-1.62)] and no index MI revascularisation [1.88 (1.83-1.93)] were each independently associated with a higher risk of ischaemic events or death. For patients without a combined endpoint event during the first 365 days, composite endpoint risk was 20.0% in the following 36 months.

    CONCLUSIONS: Risk of cardiovascular events appeared high beyond the first year post-MI, indicating a need for prolonged surveillance, particularly in patients with additional risk factors.

  • 88.
    Jernberg, Tomas
    et al.
    Hjärtkliniken Stockholm, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    [The truth about the clinical reality is in the registries. A register-based randomized clinical trial could provide representative picture].2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Refereed)
    Abstract [sv]

    A randomized, controlled clinical trial (RCT) is the best way to compare two treatment options since it eliminates the problem with confounding. However, todays' RCTs are often limited by including selected patients by the use of narrow inclusion criteria and multiple exclusion criteria. In a recent study of myocardial infarction survivors, the median age was 10 years older and the long term risk was 2-3 times higher in »real-world« data from a national registry compared with results from recently performed RCTs. These results raise questions about the generalizability of many RCTs. Our registries should therefore be used more often to evaluate new treatments. Registry-based randomized, controlled clinical trial (R-RCT) is a new concept that may not only lower the costs of randomized studies but also increase the generalizability of the trials.

  • 89.
    Jernberg, Tomas
    et al.
    Karolinska Inst, Sweden.
    Lindholm, Daniel
    Uppsala Clin Res Ctr, Sweden.
    Hasvold, Lars Pal
    AstraZeneca Nord, Norway.
    Svennblad, Bodil
    Uppsala Clin Res Ctr, Sweden.
    Bodegard, Johan
    AstraZeneca Nord, Norway.
    Andersson, Karolina Sundell
    AstraZeneca RandD, Sweden.
    Thuresson, Marcus
    Statisticon, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Impact of ischaemic heart disease severity and age on risk of cardiovascular outcome in diabetes patients in Sweden: a nationwide observational study2019In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 4, article id e027199Article in journal (Refereed)
    Abstract [en]

    Objectives To compare short-term cardiovascular (CV) outcome in type 2 diabetes (T2D) patients without ischaemic heart disease (IHD), with IHD but no prior myocardial infarction (MI), and those with prior MI; and assess the impact on risk of age when initiating first-time glucose-lowering drug (GLD). Design Cohort study linking morbidity, mortality and medication data from Swedish national registries. Participants First-time users of GLD during 2007-2016. Outcomes Predicted cumulative incidence for the CV outcome (MI, stroke and CV mortality) was estimated. A Cox model was developed where age at GLD start and CV risk was modelled. Results 260 070 first-time GLD users were included, 221 226 (85%) had no IHD, 16 294 (6%) had stable IHD-prior MI and 22 550 (9%) had IHD+ MI. T2D patients without IHD had a lower risk of CV outcome compared with the IHD populations (+/- prior MI), (3-year incidence 4.78% vs 5.85% and 8.04%). The difference in CV outcome was primarily driven by a relative greater MI risk among the IHD patients. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger (amp;lt; 60 years) patients had a relative greater risk compared with older patients. Conclusions T2D patients without IHD had a lower risk of the CV outcome compared with the T2D populations with IHD, primarily driven by a greater risk of MI. For T2D patients without IHD, an almost linear association between age at start of GLD and relative risk was observed, whereas in IHD patients, the younger patients had a relative greater risk compared with older patients. Our findings suggest that intense risk prevention should be the key strategy in the management of T2D patients, especially for younger patients.

  • 90.
    Karlsson, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Bång, Magnus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Charitakis, Emmanouil
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    A clinical decision support tool for improving adherence to guidelines on anticoagulant therapy in patients with atrial fibrillation at risk of stroke: A cluster-randomized trial in a Swedish primary care setting (the CDS-AF study)2018In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, no 3, article id e1002528Article in journal (Refereed)
    Abstract [en]

    Background

    Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains significant undertreatment. The main aim of the current study was to investigate whether a clinical decision support tool (CDS) for stroke prevention integrated in the electronic health record could improve adherence to guidelines for stroke prevention in patients with AF.

    Methods and findings

    We conducted a cluster-randomized trial where all 43 primary care clinics in the county of Östergötland, Sweden (population 444,347), were randomized to be part of the CDS intervention or to serve as controls. The CDS produced an alert for physicians responsible for patients with AF and at increased risk for thromboembolism (according to the CHA2DS2-VASc algorithm) without anticoagulant therapy. The primary endpoint was adherence to guidelines after 1 year. After randomization, there were 22 and 21 primary care clinics in the CDS and control groups, respectively. There were no significant differences in baseline adherence to guidelines regarding anticoagulant therapy between the 2 groups (CDS group 70.3% [5,186/7,370; 95% CI 62.9%–77.7%], control group 70.0% [4,187/6,009; 95% CI 60.4%–79.6%], p = 0.83). After 12 months, analysis with linear regression with adjustment for primary care clinic size and adherence to guidelines at baseline revealed a significant increase in guideline adherence in the CDS (73.0%, 95% CI 64.6%–81.4%) versus the control group (71.2%, 95% CI 60.8%–81.6%, p = 0.013, with a treatment effect estimate of 0.016 [95% CI 0.003–0.028]; number of patients with AF included in the final analysis 8,292 and 6,508 in the CDS and control group, respectively). Over the study period, there was no difference in the incidence of stroke, transient ischemic attack, or systemic thromboembolism in the CDS group versus the control group (49 [95% CI 43–55] per 1,000 patients with AF in the CDS group compared to 47 [95% CI 39–55] per 1,000 patients with AF in the control group, p = 0.64). Regarding safety, the CDS group had a lower incidence of significant bleeding, with events in 12 (95% CI 9–15) per 1,000 patients with AF compared to 16 (95% CI 12–20) per 1,000 patients with AF in the control group (p = 0.04). Limitations of the study design include that the analysis was carried out in a catchment area with a high baseline adherence rate, and issues regarding reproducibility to other regions.

    Conclusions

    The present study demonstrates that a CDS can increase guideline adherence for anticoagulant therapy in patients with AF. Even though the observed difference was small, this is the first randomized study to our knowledge indicating beneficial effects with a CDS in patients with AF.

  • 91.
    Karlsson, Lars O.
    et al.
    Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Charitakis, Emmanouil
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Bång, Magnus
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Johansson, Gustav
    Linköping University, Department of Computer and Information Science. Linköping University, Faculty of Science & Engineering.
    Nilsson, Lennart
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Clinical decision support for stroke prevention in atrial fibrillation (CDS-AF): Rationale and design of a cluster randomized trial in the primary care setting2017In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 187, p. 45-52Article in journal (Refereed)
    Abstract [en]

    Background Atrial fibrillation (AF) is associated with substantial morbidity, in particular stroke. Despite good evidence for the reduction of stroke risk with anticoagulant therapy, there remains a significant undertreatment. The main aim of the current study is to investigate whethera clinical decision support tool for stroke prevention (CDS) integrated in the electronic health record can improve adherence to guidelines for stroke prevention in patients with AF. Methods We will conduct a cluster randomized trial where 43 primary care clinics in the county of Ostergotland, Sweden (population 444,347), will be randomized to be part of the CDS intervention or serve as controls. The CDS will alert responsible physicians of patients with AF and increased risk for thromboembolism according to the CHA(2)DS(2)VASc (Congestive heart failure, Hypertension, Age 74 years, Diabetes mellitus, previous Stroke/TIA/thromboembolism, Vascular disease, Age 65-74 years, Sex category (i.e. female sex)) algorithm without anticoagulant therapy. The primary end point will be adherence to guidelines after 1 year. Conclusion The present study will investigate whether a clinical decision support system integrated in an electronic health record can increase adherence to guidelines regarding anticoagulant therapy in patients with AF.

  • 92. Knot, J
    et al.
    Widimsky, P
    Wijns, W
    Stenestrand, Ulf
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Kristensen, SD
    Van´T Hof, A
    Weidinger, F
    Janzon, Magnus
    Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology. Linköping University, Faculty of Health Sciences.
    Nörgaard, BL
    Soerensen, JT
    van de Wetering,
    Thygesen, K
    Bergsten, PA
    Digerfeldt, C
    Potgieter, A
    Tomer, N
    Fajadet,
    How to set up an effective national primary angioplasty network: Lessons learned from five European countries2009In: EuroIntervention, ISSN 1774-024X, Vol. 3, no 299, p. 301-309Article in journal (Refereed)
    Abstract [en]

    AIMS: Percutaneous coronary interventions (PCI) are used to treat acute and chronic forms of coronary artery disease. While in chronic forms the main goal of PCI is to improve the quality of life, in acute coronary syndromes (ACS) timely PCI is a life-saving procedure - especially in the setting of ST-elevation myocardial infarction (STEMI). The aim of this study was to describe the experience of countries with successful nationwide implementation of PCI in STEMI, and to provide general recommendations for other countries. METHODS AND RESULTS: The European Association of Percutaneous Cardiovascular Interventions (EAPCI) recenty launched the Stent For Life Initiative (SFLI). The initial phase of this pan-European project was focused on the positive experience of five countries to provide the best practice examples. The Netherlands, the Czech Republic, Sweden, Denmark and Austria were visited and the logistics of ACS treatment was studied. Public campaigns improved patient access to acute PCI. Regional networks involving emergency medical services (EMS), non-PCI hospitals and PCI centres are useful in providing access to acute PCI for most patients. Direct transfer from the first medical contact site to the cathlab is essential to minimise the time delays. Cathlab staff work is organised to provide acute PCI services 24 hours a day / seven days a week (24/7). Even in those regions where thrombolysis is still used due to long transfer distances to PCI, patients should still be transferred to a PCI centre (after thrombolysis). The highest risk non-ST elevation acute myocardial infarction patients should undergo emergency coronary angiography within two hours of hospital admission, i.e. similar to STEMI patients. CONCLUSIONS: Three realistic goals for other countries were defined based on these experiences: 1) primary PCI should be used for >70% of all STEMI patients, 2) primary PCI rates should reach >600 per million inhabitants per year and 3) existing PCI centres should treat all their STEMI patients by primary PCI, i.e. should offer a 24/7 service

  • 93.
    Lapostolle, Frédéric
    et al.
    UF Recherche-Enseignement-Qualité, Université Paris, Hôpital Avicenne, Bobigny, France..
    Van't Hof, Arnoud W
    Department of Cardiology, Isala Clinics, Zwolle, The Netherlands, Maastricht University Medical Center, Maastricht, The Netherlands.
    Hamm, Christian W
    Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
    Stibbe, Olivier
    Service Médical d'Urgence, Brigade de Sapeurs-Pompiers de Paris, Paris, France.
    Ecollan, Patrick
    Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière , Paris, France.
    Collet, Jean-Philippe
    Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière , Paris, France.
    Silvain, Johanne
    Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière , Paris, France.
    Lassen, Jens Flensted
    Department of Cardiology B, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
    Heutz, Wim M J M
    Regionale Ambulance Voor ziening Gelderland-Midden, Arnhem, The Netherlands.
    Bolognese, Leonardo
    Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy.
    Cantor, Warren J
    Southlake Regional Health Centre, University of Toronto, Newmarket, ON, Canada.
    Cequier, Angel
    Heart Disease Institute, Hospital Universitario de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
    Chettibi, Mohamed
    Centre Hospito-universitaire Frantz Fanon, Blida, Algeria.
    Goodman, Shaun G
    Division of Cardiology, Canadian Heart Research Centre, St Michael's Hospital, University of Toronto, Toronto, Canada.
    Hammett, Christopher J
    Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
    Huber, Kurt
    3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical School, Vienna, Austria.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Merkely, Béla
    Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
    Storey, Robert F
    Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
    Ten Berg, Jur
    Department of Cardiology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
    Zeymer, Uwe
    Klinikum Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.
    Licour, Muriel
    AstraZeneca, Rueil Malmaison, France.
    Tsatsaris, Anne
    AstraZeneca, Rueil Malmaison, France.
    Montalescot, Gilles
    Sorbonne Université, ACTION Study Group, Hôpital Pitié-Salpêtrière (AP-HP), 47 boul de l'Hôpital, Paris, France.
    Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine2019In: American Journal of Cardiovascular Drugs, ISSN 1175-3277, E-ISSN 1179-187X, Vol. 19, p. 173-183Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Morphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management.

    METHODS: ATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180 mg ± morphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded.

    RESULTS: Opioids (97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were no significant differences in age, sex or cardiovascular history, but more morphine-treated patients had anterior myocardial infarction and left-main disease. Time from chest pain to electrocardiogram and ticagrelor loading was shorter with morphine (both p = 0.01) but not total ischemic time. Morphine-treated patients more frequently received glycoprotein IIb/IIIa inhibitors (p = 0.002), thromboaspiration and stent implantation (both p < 0.001). No significant difference between the two groups was found regarding pre-PCI ≥ 70% ST-segment elevation resolution, death, myocardial infarction, stroke, urgent revascularization and definitive acute stent thrombosis. More morphine-treated patients had an absence of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs. 79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p = 0.02).

    CONCLUSIONS: Morphine-treatment was associated with increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more bleeding. Judicious morphine use is advised with non-opioid analgesics preferred for non-severe acute pain.

    TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01347580.

  • 94.
    Lawesson, Sofia
    et al.
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Tödt, Tim
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology.
    Alfredsson, Joakim
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Stenestrand, Ulf
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Swahn, Eva
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention2011In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 97, no 4, p. 308-314Article in journal (Refereed)
    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.

  • 95. Legutko, Jacek
    et al.
    Rakowski, Tomasz
    Siudak, Zbigniew
    Rzeszutko, Lukasz
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Birkemeyer, Ralf
    Kleczynski, Pawel
    Dudek, Dariusz
    Efficacy and safety of early clopidogrel administration with or without Abciximab in patients with ST-segment elevation myocardial infarction transferred for primary PCI. Results from the EUROTRANSFER registry.2008In: ACC - 57th Annual Scientific Session,2007, 2008Conference paper (Refereed)
  • 96.
    Legutko, Jacek
    et al.
    Jagiollonial University, Krakow, Poland.
    Siudak, Zbigniew
    Jagiollonial University, Krakow, Poland.
    Bartuś, Stanisław
    Jagiollonial University, Krakow, Poland.
    Dziewierz, Artur
    Jagiollonial University, Krakow, Poland.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Birkemeyer, Ralf
    University of Rostock, Germany.
    Zmudka, Krzysztof
    John Paul II Hospital, Krakow, Poland.
    Dudek, Dariusz
    Jagiollonial University, Krakow, Poland.
    Similar outcome of ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention regardless of presence of cardiac surgery on-site.2014In: Kardiologia polska, ISSN 0022-9032, E-ISSN 1897-4279, Vol. 72, no 10, p. 949-53Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The growing penetration of mechanical reperfusion in ST-elevation myocardial infarction (STEMI) has been achieved by the creation of new percutaneous coronary intervention (PCI) centres which have helped to shorten delays but have compromised PCI volumes.

    AIM: To compare the outcomes in STEMI patients treated in PCI centres with or without surgical back-up.

    METHODS: Data concerning 1,650 registry patients was analysed. The analysis was based on cathlab classification with cardiac surgery on site (n = 996) and without (n = 654).

    RESULTS: There was a 0.3% rate of transfer (two patients out of 654) for urgent coronary artery bypass grafting from PCI centres without cardiac surgery on site. There were no differences in in-hospital and long-term mortality in patients in both studied groups.

    CONCLUSIONS: No differences in short and long-term outcomes were noticed for STEMI patients treated in centres with or without cardiac surgery on-site.

  • 97.
    Levin, Lars-Åke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Sennfält, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Henriksson, Martin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Andersson, Agneta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Bernfort, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    En introduktion i hälsoekonomi2004Book (Other (popular science, discussion, etc.))
  • 98.
    Levin, Lars-Åke
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Wallentin, Lars
    Uppsala University, Sweden .
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Andersson, David
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Storey, Robert F.
    University of Sheffield, England .
    Bergstrom, Gina
    AstraZeneca RandD, Sweden .
    Lamm, Carl-Johan
    AstraZeneca RandD, Sweden .
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Kaul, Padma
    University of Alberta, Canada .
    Health-Related Quality of Life of Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes-Results from the PLATO Trial2013In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 16, no 4, p. 574-580Article in journal (Refereed)
    Abstract [en]

    Objectives: The purpose of this study was to compare the effects of ticagrelor versus clopidogrel on health-related quality of life in the PLATelet inhibition and patient Outcomes (PLATO) trial. Background: The PLATO trial showed that ticagrelor was superior to clopidogrel for the prevention of cardiovascular death, myocardial infarction, or stroke in a broad population of patients with acute coronary syndromes. Methods: HRQOL in the PLATO study was measured at hospital discharge, 6-month visit, and end of treatment (anticipated at 12 months) by using the EuroQol five-dimensional (EQ-5D) questionnaire. All patients who had an EQ-5D questionnaire assessment at discharge from the index hospitalization (n = 15,212) were included in the study. Patients who died prior to the end-of-treatment visit were assigned an EQ-5D questionnaire value of 0. Results: The EQ-5D questionnaire value at discharge among 7631 patients assigned to ticagrelor was 0.847 and among 7581 patients assigned to clopidogrel was 0.846 (P = 0.71). At 12 months, the mean EQ-5D questionnaire value was 0.840 for ticagrelor and 0.832 for clopidogrel (P = 0.046). Excluding patients who died resulted in mean EQ-5D questionnaire values of 0.864 among ticagrelor patients and 0.863 among clopidogrel patients (P = 0.69). Conclusions: In patients hospitalized with acute coronary syndromes with or without ST-segment elevation, treatment with ticagrelor was associated with a lower mortality but otherwise no difference in quality of life relative to treatment with clopidogrel. The improved survival and reduction in cardiovascular events with ticagrelor are therefore obtained with no loss in quality of life.

  • 99.
    Lindholm, Daniel
    et al.
    AstraZeneca RandD, Sweden.
    Sarno, Giovanna
    Uppsala Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Svennblad, Bodil
    Uppsala Univ, Sweden.
    Hasvold, Lars Pal
    AstraZeneca, Sweden.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden.
    Combined association of key risk factors on ischaemic outcomes and bleeding in patients with myocardial infarction2019In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 105, no 15, p. 1175-1181Article in journal (Refereed)
    Abstract [en]

    Objective In patients with myocardial infarction (MI), risk factors for bleeding and ischaemic events tend to overlap, but the combined effects of these factors have scarcely been studied in contemporary real-world settings. We aimed to assess the combined associations of established risk factors using nationwide registries. Methods Using the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry, patients with invasively managed MI in 2006-2014 were included. Six factors were assessed in relation to cardiovascular death (CVD)/MI/stroke, and major bleeding: age amp;gt;= 65, chronic kidney disease, diabetes, multivessel disease, prior bleeding and prior MI. Results We studied 100 879 patients, of whom 20 831 (20.6%) experienced CVD/MI/stroke and 5939 (5.9%) major bleeding, during 3.6 years median follow-up. In adjusted Cox models, all factors were associated with CVD/MI/stroke, and all but prior MI were associated with major bleeding. The majority (53.5%) had amp;gt;= 2 risk factors. With each added risk factor, there was a marked but gradual increase in incidence of the CVD/MI/stroke. This was seen also for major bleeding, but to a lesser extent, largely driven by prior bleeding as the strongest risk factor. Conclusions The majority of patients with MI had two or more established risk factors. Increasing number of risk factors was associated with higher rate of ischaemic events. When excluding patients with prior major bleeding, bleeding incidence rate increased only minimally with increasing number of risk factors. The high ischaemic risk in those with multiple risk factors highlights an unmet need for additional preventive measures.

  • 100.
    Liuba, Ioan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Janzon, Magnus
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Ulla
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Walfridsson, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Impact of catheter ablation on health related quality of life in patients with focal atrial tachycardia2006In: VIII Svenska Kardiovaskulära Vårmötet,2006, 2006Conference paper (Other academic)
123 51 - 100 of 139
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf