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  • 1.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Lie, Irene
    Oslo Univ Hosp, Norway; Norwegian Univ Sci & Technol, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania; Vilnius Univ, Lithuania.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Informal Caregivers Experiences with Performing Telemonitoring in Heart Failure Care at Home-A Qualitative Study2022In: Healthcare, E-ISSN 2227-9032, Vol. 10, no 7, article id 1237Article in journal (Refereed)
    Abstract [en]

    Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.

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  • 2.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Lycholip, Edita
    Vilnius Univ, Lithuania.
    Celutkiene, Jelena
    Vilnius Univ, Lithuania.
    von Lueder, Thomas
    Oslo Univ Hosp, Norway.
    Atar, Dan
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Falk, Ragnhild Sorum
    Oslo Univ Hosp, Norway.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal Study2020In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 22, no 1, article id e15445Article in journal (Refereed)
    Abstract [en]

    Background: Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective: This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods: This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals-one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the Cardio Set Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results: The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions: Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

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  • 3.
    Aamodt, Ina Thon
    et al.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway; Lovisenberg Diaconal Univ Coll, Norway.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Helleso, Ragnhild
    Univ Oslo, Norway.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lie, Irene
    Oslo Univ Hosp, Norway.
    Tools to Support Self-Care Monitoring at Home: Perspectives of Patients with Heart Failure2020In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 17, no 23, article id 8916Article in journal (Refereed)
    Abstract [en]

    Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

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  • 4.
    Aengerud, Karin Hellstroem
    et al.
    Umea Univ, Sweden.
    Ericsson, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Brannstrom, Margareta
    Umea Univ, Sweden.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Thylén, Ingela
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires A Mixed-Methods Study2023In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 38, no 2, p. 150-157Article in journal (Refereed)
    Abstract [en]

    BackgroundPatient-reported symptoms of acute myocardial infarction (MI) may be affected by recall bias depending on when and where symptoms are assessed.AimThe aim of this study was to gain an understanding of patients symptom description in more detail before and within 24 hours after a confirmed MI diagnosis.MethodsA convergent parallel mixed-methods design was used to examine symptoms described in calls between the tele-nurse and the patient compared with symptoms selected by the patient from a questionnaire less than 24 hours after hospital admission. Quantitative and qualitative data were analyzed separately and then merged into a final interpretation.ResultsThirty patients (median age, 67.5 years; 20 men) were included. Chest pain was the most commonly reported symptom in questionnaires (24/30). Likewise, in 19 of 30 calls, chest pain was the first complaint mentioned, usually described together with the symptom onset. Expressions used to describe symptom quality were pain, pressure, discomfort, ache, cramp, tension, and soreness. Associated symptoms commonly described were pain or numbness in the arms, cold sweat, dyspnea, weakness, and nausea. Bodily sensations, such as feeling unwell or weak, were also described. Fear and tiredness were described in calls significantly less often than reported in questionnaires (P = .01 and P = .02), whereas "other" symptoms were more often mentioned in calls compared with answers given in the questionnaire (P = .02). Some symptoms expressed in the calls were not listed in the questionnaire, which expands the understanding of acute MI symptoms. The results showed no major inconsistencies between datasets.ConclusionPatients MI symptom descriptions in tele-calls and those reported in questionnaires after diagnosis are comparable and convergent.

  • 5.
    Agerstrom, Jens
    et al.
    Linnaeus Univ, Sweden.
    Andrell, Cecilia
    Lund Univ, Sweden.
    Bremer, Anders
    Linnaeus Univ, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Arestedt, Kristofer
    Linnaeus Univ, Sweden; Reg Kalmar Cty, Sweden.
    Israelsson, Johan
    Linnaeus Univ, Sweden; Kalmar Cty Hosp, Sweden.
    All else equal: Examining treatment bias and stereotypes based on patient ethnicity and socioeconomic status using in-hospital cardiac arrest clinical vignettes2024In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 63, p. 86-91Article in journal (Refereed)
    Abstract [en]

    Background: Research on ethnic and socioeconomic treatment differences following in-hospital cardiac arrest (IHCA) largely draws on register data. Due to the correlational nature of such data, it cannot be concluded whether detected differences reflect treatment bias/discrimination - whereby otherwise identical patients are treated differently solely due to sociodemographic factors. To be able to establish discrimination, experimental research is needed. Objective: The primary aim of this experimental study was to examine whether simulated IHCA patients receive different treatment recommendations based on ethnicity and socioeconomic status (SES), holding all other factors (e.g., health status) constant. Another aim was to examine health care professionals (HCP) stereotypical beliefs about these groups. Methods: HCP (N = 235) working in acute care made anonymous treatment recommendations while reading IHCA clinical vignettes wherein the patients ethnicity (Swedish vs. Middle Eastern) and SES had been manipulated. Afterwards they estimated to what extent hospital staff associate these patient groups with certain traits (stereotypes). Results: No significant differences in treatment recommendations for Swedish versus Middle Eastern or high versus low SES patients were found. Reported stereotypes about Middle Eastern patients were uniformly negative. SES-related stereotypes, however, were mixed. High SES patients were believed to be more competent (e.g., respected), but less warm (e.g., friendly) than low SES patients. Conclusions: Swedish HCP do not seem to discriminate against patients with Middle Eastern or low SES backgrounds when recommending treatment for simulated IHCA cases, despite the existence of negative stereotypes about these groups. Implications for health care equality and quality are discussed.

  • 6.
    Akerstrom, Finn
    et al.
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Hutter, Julie
    Kerckhoff Heart & Thorax Ctr, Germany.
    Charitakis, Emmanouil
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Tabrizi, Fariborz
    Arrhythm Ctr, Sweden.
    Asaad, Fahd
    Karolinska Univ Hosp, Sweden.
    Bastani, Hamid
    Karolinska Univ Hosp, Sweden.
    Bourke, Tara
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Braunschweig, Frieder
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Drca, Nikola
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Englund, Anders
    Arrhythm Ctr, Sweden.
    Friberg, Leif
    Karolinska Inst, Sweden.
    Insulander, Per
    Karolinska Inst, Sweden.
    Jonsson, Anders Hassel
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Kenneback, Goran
    Karolinska Univ Hosp, Sweden.
    Paul-Nordin, Astrid
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Sadigh, Bita
    Karolinska Univ Hosp, Sweden.
    Saluveer, Ott
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Saygi, Serkan
    Karolinska Univ Hosp, Sweden.
    Schwieler, Jonas
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Svennberg, Emma
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Tapanainen, Jari
    Danderyd Hosp, Sweden.
    Turkmen, Yusuf
    Karolinska Univ Hosp, Sweden.
    Jensen-Urstad, Mats
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Association between catheter ablation of atrial fibrillation and mortality or stroke2024In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 110, p. 163-169Article in journal (Refereed)
    Abstract [en]

    Objective Catheter ablation of atrial fibrillation effectively reduces symptomatic burden. However, its long-term effect on mortality and stroke is unclear. We investigated if patients with atrial fibrillation who undergo catheter ablation have lower risk for all-cause mortality or stroke than patients who are managed medically. Methods We retrospectively included 5628 consecutive patients who underwent first-time catheter ablation for atrial fibrillation between 2008 and 2018 at three major Swedish electrophysiology units. Control individuals with an atrial fibrillation diagnosis but without previous stroke were selected from the Swedish National Patient Register, resulting in a control group of 48 676 patients. Propensity score matching was performed to produce two cohorts of equal size (n=3955) with similar baseline characteristics. The primary endpoint was a composite of all-cause mortality or stroke. Results Patients who underwent catheter ablation were healthier (mean CHA(2)DS(2)-VASc score 1.4 +/- 1.4 vs 1.6 +/- 1.5, p<0.001), had a higher median income (288 vs 212 1000 Swedish krona [KSEK]/year, p<0.001) and had more frequently received university education (45.1% vs 28.9%, p<0.001). Mean follow-up was 4.5 +/- 2.8 years. After propensity score matching, catheter ablation was associated with lower risk for the combined primary endpoint (HR 0.58, 95% CI 0.48 to 0.69). The result was mainly driven by a decrease in all-cause mortality (HR 0.51, 95% CI 0.41 to 0.63), with stroke reduction showing a trend in favour of catheter ablation (HR 0.75, 95% CI 0.53 to 1.07). Conclusions Catheter ablation of atrial fibrillation was associated with a reduction in the primary endpoint of all-cause mortality or stroke. This result was driven by a marked reduction in all-cause mortality.

  • 7.
    Aktaa, Suleman
    et al.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Batra, Gorav
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Cleland, John G. F.
    Univ Glasgow, Scotland; Univ Glasgow, Scotland; Imperial Coll London, England.
    Coats, Andrew
    Univ Warwick, England; European Soc Cardiol, Belgium.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    McDonagh, Theresa
    Kings Coll Hosp London, England; Kings Coll London, England.
    Rosano, Giuseppe
    St Georges Hosp NHS Trust Univ London, England; IRCCS San Raffaele Pisana, Italy.
    Seferovic, Petar
    Univ Belgrade, Serbia.
    Vasko, Peter
    Region Östergötland, Heart Center, Department of Cardiology in Linköping. SWEDEHEART Swedish Web Syst Enhancement & Dev Evi, Sweden; SwedeHF Swedish Heart Failure Registry, Sweden.
    Wallentin, Lars
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Maggioni, Aldo P.
    Natl Assoc Hosp Cardiologists Res Ctr ANMCO, Italy.
    Casadei, Barbara
    Univ Oxford, England.
    Gale, Chris P.
    Univ Leeds, England; Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Data standards for heart failure: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart)2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no 23, p. 2185-2195Article in journal (Refereed)
    Abstract [en]

    Standardized data definitions are essential for assessing the quality of care and patient outcomes in observational studies and randomized controlled trials. The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create contemporary pan-European data standards for cardiovascular diseases, including heart failure (HF). We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group including experts in HF registries, representatives from the Heart Failure Association of the ESC, and the EuroHeart was formed. Using Embase and Medline (2016-21), we conducted a systematic review of the literature on data standards, registries, and trials to identify variables pertinent to HF. A modified Delphi method was used to reach a consensus on the final set of variables. For each variable, the Working Group developed data definitions and agreed on whether it was mandatory (Level 1) or additional (Level 2). In total, 84 Level 1 and 79 Level 2 variables were selected for nine domains of HF care. These variables were reviewed by an international Reference Group with the Level 1 variables providing the dataset for registration of patients with HF on the EuroHeart IT platform. By means of a structured process and interaction with international stakeholders, harmonized data standards for HF have been developed. In the context of the EuroHeart, this will facilitate quality improvement, international observational research, registry-based randomized trials, and post-marketing surveillance of devices and pharmacotherapies across Europe.

  • 8.
    Alfredsson, Joakim
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    James, Stefan K.
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden.
    Herlitz, Johan
    Univ Boras, Sweden.
    Frobert, Ole
    Orebro Univ, Sweden.
    Dworeck, Christian
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Redfors, Bjorn
    Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Arefalk, Gabriel
    Uppsala Univ, Sweden.
    Ostlund, Ollie
    Uppsala Univ, Sweden.
    Jernberg, Tomas
    Karolinska Inst, Sweden.
    Mars, Katarina
    Karolinska Inst, Sweden.
    Haaga, Urban
    Karlstad Cent Hosp, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Hofmann, Robin
    Karolinska Inst, Sweden.
    Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction: Sex-related outcomes from DETO2X-AMI2021In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 237, p. 13-24Article in journal (Refereed)
    Abstract [en]

    Background The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI). Methods The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex. Results Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found ( P = .16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment. Conclusion Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age. (Am Heart J 2021;237:13 & ndash;24.)

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  • 9.
    Alfredsson, Joakim
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Omar, Kime
    Vastmanland Cty Hosp, Sweden.
    Csog, Jozsef
    Region Östergötland, Local Health Care Services in East Östergötland, Department of Internal Medicine in Norrköping.
    Venetsanos, Dimitrios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist 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 Health, Medicine and Caring Sciences, Division of Society and Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Ekstedt, Mattias
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Mag- tarmmedicinska kliniken.
    Bleeding complications with clopidogrel or ticagrelor in ST-elevation myocardial infarction patients: A real life cohort study of two treatment strategies2020In: IJC Heart & Vasculature, E-ISSN 2352-9067, Vol. 27, article id 100495Article in journal (Refereed)
    Abstract [en]

    Introduction

    Dual antiplatelet therapy (DAPT), including potent P2Y12 inhibition after ST-elevation myocardial infarction (STEMI) is recommended in clinical guidelines. However, bleeding complications are common, and associated with worse outcomes. The aim of this study was to assess incidence of bleeding events with a clopidogrel-based compared to a ticagrelor-based DAPT strategy, in a real world population. Secondary aims were to assess ischemic complications and mortality.

    Methods and Results

    We identified 330 consecutive STEMI patients with a clopidogrel-based and 330 with a ticagrelor-based DAPT strategy. Patientś medical records were searched for bleeding and ischemic complications, over 6 months follow-up.

    The two groups were well balanced in baseline characteristics, age (69 years inboth groups), sex (31% vs 32% females), history of diabetes (19% vs 21%), hypertension (43% in both) and MI (17% vs 15%). There was no difference in CRUSADE bleeding score (28 vs 29). After discharge, there were more than twice as many bleeding events with a ticagrelor-based compared with a clopidogrel-based strategy (13.3% vs. 6.5%, p = 0.005). Bleeding events included significantly more severe bleeding complications (TIMI major/minor [5.8 vs 1.0, p = 0.001]) during the ticagrelor-based period. There was no significant difference in the composite of death, MI or stroke (7.8% vs 7.1%, p = 0.76).

    Conclusions

    In this observational study, a ticagrelor-based DAPT strategy was associated with significantly more bleeding complications, without any significant change in death, MI or stroke. Larger studies are needed to determine whether bleeding complications off-sets benefits with a more potent DAPT strategy in older and more comorbid real-life patients.

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  • 10.
    Allemann, Hanna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Andreasson, Frida
    Linnaeus Univ, Sweden.
    Hanson, Elizabeth
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Magnusson, Lennart
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Thylén, Ingela
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    The co-design of an online support programme with and for informal carers of people with heart failure: A methodological paper2023In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 32, no 19-20, p. 7589-7604Article in journal (Refereed)
    Abstract [en]

    Aim To describe the co-designing process of an online support programme with and for informal carers of people with heart failure.Design A co-design process built on core concepts and ideas embedded in co-design methodology.Data sources Our co-design process included three phases involving 32 informal caregivers and 25 content creators; (1) Identification of topics and content through literature searches, focus group interviews and user group sessions; (2) Development of the online support programme and; (3) Refinement and finalization which included testing a paper prototype followed by testing the online version and testing and approval of the final version of the support programme.Outcomes The co-design process resulted in a support programme consisting of 15 different modules relevant to informal carers, delivered on a National Health Portal.Conclusion Co-design is an explorative process where researchers need to balance a range of potentially conflicting factors and to ensure that the end users are genuinely included in the process.Relevance to clinical practice Emphasizing equal involvement of end users (e.g. carers or patients) in the design and development of healthcare interventions aligns with contemporary ideas of person-centred care and provides a valuable learning opportunity for those involved. Furthermore, a co-designed online support programme has the capacity to be both accessible and meet end users information and support needs, thereby optimizing their self-care abilities. Additionally, an online support programme provides the opportunity to address current challenges regarding scarce resources and the lack of healthcare personnel.Reporting methods Consolidated criteria for reporting qualitative research (COREQ).Patient or public contribution Both informal carers and content creators were involved in developing the support programme.

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  • 11.
    Andersson, Elisabeth
    et al.
    Skane Univ Hosp, Sweden.
    Dai Ydrefelt, Ying
    Skane Univ Hosp, Sweden.
    Johannesson, Marit
    Sahlgrens Univ Hosp, Sweden.
    Lundbäck, Maria
    Umea Univ, Sweden.
    Mannila, Maria
    Karolinska Univ Hosp, Sweden.
    Persson, Margaretha
    Lund Univ, Sweden.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Bolejko, Anetta
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Surveillance of indeterminate pulmonary nodules detected with CT in a Swedish population-based study (SCAPIS): psychosocial consequences and impact on health-related quality of life-a multicentre prospective cross-sectional study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 9, article id e048721Article in journal (Refereed)
    Abstract [en]

    Objectives To investigate whether surveillance of pulmonary nodules detected with low-dose CT (LDCT) impacted health-related quality of life and psychosocial consequences in the Swedish population-based study, Swedish CArdioPulmonary bioImage Study (SCAPIS). Design A prospective cross-sectional study. Settings and participants This multicentre (five sites) observational study, which included a cohort from SCAPIS, consisted of 632 participants with indeterminate pulmonary nodules detected with LDCT. These participants continued surveillance for up to 36 months, during which lung cancer was not detected (surveillance group). Additionally, 972 participants with a negative pulmonary LDCT scan were included as a control group. Matching criteria were LDCT date (+/- 2 weeks), gender and site. Outcome measures All participants completed a health-related quality of life questionnaire (RAND-36) and the Consequences of Screening (COS) questionnaire, an average of 3 years after LDCT was conducted at entry into SCAPIS. Results Participants were 51-70 years old at study commencement. Overall, the two groups did not differ in demographic or psychosocial variables, smoking habits or pulmonary medical history. Individuals from countries other than Sweden and those with low socioeconomic status were less likely to participate (p<0.001). No effects on health-related quality of life were observed via RAND-36. In COS, the surveillance group demonstrated a higher OR for anxiety about lung cancer (OR 3.96, 95% CI 2.35 to 6.66, p<0.001), experiencing a sense of dejection (OR 1.35, 95% CI 1.06 to 1.72, p=0.015) and thoughts about existential values (OR 1.30, 95% CI 1.04 to 1.60, p=0.018). Conclusions Lung surveillance with LDCT contributed to significant experiences of sense of dejection, anxiety about lung cancer and development of thoughts about existential values among participants in the surveillance group compared with the controls. The risk of side effects should be communicated for informed decision-making about (non-)attendance in lung cancer screening.

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  • 12.
    Andreae, Christina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Centre for Clinical Research Sörmland, Uppsala University, Sweden.
    van der Wal, Martje H. L.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
    van Veldhuisen, Dirk J.
    Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
    Yang, Bei
    entre for Clinical Research Sörmland, Uppsala University, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands.
    Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life2021In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 36, no 6, p. 539-545Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.

    OBJECTIVE: The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.

    METHODS: Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.

    RESULTS: A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates.

    CONCLUSIONS: Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

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  • 13.
    Andréasson, Frida
    et al.
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Aidemark, Jan
    Linnaeus Univ, Sweden.
    Magnusson, Lennart
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Hanson, Elizabeth Jane
    Linnaeus Univ, Sweden; Swedish Family Care Competence Ctr, Sweden.
    Lifeworld in co-designing with informal carers2019In: JOURNAL OF ENABLING TECHNOLOGIES, ISSN 2398-6263, Vol. 13, no 1, p. 29-39Article in journal (Refereed)
    Abstract [en]

    Purpose

    The purpose of this paper is to reflect on carers’ experiences of being involved in the development of a web-based support programme for carers of people with heart failure (CPwHF), and discuss the challenges related to their involvement in the development process. The focus was on the different phases in the project as well as the methodological challenges and opportunities that occurred in the user group sessions conducted.

    Design/methodology/approach

    This research adopt an explorative design studying a co-design process to develop an information and communication technology based support programme for and with CPwHF. Habermas’ concepts of lifeworld and system are used as a theoretical framework to analyse the co-design process employed in the study.

    Findings

    Reflecting on the co-design approach adopted, the findings highlight the methodological challenges that arise with carer involvement and the possible tensions that occur between researchers’ ambitions to include users in the design process, and the goal of developing a product or service, in the different phases of the design process.

    Originality/value

    Findings highlight that there is a tension between the system and lifeworld in the co-design process which are not totally compatible. The paper highlights that there is a need to develop flexible and reflexive human-centred design methodologies, able to meet carers’ needs and ideas, and at the same time balance this with proposed research outcomes.

  • 14.
    Ardo, Jessica
    et al.
    Univ Calif Irvine, CA USA.
    Lee, Jung-Ah
    Univ Calif Irvine, CA USA.
    Hildebrand, Janett A.
    Univ Southern Calif, CA 90007 USA.
    Guijarro, Diana
    Univ Calif Irvine, CA USA.
    Ghasemazadeh, Hassan
    Washington State Univ, WA USA.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Evangelista, Lorraine S.
    Univ Texas Med Branch, TX 77555 USA.
    Codesign of a cardiovascular disease prevention text message bank for older adults2021In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 104, no 11, p. 2772-2784Article in journal (Refereed)
    Abstract [en]

    Objective: Develop and validate a text message bank to support healthier lifestyle behaviors in older adults at risk for cardiovascular disease utilizing a codesign approach. Methods: Initially, the researchers, based on literature, developed a bank of 68 SMS text messages focusing on healthy eating (24 messages), physical activity (24 messages), and motivational feedback (20 messages), based on a scoping review of the literature on promoting behavioral change to engage in healthy lifestyle behaviors. In the next step, a panel of five experts analyzed every subset of SMS text messages. Further validation was conducted by nine older adults (>= 60 years). The user demographics, telephone literacy, understanding, and appeal for every SMS text message were evaluated using a 31-item questionnaire. Results: Participants provided an acceptable understanding of the critical concept found in the 49 SMS text message (physical activity M = 1.73 +/- 0.18; diet M = 1.73 +/- 0.26; motivation M = 1.85 +/- 0.25; range 0-2). The average ratings for physical activity (i.e., likability), healthy eating, and motivation were 8.62 +/- 0.64, 8.57 +/- 0.76, and 8.40 +/- 0.83, respectively (range 0-10). Conclusion: Co-designers were able to identify the technological and content requirements for each text message and infographic to enhance understanding and appeal. Practice implications: A feasibility study will need to be conducted as a next step to testing the effectiveness of text messages in a mobile-based intervention to promote healthy behaviors in older adults at high CVD risk. (C) 2021 Elsevier B.V. All rights reserved.

  • 15.
    Arestedt, Kristofer
    et al.
    Linnaeus Univ, Sweden; Kalmar Cty Council, Sweden.
    Brannstrom, Margareta
    Umea Univ, Sweden.
    Evangelista, Lorraine S.
    Univ Texas Med Branch, TX 77555 USA.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Alvariza, Anette
    Ersta Skondal Bracke Univ Coll, Sweden; Dalen Hosp, Sweden.
    Palliative key aspects are of importance for symptom relief during the last week of life in patients with heart failureIn: ESC Heart Failure, E-ISSN 2055-5822Article in journal (Refereed)
    Abstract [en]

    Aims This study aimed to describe symptom prevalence of pain, shortness of breath, anxiety, and nausea and to identify factors associated with symptom relief in patients with heart failure during their last week of life. Methods and results This nationwide study used data from the Swedish Register of Palliative Care and the Swedish Causes of Death Certificate Register. The sample included 4215 patients with heart failure as the underlying cause of death. Descriptive statistics and logistic regression were used to analyse data. Pain was the most prevalent symptom (64.0%), followed by anxiety (45.1%), shortness of breath (28.8%), and nausea (11.4%). Pain was the most often totally relieved (77.5%), followed by anxiety (68.4%), nausea (54.7%), and shortness of breath (37.1%). Key aspects of palliative care such as documented palliative care in the patient record, individual medication prescriptions by injection, symptom assessment with validated scales, documented end-of-life discussions with patients and/or family members, and external consultation were significantly associated with symptom relief. Relief of pain, shortness of breath, anxiety, and nausea were significantly better managed in nursing homes and hospice/inpatient palliative care compared with care in hospitals. Conclusions The results show that key aspects of palliative care during the last week of life are significantly associated with symptom relief. Increased access to palliative care could provide a way to improve care during the last week of life for patients with heart failure. Home-based settings provided more symptom relief than hospitals, which may indicate that the latter focuses on treatments and saving lives rather than promoting life before death.

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  • 16.
    Arvidsson, Ida
    et al.
    Lund Univ, Sweden.
    Davidsson, Anette
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Overgaard, Niels Christian
    Lund Univ, Sweden.
    Pagonis, Christos
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Astrom, Kalle
    Lund Univ, Sweden.
    Good, Elin
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Frias-Rose, Jeronimo
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical pathology.
    Heyden, Anders
    Lund Univ, Sweden.
    Ochoa-Figueroa, Miguel
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Deep learning prediction of quantitative coronary angiography values using myocardial perfusion images with a CZT camera2023In: Journal of Nuclear Cardiology, ISSN 1071-3581, E-ISSN 1532-6551, Vol. 30, p. 116-126Article in journal (Refereed)
    Abstract [en]

    Purpose Evaluate the prediction of quantitative coronary angiography (QCA) values from MPI, by means of deep learning. Methods 546 patients (67% men) undergoing stress 99mTc-tetrofosmin MPI in a CZT camera in the upright and supine position were included (1092 MPIs). Patients were divided into two groups: ICA group included 271 patients who performed an ICA within 6 months of MPI and a control group with 275 patients with low pre-test probability for CAD and a normal MPI. QCA analyses were performed using radiologic software and verified by an expert reader. Left ventricular myocardium was segmented using clinical nuclear cardiology software and verified by an expert reader. A deep learning model was trained using a double cross-validation scheme such that all data could be used as test data as well. Results Area under the receiver-operating characteristic curve for the prediction of QCA, with > 50% narrowing of the artery, by deep learning for the external test cohort: per patient 85% [95% confidence interval (CI) 84%-87%] and per vessel; LAD 74% (CI 72%-76%), RCA 85% (CI 83%-86%), LCx 81% (CI 78%-84%), and average 80% (CI 77%-83%). Conclusion Deep learning can predict the presence of different QCA percentages of coronary artery stenosis from MPIs.

  • 17.
    Attia, Zachi I.
    et al.
    Mayo Clin, MN USA.
    Kapa, Suraj
    Mayo Clin, MN USA.
    Dugan, Jennifer
    Mayo Clin, MN USA.
    Pereira, Naveen
    Mayo Clin, MN USA.
    Noseworthy, Peter A.
    Mayo Clin, MN USA.
    Jimenez, Francisco Lopez
    Mayo Clin, MN USA.
    Cruz, Jessica
    Mayo Clin, MN USA.
    Carter, Rickey E.
    Mayo Clin, FL 32224 USA.
    DeSimone, Daniel C.
    Mayo Clin, MN USA; Mayo Clin, MN USA.
    Signorino, John
    Mayo Clin, MN USA.
    Halamka, John
    Mayo Clin, MN USA.
    Gari, Nikhita R. Chennaiah
    Mayo Clin, MN USA.
    Madathala, Raja Sekhar
    Mayo Clin, MN USA.
    Platonov, Pyotr G.
    Lund Univ, Sweden.
    Gul, Fahad
    Einstein Healthcare Network, PA USA.
    Janssens, Stefan P.
    Katholieke Univ Leuven, Belgium.
    Narayan, Sanjiv
    Stanford Univ, CA 94305 USA; Stanford Univ, CA 94305 USA.
    Upadhyay, Gaurav A.
    Univ Chicago, IL 60637 USA.
    Alenghat, Francis J.
    Univ Chicago, IL 60637 USA.
    Lahiri, Marc K.
    Henry Ford Hosp, MI 48202 USA.
    Dujardin, Karl
    AZ Delta Hosp, Belgium.
    Hermel, Melody
    Scripps Hlth, CA USA; Scripps Clin, CA 92037 USA.
    Dominic, Paari
    Louisiana State Univ, LA 71105 USA.
    Turk-Adawi, Karam
    Qatar Univ, Qatar.
    Asaad, Nidal
    Hamad Med Corp, Qatar.
    Svensson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Fernandez-Aviles, Francisco
    Univ Complutense, Spain.
    Esakof, Darryl D.
    Lahey Hosp & Med Ctr, MA USA.
    Bartunek, Jozef
    Onze Lieve Vrouw Hosp, Belgium.
    Noheria, Amit
    Univ Kansas Hlth Syst, KS USA.
    Sridhar, Arun R.
    Univ Washington, WA 98195 USA.
    Lanza, Gaetano A.
    Univ Cattolica Sacro Cuore, Italy.
    Cohoon, Kevin
    Froedtert & Med Coll Wisconsin, WI USA.
    Padmanabhan, Deepak
    Sri Jayadeva Inst Cardiovasc Sci & Res, India.
    Gutierrez, Jose Alberto Pardo
    Clin Santa Maria, Chile.
    Sinagra, Gianfranco
    Cardiovasc Dept Ospedali Riuniti, Italy; Univ Trieste, Italy.
    Merlo, Marco
    Cardiovasc Dept Ospedali Riuniti, Italy; Univ Trieste, Italy.
    Zagari, Domenico
    Humanitas Mater Domini Clin Inst, Italy.
    Escenaro, Brenda D. Rodriguez
    Medica Sur, Mexico.
    Pahlajani, Dev B.
    Breach Candy Hosp Trust, India.
    Loncar, Goran
    Inst Cardiovasc Dis Dedinje ICVDD, Serbia.
    Vukomanovic, Vladan
    Univ Hosp Ctr Dr Dragisa Misov Dedinje, Serbia.
    Jensen, Henrik K.
    Aarhus Univ Hosp, Denmark.
    Farkouh, Michael E.
    Univ Toronto, Canada.
    Luescher, Thomas F.
    Royal Brompton & Harefield Hosp, England.
    Ping, Carolyn Lam Su
    Natl Heart Ctr, Singapore; Duke Natl Univ Singapore, Singapore.
    Peters, Nicholas S.
    Imperial Coll London, England.
    Friedman, Paul A.
    Mayo Clin, MN USA.
    Rapid Exclusion of COVID Infection With the Artificial Intelligence Electrocardiogram2021In: Mayo Clinic proceedings, ISSN 0025-6196, E-ISSN 1942-5546, Vol. 96, no 8, p. 2081-2094Article in journal (Refereed)
    Abstract [en]

    Objective: To rapidly exclude severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection using artificial intelligence applied to the electrocardiogram (ECG). Methods: A global, volunteer consortium from 4 continents identified patients with ECGs obtained around the time of polymerase chain reaction-confirmed COVID-19 diagnosis and age- and sex-matched controls from the same sites. Clinical characteristics, polymerase chain reaction results, and raw electrocardiographic data were collected. A convolutional neural network was trained using 26,153 ECGs (33.2% COVID positive), validated with 3826 ECGs (33.3% positive), and tested on 7870 ECGs not included in other sets (32.7% positive). Performance under different prevalence values was tested by adding control ECGs from a single high-volume site. Results: The area under the curve for detection of acute COVID-19 infection in the test group was 0.767 (95% CI, 0.756 to 0.778; sensitivity, 98%; specificity, 10%; positive predictive value, 37%; negative predictive value, 91%). To more accurately reflect a real-world population, 50,905 normal controls were added to adjust the COVID prevalence to approximately 5% (2657/58,555), resulting in an area under the curve of 0.780 (95% CI, 0.771 to 0.790) with a specificity of 12.1% and a negative predictive value of 99.2%. Conclusion: Infection with SARS-CoV-2 results in electrocardiographic changes that permit the artificial intelligence-enhanced ECG to be used as a rapid screening test with a high negative predictive value (99.2%). This may permit the development of electrocardiography-based tools to rapidly screen individuals for pandemic control. (C) 2021 Mayo Foundation Medical Education and Research

  • 18.
    Balata, Dilan
    et al.
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Mellergård, Johan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Neurologiska kliniken i Linköping.
    Ekqvist, David
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Molecular Medicine and Virology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Baranowski, Jacek
    Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Garcia, Isidro Albert
    Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Volosyraki, Marina
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine and Geriatrics.
    Broqvist, Mats
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Non-Bacterial Thrombotic Endocarditis: A Presentation of COVID-192020In: European journal of case reports in internal medicine, ISSN 2284-2594, Vol. 7, no 8Article in journal (Refereed)
    Abstract [en]

    The SARS-CoV-2 virus is a newly emergent pathogen first identified in Wuhan, China, and responsible for the COVID-19 global pandemic. In this case report we describe a manifestation of non-bacterial thrombotic endocarditis with continuous peripheral embolization in a COVID-19-positive patient. The patient responded well to high-dose LMWH treatment with cessation of the embolic process.

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  • 19.
    Basic, C.
    et al.
    Univ Gothenburg, Sweden.
    Rosengren, A.
    Univ Gothenburg, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Edner, M.
    Karolinska Inst, Sweden.
    Fu, M.
    Univ Gothenburg, Sweden.
    Zverkova-Sandstrom, T.
    Univ Gothenburg, Sweden.
    Schaufelberger, M.
    Univ Gothenburg, Sweden.
    Sex-related differences among young adults with heart failure in Sweden2022In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 362, p. 97-103Article in journal (Refereed)
    Abstract [en]

    Background: Differences between the sexes among the non-elderly with heart failure (HF) have been insufficiently evaluated. This study aims to investigate sex-related differences in early-onset HF. Methods: Patients aged 18 to 54 years who were registered from 2003 to 2014 in the Swedish Heart Failure Register were included. Each patient was matched with two controls from the Swedish Total Population Register. Data on comorbidities and outcomes were obtained through the National Patient Register and Cause of Death Register. Results: We identified 3752 patients and 7425 controls. Of the patients, 971 (25.9%) were women and 2781 (74.1%) were men with a mean (standard deviation) age of 44.9 (8.4) and 46.4 (7.3) years, respectively. Men had more hypertension and ischemic heart disease, whereas women had more congenital heart disease and obesity. During the median follow-up of 4.87 years, 26.5 and 24.7 per 1000 person-years male and female patients died, compared with 3.61 and 2.01 per 1000 person-years male and female controls, respectively. The adjusted hazard ratios for all-cause mortality, compared with controls, were 4.77 (3.78-6.01) in men and 7.84 (4.85-12.7) in women (p for sex difference = 0.11). When HF was diagnosed at 30, 35, 40, and 45 years, women and men lost up to 24.6 and 24.2, 24.4 and 20.9, 20.5 and 18.3, and 20.7 and 16.5 years of life, respectively. Conclusion: Long-term mortality was similar between the sexes. Women lost more years of life than men.

  • 20.
    Basic, Carmen
    et al.
    Univ Gothenburg, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden.
    Alehagen, Urban
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Edner, Magnus
    Karolinska Inst, Sweden.
    Fu, Michael
    Univ Gothenburg, Sweden.
    Novak, Masuma
    Univ Gothenburg, Sweden.
    Zverkova Sandstrom, Tatiana
    Univ Gothenburg, Sweden.
    Schaufelberger, Maria
    Univ Gothenburg, Sweden.
    Young patients with heart failure: clinical characteristics and outcomes. Data from the Swedish Heart Failure, National Patient, Population and Cause of Death Registers2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 7, p. 1125-1132Article in journal (Refereed)
    Abstract [en]

    Aims The prevalence and hospitalizations of patients with heart failure (HF) aged <55 years have increased in Sweden during the last decades. We aimed to compare characteristics of younger and older patients with HF, and examine survival in patients All patients >= 18 years in the Swedish Heart Failure Register from 2003 to 2014 were included. Data were merged with National Patient and Cause of Death Registers. Among 60 962 patients, 3752 (6.2%) were <55 years, and were compared with 7425 controls from the Population Register. Compared with patients >= 55 years, patients <55 years more frequently had registered diagnoses of obesity, dilated cardiomyopathy, congenital heart disease, and an ejection fraction <40% (9.8% vs. 4.7%, 27.2% vs. 5.5%, 3.7% vs. 0.8%, 67.9% vs. 45.1%, respectively; allP < 0.001). One-year all-cause mortality was 21.2%, 4.2%, and 0.3% in patients >= 55 years, patients <55 years, and controls <55 years, respectively (allP < 0.001). Patients <55 years had a five times higher mortality risk compared with controls [hazard ratio (HR) 5.48, 95% confidence interval (CI) 4.45-6.74]; the highest HR was in patients 18-34 years (HR 38.3, 95% CI 8.70-169; bothP < 0.001). At the age of 20, the estimated life-years lost was up to 36 years for 50% of patients, with declining estimates with increasing age. Conclusion Patients with HF <55 years had different comorbidities than patients >= 55 years. The highest mortality risk relative to that of controls was among the youngest patients.

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  • 21.
    Batra, Gorav
    et al.
    Uppsala Univ, Sweden.
    Aktaa, Suleman
    Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Benson, Lina
    Karolinska Inst, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Hage, Camilla
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Vasko, Peter
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Gale, Chris P.
    Univ Leeds, England; Leeds Teaching Hosp NHS Trust, England.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Association between heart failure quality of care and mortality: a population-based cohort study using nationwide registries2022In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 24, no 11, p. 2066-2077Article in journal (Refereed)
    Abstract [en]

    Aims To evaluate the quality of heart failure (HF) care using the European Society of Cardiology (ESC) quality indicators (QIs) for HF and to assess whether better quality of care is associated with improved outcomes. Methods and results We performed a nationwide cohort study using the Swedish HF registry, consisting of patients with any type of HF at their first outpatient visit or hospitalization. Independent participant data for quality of HF care was evaluated against the ESC QIs for HF, and association with mortality estimated using multivariable Cox regression. In total, 43 704 patients from 80 hospitals across Sweden enrolled between 2013-2019 were included, with median follow-up 23.6 months. Of the 16 QIs for HF, 13 could be measured and 5 were inversely associated with all-cause mortality during follow-up. Higher attainment (>= 50% vs. <50% attainment) of the composite opportunity-based score (combination of QIs into a single score) for patients with reduced ejection fraction was associated with lower all-cause mortality (adjusted hazard ratio 0.81; 95% confidence interval 0.72-0.91). Attainment of the composite score was less in the outpatient than inpatient setting (adjusted odds ratio 0.85; 95% confidence interval 0.72-0.99). Quality of care varied across hospitals, with assessment of health-related quality of life being the indicator with the widest variation in attainment (interquartile range 61.7%). Conclusion Quality of HF care may be measured using the ESC HF QIs. In Sweden, attainment of HF care evaluated using the QIs demonstrated between and within hospital variation, and many QIs were inversely associated with mortality.

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  • 22.
    Batra, Gorav
    et al.
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Lindback, Johan
    Uppsala Univ, Sweden.
    Becker, Richard C.
    Univ Cincinnati, OH USA.
    Harrington, Robert A.
    Stanford Univ, CA USA.
    Held, Claes
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Kempf, Tibor
    Hannover Med Sch, Germany.
    Lopes, Renato D.
    Duke Univ, NC USA.
    Mahaffey, Kenneth W.
    Stanford Univ, CA USA.
    Steg, Philippe Gabriel
    Univ Paris, France.
    Storey, Robert F.
    Univ Sheffield, England.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Wollert, Kai C.
    Hannover Med Sch, Germany.
    Siegbahn, Agneta
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Wallentin, Lars
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Biomarker-Based Prediction of Recurrent Ischemic Events in Patients With Acute Coronary Syndromes2022In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 80, no 18, p. 1735-1747Article in journal (Refereed)
    Abstract [en]

    BACKGROUND In patients with acute coronary syndrome (ACS), there is residual and variable risk of recurrent ischemic events. OBJECTIVES This study aimed to develop biomarker-based prediction models for 1-year risk of cardiovascular (CV) death and myocardial infarction (MI) in patients with ACS undergoing percutaneous coronary intervention. METHODS We included 10,713 patients from the PLATO (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome) trial in the development cohort and externally validated in 3,508 patients from the TRACER (Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome) trial. Variables contributing to risk of CV death/MI were assessed using Cox regression models, and a score was derived using subsets of variables approximating the full model. RESULTS There were 632 and 190 episodes of CV death/MI in the development and validation cohorts. The most important predictors of CV death/MI were the biomarkers, growth differentiation factor 15, and N-terminal pro-B-type natriuretic peptide, which had greater prognostic value than all candidate variables. The final model included 8 items: age (A), biomarkers (B) (growth differentiation factor 15 and N-terminal pro-B-type natriuretic peptide), and clinical variables (C) (extent of coronary artery disease, previous vascular disease, Killip class, ACS type, P2Y12 inhibitor). The model, named ABC-ACS ischemia, was well calibrated and showed good discriminatory ability for 1-year risk of CV death/MI with C-indices of 0.71 and 0.72 in the development and validation cohorts, respectively. For CV death, the score performed better, with C-indices of 0.80 and 0.84 in the development and validation cohorts, respectively. CONCLUSIONS An 8-item score for the prediction of CV death/MI was developed and validated for patients with ACS undergoing percutaneous coronary intervention. The ABC-ACS ischemia score showed good calibration and discrimination and might be useful for risk prediction and decision support in patients with ACS. (A Comparison of Ticagrelor [AZD6140] and Clopidogrel in Patients With Acute Coronary Syndrome [PLATO]; NCT00391872; Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Participants With Acute Coronary Syndrome [TRACER]; NCT00527943) (c) 2022 by the American College of Cardiology Foundation.

  • 23.
    Baturova, Maria A.
    et al.
    Lund Univ, Sweden; St Petersburg State Univ, Russia.
    Haugaa, Kristina H.
    Natl Hosp Norway, Norway; Univ Oslo, Norway.
    Jensen, Henrik K.
    Aarhus Univ Hosp, Denmark; Aarhus Univ, Denmark.
    Svensson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Gilljam, Thomas
    Sahlgrens Univ Hosp, Sweden.
    Bundgaard, Henning
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Madsen, Trine
    Aalborg Univ Hosp, Denmark.
    Hansen, Jim
    Univ Copenhagen, Denmark.
    Chivulescu, Monica
    Natl Hosp Norway, Norway; Univ Oslo, Norway.
    Christiansen, Morten Krogh
    Aarhus Univ Hosp, Denmark.
    Carlson, Jonas
    Lund Univ, Sweden.
    Edvardsen, Thor
    Natl Hosp Norway, Norway; Univ Oslo, Norway.
    Svendsen, Jesper H.
    Rigshosp, Denmark; Univ Copenhagen, Denmark.
    Platonov, Pyotr G.
    Lund Univ, Sweden.
    Atrial fibrillation as a clinical characteristic of arrhythmogenic right ventricular cardiomyopathy: Experience from the Nordic ARVC Registry2020In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 298, p. 39-43Article in journal (Refereed)
    Abstract [en]

    Background: Recent studies in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients have drawnattention to atrial fibrillation (AF) as an arrhythmic manifestation of ARVC and as an indicator of atrial involvement in the disease progression. We aimed to assess the prevalence of AF in the Scandinavian cohort of ARVC patients and to evaluate its association with disease clinical manifestations. Methods: Study sample comprised of 293 definite ARVC patients by 2010 Task Force criteria (TFC2010) and 141 genotype-positive family members (total n = 434, 43% females, median age at ARVC diagnosis 41 years [inter-quartile range (IQR) 28-52 years]). ARVC diagnostic score was calculated as the sum of major (2 points) and minor (1 point) criteria in all categories of the TFC2010. Results: AF was diagnosed in 42 patients (10%): in 41 patients with definite ARVC diagnosis (14%) vs in one genotype-positive familymember (1%), p amp;lt; 0.001. Themedian age at AF onsetwas 51 (IQR 38-58) years. The prevalence of AFwas related to the ARVC diagnostic score: it significantly increased startingwith the diagnostic score 4 (2% in those with score 3 vs 13% in those with score 4, p = 0.023) and increased further with increased diagnostic score (Somers d value is 0.074, p amp;lt; 0.001). Conclusion: AF is seen in 14% of definite ARVC patients and is related to the severity of disease phenotype thus suggesting AF being an arrhythmic manifestation of this cardiomyopathy indicating atrial myocardial involvement in the disease progression. (C) 2019 Elsevier B.V. All rights reserved.

  • 24.
    Baturova, Maria A.
    et al.
    Department of Cardiology, Clinical Sciences, Lund University, Sweden; Research Park, Saint Petersburg State University, Russia.
    Svensson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Åström Aneq, Meriam
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Svendsen, Jesper H.
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Risum, Niels
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Sherina, Valeriia
    Department of Biostatistics and Computational Biology, School of Medicine and Dentistry, University of Rochester Medical Center, USA.
    Bundgaard, Henning
    Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
    Meurling, Carl
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Lundin, Catarina
    Department of Clinical Genetics and Pathology, Division of Laboratory Medicine, Sweden.
    Carlson, Jonas
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Platonov, Pyotr G.
    Department of Cardiology, Clinical Sciences, Lund University, Sweden.
    Evolution of P-wave indices during long-term follow-up as markers of atrial substrate progression in arrhythmogenic right ventricular cardiomyopathy2021In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 23, no Supplement_1, p. i29-i37Article in journal (Refereed)
    Abstract [en]

    AIMS: Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have increased prevalence of atrial arrhythmias indicating atrial involvement in the disease. We aimed to assess the long-term evolution of P-wave indices as electrocardiographic (ECG) markers of atrial substrate during ARVC progression.

    METHODS AND RESULTS: We included 100 patients with a definite ARVC diagnosis according to 2010 Task Force criteria [34% females, median age 41 (inter-quartile range 30-55) years]. All available sinus rhythm ECGs (n = 1504) were extracted from the regional electronic ECG databases and automatically processed using Glasgow algorithm. P-wave duration, P-wave area, P-wave frontal axis, and prevalence of abnormal P terminal force in lead V1 (aPTF-V1) were assessed and compared at ARVC diagnosis, 10 years before and up to 15 years after diagnosis.Prior to ARVC diagnosis, none of the P-wave indices differed significantly from the data at ARVC diagnosis. After ascertainment of ARVC diagnosis, P-wave area in lead V1 decreased from -1 to -30 µV ms at 5 years (P = 0.002). P-wave area in lead V2 decreased from 82 µV ms at ARVC diagnosis to 42 µV ms 10 years after ARVC diagnosis (P = 0.006). The prevalence of aPTF-V1 increased from 5% at ARVC diagnosis to 18% by the 15th year of follow-up (P = 0.004). P-wave duration and frontal axis did not change during disease progression.

    CONCLUSION: Initial ARVC progression was associated with P-wave flattening in right precordial leads and in later disease stages an increased prevalence of aPTF-V1 was seen.

  • 25.
    Becher, Peter M.
    et al.
    Karolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; Germany German Ctr Cardiovasc Res DZHK, Germany.
    Schrage, Benedikt
    Karolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; Germany German Ctr Cardiovasc Res DZHK, Germany.
    Ferrannini, Giulia
    Karolinska Inst, Sweden.
    Benson, Lina
    Karolinska Inst, Sweden.
    Butler, Javed
    Univ Mississippi, MS 39216 USA.
    Carrero, Juan Jesus
    Karolinska Inst, Sweden.
    Cosentino, Francesco
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Mellbin, Linda
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Rosano, Giuseppe M. C.
    IRCCS San Raffaele, Italy.
    Sinagra, Gianfranco
    Univ Trieste, Italy.
    Stolfo, Davide
    Karolinska Inst, Sweden; Univ Trieste, Italy.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Use of sodium-glucose co-transporter 2 inhibitors in patients with heart failure and type 2 diabetes mellitus: data from the Swedish Heart Failure Registry2021In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 23, no 6, p. 1012-1022Article in journal (Refereed)
    Abstract [en]

    Aims Use of sodium-glucose co-transporter 2 inhibitors (SGLT2i) in real-world heart failure (HF) is poorly characterised. In contemporary patients with HF and type 2 diabetes mellitus (T2DM) we assessed over time SGLT2i use, clinical characteristics and outcomes associated with SGLT2i use. Methods and results Type 2 diabetes patients enrolled in the Swedish HF Registry between 2016-2018 were considered. We performed multivariable logistic regression models to assess the independent predictors of SGLT2i use and Cox regression models in a 1:3 propensity score-matched cohort and relevant subgroups to investigate the association between SGLT2i use and outcomes. Of 6805 eligible HF patients with T2DM, 376 (5.5%) received SGLT2i, whose use increased over time with 12% of patients on treatment at the end of 2018. Independent predictors of SGLT2i use were younger age, HF specialty care, ischaemic heart disease, preserved kidney function, and absence of anaemia. Over a median follow-up of 256 days, SGLT2i use was associated with a 30% lower risk of cardiovascular (CV) death/first HF hospitalisation (hazard ratio 0.70, 95% confidence interval 0.52-0.95), which was consistent regardless of ejection fraction, background metformin treatment and kidney function. SGLT2i use was also associated with a lower risk of all-cause and CV death, HF and CV hospitalisation, and CV death/myocardial infarction/stroke. Conclusion In a contemporary HF cohort with T2DM, SGLT2i use increased over time, was more common with specialist care, younger age, ischaemic heart disease, and preserved renal function, and was associated with lower mortality and morbidity.

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  • 26.
    Becher, Peter Moritz
    et al.
    Karolinska Inst, Sweden; Univ Med Ctr Hamburg Eppendorf, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Benson, Lina
    Karolinska Inst, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Karlström, Patric
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Ryhov Cty Hosp Reg Jonkoping Cty, Sweden.
    Mol, Peter G. M.
    Univ Groningen, Netherlands.
    Metra, Marco
    Univ Brescia, Italy.
    Bhatt, Deepak L.
    Mt Sinai Hlth Syst, NY 10029 USA.
    Pitt, Bertram
    Univ Michigan, MI 48109 USA.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Eligibility for sotagliflozin in a real-world heart failure population based on the SOLOIST-WHF trial enrolment criteria: data from the Swedish heart failure registry2023In: European Heart Journal - Cardiovascular Pharmacotherapy, ISSN 2055-6837, E-ISSN 2055-6845, Vol. 9, no 4, p. 343-352Article in journal (Refereed)
    Abstract [en]

    Aims The SOLOIST-WHF trial demonstrated efficacy of sotagliflozin in patients with type 2 diabetes mellitus (T2DM) and recent worsening heart failure (HF) regardless of ejection fraction (EF). Selection criteria in trials may limit their generalizability. Therefore, we aimed to investigate eligibility for sotagliflozin based on the SOLOIST-WHF criteria in a real-world HF population. Methods and results SOLOIST-WHF criteria were applied to patients stabilized after HF hospitalization in the Swedish HF Registry according to (i) literal scenario (all inclusion/exclusion criteria) or (ii) pragmatic scenario (only criteria likely to influence treatment decisions). Of 5453 inpatients with T2DM and recent worsening HF, 51.4% had reduced EF (HFrEF), 19.1% mildly reduced (HFmrEF), and 29.5% preserved EF (HFpEF). Eligibility (literal) was: 27.2% (32.4% in HFrEF, 24.7% in HFmrEF, 19.7% in HFpEF) and eligibility (pragmatic) was 62.8% (69.1%, 60.3%, 53.4%, respectively). In the literal scenario, criteria limiting eligibility were HF duration <3 months, eGFR <30 ml/min/1.73 m(2), age >85 years, acute coronary syndrome <3 months, and insufficiently high N-terminal pro-B-type natriuretic peptide levels. Eligible vs. non-eligible patients had more severe HF, higher cardiovascular (CV) comorbidity burden, higher use of HF treatments, and higher event rates (all-cause death 30.8 vs. 27.2 per 100 patient-years, CV death 19.1 vs. 16.6, and HF hospitalization 36.7 vs. 24.0). Conclusion In this large, real-world HF cohort with T2DM, similar to 1/3 of patients were eligible for sotagliflozin in the literal and similar to 2/3 of patients in the pragmatic scenario. Eligible patients had more severe HF and higher event rates, in particular CV and HF events.

  • 27.
    Becher, Peter Moritz
    et al.
    Karolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Schrage, Benedikt
    Karolinska Inst, Sweden; Univ Heart & Vasc Ctr Hamburg, Germany; German Ctr Cardiovasc Res DZHK, Germany.
    Benson, Lina
    Karolinska Inst, Sweden.
    Fudim, Marat
    Duke Univ, NC 27710 USA; Duke Clin Res Inst, NC USA.
    Cabrera, Carin Corovic
    Karolinska Inst, Sweden; Soder Sjukhuset, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Rosano, Giuseppe M. C.
    St Georges Hosp Med Sch, England; IRCCS San Raffaele Roma, Italy.
    Jankowska, Ewa A.
    Wroclaw Med Univ, Poland; Univ Hosp, Poland.
    Anker, Stefan D.
    Dept Cardiol CVK, Germany; Berlin Inst Hlth Ctr Regenerat Therapies BCRT, Germany; German Ctr Cardiovasc Res DZHK, Germany; Charite Univ Med Berlin, Germany.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Phenotyping heart failure patients for iron deficiency and use of intravenous iron therapy: data from the Swedish Heart Failure Registry2021In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 23, no 11, p. 1844-1854Article in journal (Refereed)
    Abstract [en]

    Aims Iron deficiency (ID) is associated with poor prognosis regardless of anaemia. Intravenous iron improves quality of life and outcomes in patients with ID and heart failure (HF) with reduced ejection fraction (HFrEF). In the Swedish HF registry, we assessed (i) frequency and predictors of ID testing; (ii) prevalence and outcomes of ID with/without anaemia; (iii) use of ferric carboxymaltose (FCM) and its predictors in patients with ID. Methods and results We used multivariable logistic regressions to assess patient characteristics independently associated with ID testing/FCM use, and Cox regressions to assess risk of outcomes associated with ID. Of 21 496 patients with HF and any ejection fraction enrolled in 2017-2018, ID testing was performed in 27%. Of these, 49% had ID and more specifically 36% had ID-/anaemia-, 15% ID-/anaemia+, 29% ID+/anaemia-, and 20% ID+/anaemia+ (48%, 39%, 13%, 30% and 18% in HFrEF, respectively). Risk of recurrent all-cause hospitalizations was higher in patients with ID regardless of anaemia. Of 1959 patients with ID, 19% received FCM (24% in HFrEF). Important independent predictors of ID testing and FCM use were anaemia, higher New York Heart Association class, having HFrEF, and referral to HF specialty care. Conclusion In this nationwide HF registry, ID testing occurred in only about a quarter of the patients. Among tested patients, ID was present in one half, but only one in five patients received FCM indicating low adherence to current guidelines on screening and treatment.

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  • 28.
    Ben Gal, Tuvia
    et al.
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Ben Avraham, Binyamin
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Abu-Hazira, Miriam
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Frigerio, Maria
    ASST Grande Osped Metropolitano Niguarda, Italy.
    Crespo-Leiro, Maria G.
    Univ A Coruna CHUAC, Spain.
    Oppelaar, Anne Marie
    Univ Utrecht, Netherlands.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Univ Utrecht, Netherlands.
    The consequences of the COVID-19 pandemic for self-care in patients supported with a left ventricular assist device2020In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 6, p. 933-936Article in journal (Other academic)
    Abstract [en]

    n/a

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  • 29.
    Ben Gal, Tuvia
    et al.
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Perkiö Kato, Naoko
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Yaari, Vicky
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Avraham, Ben
    Heart Failure Unit, Cardiology Department, "Rabin" Medical Center, Petah Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
    Verheijden Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Psychometric Testing of the Hebrew Version of the European Heart Failure Self-Care Behaviour Scale2020In: Heart, Lung and Circulation, ISSN 1443-9506, E-ISSN 1444-2892, no 7, p. E121-E130Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The assessment of self-care behaviour is important for tailoring care to patients and evaluating the effectiveness of heart failure (HF) disease-management programmes. The European HF Self-care Behaviour (EHFScB) scale is a validated instrument used worldwide.

    AIM: The purpose of the study was to evaluate psychometric properties of the Hebrew version of the nine-item EHFScB scale in Israeli patients with HF.

    METHOD: To develop the Hebrew version of the EHFScB scale, forward and back translation was performed. The psychometric evaluation was based on data from 102 patients with HF (mean age 61±12 yr, male 75%, New York Heart Association [NYHA] class II 42% and NYHA class III 51%) included in two cross-sectional studies performed in 2007 and 2015-2017 in an Israeli hospital. Content validity, construct validity, known-groups validity, and discriminant validity were assessed. Reliability was evaluated with internal consistency.

    RESULTS: Content validity and useability were confirmed by HF experts and patients with HF. Construct validity was tested using factor analysis and two factors were extracted (factor 1: consulting behaviour; factor 2: adherence to the regimen). Known-groups validity testing revealed a significant difference before and after an educational intervention in the total score (n=40 [41.6±23.8] vs [67.6±21.8]; p<0.01). A weak correlation between the self-care score and health-related quality of life (r= -0.299, p<0.01) was observed, showing that these concepts were related but not overlapping. Cronbach's alpha was 0.78 for the total scale, 0.76 for factor 1, and 0.68 for factor 2, suggesting that the internal consistency of this scale was acceptable.

    CONCLUSIONS: Our study provides support for the useability, validity, and reliability of the nine-item Hebrew version of the EHFScB scale.

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  • 30.
    Berglund, Aseel
    et al.
    Linköping University, Department of Computer and Information Science, Software and Systems. Linköping University, Faculty of Science & Engineering.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Berglund, Erik
    Linköping University, Department of Computer and Information Science, Human-Centered systems. Linköping University, Faculty of Science & Engineering.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Understanding and assessing gamification in digital healthcare interventions for patients with cardiovascular disease2022In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 6, p. 630-638Article in journal (Refereed)
    Abstract [en]

    Gamification is defined as the use of game design elements in contexts other than gaming to increase user engagement and experience. Gamification in cardiovascular care can contribute to positively change health behaviour with possible effects and benefits on physical health and mental well-being. Based on previous literature, in this article we describe: the conceptualization of gamification, the five gamification principles for gamified digital health programmes or applications, the six most common game elements used to impact health behaviour applied in gamified digital health interventions and finally scientifically validated instruments to use for assessment of gamification in terms of self-reported psychological outcomes.

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  • 31.
    Bergström, Göran
    et al.
    Sahlgrens Acad, Sweden; Reg Västra Götaland, Sweden.
    Persson, Margaretha
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden.
    Adiels, Martin
    Univ Gothenburg, Sweden.
    Björnson, Elias
    Sahlgrens Acad, Sweden.
    Bonander, Carl
    Univ Gothenburg, Sweden.
    Ahlström, Håkan
    Uppsala Univ, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Angerås, Oskar
    Sahlgrens Acad, Sweden; Reg Västra Götaland, Sweden.
    Berglund, Göran
    Lund Univ, Sweden.
    Blomberg, Anders
    Umeå Univ, Sweden.
    Brandberg, John
    Sahlgrens Acad, Sweden; Reg Västra Götaland, Sweden.
    Börjesson, Mats
    Sahlgrens Acad, Sweden; Univ Gothenburg, Sweden.
    Cederlund, Kerstin
    Karolinska Inst, Sweden.
    de Faire, Ulf
    Karolinska Inst, Sweden.
    Duvernoy, Olov
    Uppsala Univ, Sweden.
    Ekblom, Örjan
    Swedish Sch Sport & Hlth Sci GIH, Sweden.
    Engström, Gunnar
    Lund Univ, Sweden.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Fagman, Erika
    Sahlgrens Acad, Sweden; Reg Vastra Gotaland, Sweden.
    Eriksson, Mats
    Karolinska Univ Hosp Huddinge, Sweden; Karolinska Univ Hosp Huddinge, Sweden.
    Erlinge, David
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden.
    Fagerberg, Björn
    Sahlgrens Acad, Sweden; Sahlgrens Univ Hosp, Sweden.
    Flinck, Agneta
    Sahlgrens Acad, Sweden; Reg Västra Götaland, Sweden.
    Goncalves, Isabel
    Lund Univ, Sweden.
    Hagström, Emil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Hjelmgren, Ola
    Sahlgrens Acad, Sweden; Reg Västra Götaland, Sweden.
    Lind, Lars
    Uppsala Univ, Sweden.
    Lindberg, Eva
    Uppsala Univ, Sweden.
    Lindqvist, Per
    Umea Univ, Sweden.
    Ljungberg, Johan
    Umeå Univ, Sweden.
    Magnusson, Martin
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden; Lund Univ, Sweden; North West Univ, South Africa.
    Mannila, Maria
    Karolinska Univ Hosp, Sweden.
    Markstad, Hanna
    Lund Univ, Sweden; Lund Univ, Sweden.
    Mohammad, Moman A.
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden.
    Nyström, Fredrik H
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    Ostenfeld, Ellen
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Persson, Anders
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Rosengren, Annika
    Sahlgrens Acad, Sweden; Sahlgrens Univ Hosp, Sweden.
    Sandström, Anette
    Umeå Univ, Sweden.
    Själander, Anders
    Umea Univ, Sweden; Umea Univ, Sweden.
    Sköld, Magnus C.
    Karolinska Inst, Sweden; Karolinska Inst, Sweden; Karolinska Univ Hosp Solna, Sweden.
    Sundström, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Söderberg, Stefan
    Umeå Univ, Sweden.
    Torén, Kjell
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population2021In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 144, no 12, p. 916-929Article in journal (Refereed)
    Abstract [en]

    Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population. Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or &gt;= 50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data. Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (&gt;= 50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score &gt;400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population. Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.

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  • 32.
    Bergström, Göran
    et al.
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Rosengren, Annika
    Univ Gothenburg, Sweden; Sahlgrenska Univ Hosp Ostra Hosp, Sweden.
    Bacsovics Brolin, Elin
    Karolinska Inst, Sweden; Capio St Goran Hosp, Sweden.
    Brandberg, John
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Cederlund, Kerstin
    Karolinska Inst, Sweden.
    Engström, Gunnar
    Lund Univ, Sweden.
    Engvall, Jan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Eriksson, Maria J.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Gonçalves, Isabel
    Skane Univ Hosp, Sweden; Lund Univ, Sweden.
    Hagström, Emil
    Uppsala Univ, Sweden.
    James, Stefan K.
    Uppsala Univ, Sweden.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Lilja, Mikael
    Umea Univ, Sweden.
    Magnusson, Martin
    Lund Univ, Sweden; Skane Univ Hosp, Sweden; North West Univ, South Africa.
    Persson, Anders
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Karolinska Inst, Sweden.
    Persson, Margaretha
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Sandström, Anette
    Umea Univ, Sweden.
    Schmidt, Caroline
    Univ Gothenburg, Sweden.
    Skoglund Larsson, Linn
    Umea Univ, Sweden.
    Sundström, Johan
    Uppsala Univ, Sweden; Univ New South Wales, Australia.
    Swahn, Eva
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Söderberg, Stefan
    Umea Univ, Sweden.
    Torén, Kjell
    Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen.
    Lampa, Erik
    Uppsala Univ, Sweden.
    Lind, Lars
    Uppsala Univ, Sweden.
    Body weight at age 20 and in midlife is more important than weight gain for coronary atherosclerosis: Results from SCAPIS2023In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 373, p. 46-54Article in journal (Refereed)
    Abstract [en]

    Background and aims: Elevated body weight in adolescence is associated with early cardiovascular disease, but whether this association is traceable to weight in early adulthood, weight in midlife or to weight gain is not known. The aim of this study is to assess the risk of midlife coronary atherosclerosis being associated with body weight at age 20, body weight in midlife and body weight change.Methods: We used data from 25,181 participants with no previous myocardial infarction or cardiac procedure in the Swedish CArdioPulmonary bioImage Study (SCAPIS, mean age 57 years, 51% women). Data on coronary atherosclerosis, self-reported body weight at age 20 and measured midlife weight were recorded together with potential confounders and mediators. Coronary atherosclerosis was assessed using coronary computed tomog-raphy angiography (CCTA) and expressed as segment involvement score (SIS).Results: The probability of having coronary atherosclerosis was markedly higher with increasing weight at age 20 and with mid-life weight (p < 0.001 for both sexes). However, weight increase from age 20 until mid-life was only modestly associated with coronary atherosclerosis. The association between weight gain and coronary atherosclerosis was mainly seen in men. However, no significant sex difference could be detected when adjusting for the 10-year delay in disease development in women.Conclusions: Similar in men and women, weight at age 20 and weight in midlife are strongly related to coronary atherosclerosis while weight increase from age 20 until midlife is only modestly related to coronary atherosclerosis.

  • 33.
    Beygui, Farzin
    et al.
    Caen Univ Hosp, France.
    Castren, Maaret
    Helsinki Univ Hosp, Finland; Univ Helsinki, Finland; Karolinska Inst, Sweden.
    Brunetti, Natale Daniele
    Univ Foggia, Italy.
    Rosell-Ortiz, Fernando
    Empresa Publ Emergencias Sanitarias Andalucia, Spain.
    Christ, Michael
    Paracelsus Med Univ, Germany.
    Zeymer, Uwe
    Klinikum Stadt Ludwigshafen Rhein gGmbH, Germany.
    Huber, Kurt
    Wilhelminenhospital, Austria.
    Folke, Fredrik
    Copenhagen Univ Hosp, Denmark.
    Svensson, Leif
    Karolinska Inst Solna, Sweden.
    Bueno, Hector
    Hosp 12 Octubre, Spain.
    vant Hof, Arnoud
    ISALA Acad, Netherlands.
    Nikolaou, Nikolaos
    Konstantopouleio Gen Hosp, Greece.
    Nibbe, Lutz
    Univ Med Berlin, Germany.
    Charpentier, Sandrine
    Univ Hosp Rangueil, France.
    Swahn, Eva
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Tubaro, Marco
    San Filippo Neri Hosp, Italy.
    Goldstein, Patrick
    Lille Univ Hosp, France; Lille Univ Hosp, France.
    Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.2020In: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 9, no 1_SUPPL, p. 59-81Article in journal (Refereed)
    Abstract [en]

    Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts opinions, for all emergency medical services health providers involved in the pre-hospital management of acute cardiovascular care.

  • 34.
    Bilchick, Kenneth C.
    et al.
    Univ Virginia Hlth Syst, VA USA.
    Wang, Yongfei
    Yale New Haven Med Ctr, CT USA; Yale Univ, CT 06511 USA.
    Curtis, Jeptha P.
    Yale New Haven Med Ctr, CT USA; Yale Univ, CT 06511 USA.
    Shadman, Ramin
    Southern Calif Permanente, CA USA.
    Dardas, Todd F.
    Univ Washington, WA 98195 USA.
    Anand, Inder
    Univ Minnesota, MN 55455 USA.
    Lund, Lars H.
    Karolinska Univ Hosp, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Sartipy, Ulrik
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Levy, Wayne C.
    Univ Washington, WA 98195 USA.
    Survival Probability and Survival Benefit Associated With Primary Prevention Implantable Cardioverter-Defibrillator Generator Changes2022In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 11, no 13, article id e023743Article in journal (Refereed)
    Abstract [en]

    Background As patients derive variable benefit from generator changes (GCs) of implantable cardioverter-defibrillators (ICDs) with an original primary prevention (PP) indication, better predictors of outcomes are needed. Methods and Results In the National Cardiovascular Data Registry ICD Registry, patients undergoing GCs of initial non-cardiac resynchronization therapy PP ICDs in 2012 to 2016, predictors of post-GC survival and survival benefit versus control heart failure patients without ICDs were assessed. These included predicted annual mortality based on the Seattle Heart Failure Model, left ventricular ejection fraction (LVEF) &gt;35%, and the probability that a patients death would be arrhythmic (proportional risk of arrhythmic death [PRAD]). In 40 933 patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs (age 67.7 +/- 12.0 years, 24.5% women, 34.1% with LVEF &gt;35%), Seattle Heart Failure Model-predicted annual mortality had the greatest effect size for decreased post-GC survival (P&lt;0.0001). Patients undergoing GCs of initial noncardiac resynchronization therapy PP ICDs with LVEF &gt;35% had a lower Seattle Heart Failure Model-adjusted survival versus 23 472 control heart failure patients without ICDs (model interaction hazard ratio, 1.21 [95% CI, 1.11-1.31]). In patients undergoing GCs of initial noncardiac resynchonization therapy PP ICDs with LVEF &lt;= 35%, the model indicated worse survival versus controls in the 21% of patients with a PRAD 65%. The association of the PRAD with survival benefit or harm was similar in patients with or without pre-GC ICD therapies. Conclusions Patients who received replacement of an ICD originally implanted for primary prevention and had at the time of GC either LVEF &gt;35% alone or both LVEF &lt;= 35% and PRAD &lt;43% had worse survival versus controls without ICDs.

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  • 35.
    Bjursten, Henrik
    et al.
    Lund Univ, Sweden.
    Koul, Sasha
    Lund Univ, Sweden.
    Duvernoy, Olov
    Uppsala Univ, Sweden.
    Fagman, Erika
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Samano, Ninos
    Orebro Univ, Sweden.
    Nilsson, Johan
    Umea Univ, Sweden.
    Nielsen, Niels Erik
    Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Rück, Andreas
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Johansson, Jan
    Blekinge Hosp, Sweden.
    James, Stefan
    Uppsala Univ, Sweden.
    Settergren, Magnus
    Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden.
    Götberg, Matthias
    Lund Univ, Sweden.
    Pistea, Adrian
    Lund Univ, Sweden.
    Calcium Load in the Aortic Valve, Aortic Root, and Left Ventricular Outflow Tract and the Risk for a Periprocedural Stroke2022In: Structural Heart, ISSN 2474-8706, Vol. 6, no 4, article id 100070Article in journal (Refereed)
    Abstract [en]

    Background: Periprocedural stroke during transcatheter aortic valve implantation is a rare but devastating complication. The calcified aortic valve is the most likely source of the emboli in a periprocedural stroke. The total load and distribution of calcium in the leaflets, aortic root, and left ventricular outflow tract varies from patient to patient. Consequently, there could be patterns of calcification that are associated with a higher risk of stroke. This study aimed to explore whether the pattern of calcification in the left ventricular outflow tract, annulus, aortic valve, and ascending aorta can be used to predict a periprocedural stroke. Methods: Among the 3282 consecutive patients who received a transcatheter aortic valve implantation in the native valve in Sweden from 2014 to 2018, we identified 52 who had a periprocedural stroke. From the same cohort, a control group of 52 patients was constructed by propensity score matching. Both groups had one missing cardiac computed tomography, and 51 stroke and 51 control patients were blindly reviewed by an experienced radiologist. Results: The groups were well balanced in terms of demographics and procedural data. Of the 39 metrics created to describe calcium pattern, only one differed between the groups. The length of calcium protruding above the annulus was 10.6 mm (interquartile range 7-13.6) for patients without stroke and 8 mm (interquartile range 3-10) for stroke patients. Conclusions: This study could not find any pattern of calcification that predisposes for a periprocedural stroke.

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  • 36.
    Björkman, Stina
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences.
    Lilliecreutz, Caroline
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Bladh, Marie
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Strömberg, Tomas
    Linköping University, Department of Biomedical Engineering, Division of Biomedical Engineering. Linköping University, Faculty of Science & Engineering.
    Östgren, Carl Johan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ekholmen. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Mahmoud, Arina
    Linköping University.
    Kafashian, Arian
    Linköping University.
    Bergstrand, Sara
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Sederholm Lawesson, Sofia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Microvascular dysfunction in women with a history of hypertensive disorders of pregnancy: A population-based retrospective cohort study2024In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 131, no 4, p. 433-443Article in journal (Refereed)
    Abstract [en]

    ObjectiveTo evaluate microvascular function in women with previous hypertensive disorders of pregnancy (HDP).DesignRetrospective population-based cohort study.SettingLinkoping, Sweden.PopulationWomen aged 50-65 years, participating in the Swedish CArdioPulmonary bioImage Study (SCAPIS) at one site (Linkoping) 2016-18, who underwent microcirculatory assessment (N = 1222).MethodsForearm skin comprehensive microcirculatory assessment was performed with a PeriFlux PF6000 EPOS (Enhanced Perfusion and Oxygen Saturation) system measuring oxygen saturation and total speed resolved perfusion. Obstetric records were reviewed to identify women with previous HDP. Data on cardiovascular risk factors, comorbidities, medication, lifestyle, anthropometric data, and biochemical analyses were obtained from SCAPIS. The microcirculatory data were compared between women with and without previous HDP.Main outcome measuresSkin microcirculatory oxygen saturation and total speed resolved perfusion at baseline and post-ischaemic peak.ResultsWomen with previous pre-eclampsia displayed impaired post-ischaemic peak oxygen saturation compared with women with normotensive pregnancies (88%, interquartile range [IQR] 84-89% vs 91%, IQR 87-94%, p = 0.001) 6-30 years after pregnancy. The difference remained after multivariable adjustment (& beta; -2.69, 95% CI -4.93 to -0.45).ConclusionsThe findings reveal microvascular dysfunction at long-term follow up in women with previous pre-eclampsia and strengthen the possible role of endothelial dysfunction as a link to the increased risk of cardiovascular disease in women with HDP.

  • 37.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Usability and feasibility analysis of an mHealth-tool for supporting physical activity in people with heart failure2024In: BMC Medical Informatics and Decision Making, E-ISSN 1472-6947, Vol. 24, no 1, article id 44Article in journal (Refereed)
    Abstract [en]

    BackgroundPhysical inactivity and a sedentary lifestyle are common among people with heart failure (HF), which may lead to worse prognosis. On an already existing mHealth platform, we developed a novel tool called the Activity coach, aimed at increasing physical activity. The aim of this study was to evaluate the usability of the Activity coach and assess feasibility of outcome measures for a future efficacy trial.MethodsA mixed-methods design was used to collect data. People with a HF diagnosis were recruited to use the Activity coach for four weeks. The Activity coach educates the user about physical activity, provides means of registering daily physical activity and helps the user to set goals for the next week. The usability was assessed by analysing system user logs for adherence, reported technical issues and by interviews about user experiences. Outcome measures assessed for feasibility were objective physical activity as measured by an accelerometer, and subjective goal attainment. Progression criteria for the usability assessment and for the proposed outcomes, were described prospectively.ResultsTen people with HF were recruited, aged 56 to 78 with median age 72. Data from nine of the ten study participants were included in the analyses. Usability: The Activity coach was used 61% of the time and during the first week two study participants called to seek technical support. The Activity coach was found to be intuitive and easy to use by all study participants. An increased motivation to be more physically active was reported by six of the nine study participants. However, in spite of feeling motivated, four reported that their habits or behaviours had not been affected by the Activity coach. Feasibility: Data was successfully stored in the deployed hardware as intended and the accelerometers were used enough, for the data to be analysable. One finding was that the subjective outcome goal attainment, was challenging to collect. A proposed mitigator for this is to use pre-defined goals in future studies, as opposed to having the study participants be completely free to formulate the goals themselves.ConclusionsIt was confirmed that the Activity coach was easy to use. Furthermore, it might stimulate increased physical activity in a population of people with HF, who are physically inactive. The outcomes investigated seem feasible to include in a future efficacy trial.Trial registrationClinicalTrials.gov identifier: NCT05235763. Date of first registration: 11/02/2022.

  • 38.
    Blomqvist, Andreas
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Utility of single-item questions to assess physical inactivity in patients with chronic heart failure2020In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 7, no 4, p. 1467-1476Article in journal (Refereed)
    Abstract [en]

    Aim The purpose of this study was to explore the utility of two single-item self-report (SR) questions to assess physical inactivity in patients with heart failure (HF). Methods and results This is a cross-sectional study using data from 106 patients with HF equipped with accelerometers for 1 week each. Two SR items relating to physical activity were also collected. Correlations between accelerometer activity counts and the SR items were analysed. Patients were classified as physically active or inactive on the basis of accelerometer counts, and the SR items were used to try to predict that classification. Finally, patients were classified as having high self-reported physical activity or low self-reported physical activity, on the basis of the SR items, and the resulting groups were analysed for differences in actual physical activity. There were significant but weak correlations between the SR items and accelerometer counts: rho = 0.24, P = 0.016 for SR1 and rho = 0.21, P = 0.033 for SR2. Using SR items to predict whether a patient was physically active or inactive produced an area under the curve of 0.62 for SR1, with a specificity of 92% and a sensitivity of 30%. When dividing patients into groups on the basis of SR1, there was a significant difference of 1583 steps per day, or 49% more steps in the high self-reported physical activity group (P &lt; 0.001). Conclusions There might be utility in the single SR question for high-specificity screening of large populations to identify physically inactive patients in order to assign therapeutic interventions efficiently where resources are limited.

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  • 39.
    Boano, Gabriella
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Åström Aneq, Meriam
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Spyrou, Giannis
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry. Linköping University, Faculty of Medicine and Health Sciences.
    Enocsson, Helena
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences.
    Charitakis, Emmanouil
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Vánky, Farkas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Biochemical response to cryothermal and radiofrequency exposure of the human myocardium at surgical ablation of atrial fibrillation: a randomized controlled trial2020In: Translational Medicine Communications, ISSN 2396-832X, Vol. 5, article id 11Article in journal (Refereed)
    Abstract [en]

    Background: Surgical cryothermia and radiofrequency (RF) ablations for atrial fibrillation (AF) seem to result in similar sinus rhythm restoration, but the biochemical consequences of the two methods are unclear. We aimed to compare the biochemical responses to the two ablative methods in concomitant mitral valve surgery (MVS).

    Methods: Sixty mitral valve surgery patients with AF were prospectively included. Forty-one patients planned for ablation were randomized to cryothermia (n = 20) or radiofrequency (n = 21) ablation and 19 served as controls. Markers for myocardial injury, inflammation, cell stress, apoptosis, and heart failure were analyzed pre- and postoperatively at different time points.

    Results: Troponin T and creatine kinase isoenzyme MB (CK-MB) peak levels were significantly higher in the cryothermia group compared with the RF group (12,805 [6140–15,700] vs. 2790 [1880–4180] ng/L; P = 0.002 and 271 [217–357] vs. 79 [66–93] μg/L; P < 0.001, respectively). Both groups had significantly higher levels than the no-ablation group. There were no group differences in C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), but there were correlations between pre- and postoperative levels of both CRP (rs = 0.41, P = 0.001) and NT-proBNP (rs = 0.48, P < 0.001). Protease-activated receptor 1 (PAR-1) and heat shock protein 27 (HSP27) were significantly increased in the cryoablation group.

    Conclusions: Cryoablation results in a larger myocardial injury and possibly more elevated apoptotic activity and cell stress compared with the RF technique. The type of ablation device did not have any significant influence on the postoperative inflammatory response nor on the early postoperative levels of NT-proBNP.

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  • 40.
    Bollano, Entela
    et al.
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Redfors, Björn
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Rawshani, Araz
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Venetsanos, Dimitrios
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Völz, Sebastian
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Angerås, Oskar
    Sahlgrens Univ Hosp, Sweden.
    Ljungman, Charlotta
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Alfredsson, Joakim
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Råmunddal, Truls
    Sahlgrens Univ Hosp, Sweden.
    Petursson, Petur
    Sahlgrens Univ Hosp, Sweden.
    Smith, J. Gustav
    Sahlgrens Univ Hosp, Sweden; Lund Univ, Sweden; Skåne Univ Hosp, Sweden; Lund Univ, Sweden; Lund Univ, Sweden.
    Braun, Oscar
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden.
    Hagström, Henrik
    Umeå Univ, Sweden; Umeå Univ Hosp, Sweden.
    Fröbert, Ole
    Örebro Univ, Sweden.
    Erlinge, David
    Lund Univ, Sweden; Skåne Univ Hosp, Sweden.
    Omerovic, Elmir
    Sahlgrens Univ Hosp, Sweden; Univ Gothenburg, Sweden.
    Temporal trends in characteristics and outcome of heart failure patient with and without signification coronary artery disease2022In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 9, no 3, p. 1812-1822Article in journal (Refereed)
    Abstract [en]

    Aims

    Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level.

    Methods and results

    We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long-term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P<0.001). No such increase was seen for indications angina pectoris and ST-elevation myocardial infarction. A normal CAG or non-obstructive CAD was reported in 63.2% (HF-NCAD), and 36.8% had &gt;50% diameter stenosis in one or more coronary arteries (HF-CAD). The median follow-up time was 3.6 years in HF-CAD and 5 years in HF-NCAD. Age and sex-adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF-NCAD, long-term mortality was higher in HF-CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF-NCAD, the risk estimate in patients with a single-vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20-1.41; P<0.0011, a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% C11.58-1.88; P &lt; 0.001), and with left main disease (HR 2.02; 95% CI 1.88-2.18; P &lt; 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P &lt; 0.001) per calendar year. The majority (53.4%) of HF-CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P<0.001).

    Conclusions

    Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long-term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities.

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  • 41. Order onlineBuy this publication >>
    Borg, Sabina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Exercise-Based Cardiac Rehabilitation in Patients with Coronary Artery Disease: Attendance, Adherence and the Added Value of a Behavioural Medicine Intervention2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Coronary artery disease (CAD) is the leading global cause of death. After an index event related to CAD, exercise-based cardiac rehabilitation (exCR) is strongly recommended as part of the secondary prevention. Despite the well-established beneficial effects of exCR in patients with CAD, attendance at and adherence to the programme are low, and remain a matter of major concern. One strategy that may increase adherence and rehabilitation outcomes in patients with CAD is to add a behavioural medicine intervention to routine exCR care. The added value of such interventions needs to be further explored. Although several factors associated with non-attendance at exCR appear to be similar between different countries, patterns of attendance may differ due to differences in contextual aspects. The factors that affect attendance at exCR in a Swedish context remain to be explored.

    Overall aim: To investigate barriers for exCR attendance and to evaluate the added value of a behavioural medicine intervention in physiotherapy on exercise adherence and rehabilitation outcomes in patients with CAD.

    Methods: The three papers in this thesis are based on two studies of patients with CAD, one registrybased cohort study of 31,297 patients included from the SWEDEHEART registry (Paper I), and one randomised controlled trial of 170 patients included at a Swedish university hospital (Papers II and III). In the first paper, several individual and structural variables were compared for attenders and nonattenders, using multivariable analysis in a logistic regression model. In Papers II and III, patients were randomised 1:1 either to a behavioural medicine intervention in physiotherapy in addition to routine exCR care or to routine exCR care alone for four months. The behaviour change techniques used in the behavioural medicine intervention – specific goal-setting, re-evaluation of the goals, and selfmonitoring and feedback – were based on control theory. Outcome assessment took place at baseline, four and 12 months, and included physical fitness, psychological outcomes and health-related quality of life. Exercise adherence was evaluated at the end of the four-month intervention. An intention-to-treat and a per-protocol analysis were performed.

    Results: Individual and structural factors associated with non-attendance at exCR in a Swedish context were identified as having a distance greater than 16 km to the hospital, belonging to a county hospital, having a higher burden of comorbidities, being male, and being retired. Exercise adherence was higher for patients who received the behavioural medicine intervention in physiotherapy together with routine exCR (31%) than it was for those who received routine exCR care alone (19%). Rehabilitation outcomes did not differ significantly between the two groups, either between baseline and four months or between four and 12 months. Both groups improved significantly in all measures of physical fitness, and in several measures of health-related quality of life and anxiety at the four-month follow-up. Sufficient enablement remained for patients in both groups at the 12-months follow-up.

    Conclusions: Distance to the hospital was the strongest predictor for non-attendance at exCR in a Swedish context. The individual factors associated with non-attendance at exCR identified in this thesis confirm previous results, with the exception that female gender was associated with a higher attendance at exCR. The results of this thesis confirm what others have pointed out: it is challenging to achieve behavioural change in patients with the aim to improve rehabilitation outcomes. Even though adherence was higher when a behavioural medicine intervention was added, it was low in both groups. The current behavioural medicine intervention in physiotherapy did not give any improvements over routine exCR care alone in physical fitness, psychological outcomes or health-related quality of life. As such, there is still room for further development and evaluation of behavioural medicine interventions within the context of exCR. A greater tailoring of these interventions to individual needs in a broader population of patients with CAD is suggested.

    List of papers
    1. Factors associated with non-attendance at exercise-based cardiac rehabilitation
    Open this publication in new window or tab >>Factors associated with non-attendance at exercise-based cardiac rehabilitation
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    2019 (English)In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 11, article id 13Article in journal (Refereed) Published
    Abstract [en]

    BackgroundDespite its well-established positive effects, exercise-based cardiac rehabilitation (exCR) is underused in patients following an acute myocardial infarction (AMI). The aim of the study was to identify factors associated with non-attendance at exCR in patients post-AMI in a large Swedish cohort.MethodsA total of 31,297 patients who have suffered an AMI, mean age 62.44years, were included from the SWEDEHEART registry during the years 2010-2016. Comparisons between attenders and non-attenders at exCR were done at baseline for the following variables: age, sex, body mass index, occupational status, smoking, previous diseases, type of index cardiac event and intervention, and left ventricular function. Distance of residence from the hospital and type of hospital were added as structural variables in logistic regression analyses, with non-attendance at exCR at one-year follow-up as dependent, and with individual and structural variables as independent variables.ResultsIn total, 16,214 (52%) of the patients did not attend exCR. The strongest predictor for non-attendance was distance to the exCR centre (OR 1.75 [95% CI: 1.64-1.86]). Other predictors for non-attendance included smoking, history of stroke, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), AMI or diabetes, male sex, being retired vs. being employed, and being followed-up at a county hospital. Patients with ST-elevation myocardial infarction (STEMI) and those intervened with PCI or CABG were more likely to attend exCR.Conclusions A distance greater than 16km was associated with increased probability of non-attendance at exCR, as were smoking, a higher burden of comorbidities, and male sex. A better understanding of individual and structural factors can support the development of future rehabilitation services.

    Place, publisher, year, edition, pages
    BMC, 2019
    Keywords
    Acute myocardial infarction; Coronary artery disease; Exercise-based cardiac rehabilitation; Non-attendance; Physiotherapy; Secondary prevention
    National Category
    Orthopaedics
    Identifiers
    urn:nbn:se:liu:diva-159571 (URN)10.1186/s13102-019-0125-9 (DOI)000477630600001 ()31372231 (PubMedID)
    Note

    Funding Agencies|Swedish Heart and Lung Association; Swedish Society for Medical Research

    Available from: 2019-08-13 Created: 2019-08-13 Last updated: 2023-12-28
    2. Correction:Factors associated with non-attendance at exercise-based cardiac rehabilitation (vol 11, 13, 2019)
    Open this publication in new window or tab >>Correction:Factors associated with non-attendance at exercise-based cardiac rehabilitation (vol 11, 13, 2019)
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    2019 (English)In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 11, no 1, article id 24Article in journal (Other academic) Published
    Abstract [en]

    n/a

    Place, publisher, year, edition, pages
    BMC, 2019
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-161615 (URN)10.1186/s13102-019-0135-7 (DOI)000490974600001 ()31636911 (PubMedID)
    Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2023-12-28
    3. The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial
    Open this publication in new window or tab >>The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial
    Show others...
    2020 (English)In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 14, p. 2517-2529Article in journal (Refereed) Published
    Abstract [en]

    Purpose: Despite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMW) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care. Patients and Methods: In a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity. Results: The four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate. Conclusion: Both groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.

    Place, publisher, year, edition, pages
    DOVE MEDICAL PRESS LTD, 2020
    Keywords
    aerobic capacity; coronary artery disease; control theory; secondary prevention
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-172981 (URN)10.2147/PPA.S285905 (DOI)000603466600001 ()33380790 (PubMedID)
    Note

    Funding Agencies|Swedish Heart and Lung AssociationSwedish Heart-Lung Foundation; Swedish Society of Medical Research; Region Ostergotland

    Available from: 2021-01-26 Created: 2021-01-26 Last updated: 2024-01-17
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  • 42.
    Borg, Sabina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Alfredsson, Joakim
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    Soderlund, Anne
    Malardalen Univ, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    Effectiveness of a behavioral medicine intervention in physical therapy on secondary psychological outcomes and health-related quality of life in exercise-based cardiac rehabilitation: a randomized, controlled trial2023In: BMC SPORTS SCIENCE MEDICINE AND REHABILITATION, ISSN 2052-1847, Vol. 15, no 1, article id 42Article in journal (Refereed)
    Abstract [en]

    BackgroundInterventions promoting adherence to exercise-based cardiac rehabilitation (exCR) are important to achieve positive physical and psychological outcomes, but knowledge of the added value of behavioral medicine interventions for these measures is limited. The aim of the study was to investigate the added value of a behavioral medicine intervention in physical therapy (BMIP) in routine exCR on psychological outcomes and health-related quality of life (HRQoL) versus routine exCR alone (RC).MethodsA total of 170 patients with coronary artery disease (136 men), mean age 62.3 +/- 7.9 years, were randomized at a Swedish university hospital to a BMIP plus routine exCR or to RC for four months. The outcome assessments included HRQoL (SF-36, EQ-5D), anxiety and depression (HADS), patient enablement and self-efficacy and was performed at baseline, four and 12 months. Between-group differences were tested with an independent samples t-test and, for comparisons within groups, a paired t-test was used. An intention-to-treat and a per-protocol analysis were performed.ResultsNo significant differences in outcomes between the groups were shown between baseline and four months or between four and 12 months. Both groups improved in most SF-36 domains, EQ-VAS and HADS anxiety at the four-month follow-up and sufficient enablement remained at the 12-months follow-up.ConclusionA BMIP added to routine exCR care had no significant effect on psychological outcomes and HRQoL compared with RC, but significant improvements in several measures were shown in both groups at the four-month follow-up. Since recruited participants showed a better psychological profile than the general coronary artery disease population, further studies on BMIP in exCR, tailored to meet individual needs in broader patient groups, are needed.Trial registration number NCT02895451, 09/09/2016, retrospectively registered.

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  • 43.
    Borg, Sabina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Öberg, Birgitta
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Söderlund, Anne
    Malardalen Univ, Sweden.
    Bäck, Maria
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Sahlgrens Univ Hosp, Sweden.
    The Added Value of a Behavioral Medicine Intervention in Physiotherapy on Adherence and Physical Fitness in Exercise-Based Cardiac Rehabilitation (ECRA): A Randomised, Controlled Trial2020In: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 14, p. 2517-2529Article in journal (Refereed)
    Abstract [en]

    Purpose: Despite beneficial effects, adherence to exercise-based cardiac rehabilitation (exCR) is low in patients with coronary artery disease (CAD). The aim of this study was to investigate adherence to and the effects of a behavioral medicine intervention in physiotherapy (BMW) added to routine exCR care on the primary outcome of physical fitness compared with routine exCR care. Patients and Methods: In a randomized, controlled trial, 170 patients with CAD (136 men), mean age 62.3 (7.9) years, were included at a Swedish university hospital. Patients were randomized 1:1 to routine exCR care (RC) or to a BMIP added to routine exCR care for four months, with a long-term follow-up at 12 months. The outcome assessment included submaximal aerobic exercise capacity, muscle endurance and self-reported physical activity and physical capacity. Results: The four-month follow-up showed improvements in all outcomes for both groups, but changes did not differ significantly between the groups. Patients in the BMIP group were more adherent to exCR recommendations compared with the RC group (31% vs 19%) and a non-significant tendency towards the maintenance of submaximal aerobic exercise capacity over time was seen in the BMIP group, whereas patients in the RC group appeared to deteriorate. Conclusion: Both groups improved significantly at the four-month follow-up, while the 12-month follow-up showed a non-significant tendency towards better long-term effects on submaximal aerobic exercise capacity and exercise adherence for a BMIP compared with RC. In spite of this, a better understanding of the role of a BMIP in enhancing adherence is needed.

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  • 44.
    Bouzina, Habib
    et al.
    Lund Univ, Sweden.
    Radegran, Goran
    Lund Univ, Sweden.
    Butler, Oisin
    Bayer AG, Germany.
    Hesselstrand, Roger
    Lund Univ, Sweden.
    Hjalmarsson, Clara
    Gothenburg Univ, Sweden.
    Holl, Katsiaryna
    Bayer AG, Germany.
    Jansson, Kjell
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Klok, Rogier
    Merck & Co Inc, NJ USA.
    Soderberg, Stefan
    Umea Univ, Sweden.
    Kjellstrom, Barbro
    Lund Univ, Sweden; Karolinska Inst, Sweden.
    Longitudinal changes in risk status in pulmonary arterial hypertension2021In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, no 1, p. 680-690Article in journal (Refereed)
    Abstract [en]

    Aims Low-risk status in pulmonary arterial hypertension (PAH) predicts better survival. The present study aimed to describe changes in risk status and treatment approaches over multiple clinical assessments in PAH, taking age and comorbidity burden into consideration. Methods and results The study included incident patients from the Swedish PAH registry, diagnosed with PAH in 2008-2019. Group A (n = 340) were &lt;= 75 years old with &lt;3 comorbidities. Group B (n = 163) were &gt;75 years old with &gt;= 3 comorbidities. Assessments occurred at baseline, first-year (Y1) and third-year (Y3) follow-ups. The study used an explorative and descriptive approach. Group A: median age was 65 years, 70% were female, and 46% had no comorbidities at baseline. Baseline risk assessment yielded low (23%), intermediate (66%), and high risk (11%). Among patients at low, intermediate, or high risk at baseline, 51%, 18%, and 13%, respectively, were at low risk at Y3. At baseline, monotherapy was the most common therapy among low (68%) and intermediate groups (60%), while dual therapy was the most common among high risk (69%). In patients assessed as low, intermediate, or high risk at Y1, 66%, 12%, and 0% were at low risk at Y3, respectively. Of patients at intermediate or high risk at Y1, 35% received monotherapy and 13% received triple therapy. In low-risk patients at Y1, monotherapy (40%) and dual therapy (43%) were evenly distributed. Group B: median age was 77 years, 50% were female, and 44% had &gt;= 3 comorbidities at baseline. At baseline, 8% were at low, 80% at intermediate, and 12% at high risk. Monotherapy was the most common therapy (62%) in Group B at baseline. Few patients maintained or reached low risk at follow-ups. Conclusions Most patients with PAH did not meet low-risk criteria during the 3 year follow-up. The first year from diagnosis seems important in defining the longitudinal risk status.

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  • 45.
    Bäck, Sophia
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Skoda, Iulia
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Lantz, Jonas
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Henriksson, Lilian
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Karlsson, Lars
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Persson, Anders
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Carlhäll, Carljohan
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV). Region Östergötland, Heart Center, Department of Clinical Physiology in Linköping.
    Ebbers, Tino
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Elevated atrial blood stasis in paroxysmal atrial fibrillation during sinus rhythm: a patient-specific computational fluid dynamics study2023In: Frontiers in Cardiovascular Medicine, E-ISSN 2297-055X, Vol. 10, article id 1219021Article in journal (Refereed)
    Abstract [en]

    Introduction: Atrial fibrillation (AF) is associated with an increased risk of stroke, often caused by thrombi that form in the left atrium (LA), and especially in the left atrial appendage (LAA). The underlying mechanism is not fully understood but is thought to be related to stagnant blood flow, which might be present despite sinus rhythm. However, measuring blood flow and stasis in the LAA is challenging due to its small size and low velocities. We aimed to compare the blood flow and stasis in the left atrium of paroxysmal AF patients with controls using computational fluid dynamics (CFD) simulations.Methods : The CFD simulations were based on time-resolved computed tomography including the patient-specific cardiac motion. The pipeline allowed for analysis of 21 patients with paroxysmal AF and 8 controls. Stasis was estimated by computing the blood residence time.Results and Discussion: Residence time was elevated in the AF group (p &lt; 0.001). Linear regression analysis revealed that stasis was strongest associated with LA ejection ratio (p &lt; 0.001, R-2 = 0.68) and the ratio of LA volume and left ventricular stroke volume (p &lt; 0.001, R-2 = 0.81). Stroke risk due to LA thrombi could already be elevated in AF patients during sinus rhythm. In the future, patient specific CFD simulations may add to the assessment of this risk and support diagnosis and treatment.

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  • 46.
    Cacciata, Marysol C.
    et al.
    Vet Affairs Long Beach Healthcare Syst, CA 90822 USA.
    Strömberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Klompstra, Leonie
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Nursing Sciences and Reproductive Health. Linköping University, Faculty of Medicine and Health Sciences.
    Kuriakose, Mebin
    Univ Calif Irvine, CA USA.
    Lee, Jung-Ah
    Univ Calif Irvine, CA USA.
    Lombardo, Dawn
    Univ Calif Irvine Hlth, CA USA.
    Evangelista, Lorraine S.
    Univ Texas Med Branch, TX 77555 USA.
    Facilitators and Challenges to Exergaming Perspectives of Patients With Heart Failure2022In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 37, no 3, p. 281-288Article in journal (Refereed)
    Abstract [en]

    Background Few investigators have explored challenges and facilitators to exergaming, essential factors to exergaming adherence, among patients with heart failure. Objectives In this qualitative study, we explored facilitators and challenges using a home-based exergame platform, the Nintendo Wii Sports, in patients with heart failure. Methods Semistructured face-to-face interviews were conducted in 13 participants given a diagnosis of heart failure (age range, 34-69 years). Participants were asked about their experiences with exergaming. Transcribed interviews were analyzed with content analysis. Results The following 4 facilitators were identified: (1) enjoyment and competition motivated gaming, (2) accessibility at home gave freedom and lowered participants barriers to exercise, (3) physical benefits when decreasing sedentary lifestyle, and (4) psychosocial benefits on stress, mood, and family interactions. Challenges included (1) diminished engagement over time due to boredom playing similar games and (2) frustrations due to game difficulty and lack of improvement. Conclusion Exergaming can increase individuals physical activity because of easy accessibility and the fun and motivating factors the games offer. Participants initially found exergaming enjoyable and challenging. However, engagement diminished over time because of boredom from playing the same games for a period of time. Participants preferences and capacities, participants past experiences, and social support must be considered to avoid boredom and frustrations. Future studies are warranted to determine adherence to exergaming among patients with heart failure and, ultimately, increased overall well-being and healthcare delivery in this patient population.

  • 47.
    Cadrin-Tourigny, Julia
    et al.
    Johns Hopkins Univ Hosp, MD 21287 USA; Univ Montreal, Canada.
    Bosman, Laurens P.
    Netherlands Heart Inst, Netherlands; Univ Utrecht, Netherlands.
    Nozza, Anna
    Univ Montreal, Canada.
    Wang, Weijia
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Tadros, Rafik
    Univ Montreal, Canada.
    Bhonsale, Aditya
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Bourfiss, Mimount
    Univ Utrecht, Netherlands.
    Fortier, Annik
    Univ Montreal, Canada.
    Lie, Oyvind H.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Saguner, Ardan M.
    Univ Heart Ctr Zurich, Switzerland.
    Svensson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Andorin, Antoine
    Univ Montreal, Canada.
    Tichnell, Crystal
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Murray, Brittney
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Zeppenfeld, Katja
    Leiden Univ, Netherlands.
    van den Berg, Maarten P.
    Univ Groningen, Netherlands.
    Asselbergs, Folkert W.
    Netherlands Heart Inst, Netherlands; Univ Utrecht, Netherlands; UCL, England.
    Wilde, Arthur A. M.
    Univ Amsterdam, Netherlands.
    Krahn, Andrew D.
    Univ British Columbia, Canada.
    Talajic, Mario
    Univ Montreal, Canada.
    Rivard, Lena
    Univ Montreal, Canada.
    Chelko, Stephen
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Zimmerman, Stefan L.
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Kamel, Ihab R.
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Crosson, Jane E.
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Judge, Daniel P.
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Yap, Sing-Chien
    Erasmus MC, Netherlands.
    van der Heijden, Jeroen F.
    Univ Utrecht, Netherlands.
    Tandri, Harikrishna
    Johns Hopkins Univ Hosp, MD 21287 USA.
    Jongbloed, Jan D. H.
    Univ Groningen, Netherlands.
    Guertin, Marie-Claude
    Univ Montreal, Canada.
    van Tintelen, J. Peter
    Netherlands Heart Inst, Netherlands; Univ Amsterdam, Netherlands.
    Platonov, Pyotr G.
    Lund Univ Hosp, Sweden.
    Duru, Firat
    Univ Heart Ctr Zurich, Switzerland.
    Haugaa, Kristina H.
    Oslo Univ Hosp, Norway; Univ Oslo, Norway.
    Khairy, Paul
    Univ Montreal, Canada.
    Hauer, Richard N. W.
    Netherlands Heart Inst, Netherlands; Univ Utrecht, Netherlands.
    Calkins, Hugh
    Johns Hopkins Univ Hosp, MD 21287 USA.
    te Riele, Anneline S. J. M.
    Netherlands Heart Inst, Netherlands; Univ Utrecht, Netherlands.
    James, Cynthia A.
    Johns Hopkins Univ Hosp, MD 21287 USA.
    A new prediction model for ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, no 32, p. e1-e9Article in journal (Refereed)
    Abstract [en]

    Aims Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC) is characterized by ventricular arrhythmias (VAs) and sudden cardiac death (SCD). We aimed to develop a model for individualized prediction of incident VA/SCD in ARVC patients. Methods and results Five hundred and twenty-eight patients with a definite diagnosis and no history of sustained VAs/SCD at baseline, aged 38.2 +/- 15.5 years, 44.7% male, were enrolled from five registries in North America and Europe. Over 4.83 (interquartile range 2.44-9.33) years of follow-up, 146 (27.7%) experienced sustained VA, defined as SCD, aborted SCD, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator (ICD) therapy. A prediction model estimating annual VA risk was developed using Cox regression with internal validation. Eight potential predictors were pre-specified: age, sex, cardiac syncope in the prior 6 months, non-sustained ventricular tachycardia, number of premature ventricular complexes in 24 h, number of leads with T-wave inversion, and right and left ventricular ejection fractions (LVEFs). All except LVEF were retained in the final model. The model accurately distinguished patients with and without events, with an optimism-corrected C-index of 0.77 [95% confidence interval (CI) 0.73-0.81] and minimal over-optimism [calibration slope of 0.93 (95% CI 0.92-0.95)]. By decision curve analysis, the clinical benefit of the model was superior to a current consensus-based ICD placement algorithm with a 20.3% reduction of ICD placements with the same proportion of protected patients (P &lt; 0.001). Conclusion Using the Largest cohort of patients with ARVC and no prior VA, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs (www.arvcrisk.com).

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  • 48.
    Cadrin-Tourigny, Julia
    et al.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA; Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada.
    Bosman, Laurens P.
    Netherlands Heart Institute, Netherlands.
    Wang, Weijia
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Tadros, Rafik
    Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada .
    Bhonsale, Aditya
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Bourfiss, Mimount
    Department of Cardiology, Utrecht University, the Netherlands.
    Lie, Øyvind H.
    Department of Cardiology and Research group for Cardiogenetics and Sudden Cardiac Death, Oslo University Hospital, Rikshospitalet, Norway .
    Saguner, Ardan M
    Department of Cardiology, University Heart Center Zurich, Switzerland .
    Svensson, Anneli
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Andorin, Antoine
    Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada.
    Tichnell, Crystal
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Murray, Brittney
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Zeppenfeld, Katja
    Department of Cardiology, Leiden University Medical Center, Netherlands.
    van den Berg, Maarten P
    Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands.
    Asselbergs, Folkert W.
    Netherlands Heart Institute Department of Cardiology University Medical Center Utrecht, Utrecht University, the Netherlands; Institute of Cardiovascular Science & Institute of Health Informatics, Faculty of Population Health Sciences, University College London, United Kingdom.
    Wilde, Arthur A. M.
    Amsterdam UMC, University of Amsterdam, Heart Center, the Netherlands .
    Krahn, Andrew D
    Division of Cardiology, University of British Columbia, Vancouver, Canada.
    Talajic, Mario
    Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada .
    Rivard, Lena
    Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Canada .
    Chelko, Stephen
    Department of Medicine, Division of Cardiology Johns Hopkins Hospital, Baltimore, USA; Department of Biomedical Sciences, Florida State University College of Medicine, USA.
    Zimmerman, Stefan L
    The Russell H. Morgan Department of Radiology and Radiological Science , Johns Hopkins Hospital, USA.
    Kamel, Ihab R.
    The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, USA.
    Crosson, Jane E.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Judge, Daniel P.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Yap, Sing-Chien
    Department of Cardiology, Erasmus Medical Center, Rotterdam .
    Van der Heijden, Jeroen F
    Department of Cardiology, University Medical Center Utrecht, Utrecht University, the Netherlands.
    Tandri, Harikrishna
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, USA.
    Jongbloed, Jan D H
    Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands.
    van Tintelen, J Peter
    Netherlands Heart Institute, University Medical Center Utrecht, Utrecht University, the Netherlands; Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, the Netherlands.
    Platonov, Pyotr G.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, USA.
    Duru, Firat
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Haugaa, Kristina H
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, USA.
    Khairy, Paul
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, USA.
    Hauer, Richard N.W.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Calkins, Hugh
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Te Riele, Anneline S J M
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    James, Cynthia A.
    Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, USA.
    Sudden Cardiac Death Prediction in Arrhythmogenic Right Ventricular Cardiomyopathy: A Multinational Collaboration2021In: Circulation: Arrhythmia and Electrophysiology, ISSN 1941-3149, E-ISSN 1941-3084, Vol. 14, no 1, article id e008509Article in journal (Refereed)
    Abstract [en]

    Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with ventricular arrhythmias (VA) and sudden cardiac death (SCD). A model was recently developed to predict incident sustained VA in patients with ARVC. However, since this outcome may overestimate the risk for SCD, we aimed to specifically predict life-threatening VA (LTVA) as a closer surrogate for SCD.

    Methods: We assembled a retrospective cohort of definite ARVC cases from 15 centers in North America and Europe. Association of 8 prespecified clinical predictors with LTVA (SCD, aborted SCD, sustained, or implantable cardioverter-defibrillator treated ventricular tachycardia >250 beats per minute) in follow-up was assessed by Cox regression with backward selection. Candidate variables included age, sex, prior sustained VA (≥30s, hemodynamically unstable, or implantable cardioverter-defibrillator treated ventricular tachycardia; or aborted SCD), syncope, 24-hour premature ventricular complexes count, the number of anterior and inferior leads with T-wave inversion, left and right ventricular ejection fraction. The resulting model was internally validated using bootstrapping.

    Results: A total of 864 patients with definite ARVC (40±16 years; 53% male) were included. Over 5.75 years (interquartile range, 2.77-10.58) of follow-up, 93 (10.8%) patients experienced LTVA including 15 with SCD/aborted SCD (1.7%). Of the 8 prespecified clinical predictors, only 4 (younger age, male sex, premature ventricular complex count, and number of leads with T-wave inversion) were associated with LTVA. Notably, prior sustained VA did not predict subsequent LTVA (P=0.850). A model including only these 4 predictors had an optimism-corrected C-index of 0.74 (95% CI, 0.69-0.80) and calibration slope of 0.95 (95% CI, 0.94-0.98) indicating minimal over-optimism.

    Conclusions: LTVA events in patients with ARVC can be predicted by a novel simple prediction model using only 4 clinical predictors. Prior sustained VA and the extent of functional heart disease are not associated with subsequent LTVA events.

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  • 49.
    Cannavan, Priscila M. S.
    et al.
    Univ Estadual Campinas, Brazil.
    Cannavan, Fernando P. S.
    Univ Estadual Campinas, Brazil.
    Walfridsson, Ulla
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Lopes, Maria H. B. M.
    Univ Estadual Campinas, Brazil.
    Translation and Validation of the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) to the Brazilian Context: An Instrument Focusing on Arrhythmia Symptoms2020In: Cardiology Research and Practice, ISSN 2090-8016, E-ISSN 2090-0597, Vol. 2020, article id 1402916Article in journal (Refereed)
    Abstract [en]

    Introduction. The wide variety of symptoms in patients with cardiac arrhythmias can affect daily living activities. The evaluation of symptoms with patient-reported outcome measures (PROMs), with validated instruments, can provide information that contributes to clinical decisions and treatment. In Brazil, however, there is no available scale that evaluates symptoms in different types of arrhythmias. Purpose. This study aimed to translate the Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia symptom scale (ASTA-symptom scale) and then validate the questionnaire in terms of Brazilian culture. Method. The methodological process of cultural adaptation used was based on international literature guidelines consisting of forward translation, synthesis, back translation, review by an expert committee, and pretest. Psychometric analyses were conducted with 140 patients. These included measuring internal consistency (Cronbachs alpha), construct validity with item-total correlations, and convergent construct validity with correlations with the quality of life questionnaire for patients with atrial fibrillation-version 2 (QVFA-v2). Usability and understandability were evaluated through the usability evaluation of instruments. Results. The translation and adaptation processes were performed by obtaining the Brazilian Portuguese version of the original Swedish instrument. This version presented the internal consistency of items, evaluated through Cronbachs alpha (0.79). Construct validity was demonstrated by item-total correlations for the nine items, all except one reached the level of &gt;0.30 (0.24). Convergent validity showed a high correlation with QVFA-v2 (0.89). As for the evaluation of usability and understanding, after two small suggested changes, no additional alterations were necessary. Conclusion. The psychometric properties of the Brazilian version of ASTA-symptom scale evaluated in this study were satisfactory, and the scale was proved to be a valid and reliable tool to assess the symptom burden in patients with different forms of tachyarrhythmia. The ASTA-Br-symptom scale questionnaire can be an important addition to PROMs for patients with arrhythmias and could help healthcare professionals in decision-making.

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  • 50.
    Cappelletto, Chiara
    et al.
    Karolinska Inst, Sweden; Azienda Sanit Univ Giuliano Isontina & Univ Triest, Italy.
    Stolfo, Davide
    Karolinska Inst, Sweden; Azienda Sanit Univ Giuliano Isontina & Univ Triest, Italy.
    Orsini, Nicola
    Karolinska Inst, Sweden.
    Benson, Lina
    Karolinska Inst, Sweden.
    Rodolico, Daniele
    Karolinska Inst, Sweden; Univ Cattolica Sacro Cuore, Italy.
    Rosano, Giuseppe M. C.
    St Georges Univ London, England; IRCCS San Raffaele Pisana, Italy.
    Dahlström, Ulf
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Cardiology in Linköping.
    Sinagra, Gianfranco
    Azienda Sanit Univ Giuliano Isontina & Univ Triest, Italy.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden; Karolinska Univ Hosp Norrbacka, Sweden.
    Use of and association between heart failure pharmacological treatments and outcomes in obese versus non-obese patients with heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry2023In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 25, no 5, p. 698-710Article in journal (Refereed)
    Abstract [en]

    Aims To investigate the use of guideline-directed medical therapies (GDMT) and associated outcomes in obese (body mass index &gt;= 30 kg/m(2)) versus non-obese patients with heart failure (HF) with reduced ejection fraction (HFrEF). Methods and results Patients with HFrEF from the Swedish HF Registry were included. Of 16 116 patients, 24% were obese. In obese versus non-obese patients, use of treatments was 91% versus 86% for renin-angiotensin system inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi), 94% versus 91% for beta-blockers, 53% versus 43% for mineralocorticoid receptor antagonists. Obesity was shown to be independently associated with more likely use of each treatment, triple combination therapy, and the achievement of target dose by multivariable logistic regressions. Multivariable Cox regressions showed use of RASi/ARNi and beta-blockers being independently associated with lower risk of all-cause/cardiovascular death regardless of obesity, although, when considering competing risks, a lower risk of cardiovascular death with RASi/ARNi in obese versus non-obese patients was observed. RASi/ARNi were associated with lower risk of HF hospitalization in obese but not in non-obese patients, whereas beta-blockers were not associated with the risk of HF hospitalization regardless of obesity. At the competing risk analysis, RASi/ARNi use was associated with higher risk of HF hospitalization regardless of obesity. Conclusion Obese patients were more likely to receive optimal treatments after adjustment for factors affecting tolerability, suggesting that perceived beyond actual tolerance issues limit GDMT implementation. RASi/ARNi and beta-blockers were associated with lower mortality regardless of obesity, with a greater association between RASi/ARNi and lower cardiovascular death in obese versus non-obese patients when considering competing risk.

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