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  • 1. Aasa, M
    et al.
    Dellborg, M
    Herlitz, Johan
    [external].
    Svensson, L
    Grip, L
    Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial)2010In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 106, no 12, p. 1685-1691Article in journal (Refereed)
    Abstract [en]

    Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.

  • 2. Aavik, Einari
    et al.
    Lumivuori, Henri
    Leppänen, Olli
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Wirth, Thomas
    Hakkinen, Sanna-Kaisa
    Braesen, Jan-Hinrich
    Beschorner, Ulrich
    Zeller, Thomas
    Braspenning, Maarten
    van Criekinge, Wim
    Makinen, Kimmo
    Yla-Herttuala, Seppo
    Global DNA methylation analysis of human atherosclerotic plaques reveals extensive genomic hypomethylation and reactivation at imprinted locus 14q32 involving induction of a miRNA cluster2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 16, p. 993-U23Article in journal (Refereed)
    Abstract [en]

    Aims Genetics can explain just above 10% of the observed heritability in cardiovascular diseases. Epigenetics is about to provide some further explanations, but the information needed for that is in the accumulation phase. Genome-wide DNA methylation analysis has revealed thousands of genes, which are epigenetically differentially regulated in atherosclerotic plaques. Our results point to an additional level of complexity that needs to be integrated into the aetiology of atherogenesis.We conducted a genome-wide analysis to identify differentially methylated genes in atherosclerotic lesions. Methods DNA methylation at promoters, exons and introns was identified by massive parallel sequencing. Gene expression was analysed by microarrays, qPCR, immunohistochemistry and western blots. Results Globally, hypomethylation of chromosomal DNA predominates in atherosclerotic plaques and two-thirds of genes showing over 2.5-fold differential in DNA methylation are up-regulated in comparison to healthy mammary arteries. The imprinted chromatin locus 14q32 was identified for the first time as an extensively hypomethylated area in atherosclerosis with highly induced expression of miR127, -136, -410, -431, -432, -433 and capillary formation-associated gene RTL1. The top 100 list of hypomethylated promoters exhibited over 1000-fold enrichment for miRNAs, many of which mapped to locus 14q32. Unexpectedly, also gene body hypermethylation was found to correlate with stimulated mRNA expression. Conclusion Significant changes in genomic methylation were identified in atherosclerotic lesions. The most prominent gene cluster activated via hypomethylation was detected at imprinted chromosomal locus 14q32 with several clustered miRNAs that were up-regulated. These results suggest that epigenetic changes are involved in atherogenesis and may offer new potential therapeutic targets for vascular diseases.

  • 3.
    Abawi, Akram
    et al.
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fröbert, Ole
    Örebro University, School of Medical Sciences. Department of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Samano, Ninos
    Örebro University Hospital. Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience2023In: Brazilian Journal of Cardiovascular Surgery, ISSN 0102-7638, E-ISSN 1678-9741, Vol. 39, no 1, article id e20220461Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.

    METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.

    RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.

    CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.

  • 4.
    Abbassi, Fariba
    et al.
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Gero, Daniel
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Muller, Xavier
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Bueno, Alba
    Kings Coll Hosp London, Inst Liver Studies, London, England..
    Figiel, Wojciech
    Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland..
    Robin, Fabien
    Univ Hosp Rennes, Dept HPB Surg & Transplantat, Rennes, France..
    Laroche, Sophie
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Picard, Benjamin
    Hop Beaujon, APHP Nord, DMU PARABOL, Dept Anesthesiol Crit Care & Perioperat Med, Clichy, Nord, France..
    Shankar, Sadhana
    Leeds Teaching Hosp trust, Dept Abdominal Transplant & Hepatobiliary Surg, Leeds, W Yorkshire, England..
    Ivanics, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery. Univ Toronto, Univ Hlth Network, Multiorgan Transplant Program, Toronto, ON, Canada.;Henry Ford Hosp, Dept Surg, Detroit, MI USA..
    van Reeven, Marjolein
    Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div HPB & Transplant Surg, Rotterdam, Netherlands..
    van Leeuwen, Otto B.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    Braun, Hillary J.
    Univ Calif San Francisco, Div Transplant Surg, San Francisco, CA USA..
    Monbaliu, Diethard
    Univ Hosp Leuven, Dept Abdominal Transplant Surg & Transplant Coord, Leuven, Belgium..
    Breton, Antoine
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Vachharajani, Neeta
    Washington Univ, St Louis Sch Med, Div Abdominal Transplantat, Dept Surg, St Louis, MO USA..
    Bonaccorsi Riani, Eliano
    Univ Hosp St Luc, Dept Abdominal & Transplant Surg, Brussels, Belgium..
    Nowak, Greg
    Karolinska Univ, Hosp Huddinge, Dept Transplantat Surg, Stockholm, Sweden..
    McMillan, Robert R.
    Houston Methodist Hosp, Weill Cornell Med Ctr, Houston, TX USA..
    Abu-Gazala, Samir
    Hosp Univ Penn, Penn Transplant Inst, Dept Surg, Philadelphia, PA USA..
    Nair, Amit
    Univ Rochester, Div Transplantat & Hepatobiliary Surg, Rochester, MN USA..
    Bruballa, Rocio
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    Paterno, Flavio
    Univ Hosp, Rutgers New Jersey Med Sch, Div Liver Transplant, Newark, NJ USA..
    Weppler Sears, Deborah
    Cleveland Clin Florida, Dept Abdominal & Transplant Surg, Weston, FL USA..
    Pinna, Antonio D.
    Cleveland Clin Florida, Dept Abdominal & Transplant Surg, Weston, FL USA..
    Guarrera, James V.
    Univ Hosp, Rutgers New Jersey Med Sch, Div Liver Transplant, Newark, NJ USA..
    de Santibanes, Eduardo
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    de Santibanes, Martin
    Hosp Italiano Buenos Aires, HPB & Liver Transplant Unit, Buenos Aires, Argentina..
    Hernandez-Alejandro, Roberto
    Univ Rochester, Div Transplantat & Hepatobiliary Surg, Rochester, MN USA..
    Olthoff, Kim
    Hosp Univ Penn, Penn Transplant Inst, Dept Surg, Philadelphia, PA USA..
    Ghobrial, R. Mark
    Houston Methodist Hosp, Weill Cornell Med Ctr, Houston, TX USA..
    Ericzon, Bo-Goran
    Karolinska Univ, Hosp Huddinge, Dept Transplantat Surg, Stockholm, Sweden..
    Ciccarelli, Olga
    Univ Hosp St Luc, Dept Abdominal & Transplant Surg, Brussels, Belgium..
    Chapman, William C.
    Washington Univ, St Louis Sch Med, Div Abdominal Transplantat, Dept Surg, St Louis, MO USA..
    Mabrut, Jean-Yves
    Croix Rousse Hosp, Dept Gen Abdominal & Transplant Surg, Lyon, France..
    Pirenne, Jacques
    Univ Hosp Leuven, Dept Abdominal Transplant Surg & Transplant Coord, Leuven, Belgium..
    Mullhaupt, Beat
    Univ Hosp Zurich, Dept Gastroenterol & Hepatol, Zurich, Switzerland..
    Ascher, Nancy L.
    Univ Calif San Francisco, Div Transplant Surg, San Francisco, CA USA..
    Porte, Robert J.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    de Meijer, Vincent E.
    Univ Groningen, Univ Med Ctr Groningen, Div HPB Surg & Liver Transplantat, Groningen, Netherlands..
    Polak, Wojciech G.
    Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Dept Surg, Div HPB & Transplant Surg, Rotterdam, Netherlands..
    Sapisochin, Gonzalo
    Univ Toronto, Univ Hlth Network, Multiorgan Transplant Program, Toronto, ON, Canada..
    Attia, Magdy
    Leeds Teaching Hosp trust, Dept Abdominal Transplant & Hepatobiliary Surg, Leeds, W Yorkshire, England..
    Soubrane, Olivier
    Hop Beaujon, APHP Nord, DMU DIGEST, Dept HPB Surg & Liver Transplantat, Clichy, France..
    Weiss, Emmanuel
    Hop Beaujon, APHP Nord, DMU PARABOL, Dept Anesthesiol Crit Care & Perioperat Med, Clichy, Nord, France..
    Adam, Rene A.
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Cherqui, Daniel
    Hop Paul Brousse, Hepatobiliary Ctr, Dept Surg & Transplantat, Villejuif, France..
    Boudjema, Karim
    Univ Hosp Rennes, Dept HPB Surg & Transplantat, Rennes, France..
    Zieniewicz, Krzysztof
    Med Univ Warsaw, Dept Gen Transplant & Liver Surg, Warsaw, Poland..
    Jassem, Wayel
    Kings Coll Hosp London, Inst Liver Studies, London, England..
    Dutkowski, Philipp
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Clavien, Pierre-Alain
    Univ Hosp Zurich, Dept Surg & Transplantat, Zurich, Switzerland..
    Novel Benchmark Values for Redo Liver Transplantation Does the Outcome Justify the Effort?2022In: Annals of Surgery, ISSN 0003-4932, E-ISSN 1528-1140, Vol. 276, no 5, p. 860-867Article in journal (Refereed)
    Abstract [en]

    Objective: To define benchmark cutoffs for redo liver transplantation (redo-LT). Background: In the era of organ shortage, redo-LT is frequently discussed in terms of expected poor outcome and wasteful resources. However, there is a lack of benchmark data to reliably evaluate outcomes after redo-LT. Methods: We collected data on redo-LT between January 2010 and December 2018 from 22 high-volume transplant centers. Benchmark cases were defined as recipients with model of end stage liver disease (MELD) score <= 25, absence of portal vein thrombosis, no mechanical ventilation at the time of surgery, receiving a graft from a donor after brain death. Also, high-urgent priority and early redo-LT including those for primary nonfunction (PNF) or hepatic artery thrombosis were excluded. Benchmark cutoffs were derived from the 75th percentile of the medians of all benchmark centers. Results: Of 1110 redo-LT, 373 (34%) cases qualified as benchmark cases. Among these cases, the rate of postoperative complications until discharge was 76%, and increased up to 87% at 1-year, respectively. One-year overall survival rate was excellent with 90%. Benchmark cutoffs included Comprehensive Complication Index CCI (R) at 1-year of <= 72, and in-hospital and 1-year mortality rates of <= 13% and <= 15%, respectively. In contrast, patients who received a redo-LT for PNF showed worse outcomes with some values dramatically outside the redoLT benchmarks. Conclusion: This study shows that redo-LT achieves good outcome when looking at benchmark scenarios. However, this figure changes in high-risk redo-LT, as for example in PNF. This analysis objectifies for the first-time results and efforts for redo-LT and can serve as a basis for discussion about the use of scarce resources.

  • 5. Abbott, A. L.
    et al.
    Adelman, M. A.
    Alexandrov, A. V.
    Barnett, H. J. M.
    Beard, J.
    Bell, P.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Blacker, D.
    Buckley, C. J.
    Cambria, R. P.
    Comerota, A. J.
    Connolly, E. S., Jr.
    Davies, A. H.
    Eckstein, H. H.
    Faruqi, R.
    Fraedrich, G.
    Gloviczki, P.
    Hankey, G. J.
    Harbaugh, R. E.
    Heldenberg, E.
    Kittner, S. J.
    Kleinig, T. J.
    Mikhailidis, D. P.
    Moore, W. S.
    Naylor, R.
    Nicolaides, A.
    Paraskevas, K. I.
    Pelz, D. M.
    Prichard, J. W.
    Purdie, G.
    Ricco, J. B.
    Riles, T.
    Rothwell, P.
    Sandercock, P.
    Sillesen, H.
    Spence, J. D.
    Spinelli, F.
    Tan, A.
    Thapar, A.
    Veith, F. J.
    Zhou, W.
    Why the United States Center for Medicare and Medicaid Services (CMS) Should not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting2012In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 43, no 3, p. 247-251Article in journal (Refereed)
  • 6. Abbott, Anne L.
    et al.
    Adelman, Mark A.
    Alexandrov, Andrei V.
    Barnett, Henry J. M.
    Beard, Jonathan
    Bell, Peter
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Blacker, David
    Buckley, Clifford J.
    Cambria, Richard P.
    Comerota, Anthony J.
    Connolly, E. Sander
    Davies, Alun H.
    Eckstein, Hans-Henning
    Faruqi, Rishad
    Fraedrich, Gustav
    Gloviczki, Peter
    Hankey, Graeme J.
    Harbaugh, Robert E.
    Heldenberg, Eitan
    Kittner, Steven J.
    Kleinig, Timothy J.
    Mikhailidis, Dimitri P.
    Moore, Wesley S.
    Naylor, Ross
    Nicolaides, Andrew
    Paraskevas, Kosmas I.
    Pelz, David M.
    Prichard, James W.
    Purdie, Grant
    Ricco, Jean-Baptiste
    Riles, Thomas
    Rothwell, Peter
    Sandercock, Peter
    Sillesen, Henrik
    Spence, J. David
    Spinelli, Francesco
    Tan, Aaron
    Thapar, Ankur
    Veith, Frank J.
    Zhou, Wei
    Why the United States Center for Medicare and Medicaid Services should not extend reimbursement indications for carotid artery angioplasty/stenting2012In: VASCULAR, ISSN 1708-5381, Vol. 20, no 1, p. 1-7Article in journal (Other academic)
  • 7.
    Abdelakram, Hafid
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Abdullah, Saad
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Estimating Physiological Parameters in Various Age Groups: Windkessel 4 Element Model and PPG Waveform Analysis Approach2023In: IEEE 4th International Multidisciplinary Conference on Engineering Technology, IMCET 2023, IEEE, 2023, p. 194-197Conference paper (Refereed)
    Abstract [en]

    Non-invasive monitoring of cardiovascular health through photoplethysmography (PPG) waveforms has emerged as a crucial area of research. The Windkessel 4-Element (WK4) model is a mathematical approach used to estimate key physiological parameters related to cardiovascular health, including arterial compliance, peripheral resistance, inertance, and total arterial resistance. This study aimed to evaluate key physiological parameters associated with cardiovascular health using the WK4 model, leveraging real-life PPG waveform data obtained from volunteers across three distinct age groups. To achieve this, an algorithm was developed to automatically determine optimal parameter values for each volunteer. The results revealed a mean correlation coefficient of 0.96 between the automatically generated waveforms by the algorithm and the actual real-life PPG waveforms, indicating robust agreement. Notably, only the total arterial resistance parameter exhibited significant differences among the age groups, suggesting that the algorithm holds promise for detecting agerelated changes in cardiovascular health. These findings emphasize the potential for the development of a non-invasive tool to assess cardiovascular health status and enhance healthcare outcomes. Furthermore, they underscore the capability of the developed algorithm as a non-invasive means to evaluate various aspects of cardiovascular physiology. Additionally, the versatility of this algorithm opens doors for its application in educational settings, promoting knowledge advancement, empowering research endeavors, and facilitating advancements in the field.

  • 8. Abdelhalim, Mohamed A.
    et al.
    Tenorio, Emanuel R.
    Oderich, Gustavo S.
    Haulon, Stephan
    Warren, Gasper
    Adam, Donald
    Claridge, Martin
    Butt, Talha
    Abisi, Said
    Dias, Nuno V.
    Kölbel, Tilo
    Gallitto, Enrico
    Gargiulo, Mauro
    Gkoutzios, Panos
    Panuccio, Giuseppe
    Kuzniar, Marek
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mees, Barend M.
    Schurink, Geert W.
    Sonesson, Björn
    Spath, Paolo
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Schanzer, Andres
    Beck, Adam W.
    Schneider, Darren B.
    Timaran, Carlos H.
    Eagleton, Matthew
    Farber, Mark A.
    Modarai, Bijan
    Multicenter trans-Atlantic experience with fenestrated-branched endovascular aortic repair of chronic post-dissection thoracoabdominal aortic aneurysms2023In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 78, no 4, p. 854-862.e1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: This multicenter international study aimed to describe outcomes of fenestrated-branched endovascular aortic repairs (FB-EVAR) in a cohort of patients treated for chronic post-dissection thoracoabdominal aortic aneurysms (PD-TAAAs).

    METHODS: We reviewed the clinical data of all consecutive patients treated by FB-EVAR for repair of extent I to III PD-TAAAs in 16 centers from the United States and Europe (2008-2021). Data were extracted from institutional prospectively maintained databases and electronic patient records. All patients received off-the-shelf or patient-specific manufactured fenestrated-branched stent grafts. Endpoints were any cause mortality and major adverse events at 30 days, technical success, target artery (TA) patency, freedom from TA instability, minor (endovascular with <12 Fr sheath) and major (open or ≥12 Fr sheath) secondary interventions, patient survival, and freedom from aortic-related mortality (ARM).

    RESULTS: A total of 246 patients (76% male; median age, 67 years [interquartile range, 61-73 years]) were treated for extent I (7%), extent II (55%), and extent III (35%) PD-TAAAs by FB-EVAR. The median aneurysm diameter was 65 mm (interquartile range, 59-73 mm). Eighteen patients (7%) were octogenarians, 212 (86%) were American Society of Anesthesiologists class ≥3, and 21 (9%) presented with contained ruptured or symptomatic aneurysms. There were 917 renal-mesenteric vessels targeted by 581 fenestrations (63%) and 336 directional branches (37%), with a mean of 3.7 vessels per patient. Technical success was 96%. Mortality and rate of major adverse events at 30 days was 3% and 28%, including disabling complications such as new onset dialysis in 1%, major stroke in 1%, and permanent paraplegia in 2%. Mean follow-up was 24 months. Kaplan-Meier (KM) estimated patient survival at 3 and 5 years was 79% ± 6% and 65% ± 10%. KM estimated freedom from ARM was 95% ± 3% and 93% ± 5% at the same intervals. Unplanned secondary interventions were needed in 94 patients (38%), including minor procedures in 64 (25%) and major procedures in 30 (12%). There was one conversion to open surgical repair (<1%). KM estimated freedom from any secondary intervention was 44% ± 9% at 5 years. KM estimated primary and secondary TA patency were 93% ± 2% and 96% ± 1% at 5 years, respectively.

    CONCLUSIONS: FB-EVAR for chronic PD-TAAAs was associated with high technical success and a low rate of mortality (3%) and disabling complications at 30 days. Although the procedure is effective in the prevention of ARM, patient survival was low at 5 years (65%), likely due to the significant comorbidities in this cohort of patients. Freedom from secondary interventions at 5 years was 44%, although most procedures were minor. The significant rate of reinterventions highlights the need for continued patient surveillance.

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  • 9.
    Abdellaoui, Nawel
    et al.
    Med Univ Sfax, Tunisia.
    Abdelmoula, Balkiss
    Med Univ Sfax, Tunisia.
    Abdelhedi, Rania
    Univ Sfax, Tunisia.
    Kharrat, Najla
    Univ Sfax, Tunisia.
    Tabebi, Mouna
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Rebai, Ahmed
    Univ Sfax, Tunisia.
    Abdelmoula, Nouha Bouayed
    Med Univ Sfax, Tunisia.
    Novel combined UGT1A1 mutations in Crigler Najjar Syndrome type I2022In: Journal of clinical laboratory analysis (Print), ISSN 0887-8013, E-ISSN 1098-2825, Vol. 36, no 6, article id e24482Article in journal (Refereed)
    Abstract [en]

    Background Uridine diphosphate-glucuronosyl transferase 1A1 (UGT1A1), which is the major UGT1 gene product, is located on chromosome 2q37. The expression of UGT1A1 is relatively managed by a polymorphic dinucleotide repeat inside the promoter TATA box consisting of 5-8 copies of a TA repeat. A (TA) 6TAA is considered as the wild type. The A (TA) 7TAA allele has been identified as the most frequent allele in the Caucasian populations while A (TA) 8TAA allele remains the rarest allele worldwide in North Africa, including the Arab populations. Methods The spectrum of UGT1A1 genetic mutations in seventeen Tunisian children affected by persistent unconjugated hyperbilirubinemias is represented in addition to their relatives, notably parents, sisters, and brothers. Tunisian children, from 16 unrelated families as well as a 17(th) family without CN1 affected child, were originated from the West Center of Tunisia. The promoter region and coding exons of the UGT1A1 were PCR amplified, subsequently subjected to Sanger sequencing. Results The frequencies of genotypes in CN1 patients were as follows (TA) (7/7) (12/17: 70.6%) and (TA) (8/8) (5/17: 29.4%). All patients harbored the c.1070A&gt;G mutation of exon 3 (UGT1A1*16) in the homozygous state. Among relatives of our patients (n = 16), who were all heterozygotes for UGT1A1*16, 13/16 (81.25%) had a heterozygous state for UGT1A1*1/UGT1A1*28 or (TA) (6/7) and, 18.75% (3/16) were heterozygous for UGT1A1*28/UGT1A1*37 or (TA) (7/8) of the promoter polymorphisms. Conclusion UGT1A1*16 accompanied with UGT1A1*28 or UGT1A1*37 had a specific geographic and ethnic distribution for CN pathogenesis in this Tunisian cohort.

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  • 10.
    Abdelsayed, Mena
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Bytyci, Ibadete
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Universi College, Bardhosh, Prishtina, Kosovo.
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Henein, Michael Y.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. Molecular and Clinical Sciences Research Institute, St George University London, UK; Institute of Fluid Dynamics, Brunel University, London, UK.
    Left Ventricular Contraction Duration Is the Most Powerful Predictor of Cardiac Events in LQTS: A Systematic Review and Meta-Analysis2020In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 9, no 9, article id 2820Article, review/survey (Refereed)
    Abstract [en]

    Background: Long-QT syndrome (LQTS) is primarily an electrical disorder characterized by a prolonged myocardial action potential. The delay in cardiac repolarization leads to electromechanical (EM) abnormalities, which adds a diagnostic value for LQTS. Prolonged left ventricular (LV) contraction was identified as a potential risk for arrhythmia. The aim of this meta-analysis was to assess the best predictor of all EM parameters for cardiac events (CEs) in LQTS patients. Methods: We systematically searched all electronic databases up to March 2020, to select studies that assessed the relationship between echocardiographic indices—contraction duration (CD), mechanical dispersion (MD), QRS onset to peak systolic strain (QAoC), and the EM window (EMW); and electrical indices— corrected QT interval (QTC), QTC dispersion, RR interval in relation to CEs in LQTS. This meta-analysis included a total of 1041 patients and 373 controls recruited from 12 studies. Results: The meta-analysis showed that LQTS patients had electrical and mechanical abnormalities as compared to controls—QTC, WMD 72.8; QTC dispersion, WMD 31.7; RR interval, WMD 91.5; CD, WMD 49.2; MD, WMD 15.9; QAoC, WMD 27.8; and EMW, WMD −62.4. These mechanical abnormalities were more profound in symptomatic compared to asymptomatic patients in whom disturbances were already manifest, compared to controls. A CD ≥430 ms had a summary sensitivity (SS) of 71%, specificity of 84%, and diagnostic odds ratio (DOR) >19.5 in predicting CEs. EMW and QTC had a lower accuracy. Conclusions: LQTS is associated with pronounced EM abnormalities, particularly prolonged LV myocardial CD, which is profound in symptomatic patients. These findings highlight the significant role of EM indices like CD in managing LQTS patients.

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  • 11. Abdon, NJ
    et al.
    Herlitz, J
    University of Borås, School of Health Science.
    Andrersson, B
    Peripartumcardiomyopathi an often mised diagnosis2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 23-24, p. 1152-1154Article in journal (Refereed)
    Abstract [sv]

    Peripartumkardiomyopati är en sällsynt form av hjärtsvikt. Diagnostiska kriterier är nytillkommen hjärtsvikt från sen graviditet och upp till fem månader efter förlossning, avsaknad av annan förklaring till hjärtsvikt och nedsatt systolisk vänsterkammarfunktion Orsaken till tillståndet tros vara omvandling av prolaktin till en kardiotoxisk variant. Terapin är den etablerade, men ACE-hämmare och ARB får inte ges till ammande mödrar. Hjärttransplantation har tillgripits. Maligna hjärtarytmier har krävt behandling med implanterbar defibrillator och pacemaker. Hämning av produktionen av prolaktin med bromokriptin har gett goda resultat i en liten studie. Resultaten har inte bekräftats.

  • 12.
    Abdukalikova, Anara
    et al.
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Computer Science.
    Kleyko, Denis
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Computer Science.
    Osipov, Evgeny
    Luleå University of Technology, Department of Computer Science, Electrical and Space Engineering, Computer Science.
    Wiklund, Urban
    Umeå University, Umeå, Sweden.
    Detection of Atrial Fibrillation from Short ECGs: Minimalistic Complexity Analysis for Feature-Based Classifiers2018In: Computing in Cardiology 2018: Proceedings / [ed] Christine Pickett; Cristiana Corsi; Pablo Laguna; Rob MacLeod, IEEE, 2018Conference paper (Refereed)
    Abstract [en]

    In order to facilitate data-driven solutions for early detection of atrial fibrillation (AF), the 2017 CinC conference challenge was devoted to automatic AF classification based on short ECG recordings. The proposed solutions concentrated on maximizing the classifiers F 1 score, whereas the complexity of the classifiers was not considered. However, we argue that this must be addressed as complexity places restrictions on the applicability of inexpensive devices for AF monitoring outside hospitals. Therefore, this study investigates the feasibility of complexity reduction by analyzing one of the solutions presented for the challenge.

  • 13. Abdukalikova, Anara
    et al.
    Kleyko, Denis
    Osipov, Evgeny
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    Detection of Atrial Fibrillation From Short ECGs: Minimalistic Complexity Analysis for Feature-Based Classifiers2018In: 2018 Computing in Cardiology Conference (CinC), IEEE, 2018Conference paper (Refereed)
    Abstract [en]

    In order to facilitate data-driven solutions for early detection of atrial fibrillation (AF), the 2017 CinC conference challenge was devoted to automatic AF classification based on short ECG recordings. The proposed solutions concentrated on maximizing the classifiers F-1 score, whereas the complexity of the classifiers was not considered. However, we argue that this must be addressed as complexity places restrictions on the applicability of inexpensive devices for AF monitoring outside hospitals. Therefore, this study investigates the feasibility of complexity reduction by analyzing one of the solutions presented for the challenge.

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  • 14.
    Abdullah, Saad
    et al.
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Abdelakram, Hafid
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Lindén, Maria
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Folke, Mia
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Kristoffersson, Annica
    Mälardalen University, School of Innovation, Design and Engineering, Embedded Systems.
    Machine Learning-Based Classification of Hypertension using CnD Features from Acceleration Photoplethysmography and Clinical Parameters2023In: Proceedings - IEEE Symposium on Computer-Based Medical Systems, Institute of Electrical and Electronics Engineers Inc. , 2023, p. 923-924Conference paper (Refereed)
    Abstract [en]

    Cardiovascular diseases (CVDs) are a leading cause of death worldwide, and hypertension is a major risk factor for acquiring CVDs. Early detection and treatment of hypertension can significantly reduce the risk of developing CVDs and related complications. In this study, a linear SVM machine learning model was used to classify subjects as normal or at different stages of hypertension. The features combined statistical parameters derived from the acceleration plethysmography waveforms and clinical parameters extracted from a publicly available dataset. The model achieved an overall accuracy of 87.50% on the validation dataset and 95.35% on the test dataset. The model's true positive rate and positive predictivity was high in all classes, indicating a high accuracy, and precision. This study represents the first attempt to classify cardiovascular conditions using a combination of acceleration photoplethysmogram (APG) features and clinical parameters The study demonstrates the potential of APG analysis as a valuable tool for early detection of hypertension.

  • 15.
    Abedpour Dehkordi, Adel
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Nayeri, H.
    Naderi, G. A.
    Dinani, N. Jafari
    Boshtam, M.
    Interleukin-6 reduces paraoxonase-1 activity in a dose-dependent manner: evidence for a potential novel lipoprotein-based modulatory mechanism2016In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 252, p. E113-E114Article in journal (Other academic)
    Abstract [en]

    Objectives: The anti-oxidant/anti-inflammatory nature of HDL is mainly associated with paraoxonase-1 (PON1). Previous studies have revealed an inverse correlation between Interleukin-6 (IL-6) and PON1 expression. The current study investigates the effect of IL-6 on serum PON1 activity in vitro, given the potential structural capability of PON1 to host multiple ligands. Methods: PON1 activity was measured spectrophotometrically (234 nm) using paraoxon substrate in the presence of concentrations of IL-6 than control samples. A sequence alignment using the FASTA sequence was manually conducted to identify possible homologies between PON1 and the IL-6-binding protein. Statistical analysis was conducted using GraphPad Prism v5.0. Results: PON1 enzyme activity decreased by 15%, 26% (P<0.05) and 55% (P<0.001) in the presence of 4, 10 and 20 pg/ml of IL-6, respectively. in comparison with the controls. Student t. test was used as statistical method (p<0.05: statistically significant). There are potential homologies between PON1 active sites and know IL-6-binding residues. Conclusions: This study shows that IL-6 directly reduce the PON1 activity in a dose-dependent manner. This observation supports some studies indicating inverse correlation between PON1 and IL-6. However, as opposed to the gene-mediated approach, this study suggest that IL-6 may act directly through specific binding to PON1 (biochemical modulation). X ray crystallography can further scrutinize the present finding.

  • 16. Aboyans, Victor
    et al.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Naylor, A Ross
    Roffi, Marco
    Tendera, Michal
    Vlachopoulos, Charalambos
    Ricco, Jean-Baptiste
    Questions and answers on diagnosis and management of patients with Peripheral Arterial Diseases: a companion document of the 2017 ESC Guidelines for the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 9, p. E35-E41Article in journal (Refereed)
  • 17. Aboyans, Victor
    et al.
    Ricco, Jean-Baptiste
    Bartelink, Marie-Louise E L
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Cohnert, Tina
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Debus, Sebastian
    Espinola-Klein, Christine
    Kahan, Thomas
    Kownator, Serge
    Mazzolai, Lucia
    Naylor, A Ross
    Roffi, Marco
    Röther, Joachim
    Sprynger, Muriel
    Tendera, Michal
    Tepe, Gunnar
    Venermo, Maarit
    Vlachopoulos, Charalambos
    Desormais, Ileana
    2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries2018In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, no 9, p. 763-816Article in journal (Refereed)
  • 18. Aboyans, Victor
    et al.
    Ricco, Jean-Baptiste
    Bartelink, Marie-Louise E L
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Brodmann, Marianne
    Cohnert, Tina
    Collet, Jean-Philippe
    Czerny, Martin
    De Carlo, Marco
    Debus, Sebastian
    Espinola-Klein, Christine
    Kahan, Thomas
    Kownator, Serge
    Mazzolai, Lucia
    Naylor, A Ross
    Roffi, Marco
    Röther, Joachim
    Sprynger, Muriel
    Tendera, Michal
    Tepe, Gunnar
    Venermo, Maarit
    Vlachopoulos, Charalambos
    Desormais, Ileana
    Widimsky, Petr
    Kolh, Philippe
    Agewall, Stefan
    Bueno, Héctor
    Coca, Antonio
    De Borst, Gert J
    Delgado, Victoria
    Dick, Florian
    Erol, Cetin
    Ferrini, Marc
    Kakkos, Stavros
    Katus, Hugo A
    Knuuti, Juhani
    Lindholt, Jes
    Mattle, Heinrich
    Pieniazek, Piotr
    Piepoli, Massimo Francesco
    Scheinert, Dierk
    Sievert, Horst
    Simpson, Iain
    Sulzenko, Jakub
    Tamargo, Juan
    Tokgozoglu, Lale
    Torbicki, Adam
    Tsakountakis, Nikolaos
    Tuñón, José
    de Ceniga, Melina Vega
    Windecker, Stephan
    Zamorano, Jose Luis
    2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS)2018In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 55, no 3, p. 305-368Article in journal (Refereed)
  • 19.
    Abrahams-Gessel, Shafika
    et al.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States.
    Gómez-Olivé, F. Xavier
    Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Wade, Alisha N.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Du Toit, Jacques D.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.
    Ferro, Enrico G.
    Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, MA, Boston, United States; Harvard Medical School, MA, Boston, United States.
    Kabudula, Chodziwadziwa W.
    Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa; Africa Wits-INDEPTH Partnership for Genomic Studies, University of the Witwatersrand, Johannesburg, South Africa.
    Gaziano, Thomas A.
    Center for Health Decision Science, Harvard T.H. Chan School of Public Health, MA, Boston, United States; Harvard Center for Population and Development Studies, Harvard University, MA, Cambridge, United States; Cardiovascular Medicine Division, Brigham & Women's Hospital, MA, Boston, United States.
    Improvements in Hypertension Control in the Rural Longitudinal HAALSI Cohort of South African Adults Aged 40 and Older, From 2014 to 20192023In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 36, no 6, p. 324-332Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Over half of the South African adults aged 45 years and older have hypertension but its effective management along the treatment cascade (awareness, treatment, and control) remains poorly understood.

    METHODS: We compared the prevalence of all stages of the hypertension treatment cascade in the rural HAALSI cohort of older adults at baseline and after four years of follow-up using household surveys and blood pressure data. Hypertension was a mean systolic blood pressure >140 mm Hg or diastolic pressure >90 mm Hg, or current use of anti-hypertension medication. Control was a mean blood pressure <140/90 mm Hg. The effects of sex and age on the treatment cascade at follow-up were assessed. Multivariate Poisson regression models were used to estimate prevalence ratios along the treatment cascade at follow-up.

    RESULTS: Prevalence along the treatment cascade increased from baseline (B) to follow-up (F): awareness (64.4% vs. 83.6%), treatment (49.7% vs. 73.9%), and control (22.8% vs. 41.3%). At both time points, women had higher levels of awareness (B: 70.5% vs. 56.3%; F: 88.1% vs. 76.7%), treatment (B: 55.9% vs. 41.55; F: 79.9% vs. 64.7%), and control (B: 26.5% vs. 17.9%; F: 44.8% vs. 35.7%). Prevalence along the cascade increased linearly with age for everyone. Predictors of awareness included being female, elderly, or visiting a primary health clinic three times in the previous 3 months, and the latter two also predicted hypertension control.

    CONCLUSIONS: There were significant improvements in awareness, treatment, and control of hypertension from baseline to follow-up and women fared better at all stages, at both time points.

  • 20.
    Abrahamsson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Editorial Material: Not all probiotic strains prevent necrotising enterocolitis in premature infants in LANCET, vol 387, issue 10019, pp 624-6252016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 387, no 10019, p. 624-625Article in journal (Other academic)
    Abstract [en]

    n/a

  • 21.
    Abramsson, Linnea
    et al.
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Backman, Annica C.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine. Umeå University, Faculty of Medicine, Wallenberg Centre for Molecular Medicine at Umeå University (WCMM).
    Edvardsson, David
    School of Nursing and Midwifery, La Trobe University, VIC, Bundoora, Australia.
    Gustafsson, Maria
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Use of heart failure medications in older individuals and associations with cognitive impairment2023In: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, no 1, article id 524Article in journal (Refereed)
    Abstract [en]

    Background: To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.

    Methods: The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.

    Results: Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026–1.152, p < 0.05) and (OR 1.057; 95% CI 1.017–1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918–0.984, p < 0.05) and (OR 0.781; 95% CI 0.645–0.946, p < 0.05), respectively.

    Conclusions: Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.

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  • 22. Abtan, Jeremie
    et al.
    Bhatt, Deepak L
    Held, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Simon, Tabassome
    Fox, Kim
    Mehta, Shamir R
    Harrington, Robert A
    Gao, Qi
    Leiter, Lawrence A
    Steg, Ph Gabriel
    Incidence of Myocardial Infarction Types in Patients Treated With Ticagrelor in the THEMIS Trial2021In: Circulation. Cardiovascular Interventions, ISSN 1941-7640, E-ISSN 1941-7632, Vol. 14, no 12, article id 011035Article in journal (Refereed)
  • 23.
    Aburawi, Elhadi H.
    et al.
    Department of Pediatrics, UAE University, Al Ain, United Arab Emirates.
    Östlundh, Linda
    Örebro University, University Library.
    Aburawi, Hanan E.
    Department of Biology, College of Sciences, UAE University, Al Ain, United Arab Emirates.
    Al Rifai, Rami H.
    Institute of Public Health, College of Medicine & Health Sciences, UAE University, Al Ain, United Arab Emirates.
    Bhagavathula, Akshaya
    Department of Public Health, North Dakota State University, Fargo, ND, United States of America.
    Bellou, Abdelouahab
    Department of Pediatrics, UAE University, Al Ain, United Arab Emirates; Department of Emergency Medicine, Institute of Sciences in Emergency Medicine, Guangdong Provincial People 's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, United States of America; Global Network on Emergency Medicine, Brookline, MA, United States of America.
    Epigenetics of conotruncal congenital heart disease: Protocol for a systematic review and meta-analysis2024In: PLOS ONE, E-ISSN 1932-6203, Vol. 19, no 4, article id e0302642Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Conotruncal congenital heart defects (CTD) are a subset of congenital heart diseases (CHD) that involve structural anomalies of the right, left, or both cardiac outflow tracts. CHD is caused by multifactorial inheritance and changes in the genes or chromosomes. Recently, CHD was found to be due to epigenetic alterations, which are a combination of genetic and other environmental factors. Epigenetics is the study of how a gene's function changes as a result of environmental and behavioral influences. These causative factors can indirectly cause CHD by altering the DNA through epigenetic modifications. This is a protocol for a systematic review and meta-analysis that aims to explore whether the strength of association between various epigenetic changes and CTD types varies by race. Furthermore, to determine and compare the changes in gene expression of each mutation.

    METHODS: Our protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. A comprehensive pre-search has been developed in PubMed and PubMed's Medical Subject Headings (MeSH). The final search will be performed in June 2023 in PubMed, Embase, Scopus, Web of Science, Cochrane Library, CIANHL, and PsycInfo, without restrictions on publication years. The Covidence systematic review software will be used for blinded screening and selection. Conflicts will be resolved by a third, independent reviewer. The risk of bias in selected studies will be assessed using the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The data to be extracted will cover basic information on the included studies, study sample size, number of patients with various types of epigenetic changes, number of patients with various CTD types, measures of association and their 95% confidence interval between each epigenetic change and each CTD. The protocol has been registered with the International Prospero Register of Systematic Review (PROSPERO) [CRD42023377597].

    DISCUSSION: To the best of our knowledge, this protocol outlines the first systematic review and meta-analysis of the epigenetics of CTD. There is a growing body of evidence on epigenetics and its indirect involvement in disease by altering the DNA through epigenetic modifications in the genes associated with the causative factors for CHD. We will conduct a comprehensive and systematic search for literature in the above-mentioned seven core biomedical databases. It is very important to identify population-specific risk factors for CHD, which will have significant creative, custom-made, and effective prevention programs for the future generation.

  • 24. Achouiti, A.
    et al.
    Vogl, T.
    Urban, Constantin
    Umeå University, Faculty of Medicine, Molecular Infection Medicine Sweden (MIMS).
    Hommes, T. J.
    van Zoelen, M. A.
    Florquin, S.
    Roth, J.
    van 't Veer, C.
    de Vos, A. F.
    van der Poll, T.
    Myeloid related protein (mrp) 8/14 contributes to an antibacterial host response against klebsiella (k.) pneumoniae2012In: Shock, ISSN 1073-2322, E-ISSN 1540-0514, Vol. 37, no S1, p. 56-56Article in journal (Other academic)
  • 25.
    Acosta, S.
    et al.
    Lund Univ, Dept Clin Sci, Vasc Ctr, Malmo, Sweden..
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Negative-pressure wound therapy for prevention and treatment of surgical-site infections after vascular surgery2017In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 104, no 2, p. E75-E84Article, review/survey (Refereed)
    Abstract [en]

    BackgroundIndications for negative-pressure wound therapy (NPWT) in vascular surgical patients are expanding. The aim of this review was to outline the evidence for NPWT on open and closed wounds. MethodsA PubMed, EMBASE and Cochrane Library search from 2007 to June 2016 was performed combining the medical subject headings terms wound infection', abdominal aortic aneurysm (AAA)', fasciotomy', vascular surgery' and NPWT' or VAC'. ResultsNPWT of open infected groin wounds was associated with shorter duration of wound healing by 47 days, and was more cost-effective than alginate dressings in one RCT. In one RCT and six observational studies, NPWT-related major bleeding and graft preservation rates were 0-10 and 83-100 per cent respectively. One retrospective comparative study showed greater wound size reduction per day, fewer dressing changes, quicker wound closure and shorter hospital stay with NPWT compared with gauze dressings for lower leg fasciotomy. NPWT and mesh-mediated fascial traction after AAA repair and open abdomen was associated with high primary fascial closure rates (96-100 per cent) and low risk of graft infection (0-7 per cent). One retrospective comparative study showed a significant reduction in surgical-site infection, from 30 per cent with standard wound care to 6 per cent with closed incisional NPWT. ConclusionNPWT has a central role in open and infected wounds after vascular surgery; the results of prophylactic care of closed incisions are promising.

  • 26.
    Acosta, S.
    et al.
    Lund Univ, Vasc Ctr, Dept Clin Sci, Malmo, Sweden..
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Temporary Abdominal Closure After Abdominal Aortic Aneurysm Repair: A Systematic Review of Contemporary Observational Studies2016In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 51, no 3, p. 371-378Article, review/survey (Refereed)
    Abstract [en]

    Objectives: The aim of this paper was to review the literature on temporary abdominal closure (TAC) after abdominal aortic aneurysm (AAA) repair. Methods: This was a systematic review of observational studies. A PubMed, EM BASE and Cochrane search from 2007 to July 2015 was performed combining the Medical Subject Headings "aortic aneurysm" and "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy", or "vacuum assisted wound closure". Results: Seven original studies were found. The methods used for TAC were the vacuum pack system with (n = 1) or without (n = 2) mesh bridge, vacuum assisted wound closure (VAWC; n = 1) and the VAWC with mesh mediated fascial traction (VACM; n = 3). The number of patients included varied from four to 30. Three studies were exclusively after open repair, one after endovascular aneurysm repair, and three were mixed series. The frequency of ruptured AAA varied from 60% to 100%. The primary fascia] closure rate varied from 79% to 100%. The median time to closure of the open abdomen was 10.5 and 17 days in two prospective studies with a fascia] closure rate of 100% and 96%, respectively; the inclusion criterion was an anticipated open abdomen therapy time >= 5 days using the VACM method. The graft infection rate was 0% in three studies. No patient with longterm open abdomen therapy with the VACM in the three studies was left with a planned ventral hernia. The in hospital survival rate varied from 46% to 80%. Conclusions: A high fascial closure rate without planned ventral hernia is possible to achieve with VACM, even after long-term open abdomen therapy. There are, however, few publications reporting specific results of open abdomen treatment after AAA repair, and there is a need for randomized controlled trials to determine the most efficient and safe TAC method during open abdomen treatment after AAA repair.

  • 27.
    Acosta, Stefan
    et al.
    Vascular Center, Skåne University Hospital, Malmö, Sweden.
    Nilsson, Torbjörn
    Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden.
    Current status on plasma biomarkers for acute mesenteric ischemia2012In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 33, no 4, p. 355-361Article, review/survey (Refereed)
    Abstract [en]

    Clinical diagnosis of acute mesenteric ischemia is difficult. The aim of this review is to provide current status on the search for an accurate plasma biomarker for acute mesenteric ischemia. A search using the medical subject heading terms marker and mesenteric ischemia or intestinal ischemia or superior mesenteric artery occlusion or mesenteric venous thrombosis in the Medline and Embase databases from 1980 to 2011. Studies without a control group or a control group consisted of healthy individuals (human studies), or studies on intestinal reperfusion were excluded. Twenty animal and twelve human studies were identified. In human studies, the studied series of patients had a control group that had a need of laparotomy (n = 2), suspected acute mesenteric ischemia (n = 7), acute abdomen (n = 2) or systemic inflammatory response syndrome (n = 1). D: -dimer has been found to be the most consistent highly sensitive early marker, but specificity was low. The follow-up study on α-glutathione S-transferase yielded inferior sensitivity and accuracy than the preliminary study, clearly questioning the value of this marker. Intestinal fatty acid binding globulin (I-FABP) and D: -lactate are both interesting markers, but the results were conflicting. Different cut-off levels have been used in the studies on I-FABP. The encouraging preliminary result of cobalt-albumin and urinary FABP as an accurate marker needs to be addressed in other study populations. The early clinical and laboratory diagnosis of intestinal ischemia remains a challenge. None of the proposed plasma-derived tests for acute mesenteric ischemia has as yet entered routine clinical practice. The proposed biomarkers need to be evaluated in a prospective clinical research project in patients with acute abdomen.

  • 28. Acosta, Stefan
    et al.
    Nilsson, Torbjörn K
    Department of Clinical Chemistry, Örebro University Hospital.
    Current status on plasma biomarkers for acute mesenteric ischemia2012In: Journal of Thrombosis and Thrombolysis, ISSN 0929-5305, E-ISSN 1573-742X, Vol. 33, no 4, p. 355-361Article in journal (Refereed)
    Abstract [en]

    Clinical diagnosis of acute mesenteric ischemia is difficult. The aim of this review is to provide current status on the search for an accurate plasma biomarker for acute mesenteric ischemia. A search using the medical subject heading terms marker and mesenteric ischemia or intestinal ischemia or superior mesenteric artery occlusion or mesenteric venous thrombosis in the Medline and Embase databases from 1980 to 2011. Studies without a control group or a control group consisted of healthy individuals (human studies), or studies on intestinal reperfusion were excluded. Twenty animal and twelve human studies were identified. In human studies, the studied series of patients had a control group that had a need of laparotomy (n = 2), suspected acute mesenteric ischemia (n = 7), acute abdomen (n = 2) or systemic inflammatory response syndrome (n = 1). D: -dimer has been found to be the most consistent highly sensitive early marker, but specificity was low. The follow-up study on α-glutathione S-transferase yielded inferior sensitivity and accuracy than the preliminary study, clearly questioning the value of this marker. Intestinal fatty acid binding globulin (I-FABP) and D: -lactate are both interesting markers, but the results were conflicting. Different cut-off levels have been used in the studies on I-FABP. The encouraging preliminary result of cobalt-albumin and urinary FABP as an accurate marker needs to be addressed in other study populations. The early clinical and laboratory diagnosis of intestinal ischemia remains a challenge. None of the proposed plasma-derived tests for acute mesenteric ischemia has as yet entered routine clinical practice. The proposed biomarkers need to be evaluated in a prospective clinical research project in patients with acute abdomen.

  • 29.
    Acuña Mora, Mariela
    et al.
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;KU Leuven Department of Public Health and Primary Care, Belgium.
    Sparud-Lundin, Carina
    Institute of Health and Care Sciences, University of Gothenburg, Sweden.
    Burström, Åsa
    Institution for Women’s and Children’s Health, Karolinska Institute, Sweden;Department of Paediatric Cardiology, Astrid Lindgren Children’s Hospital, Sweden.
    Hanseus, Katarina
    Department of Pediatric Cardiology, Skåne University Hospital, Sweden.
    Rydberg, Annika
    Department of Clinical Sciences, Pediatrics, Umeå University, Sweden.
    Moons, Philip
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;KU Leuven Department of Public Health and Primary Care, Belgium;Department of Paediatrics and Child Health, University of Cape Town, South Africa.
    Bratt, Ewa-Lena
    Institute of Health and Care Sciences, University of Gothenburg, Sweden;Department of Pediatric Cardiology, The Queen Silvia Children’s Hospital, Sweden.
    Patient empowerment and its correlates in young persons with congenital heart disease2019In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 5, p. 389-398Article in journal (Refereed)
  • 30.
    Adam, Lina N.
    et al.
    Univ Zakho, Coll Sci, Dept Biol, Duhok, Kurdistan Regio, Iraq..
    Al-Habib, Omar A. M.
    Univ Nawroz, Coll Sci, Dept Biol, Duhok, Kurdistan Regio, Iraq..
    Oraha, Ashur Y.
    Univ Duhok, Coll Med, Dept Cardiothorac & Vasc Surg, Duhok, Kurdistan Regio, Iraq..
    Shekha, Mudhir S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Salahaddin Univ Erbil, Coll Sci, Dept Biol, Erbil, Kurdistan Regio, Iraq..
    Genetic and clinical study of myeloperoxidase's association with coronary artery disease2024In: EGYPTIAN HEART JOURNAL, ISSN 1110-2608, Vol. 76, no 1, article id 27Article in journal (Refereed)
    Abstract [en]

    BackgroundUnraveling myeloperoxidase's (MPO) correlation with coronary artery disease (CAD) and genetic variations, this study seeks to enhance diagnostic precision and therapeutic strategies.ResultsCAD patients were found to be older and more male than controls. Several clinical parameters, including glucose, total bilirubin, alkaline phosphatase, creatinine, and troponin levels, showed significant variations. Moreover, CAD patients had lower red cell distribution width (RDW%) and mean platelet volume (MPV) than controls. Serum MPO levels did not differ significantly between CAD patients and controls, and no correlation was found with other clinical parameters except for glucose, creatinine, and total bilirubin.ConclusionsThe data suggest that serum MPO levels are not substantially related to CAD patients, as indicated by lower MPO levels in CAD patients compared to controls. While highlighting the potential of MPV and RDW% as predictors of severe atherosclerosis in CAD. Further research is needed to validate the diagnostic and prognostic value of RDW%, MPV, and MPO levels in CAD.Trial registration: 15092021-9-12. Registered 15 September 2021.ConclusionsThe data suggest that serum MPO levels are not substantially related to CAD patients, as indicated by lower MPO levels in CAD patients compared to controls. While highlighting the potential of MPV and RDW% as predictors of severe atherosclerosis in CAD. Further research is needed to validate the diagnostic and prognostic value of RDW%, MPV, and MPO levels in CAD.Trial registration: 15092021-9-12. Registered 15 September 2021.

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    FULLTEXT01
  • 31.
    Adam, Lina N.
    et al.
    Univ Zakho, Fac Sci, Dept Biol, Duhok, Kurdistan, Iraq..
    Oraha, Ashur Y.
    Univ Duhok, Coll Med, Dept Cardiothorac & Vasc Surg, Duhok, Kurdistan, Iraq..
    Shekha, Mudhir S.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Salahaddin Univ Erbil, Coll Sci, Dept Biol, Erbil, Kurdistan, Iraq..
    Al-Habib, Omar A. M.
    Univ Nawroz, Coll Sci, Dept Biol, Duhok, Kurdistan, Iraq..
    Exploring nitric oxide as a crucial prognostic biomarker of coronary artery disease2023In: Prostaglandins & other lipid mediators, ISSN 1098-8823, E-ISSN 2212-196X, Vol. 165, article id 106717Article in journal (Refereed)
    Abstract [en]

    Purpose: The study aimed to examine if the polymorphism of the endothelial nitric oxide synthase (eNOS) gene variable number of tandem repeats (VNTR) and the serum NO levels are associated with CAD.

    Materials/methods: Case-control study, 70 CAD and 30 control subjects were enrolled. The eNOS gene poly-morphism was measured by polymerase chain reaction-agarose gel electrophoresis and the serum NO was assessed by using an ELISA plate and reader covering 540 nm.

    Results: Uncovering the area under curve (AUC) for serum NO, which was (0.6821), indicating that NO seemed to be a critical prognostic biomarker of CAD; also, glucose, serum creatinine and total bilirubin proved to be sig-nificant predictors of CAD with AUC (0.6793, 0.6717 and 0.6662) respectively. Furthermore, higher serum NO levels were associated with the eNOS (ab) genotype. Revealing the intron (a) allele was protective against CAD. Moreover, diminished levels of serum NO in CAD groups compared to controls (P < 0.05). Additionally, Multiple logistic regression analysis shows a significantly high Odds ratio associated with CAD in the Duhok population.

    Conclusions: The eNOS (ab) variant seems to be a protective CAD factor for patients. Low serum NO levels are another risk factor for the advancement of CAD, suggesting their involvement in atherosclerosis. The (a) allele's protective effect is mediated through changes in eNOS promoter activity and higher NO levels.

  • 32.
    Adamo, Marianna
    et al.
    Univ Brescia, Italy.
    Chioncel, Ovidiu
    Univ Med & Pharm Carol Davila, Romania.
    Pagnesi, Matteo
    Univ Brescia, Italy.
    Bayes-Genis, Antoni
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Abdelhamid, Magdy
    Cairo Univ, Egypt.
    Anker, Stefan D.
    German Ctr Cardiovasc Res DZHK, Germany; Charite Univ Med Berlin, Germany.
    Antohi, Elena-Laura
    Univ Med & Pharm Carol Davila, Romania.
    Badano, Luigi
    Ist Auxol Italiano, Italy; Univ Milano Bicocca, Italy.
    Ben Gal, Tuvia
    Tel Aviv Univ, Israel.
    Boehm, Michael
    Saarland Univ Hosp, Germany.
    Delgado, Victoria
    Univ Hosp Germans Trias i Pujol, Spain; Univ Hosp Germans Trias i Pujol, Spain; Univ Autonoma Barcelona, Spain; Inst Salud Carlos III, Spain.
    Dreyfus, Julien
    Ctr Cardiol Nord, France.
    Faletra, Francesco F.
    ISMETT Ist Mediterraneo Trapianti & Terapie Alta S, Italy; Fdn Cardioctr Ticino, Switzerland.
    Farmakis, Dimitrios
    Athens Univ Hosp Attikon, Greece.
    Filippatos, Gerasimos
    Athens Univ Hosp Attikon, Greece.
    Grapsa, Julia
    Kings Coll London, England.
    Gustafsson, Finn
    Copenhagen Univ Hosp, Denmark.
    Hausleiter, Joerg
    Div Cardiol, Germany.
    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.
    Karam, Nicole
    Univ Paris Cite, France.
    Lund, Lars
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Lurz, Philipp
    Univ Med Ctr Mainz, Germany.
    Maisano, Francesco
    Univ Vita Salute, Italy.
    Moura, Brenda
    Univ Porto, Portugal; Porto Armed Forces Hosp, Portugal.
    Mullens, Wilfred
    Hosp Oost Limburg, Belgium.
    Praz, Fabien
    Univ Bern, Switzerland.
    Sannino, Anna
    Univ Naples Federico II, Italy.
    Savarese, Gianluigi
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Tocchetti, Carlo Gabriele
    Univ Naples Federico II, Italy.
    van Empel, Vanessa P. M.
    Maastricht Univ Med Ctr MUMC, Netherlands.
    von Bardeleben, Ralph Stephan
    Univ Med Ctr Mainz, Germany.
    Yilmaz, Mehmet Birhan
    Dokuz Eylul Univ, Turkiye.
    Zamorano, Jose Luis
    Hosp Univ Ramon y Cajal, Spain.
    Ponikowski, Piotr
    Wroclaw Med Univ, Poland.
    Barbato, Emanuele
    Sapienza Univ Rome, Italy.
    Rosano, Giuseppe M. C.
    Dept Med Sci, Italy.
    Metra, Marco
    Univ Brescia, Italy; Univ Brescia, Italy.
    Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC2024In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed)
    Abstract [en]

    Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.

  • 33.
    Adamopoulos, Stamatis
    et al.
    Onassis Cardiac Surg Ctr, Greece.
    Corra, Ugo
    Ctr Med Riabilitaz Veruno, Italy.
    Laoutaris, Ioannis D.
    Onassis Cardiac Surg Ctr, Greece.
    Pistono, Massimo
    Ctr Med Riabilitaz Veruno, Italy.
    Agostoni, Pier Giuseppe
    IRCCS, Italy; Univ Milan, Italy.
    Coats, Andrew J. S.
    IRCCS San Raffaele Pisana, Italy.
    Leiro, Maria G. Crespo
    UDC, Spain.
    Cornelis, Justien
    Univ Antwerp, Belgium.
    Davos, Constantinos H.
    Acad Athens, Greece.
    Filippatos, Gerasimos
    Attikon Univ Hosp, Greece.
    Lund, Lars H.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ruschitzka, Frank
    Univ Heart Ctr, Switzerland.
    Seferovic, Petar M.
    Univ Belgrade, Serbia.
    Schmid, Jean-Paul
    Klin Barmelweid AG, Switzerland.
    Volterrani, Maurizio
    IRCCS San Raffaele Pisana, Italy.
    Piepoli, Massimo F.
    Guglielmo da Saliceto Hosp, Italy.
    Exercise training in patients with ventricular assist devices: a review of the evidence and practical advice. A position paper from the Committee on Exercise Physiology and Training and the Committee of Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology2019In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 21, no 1Article, review/survey (Refereed)
    Abstract [en]

    Exercise training (ET) and secondary prevention measures in cardiovascular disease aim to stimulate early physical activity and to facilitate recovery and improve health behaviours. ET has also been proposed for heart failure patients with a ventricular assist device (VAD), to help recovery in the patients functional capacity. However, the existing evidence in support of ET in these patients remains limited. After a review of current knowledge on the causes of the persistence of limitation in exercise capacity in VAD recipients, and concerning the benefit of ET in VAD patients, the Heart Failure Association of the European Society of Cardiology has developed the present document to provide practical advice on implementing ET. This includes appropriate screening to avoid complications and then starting with early mobilisation, ET prescription is individualised to meet the patients needs. Finally, gaps in our knowledge are discussed.

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    fulltext
  • 34.
    Adamski, Jan
    et al.
    Univ Warmia & Mazury, Fac Med Sci, Dept Anaesthesiol & Intens Care, Ul Warszawska 30, PL-10082 Olsztyn, Poland..
    Weigl, Wojciech
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Musialowicz, Tadeusz
    Kuopio Univ Hosp, Dept Anaesthesiol & Intens Care Med, Kuopio, Finland..
    Lahtinen, Pasi
    Cent Hosp South Ostrobothnia, Anaesthesiol & Intens Care Dept, Seinajoki, Finland..
    Reinikainen, Matti
    Kuopio Univ Hosp, Dept Anaesthesiol & Intens Care Med, Kuopio, Finland.;Univ Eastern Finland, Fac Hlth Sci, Sch Med, Inst Clin Med, Kuopio, Finland..
    Predictors of treatment limitations in Finnish intensive care units2022In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 66, no 4, p. 526-538Article in journal (Refereed)
    Abstract [en]

    Background Few studies have examined the factors that predict the limitations of life-sustaining treatment (LST) to patients in intensive care units (ICUs). We aimed to identify variables associated with the decision of withholding of life support (WHLS) at admission, WHLS during ICU stay and the withdrawal of ongoing life support (WDLS). Methods This retrospective observational study comprised 17,772 adult ICU patients who were included in the nationwide Finnish ICU Registry in 2016. Factors associated with LST limitations were identified using hierarchical logistic regression. Results The decision of WHLS at admission was made for 822 (4.6%) patients, WHLS during ICU stay for 949 (5.3%) patients, and WDLS for 669 (3.8%) patients. Factors strongly predicting WHLS at admission included old age (adjusted odds ratio [OR] for patients aged 90 years or older in reference to those younger than 40 years was 95.6; 95% confidence interval [CI], 47.2-193.5), dependence on help for activities of daily living (OR, 3.55; 95% CI, 3.01-4.2), and metastatic cancer (OR, 4.34; 95% CI, 3.16-5.95). A high severity of illness predicted later decisions to limit LST. Diagnoses strongly associated with WHLS at admission were cardiac arrest, hepatic failure and chronic obstructive pulmonary disease. Later decisions were strongly associated with cardiac arrest, hepatic failure, non-traumatic intracranial hemorrhage, head trauma and stroke. Conclusion Early decisions to limit LST were typically associated with old age and chronic poor health whereas later decisions were related to the severity of illness. Limitations are common for certain diagnoses, particularly cardiac arrest and hepatic failure.

  • 35. Adamson, Carly
    et al.
    Cowan, Lorna M.
    de Boer, Rudolf A.
    Diez, Mirta
    Drozdz, Jaroslaw
    Dukat, Andre
    Inzucchi, Silvio E.
    Kober, Lars
    Kosiborod, Mikhail N.
    Ljungman, Charlotta E. A.
    Martinez, Felipe A.
    Ponikowski, Piotr
    Sabatine, Marc S.
    Lindholm, Daniel
    Bengtsson, Olof
    Boulton, David W.
    Greasley, Peter J.
    Langkilde, Anna Maria
    Sjostrand, Mikaela
    Solomon, Scott D.
    McMurray, John J. V.
    Jhund, Pardeep S.
    Liver Tests and Outcomes in Heart Failure with Reduced Ejection Fraction: Findings from DAPA-HF.2022In: European journal of heart failure, ISSN 1879-0844 1388-9842, Vol. 24, no 10, p. 1856-1868Article in journal (Refereed)
    Abstract [en]

    AIMS: Reflecting both increased venous pressure and reduced cardiac output, abnormal liver tests are common in patients with severe heart failure and are associated with adverse clinical outcomes. We aimed to investigate the prognostic significance of abnormal liver tests in ambulatory patients with heart failure with reduced ejection fraction (HFrEF), explore any treatment interaction between bilirubin and sodium- glucose cotransporter 2 (SGLT2) inhibitors and examine change in liver tests with SGLT2 inhibitor treatment. METHODS AND RESULTS: We explored these objectives in the Dapagliflozin And Prevention of Adverse outcomes in Heart Failure (DAPA-HF) trial, with focus on bilirubin. We calculated the incidence of cardiovascular death or worsening heart failure by bilirubin tertile. Secondary cardiovascular outcomes were examined, along with the change in liver tests at the end-of-study visit. Baseline bilirubin was available in 4720 patients (99.5%). Participants in the highest bilirubin tertile (T3) have more severe HFrEF (lower left ventricular ejection fraction, higher N-terminal pro-B-type natriuretic peptide [NT-proBNP] and worse New York Heart Association class), had a greater burden of atrial fibrillation but less diabetes. Higher bilirubin (T3 vs. T1) was associated with worse outcomes even after adjustment for other predictive variables, including NT-proBNP and troponin T (adjusted hazard ratio for the primary outcome 1.73 [95% confidence interval 1.37-2.17], p $<$ 0.001; and 1.52 [1.12-2.07], p = 0.01 for cardiovascular death). Baseline bilirubin did not modify the benefits of dapagliflozin. During follow-up, dapagliflozin had no effect on liver tests. CONCLUSION: Bilirubin concentration was an independent predictor of worse outcomes but did not modify the benefits of dapagliflozin in HFrEF. Dapagliflozin was not associated with change in liver tests. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03036124.

  • 36. Adamson, Carly
    et al.
    Jhund, Pardeep S.
    Docherty, Kieran F.
    Belohlavek, Jan
    Chiang, Chern-En
    Diez, Mirta
    Drozdz, Jaroslaw
    Dukat, Andrej
    Howlett, Jonathan
    Ljungman, Charlotta E. A.
    Petrie, Mark C.
    Schou, Morten
    Inzucchi, Silvio E.
    Kober, Lars
    Kosiborod, Mikhail N.
    Martinez, Felipe A.
    Ponikowski, Piotr
    Sabatine, Marc S.
    Solomon, Scott D.
    Bengtsson, Olof
    Langkilde, Anna Maria
    Lindholm, Daniel
    Sjostrand, Mikaela
    McMurray, John J. V.
    Efficacy of Dapagliflozin in Heart Failure with Reduced Ejection Fraction According to Body Mass Index.2021In: European journal of heart failure, ISSN 1879-0844 1388-9842, Vol. 23, no 10, p. 1662-1672Article in journal (Refereed)
    Abstract [en]

    AIMS: In heart failure with reduced ejection fraction (HFrEF), there is an ’obesity paradox’, where survival is better in patients with a higher body mass index (BMI) and weight loss is associated with worse outcomes. We examined the effect of a sodium-glucose co-transporter 2 inhibitor according to baseline BMI in the Dapagliflozin And Prevention of Adverse- outcomes in Heart Failure trial (DAPA-HF). METHODS AND RESULTS: Body mass index was examined using standard categories, i.e. underweight ($<$18.5 kg/m(2) ); normal weight (18.5-24.9 kg/m(2) ); overweight (25.0-29.9 kg/m(2) ); obesity class I (30.0-34.9 kg/m(2) ); obesity class II (35.0-39.9 kg/m(2) ); and obesity class III ($>$/=40 kg/m(2) ). The primary outcome in DAPA-HF was the composite of worsening heart failure or cardiovascular death. Overall, 1348 patients (28.4%) were under/normal- weight, 1722 (36.3%) overweight, 1013 (21.4%) obesity class I and 659 (13.9%) obesity class II/III. The unadjusted hazard ratio (95% confidence interval) for the primary outcome with obesity class 1, the lowest risk group, as reference was: under/normal-weight 1.41 (1.16-1.71), overweight 1.18 (0.97-1.42), obesity class II/III 1.37 (1.10-1.72). Patients with class I obesity were also at lowest risk of death. The effect of dapagliflozin on the primary outcome and other outcomes did not vary by baseline BMI, e.g. hazard ratio for primary outcome: under/normal-weight 0.74 (0.58-0.94), overweight 0.81 (0.65-1.02), obesity class I 0.68 (0.50-0.92), obesity class II/III 0.71 (0.51-1.00) (P-value for interaction = 0.79). The mean decrease in weight at 8 months with dapagliflozin was 0.9 (0.7-1.1) kg (P $<$ 0.001). CONCLUSION: We confirmed an ’obesity survival paradox’ in HFrEF. We showed that dapagliflozin was beneficial across the wide range of BMI studied. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT03036124.

  • 37. Adamson, Carly
    et al.
    Kondo, Toru
    Jhund, Pardeep S.
    de Boer, Rudolf A.
    Cabrera Honorio, Jose Walter
    Claggett, Brian
    Desai, Akshay S.
    Alcocer Gamba, Marco Antonio
    Al Habeeb, Waleed
    Hernandez, Adrian F.
    Inzucchi, Silvio E.
    Kosiborod, Mikhail N.
    Lam, Carolyn S. P.
    Langkilde, Anna Maria
    Lindholm, Daniel
    Bachus, Erasmus
    Litwin, Sheldon E.
    Martinez, Felipe
    Petersson, Magnus
    Shah, Sanjiv J.
    Vaduganathan, Muthiah
    Nguyen Vinh, Pham
    Wilderang, Ulrica
    Solomon, Scott D.
    McMurray, John J. V.
    Dapagliflozin for Heart Failure According to Body Mass Index: The DELIVER Trial.2022In: European heart journal, ISSN 1522-9645 0195-668X, Vol. 43, no 41, p. 4406-4417Article in journal (Refereed)
    Abstract [en]

    AIMS: Obesity is common and associated with unique phenotypic features in heart failure with preserved ejection fraction (HFpEF). Therefore, understanding the efficacy and safety of new therapies in HFpEF patients with obesity is important. The effects of dapagliflozin were examined according to body mass index (BMI) among patients in the Dapagliflozin Evaluation to Improve the LIVEs of Patients With PReserved Ejection Fraction Heart Failure trial. METHODS AND RESULTS: Body mass index was analysed by World Health Organization (WHO) categories and as a continuous variable using restricted cubic splines. Body mass index ranged from 15.2 to 50 kg/m2 with a mean value of 29.8 (standard deviation +/- 6.1) kg/m2. The proportions, by WHO category, were: normal weight 1343 (21.5%); overweight 2073 (33.1%); Class I obesity 1574 (25.2%); Class II obesity 798 (12.8%); and Class III obesity 415 (6.6%). Compared with placebo, dapagliflozin reduced the risk of the primary outcome to a similar extent across these categories: hazard ratio (95% confidence interval): 0.89 (0.69-1.15), 0.87 (0.70-1.08), 0.74 (0.58-0.93), 0.78 (0.57-1.08), and 0.72 (0.47-1.08), respectively (P-interaction = 0.82). The placebo-corrected change in Kansas City Cardiomyopathy Questionnaire total symptom score with dapagliflozin at 8 months was: 0.9 (-1.1, 2.8), 2.5 (0.8, 4.1), 1.9 (-0.1, 3.8), 2.7 (-0.5, 5.8), and 8.6 (4.0, 13.2) points, respectively (P-interaction = 0.03). The placebo-corrected change in weight at 12 months was: -0.88 (-1.28, -0.47), -0.65 (-1.04, -0.26), -1.42 (-1.89, -0.94), -1.17 (-1.94, -0.40), and -2.50 (-4.4, -0.64) kg (P-interaction = 0.002). CONCLUSIONS: Obesity is common in patients with HFpEF and is associated with higher rates of heart failure hospitalization and worse health status. Treatment with dapagliflozin improves cardiovascular outcomes across the spectrum of BMI, leads to greater symptom improvement in patients with obesity, compared with those without, and has the additional benefit of causing modest weight loss.

  • 38. Adamson, Carly
    et al.
    Welsh, Paul
    Docherty, Kieran F.
    de Boer, Rudolf A.
    Diez, Mirta
    Drozdz, Jaroslaw
    Dukat, Andre
    Inzucchi, Silvio E.
    Kober, Lars
    Kosiborod, Mikhail N.
    Ljungman, Charlotta E. A.
    Martinez, Felipe A.
    Ponikowski, Piotr
    Sabatine, Marc S.
    Morrow, David A.
    Lindholm, Daniel
    Hammarstedt, Ann
    Boulton, David W.
    Greasley, Peter J.
    Langkilde, Anna Maria
    Solomon, Scott D.
    Sattar, Naveed
    McMurray, John J. V.
    Jhund, Pardeep S.
    IGFBP-7 and Outcomes in Heart Failure With Reduced Ejection Fraction: Findings From DAPA-HF.2023In: JACC. Heart failure, ISSN 2213-1787 2213-1779, Vol. 11, no 3, p. 291-304Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insulin-like growth factor-binding protein-7 (IGFBP-7) has been proposed as a potential prognostic biomarker in heart failure (HF), but the association between elevation in IGFBP-7 and HF outcomes in ambulant patients with heart failure with reduced ejection fraction (HFrEF) is unknown. OBJECTIVES: The authors addressed this question in a post hoc analysis of the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial. METHODS: The primary outcome was a composite of cardiovascular death or a worsening HF event. The risk of adverse outcome was compared across tertiles of IGFBP-7 concentration by means of Cox proportional hazard models adjusted for N-terminal pro-B- type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT). The efficacy of randomized treatment across IGFBP-7 tertiles was assessed. Change in IGFBP-7 at 12 months was compared with the use of geometric means. RESULTS: A total of 3,158 patients had IGFBP-7 measured at baseline, and 2,493 had a repeated measure at 12 months. Patients in the highest tertile of IGFBP-7 had evidence of more advanced HFrEF. The adjusted HR for the primary endpoint in tertile 3, compared with tertile 1, was 1.48 (95% CI: 1.17-1.88). There was no modification of the benefit of dapagliflozin by baseline IGFBP-7 (P interaction = 0.34). Dapagliflozin did not change IGFBP-7 levels over 1 year (P = 0.34). CONCLUSIONS: Higher IGFBP-7 in patients with HFrEF was associated with worse clinical profile and an increased risk of adverse clinical outcomes. IGFBP-7 provided prognostic information incremental to clinical variables, NT-proBNP, and hsTnT. The benefit of dapagliflozin was not modulated by IGFBP-7 level. (Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure [DAPA-HF]; NCT03036124).

  • 39.
    Adawi, Rahim
    University of Skövde, School of Engineering Science.
    Preventing fatal effects of overworking: Product design solution2018Independent thesis Basic level (university diploma), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    “Overworking to death” is a phenomenon that has been noticeable in developing countries. The cause of death is mainly through ischemic strokes. While the victims’ occupations differed, they all shared a common characteristic, being positioned in a sedentary work, ranging from IT workers to doctors. This project’s aim was to develop a product that prevented or decreased the strokes that derived from sedentary overwork. This was mainly tackled by preventing one of the three causes of developing blood props, slowed blood flow. In order to gather rich data of the phenomenon, a qualitative study was conducted in China, during two months. By doing an extensive structured sampling, information rich data could be gathered during a short period of time. Data were derived from observations, questionnaires and an interview, which then was interpreted to customer needs and the final product specification. The final product became a trouser with an in built dynamic compression mechanic, that can compress the veins mostly during sitting activities, in order to prevent blood stasis. The compression mechanic works like the Chinese finger trap; compressing the calves while sitting and stretching the legs forward. It is made only out of polysaccharides fibres; cotton and corn.

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    PREVENTING FATAL EFFECTS OF OVERWORKING – PRODUCT DESIGN SOLUTION / Rahim_Adawi
  • 40.
    Adielsson, Anna
    et al.
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Danielsson, Christian
    Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Forkman, Pontus
    Department of Adult Psychiatry, Mora Hospital, Mora, Sweden.
    Karlsson, Thomas
    Health Metrics at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Pettersson, Linda
    Center for Clinical Research Dalarna, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Lundin, Stefan
    Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Outcome prediction for patients assessed by the medical emergency team: a retrospective cohort study2022In: BMC Emergency Medicine, E-ISSN 1471-227X, Vol. 22, no 1, article id 200Article in journal (Refereed)
    Abstract [en]

    Background: Medical emergency teams (METs) have been implemented to reduce hospital mortality by the early recognition and treatment of potentially life-threatening conditions. The objective of this study was to establish a clinically useful association between clinical variables and mortality risk, among patients assessed by the MET, and further to design an easy-to-use risk score for the prediction of death within 30 days.

    Methods: Observational retrospective register study in a tertiary university hospital in Sweden, comprising 2,601 patients, assessed by the MET from 2010 to 2015. Patient registry data at the time of MET assessment was analysed from an epidemiological perspective, using univariable and multivariable analyses with death within 30 days as the outcome variable. Predictors of outcome were defined from age, gender, type of ward for admittance, previous medical history, acute medical condition, vital parameters and laboratory biomarkers. Identified factors independently associated with mortality were then used to develop a prognostic risk score for mortality.

    Results: The overall 30-day mortality was high (29.0%). We identified thirteen factors independently associated with 30-day mortality concerning; age, type of ward for admittance, vital parameters, laboratory biomarkers, previous medical history and acute medical condition. A MET risk score for mortality based on the impact of these individual thirteen factors in the model yielded a median (range) AUC of 0.780 (0.774-0.785) with good calibration. When corrected for optimism by internal validation, the score yielded a median (range) AUC of 0.768 (0.762-0.773).

    Conclusions: Among clinical variables available at the time of MET assessment, thirteen factors were found to be independently associated with 30-day mortality. By applying a simple risk scoring system based on these individual factors, patients at higher risk of dying within 30 days after the MET assessment may be identified and treated earlier in the process.

     

  • 41.
    Adielsson, Anna
    et al.
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Djärv, Therese
    Department of Medicine, K2, Solna Karolinska Institutet, SE-171 77 Stockholm, Sweden.
    Rawshani, Araz
    Department of Molecular and Clinical Medicine, University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, SE-413 45 Gothenburg, Sweden.
    Lundin, Stefan
    Departmentof Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Blå Stråket 5, SE-413 45 Gothenburg, Sweden.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest - A population-based registry study of nearly 24,000 cases.2020In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 157, p. 135-140, article id S0300-9572(20)30522-0Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine changes over time in 30-day survival and the incidence of shockable rhythms after in-hospital cardiac arrest, from a countrywide perspective.

    METHODS: Patient information from the Swedish Registry for Cardiopulmonary Resuscitation was analysed in relation to monitoring level of ward and initial rhythm. The primary outcome was defined as survival at 30 days. Changes in survival and incidence of shockable rhythms were reported per year from 2008 to 2018. Also, epidemiological data were compared between two time periods, 2008-2013 and 2014-2018.

    RESULTS: In all, 23,186 unique patients (38.6% female) were included in the study. The mean age was 72.6 (SD 13.2) years. Adjusted trends indicated an overall increase in 30-day survival from 24.7% in 2008 to 32.5% in 2018, (on monitoring wards from 32.5% to 43.1% and on non-monitoring wards from 17.6% to 23.1%). The proportion of patients found in shockable rhythms decreased overall from 31.6% in 2008 to 23.6% in 2018, (on monitoring wards from 42.5% to 35.8 % and on non-monitoring wards from 20.1% to 12.9%). Among the patients found in shockable rhythms, the proportion of patients defibrillated before the arrival of cardiac arrest team increased from 71.0% to 80.9%.

    CONCLUSIONS: In an 11-year perspective, resuscitation in in-hospital cardiac arrest in Sweden was characterised by an overall increase in the adjusted 30-day survival, despite a decrease in shockable rhythms. An increased proportion, among the patients found in a shockable rhythm, who were defibrillated before the arrival of a cardiac arrest team may have contributed to the finding.

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  • 42.
    Adolfsson, Emma
    et al.
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Qvick, Alvida
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Gréen, Henrik
    Division of Drug Research, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Kling, Daniel
    Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Gunnarsson, Cecilia
    Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Centre for Rare Diseases in South East Region of Sweden, Linköping University, Linköping, Sweden.
    Jonasson, Jon
    Department of Laboratory Medicine, Örebro University Hospital, Sweden; Department of Clinical Genetics and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Green, Anna
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine, Örebro University Hospital, Sweden.
    Technical in-depth comparison of two massive parallel DNA-sequencing methods for formalin-fixed paraffin-embedded tissue from victims of sudden cardiac death2021In: Forensic Science International: Genetics, ISSN 1872-4973, E-ISSN 1878-0326, Vol. 53, article id 102522Article in journal (Refereed)
    Abstract [en]

    Sudden cardiac death (SCD) is a tragic and traumatic event. SCD is often associated with hereditary genetic disease and in such cases, sequencing of stored formalin fixed paraffin embedded (FFPE) tissue is often crucial in trying to find a causal genetic variant. This study was designed to compare two massive parallel sequencing assays for differences in sensitivity and precision regarding variants related to SCD in FFPE material. From eight cases of SCD where DNA from blood had been sequenced using HaloPlex, corresponding FFPE samples were collected six years later. DNA from FFPE samples were amplified using HaloPlex HS, sequenced on MiSeq, representing the first method, as well as amplified using modified Twist and sequenced on NextSeq, representing the second method. Molecular barcodes were included to distinguish artefacts from true variants. In both approaches, read coverage, uniformity and variant detection were compared using genomic DNA isolated from blood and corresponding FFPE tissue, respectively. In terms of coverage uniformity, Twist performed better than HaloPlex HS for FFPE samples. Despite higher overall coverage, amplicon-based HaloPlex technologies, both for blood and FFPE tissue, suffered from design and/or performance issues resulting in genes lacking complete coverage. Although Twist had considerably lower overall mean coverage, high uniformity resulted in equal or higher fraction of genes covered at ≥ 20X. By comparing variants found in the matched samples in a pre-defined cardiodiagnostic gene panel, HaloPlex HS for FFPE material resulted in high sensitivity, 98.0% (range 96.6-100%), and high precision, 99.9% (range 99.5-100%) for moderately fragmented samples, but suffered from reduced sensitivity (range 74.2-91.1%) in more severely fragmented samples due to lack of coverage. Twist had high sensitivity, 97.8% (range 96.8-98.7%) and high precision, 99.9% (range 99.3-100%) in all analyzed samples, including the severely fragmented samples.

  • 43.
    Aerts, Marc
    et al.
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Minalu, Girma
    Interuniversity Institute for Biostatistics and Statistical Bioinformatics.
    Bösner, Stefan
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Buntinx, Frank
    Department of Public Health and Primary Care, KU Leuven, Belgium; Department of General Practice, Maastricht University, The Netherlands..
    Burnand, Bernard
    Institute of Social and Preventive Medicine, Lausanne University Hospital, Switzerland..
    Haasenritter, Jörg
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Herzig, Lilli
    Institute of Family Medicine, University of Lausanne, Switzerland..
    Knottnerus, J André
    Department of General Practice, Maastricht University, The Netherlands..
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Renier, Walter
    Department of Public Health and Primary Care, KU Leuven, Belgium.
    Sox, Carol
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, USA..
    Sox, Harold
    Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH , USA; Patient-Centered Outcomes Research Institute, Washington, USA..
    Donner-Banzhoff, Norbert
    Department of General Practice and Family Medicine, Philipps University Marburg, Germany..
    Pooled individual patient data from five countries were used to derive a clinical prediction rule for coronary artery disease in primary care.2017In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 81, p. 120-128Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To construct a clinical prediction rule for coronary artery disease (CAD) presenting with chest pain in primary care.

    STUDY DESIGN AND SETTING: Meta-Analysis using 3,099 patients from five studies. To identify candidate predictors, we used random forest trees, multiple imputation of missing values, and logistic regression within individual studies. To generate a prediction rule on the pooled data, we applied a regression model that took account of the differing standard data sets collected by the five studies.

    RESULTS: The most parsimonious rule included six equally weighted predictors: age ≥55 (males) or ≥65 (females) (+1); attending physician suspected a serious diagnosis (+1); history of CAD (+1); pain brought on by exertion (+1); pain feels like "pressure" (+1); pain reproducible by palpation (-1). CAD was considered absent if the prediction score is <2. The area under the ROC curve was 0.84. We applied this rule to a study setting with a CAD prevalence of 13.2% using a prediction score cutoff of <2 (i.e., -1, 0, or +1). When the score was <2, the probability of CAD was 2.1% (95% CI: 1.1-3.9%); when the score was ≥ 2, it was 43.0% (95% CI: 35.8-50.4%).

    CONCLUSIONS: Clinical prediction rules are a key strategy for individualizing care. Large data sets based on electronic health records from diverse sites create opportunities for improving their internal and external validity. Our patient-level meta-analysis from five primary care sites should improve external validity. Our strategy for addressing site-to-site systematic variation in missing data should improve internal validity. Using principles derived from decision theory, we also discuss the problem of setting the cutoff prediction score for taking action.

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  • 44.
    af Geijerstam, Peder
    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, Primary Care Center, Primary Health Care Center Cityhälsan Centrum.
    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.
    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.
    Rådholm, Karin
    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 Kärna.
    Nyström, Fredrik
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Cityhälsan Centrum. Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine.
    Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease2023In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 41, no 7, p. 1084-1091Article in journal (Refereed)
    Abstract [en]

    Background: Masked hypertension is associated with cardiovascular disease (CVD). However, previous large studies have not used the same device to measure office and home blood pressure (BP) and adhered to current home BP measurement recommendations of the European Society of Hypertension. We aimed to characterize masked hypertension and explore its relation to manifestations of CVD.

    Methods: A randomly selected cohort of 5057 participants aged 50–64 years from the Swedish CardioPulmonary BioImage Study (SCAPIS) was evaluated with office and home BP using the semi-automatic Omron M10-IT oscillometric device. Additional analyses included pulse wave velocity (PWV) and coronary artery calcium score (CACS).

    Results: Of participants, 4122 did not have current antihypertensive treatment, and were thus included in our analyses. Of these, 2634 (63.9%) had sustained normotension, and 172 (4.2%) had masked hypertension. Participants with masked hypertension vs. sustained normotension were more often men (66.9 vs. 46.2%, P < 0.001). Those with masked hypertension had higher mean PWV [9.3 (95% confidence interval, 95% CI 9.1–9.5) vs. 8.3 (95% CI 8.2–8.4) m/s, P < 0.001] and odds ratio for CACS at least 100 [1.65 (95% CI 1.02–2.68), P = 0.040]. These associations were similar in a posthoc analysis of masked hypertension and sustained normotension, matched for age, sex and systolic office BP.

    Conclusion: Masked hypertension was associated with markers of CVD. This suggests that home BP is a better predictor of risk, even when the recordings are performed with the same measurement device, in a population-based setting with randomized recruitment.

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  • 45.
    af Geijerstam, Peder
    et al.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Forsberg, S.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Claesson, A.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Djärv, T.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Jonsson, M.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Nordberg, P.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Tibell, A.
    Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Solna, Sweden.
    Rosell Ortiz, F.
    Empresa Pública de Emergencias Sanitarias, Almería, Andalucía, Spain.
    Ringh, M.
    Karolinska Institutet, Department of Medicine, Solna, Sweden: Center for Resuscitation Science, Stockholm, Sweden.
    Potential organ donors after Out-of-Hospital Cardiac Arrest during a ten-year period in Stockholm, Sweden2019In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 137, p. 215-220Article in journal (Refereed)
    Abstract [en]

    Background:

    Donation after brain death (DBD) is current praxis in Sweden. Circulatory death is far more common. Donation from patients suffering Out-of-Hospital Cardiac Arrest (OHCA) may have the potential to increase the organ-donor pool. The aim of this study was to describe the potential donor pool and its characteristics if uncontrolled donation after circulatory death (uDCD) were to be implemented in the metropolitan area of Stockholm, Sweden.

    Methods:

    A retrospective analysis was made using data from the Swedish Register for cardiopulmonary resuscitation (SRCR) between 2006 and 2015. Evaluation of potential organ donors was made using selection criteria from five previously published protocols concerning uDCD.

    Results:

    When applying different criteria from each of the five studied protocols in a total of 9,793 cases of OHCA, between 7.5% (n = 732) and 1.5% (n = 150) of the patients were found to be potential candidates for uDCD. The median age of the sampled uDCD candidates in each protocol was between 48 and 57 years. Male donors were found in 67–76% of all cases.

    Conclusion:

    Although not taking important real-life limitations into account, our results indicate that implementation of a uDCD programme may substantially increase the number of potential organ donors in Stockholm.

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  • 46.
    Agarwal, Anubha
    et al.
    Washington Univ St Louis, Sch Med, St Louis, MO 63110 USA..
    Tromp, Jasper
    Natl Univ Singapore, Saw Swee Hock Sch Publ Hlth, Singapore, Singapore.;Natl Univ Hlth Syst, Singapore, Singapore..
    Almahmeed, Wael
    Cleveland Clin, Heart & Vasc Inst, Abu Dhabi, U Arab Emirates..
    Angermann, Christiane
    Univ Hosp Wuerzburg, Comprehens Heart Failure Ctr, Wurzburg, Germany..
    Chandramouli, Chanchal
    Natl Heart Ctr Singapore, Singapore, Singapore.;Duke NUS Med Sch, Singapore, Singapore..
    Cho, Hyunjai
    Seoul Natl Univ Hosp, Seoul, South Korea..
    Choi, Don-Ju
    Seoul Natl Univ Hosp, Seoul, South Korea..
    Damasceno, Albertino
    Eduardo Mondlane Univ, Maputo, Mozambique..
    Filippatos, Gerasimos
    Univ Cyprus, Sch Med, Nicosia, Cyprus.;Natl & Kapodistrian Univ Athens, Attikon Univ Hosp, Sch Med, Dept Cardiol, Athens, Greece..
    Fonarow, Gregg C.
    Ronald Reagan UCLA Med Ctr, Radiol, Los Angeles, CA USA..
    Harikrishnan, Sivadasanpillai
    Sree Chitra Tirunal Inst Med Sci & Technol, Trivandrum, Kerala, India..
    Lund, Lars
    Karolinska Univ Hosp, Stockholm, Sweden..
    Masoudi, Fred
    Univ Colorado, Sch Med, Anschutz Med Campus, Aurora, CO 80045 USA..
    Mensah, George A.
    NHLBI, NIH, Ctr Translat Res & Implementat Sci, Bethesda, MD USA..
    Pathan, Asad
    Tabba Heart Inst, Karachi, Pakistan..
    Perel, Pablo
    London Sch Hyg & Trop Med, London, England..
    Pinto, Fausto
    Univ Lisbon, Santa Maria Univ Hosp, Lisbon, Portugal..
    Ribeiro, Antonio Luiz
    Unversidade Fed Minas Gerais, Hosp Clin, Belo Horizonte, Brazil.;Unversidade Fed Minas Gerais, Sch Med, Belo Horizonte, Brazil..
    Rich, Stuart
    Northwestern Univ, Feinberg Sch Med, Chicago, IL USA..
    Sakata, Yasuhiko
    Tohoku Univ, Grad Sch Med, Sendai, Japan.;Natl Cerebral & Cardiovasc Ctr, Cardiovasc Surg, Suita, Japan..
    Sliwa, Karen
    Univ Cape Town, Cape Town, South Africa..
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology.
    Wong, Renee
    NHLBI, NIH, Div Cardiovasc Sci, Heart Failure & Arrhythmias Branch, Bethesda, MD USA..
    Yancy, Clyde
    Northwestern Univ, Feinberg Sch Med, Chicago, IL USA..
    Yiu, Kelvin
    Univ Hong Kong, Inst Cardiovasc Sci & Med, Hong Kong, Peoples R China.;Univ Hong Kong, Shenzhen Hosp, Dept Med, Hong Kong, Peoples R China..
    Zhang, Jian
    Chinese Acad Med Sci & Peking Union Med Coll, Beijing, Peoples R China..
    Zhang, Yuhui
    Chinese Acad Med Sci & Peking Union Med Coll, Beijing, Peoples R China..
    Lam, Carolyn S. P.
    Natl Heart Ctr, Singapore, Singapore.;Duke NUS Med Sch, Singapore, Singapore.;Univ Med Ctr Groningen, Groningen, Netherlands..
    Roth, Gregory A.
    Univ Washington, Seattle, DC USA.;Populat Hlth Bldg Hans Rosling Ctr, Inst Hlth Metr & Evaluat, 3980 15th Ave NE, Seattle, WA 98195 USA..
    Toward a Universal Definition of Etiologies in Heart Failure: Categorizing Causes and Advancing Registry Science2024In: Circulation Heart Failure, ISSN 1941-3289, E-ISSN 1941-3297, Vol. 17, no 4, article id e011095Article, review/survey (Refereed)
    Abstract [en]

    Heart failure (HF) is a well-described final common pathway for a broad range of diseases however substantial confusion exists regarding how to describe, study, and track these underlying etiologic conditions. We describe (1) the overlap in HF etiologies, comorbidities, and case definitions as currently used in HF registries led or managed by members of the global HF roundtable; (2) strategies to improve the quality of evidence on etiologies and modifiable risk factors of HF in registries; and (3) opportunities to use clinical HF registries as a platform for public health surveillance, implementation research, and randomized registry trials to reduce the global burden of noncommunicable diseases. Investment and collaboration among countries to improve the quality of evidence in global HF registries could contribute to achieving global health targets to reduce noncommunicable diseases and overall improvements in population health.

  • 47.
    Ageno, Walter
    et al.
    University of Insubria, Italy.
    Buller, Harry R.
    Academic Medical Centre, Netherlands.
    Falanga, Anna
    Hospital Papa Giovanni XXIII, Italy; Hospital Papa Giovanni XXIII, Italy.
    Hacke, Werner
    Heidelberg University, Germany.
    Hendriks, Jeroen
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. University of Adelaide, Australia.
    Lobban, Trudie
    Arrhythmia Alliance and AF Assoc, England.
    Merino, Jose
    University of La Paz, Spain.
    Milojevic, Ivan S.
    Gen Hospital Cuprija, Serbia.
    Moya, Francisco
    Vithas Xanit Int Hospital, Spain.
    Bart van der Worp, H.
    University of Medical Centre Utrecht, Netherlands.
    Randall, Gary
    SAFE, England.
    Tsioufis, Konstantinos
    University of Athens, Greece.
    Verhamme, Peter
    University of Leuven, Belgium.
    John Camm, A.
    St Georges University of London, England; Imperial Coll, England.
    Managing reversal of direct oral anticoagulants in emergency situations Anticoagulation Education Task Force White Paper2016In: Thrombosis and Haemostasis, ISSN 0340-6245, E-ISSN 2567-689X, Vol. 116, no 6, p. 1003-1010Article in journal (Refereed)
    Abstract [en]

    Anticoagulation is the cornerstone of prevention and treatment of venous thromboembolism (VTE) and stroke prevention in patients with atrial fibrillation (AF). However, the mechanisms by which anticoagulants confer therapeutic benefit also increase the risk of bleeding. As such, reversal strategies are critical. Until recently, the direct oral anticoagulants (DOACs) dabigatran, rivaroxaban, apixaban, and edoxaban lacked a specific reversal agent. This report is based on findings from the Anticoagulation Education Task Force, which brought together patient groups and professionals representing different medical specialties with an interest in patient safety and expertise in AF, VTE, stroke, anticoagulation, and reversal agents, to discuss the current status of anticoagulation reversal and fundamental changes in management of bleeding associated with DOACs occasioned by the approval of idarucizumab, a specific reversal agent for dabigatran, as well as recent clinical data on specific reversal agents for factor Xa inhibitors. Recommendations are given for when there is a definite need for a reversal agent (e.g. in cases of life-threatening bleeding, bleeding into a closed space or organ, persistent bleeding despite local haemostatic measures, and need for urgent interventions and/or interventions that carry a high risk for bleeding), when reversal agents may be helpful, and when a reversal agent is generally not needed. Key stakeholders who require 24-7/around-the-clock access to these agents vary among hospitals; however, from a practical perspective the emergency department is recommended as an appropriate location for these agents. Clearly, the advent of new agents requires standardised protocols for treating bleeding on an institutional level.

  • 48.
    Agerström, Jens
    et al.
    Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University.
    Carlsson, Magnus
    Department of Economics and Statistics, School of Business and Economics, Linnaeus University.
    Bremer, Anders
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. Department of Cardiology, Sahlgrenska University Hospital.
    Israelsson, Johan
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Årestedt, Kristofer
    Department of Health and Caring sciences, Faculty of Health and Life Sciences, Linnaeus University.
    Discriminatory cardiac arrest care? Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest.2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 8, p. 861-869Article in journal (Refereed)
    Abstract [en]

    AIMS: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

    METHODS AND RESULTS: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

    CONCLUSION: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

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  • 49.
    Agerström, Jens
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Carlsson, Magnus
    Linnaeus University, School of Business and Economics, Department of Economics and Statistics.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Herlitz, Johan
    Sahlgrenska University Hospital, Sweden;University of Borås, Sweden.
    Israelsson, Johan
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Årestedt, Kristofer
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Linnaeus University, Linnaeus Knowledge Environments, Sustainable Health. Region Kalmar County, Sweden.
    Discriminatory cardiac arrest care?: Patients with low socioeconomic status receive delayed cardiopulmonary resuscitation and are less likely to survive an in-hospital cardiac arrest2021In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 42, no 8, p. 861-869Article in journal (Refereed)
    Abstract [en]

    Aims: Individuals with low socioeconomic status (SES) face widespread prejudice in society. Whether SES disparities exist in treatment and survival following in-hospital cardiac arrest (IHCA) is unclear. The aim of the current retrospective registry study was to examine SES disparities in IHCA treatment and survival, assessing SES at the patient level, and adjusting for major demographic, clinical, and contextual factors.

    Methods and results: In total, 24 217 IHCAs from the Swedish Register of Cardiopulmonary Resuscitation were analysed. Education and income constituted SES proxies. Controlling for age, gender, ethnicity, comorbidity, heart rhythm, aetiology, hospital, and year, primary analyses showed that high (vs. low) SES patients were significantly less likely to receive delayed cardiopulmonary resuscitation (CPR) (highly educated: OR = 0.89, and high income: OR = 0.98). Furthermore, patients with high SES were significantly more likely to survive CPR (high income: OR = 1.02), to survive to hospital discharge with good neurological outcome (highly educated: OR = 1.27; high income: OR = 1.06), and to survive to 30 days (highly educated: OR = 1.21; and high income: OR = 1.05). Secondary analyses showed that patients with high SES were also significantly more likely to receive prophylactic heart rhythm monitoring (highly educated: OR = 1.16; high income: OR = 1.02), and this seems to partially explain the observed SES differences in CPR delay.

    Conclusion: There are clear SES differences in IHCA treatment and survival, even when controlling for major sociodemographic, clinical, and contextual factors. This suggests that patients with low SES could be subject to discrimination when suffering IHCA.

  • 50.
    Agerström, Jens
    et al.
    Linnéuniversitetet.
    Carlsson, Magnus
    Linnéuniversitetet.
    Bremer, Anders
    Linnéuniversitetet.
    Herlitz, Johan
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Rawshani, Araz
    Göteborgs universitet.
    Årestedt, Kristofer
    Linnéuniversitetet.
    Israelsson, Johan
    Linnéuniversitetet.
    Treatment and survival following in-hospital cardiac arrest: does patient ethnicity matter?2021In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, article id zvab079Article in journal (Refereed)
    Abstract [en]

    AIMS : Previous research on racial/ethnic disparities in relation to cardiac arrest has mainly focused on black vs. white disparities in the USA. The great majority of these studies concerns out-of-hospital cardiac arrest (OHCA). The current nationwide registry study aims to explore whether there are ethnic differences in treatment and survival following in-hospital cardiac arrest (IHCA), examining possible disparities towards Middle Eastern and African minorities in a European context.

    METHODS AND RESULTS: In this retrospective registry study, 24 217 patients from the IHCA part of the Swedish Registry of Cardiopulmonary Resuscitation were included. Data on patient ethnicity were obtained from Statistics Sweden. Regression analysis was performed to assess the impact of ethnicity on cardiopulmonary resuscitation (CPR) delay, CPR duration, survival immediately after CPR, and the medical team's reported satisfaction with the treatment. Middle Eastern and African patients were not treated significantly different compared to Nordic patients when controlling for hospital, year, age, sex, socioeconomic status, comorbidity, aetiology, and initial heart rhythm. Interestingly, we find that Middle Eastern patients were more likely to survive than Nordic patients (odds ratio = 1.52).

    CONCLUSION: Overall, hospital staff do not appear to treat IHCA patients differently based on their ethnicity. Nevertheless, Middle Eastern patients are more likely to survive IHCA.

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