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  • 1.
    Ahlander, Britt-Marie
    et al.
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Maret, Eva
    Department of Radiology, Ryhov County Hospital, Jönköping, Sweden.
    Brudin, Lars
    Department of Clinical Physiology, Kalmar County Hospital, Kalmar, Sweden.
    Starck, Sven-Åke
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Department of Oncology, Hospital Physics, Ryhov County Hospital, Jönköping, Sweden.
    Engvall, Jan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    An echo-planar imaging sequence is superior to a steady-state free precession sequence for visual as well as quantitative assessment of cardiac magnetic resonance stress perfusion2017In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 37, no 1, p. 52-61Article in journal (Refereed)
    Abstract [en]

    Background: To assess myocardial perfusion, steady-state free precession cardiac magnetic resonance (SSFP, CMR) was compared with gradient-echo–echo-planar imaging (GRE-EPI) using myocardial perfusion scintigraphy (MPS) as reference.

    Methods: Cardiac magnetic resonance perfusion was recorded in 30 patients with SSFP and in another 30 patients with GRE-EPI. Timing and extent of inflow delay to the myocardium was visually assessed. Signal-to-noise (SNR) and contrast-to-noise (CNR) ratios were calculated. Myocardial scar was visualized with a phase-sensitive inversion recovery sequence (PSIR). All scar positive segments were considered pathologic. In MPS, stress and rest images were used as in clinical reporting. The CMR contrast wash-in slope was calculated and compared with the stress score from the MPS examination. CMR scar, CMR perfusion and MPS were assessed separately by one expert for each method who was blinded to other aspects of the study.

    Results: Visual assessment of CMR had a sensitivity for the detection of an abnormal MPS at 78% (SSFP) versus 91% (GRE-EPI) and a specificity of 58% (SSFP) versus 84% (GRE-EPI). Kappa statistics for SSFP and MPS was 0·29, for GRE-EPI and MPS 0·72. The ANOVA of CMR perfusion slopes for all segments versus MPS score (four levels based on MPS) had correlation r = 0·64 (SSFP) and r = 0·96 (GRE-EPI). SNR was for normal segments 35·63 ± 11·80 (SSFP) and 17·98 ± 8·31 (GRE-EPI), while CNR was 28·79 ± 10·43 (SSFP) and 13·06 ± 7·61 (GRE-EPI).

    Conclusion: GRE-EPI displayed higher agreement with the MPS results than SSFP despite significantly lower signal intensity, SNR and CNR.

  • 2.
    Alehagen, Urban
    et al.
    Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Shamoun, Levar
    Division of Medical Diagnostics, Department of Laboratory Medicine, Jönköping County, Jönköping, Sweden, and Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden .
    Dimberg, Jan
    Jönköping University, School of Health and Welfare, HHJ, Department of Clinical Diagnostics. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Wågsäter, Dick
    Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden.
    Increased mortality in the A/A genotype of the SNP rs28372698 of interleukin 322021In: Experimental and Therapeutic Medicine, ISSN 1792-0981, E-ISSN 1792-1015, Vol. 21, no 2, article id 127Article in journal (Refereed)
    Abstract [en]

    One of the major causes of mortality in the western hemisphere is cardiovascular disease. Therefore, a variety of markers to identify those at risk are required. Interleukin-32 (IL-32) is a cytokine that is associated with inflammation. The aim of the current study was to investigate variations in single nucleotide polymorphisms (SNPs) of IL-32 and plasma expression, and their associations with mortality. A population of 486 elderly community-living persons were evaluated. The participants were followed for 7.1 years and underwent a clinical examination and blood sampling. SNP analyses of IL-32 rs28372698 using allelic discrimination and plasma measurement of IL-32, using ELISA, were performed. During the follow-up period, 140 (28.8%) all-cause and 87 (17.9%) cardiovascular deaths were registered. No significant difference between mortality and plasma concentration of IL-32 was observed. The A/A genotype group exhibited significantly higher all-cause mortality (P=0.036), and an almost two-fold increased risk in a multivariate Cox regression model for all-cause and cardiovascular mortality. A highly significant difference in all-cause and cardiovascular mortality between the A/A and the T/T groups was demonstrated (P=0.015 resp. P=0.014). In the present study, the cytokine IL-32 was demonstrated to have prognostic information, with an increased risk of all-cause and cardiovascular mortality for those with the A/A genotype rs28372698 of IL-32. The A/A genotype could therefore be regarded as a possible biomarker for mortality risk that may be used to offer optimized cardiovascular patient handling in the future. However, the present study sample was small, and the results should be regarded as hypothesis-generating.

  • 3.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Food and Nutrition, and Sport Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden.
    Coenen, Michaela
    Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Chair of Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Fridlund, Bengt
    Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden.
    A scoping review and mapping exercise comparing the content of patient-reported outcome measures (PROMs) across heart disease-specific scales2020In: Journal of Patient-Reported Outcomes, ISSN 2509-8020, Vol. 4, no 1, article id 7Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Over the past decade, the importance of person-centered care has led to increased interest in patient-reported outcome measures (PROMs). In cardiovascular care, selecting an appropriate PROM for clinical use or research is challenging because multimorbidity is often common in patients. The aim was therefore to provide an overview of heart-disease specific PROMs and to compare the content of those outcomes using a bio-psycho-social framework of health.

    METHODS: A scoping review of heart disease-specific PROMs, including arrhythmia/atrial fibrillation, congenital heart disease, heart failure, ischemic heart disease, and valve diseases was conducted in PubMed (January 2018). All items contained in the disease-specific PROMs were mapped to WHO's International Classification of Functioning, Disability and Health (ICF) according to standardized linking rules.

    RESULTS: A total of 34 PROMs (heart diseases in general n = 5; cardiac arrhythmia n = 6; heart failure n = 14; ischemic heart disease n = 9) and 147 ICF categories were identified. ICF categories covered Body functions (n = 61), Activities & Participation (n = 69), and Environmental factors (n = 17). Most items were about experienced problems of Body functions and less often about patients' daily activities, and most PROMs were specifically developed for heart failure and no PROM were identified for valve disease or congenital heart disease.

    CONCLUSIONS: Our results motivate and provide information to develop comprehensive PROMs that consider activity and participation by patients with various types of heart disease.

  • 4.
    Algurén, Beatrix
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Faculty of Education, Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Jernberg, Tomas
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden.
    Vasko, Peter
    Department of Internal Medicine, Central Hospital, Växjö, Sweden.
    Selb, Melissa
    ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications (at DIMDI), Nottwil, Switzerland; and Swiss Paraplegic Research, Nottwil, Switzerland .
    Coenen, Michaela
    ICF Research Branch, a cooperation partner within the WHO Collaborating Centre for the Family of International Classifications (at DIMDI), Nottwil, Switzerland; Department of Medical Information Processing, Biometry and Epidemiology-IBE, Chair of Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany; and Pettenkofer School of Public Health (PSPH), Munich, Germany .
    Content comparison and person-centeredness of standards for quality improvement in cardiovascular health care2021In: PLOS ONE, E-ISSN 1932-6203, Vol. 16, no 1, article id e0244874Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Quality standards are important for improving health care by providing compelling evidence for best practice. High quality person-centered health care requires information on patients' experience of disease and of functioning in daily life.

    OBJECTIVE: To analyze and compare the content of five Swedish National Quality Registries (NQRs) and two standard sets of the International Consortium of Health Outcomes Measurement (ICHOM) related to cardiovascular diseases.

    MATERIALS AND METHODS: An analysis of 2588 variables (= data items) of five NQRs-the Swedish Registry of Congenital Heart Disease, Swedish Cardiac Arrest Registry, Swedish Catheter Ablation Registry, Swedish Heart Failure Registry, SWEDEHEART (including four sub-registries) and two ICHOM standard sets-the Heart Failure Standard Set and the Coronary Artery Disease Standard Set. According to the name and definition of each variable, the variables were mapped to Donabedian's quality criteria, whereby identifying whether they capture health care processes or structures or patients' health outcomes. Health outcomes were further analyzed whether they were clinician- or patient-reported and whether they capture patients' physiological functions, anatomical structures or activities and participation.

    RESULTS: In total, 606 variables addressed process quality criteria (31%), 58 structure quality criteria (3%) and 760 outcome quality criteria (38%). Of the outcomes reported, 85% were reported by clinicians and 15% by patients. Outcome variables addressed mainly 'Body functions' (n = 392, 55%) or diseases (n = 209, 29%). Two percent of all documented data captured patients' lived experience of disease and their daily activities and participation (n = 51, 3% of all variables).

    CONCLUSIONS: Quality standards in the cardiovascular field focus predominately on processes (e.g. treatment) and on body functions-related outcomes. Less attention is given to patients' lived experience of disease and their daily activities and participation. The results can serve as a starting-point for harmonizing data and developing a common person-centered quality indicator set.

  • 5.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Factors affecting in-hospital sleep-wake pattern in octogenarians during the early postoperative phase after transcutaneous aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S53-S53Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarian patients are an increasing group admitted for advanced cardiac treatment. Little is known about factors disturbing their sleep-wake pattern in the early postoperative phase after transcutaneous aortic valve replacement (TAVI), as current knowledge is based upon studies on younger age groups treated for surgical aortic valve replacement.

    Aim: To determine factors affecting the in-hospital sleep wake pattern in octogenarian patients after TAVI.

    Methods: This is a prospective cohort study in a tertiary university hospital. Inclusion criteria were age > 80 years with severe aortic stenosis accepted for TAVI. Actigraphy was used to identify sleep-wake pattern (sleep time night and sleep time day), and the Minimal Insomnia Symptom Scale (MISS) to measure self-reported insomnia daily during the first five postoperative days. Charlson`s comorbidity index was used as a measure of comorbidities and the Visual Analog Scale (VAS) to rate pain severity. Information regarding duration of anesthesia, blood transfusion and parenteral administration of morphine equivalents were derived from the patients’ medical journals. Multiple regression analysis was used to test associations between variables.

    Results: In all, 65 patients (41 women) were included. Mean age was 85 years (SD 2.8). No significant associations were found between age, comorbidities, blood transfusion and morphine equivalents and sleep. Gender was significantly associated with sleep time night and sleep efficiency as men had shortest duration of sleep from the third to the fifth postoperative night (p < .001, and adjusted R2=.230 to .283). Duration of anesthesia had a significant association with sleep time night and sleep efficiency from the third to the fifth postoperative night (p=.013 to p < .001, and adjusted R2=.230 to .283), where longer duration gave less total sleep and lower sleep efficiency. VAS score correlated with wake time night the third night, where a higher VAS score gave more wake time (p=.006 and adjusted R2 .236).

    Conclusion: Male gender, longer duration of perioperative anesthesia and postoperative pain were associated with disturbances in the postoperative sleep-wake pattern in octogenarian patients in the early postoperative phase after TAVI. This knowledge is important and relevant and should have implications in improving patient care.

  • 6.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P. E.
    Bergen University College, Institute of Nursing, Faculty of Health and Social Science, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R. H.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Hufthammer, K. O. H.
    Haukeland University Hospital, Centre for Clinical research, Bergen, Norway.
    Kuiper, K. K. J. K.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Schjott, J. S.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Ranhoff, A. H. R.
    University of Bergen, Department of Clinical Science, Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekval, T. M. N.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway .
    Factors associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after surgical aortic valve replacement2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S63-S64Article in journal (Refereed)
    Abstract [en]

    Background: Disturbances of the sleep-wake pattern are known phenomenon in the postoperative phase after aortic valve replacement (SAVR) that have negative impact on the morbidity, quality of life and mortality. Octogenarian patients are an increasing group admitted for cardiac surgery, however knowledge is based on younger patients.

    Aims: To determine factors associated with disturbances in postoperative sleep-wake pattern in octogenarian patients after SAVR.

    Methods: A prospective cohort study of octogenarian patients in a single center university hospital. Inclusion criteria were age > 80 years, severe aortic stenosis, accepted for SAVR. Actigraphy was used to identify the sleep-wake pattern (sleep-time, sleep efficiency and wake time night and sleep- and wake-time day) for the five first postoperative days, and the sleep questionnaires Minimal Insomnia Symptom scale (MISS) to measure the selfreported insomnia at baseline and daily for the five first postoperative days. 

    Charlsons comorbidity index was used to score comorbidities and the Visual Analog Scale (VAS), was used to rate pain severity. The patients’ medical journals were used to record duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusions and parenteral administration of morphine equivalents. Multiple regression analysis was used to test associations between variables.

    Results: In all, 78 patients were included (40 women). Mean age was 82 years (SD 2.0). For the sleep-wake pattern first to fifth postoperative night, mean sleep-time night was 330-370 minutes (SD 32-124). Mean sleep efficiency was 68-77% (SD 21-26). Mean sleep-time day was 545-712 minutes (SD 146-169). Mean insomnia score was 1,8-5,3 (SD 2,6-3,8). On the first postoperative night the pain VAS score correlated with wake time night, where a higher VAS indicated more wake time (p=.014, adjusted R2=.213). No other variable; age, gender, duration of anesthesia, duration of cardiopulmonary by-pass, blood transfusion or morphine equivalents showed significant association with the sleep-wake pattern or insomnia.

    Conclusion: Postoperative pain was associated with disturbances in sleep-wake pattern in octogenarian patients in the early postoperative phase after SAVR. This indicates that pain management may be inadequate for patients after SAVR. More research on this issue is needed to establish data needed to improve treatment and care.

  • 7.
    Amofah, H. A.
    et al.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, R.
    Haukeland University Hospital, Thoracic surgical unit, Bergen, Norway.
    Instenes, I.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Ranhoff, A. H.
    University of Bergen, Department of clinical science, faculty of medicine, Bergen, Norway.
    Schjott, J. D.
    Haukeland University Hospital, Section of Clinical Pharmacology, Laboratory of Clinical Biochemistry, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Departement of Heart Disease, Bergen, Norway.
    Octogenarian patients experiences with hypnotics in relation to sleep disturbances and delirium after aortic valve therapy2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 104-105Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disturbance and delirium are complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve replacement (TAVI), especially in octogenarian patients. Sedatives and z-hypnotics are medications distributed to promote sleep. However, a knowledge-gap exists on patient experiences with these medications, and sleep and delirium after the cardiac treatment.

    Aim: To explore and describe how octogenarians suffering from delirium after SAVR/TAVI experience their sleep situation related to sedatives and z-hypnotics, in a long-term perspective.

    Methods An explorative and descriptive design with a longitudinal qualitative approach was applied. Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium. Information about administration of sedatives and z-hypnotics was collected from the patients journals. The Confusion Assessment Method (CAM) was used to assess delirium, the Sleep Sufficient Index (SSI) and Minimal Insomnia Symptom Scale (MISS) were used to document self-reported sleep and insomnia. All measures were performed at baseline and daily the five first postoperative days. Ten patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were re-interviewed four years later, focusing on their sleep situation.

    Findings: For the initial interview, five men and five woman, four after TAVI and six after SAVR, mean age 83 were included. One overarching theme revealed; hours in bed represented an emotional chaos. Three sub-themes described the patients experiences with sleep and delirium, a cascade of distressful experiences, the struggle between sleep and activity and elements influencing sleep. In the category physical sleep distractions, sleep medications emerged as a sleep disturbing element but also to evoke delirium. Patients described to be offered sedatives and z-hypnotics in hospital. However, they did not have a positive experience with this as the medication did not make them sleep better. Moreover, they associated the nightmares by the sedatives Four years after the cardiac treatment, the octogenarian patients described that medication did not have a sleep promoting effect, and they did not want it.

    Conclusion: Octogenarian patients are vulnerable to complications like sleep disturbances and delirium. In preventing and treating these conditions, health-care professionals should be aware of the effect and side-effect of sedatives and z-hypnotics in the octogenarian patients. Our findings show that medications should be cautiously used within this group of patients.

  • 8.
    Amofah, H. A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Instenes, I.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Fridlund, B.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Haaverstad, R.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Kuiper, K.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, A. H.
    Department of Clinical Science, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway.
    Norekvål, T. M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Octogenarian patients' sleep and delirium experiences in hospital and four years after aortic valve replacement: A qualitative interview study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 1, article id e039959Article in journal (Refereed)
    Abstract [en]

    Objectives

    Sleep disturbances and delirium are frequently observed complications after surgical aortic valve replacement (SAVR) and transcutaneous aortic valve implantation (TAVI), especially in octogenarian patients. However, a knowledge gap exists on patient experiences of sleep and delirium. In particular, patients' long-Term sleep and delirium experiences are unknown. This article explores and describes how octogenarian patients suffering from delirium after aortic valve replacement experience their sleep and delirium situation.

    Design

    An explorative and descriptive design with a longitudinal qualitative approach was applied. Qualitative content analysis following the recommended steps of Graneheim and Lundman was performed.

    Setting

    Patients were included at a tertiary university hospital with 1400 beds. Delirium and insomnia screening was performed at baseline and five postoperative days after aortic valve treatment. For qualitative data, 10 patients were interviewed 6-12 months after treatment with focus on delirium. Five of these patients were reinterviewed 4 years after treatment, with focus on their sleep situation.

    Participants

    Inclusion criteria; age 80+, treated with SAVR or TAVI and had experienced delirium after treatment.

    Results

    For the initial interview, we included five men and five women, four following TAVI and six following SAVR, mean age 83. One overarching theme revealed from the content analyses; Hours in bed represented emotional chaos. Whereas three subthemes described the patients' experiences with sleep and delirium, a cascade of distressful experiences disturbing sleep, the struggle between sleep and activity and elements influencing sleep. Four years after the treatment, sleep disturbances persisted, and patients still remembered strongly the delirium incidences.

    Conclusions

    For octogenarian patients, sleep disturbances and delirium are long-Term burdens and need a greater attention in order to improve patient care. 

  • 9.
    Amofah, Hege A.
    et al.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Institute of Nursing, Faculty of Health and Social Science, Bergen University College, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Bjorvatn, Bjørn
    Norwegian Competence Centre for Sleep Disorders, Bergen, Norway.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Sleep in octogenarians during the postoperative phase after transcatheter or surgical aortic valve replacement2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 168-177Article in journal (Refereed)
    Abstract [en]

    Background: Octogenarians with aortic stenosis are an increasing population of patients admitted for surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). Although adequate sleep is important after illness and surgery, it has scarcely been studied in the immediate postoperative phase.

    Aims: To determine and compare the nature of self-reported sleep and insomnia, and recorded sleep–wake patterns in octogenarians during the in-hospital postoperative phase after SAVR or TAVI.

    Methods: A prospective cohort design was used that included octogenarian patients undergoing SAVR or TAVI at a regional university hospital. Self-reports were used to document sleep and insomnia, and actigraphy was used to record sleep–wake patterns. Data were collected at baseline preoperatively, and then daily for the first five postoperative days.

    Results: SAVR patients experienced the most insomnia on postoperative nights later in recovery, while TAVI patients experienced the most insomnia on postoperative nights early in recovery. The median total sleep time, as measured by actigraphy, was 6.4 h, and the median sleep efficiency was 79% for the five postoperative nights, but no differences were found between SAVR and TAVI patients on this parameter. All patients slept more during daytime than at night, with SAVR patients having significantly more total sleep hours for all five days than TAVI patients (p < 0.01).

    Conclusion: Octogenarians with aortic stenosis had disturbed self-reported sleep, increased insomnia, and disturbed sleep–wake patterns postoperatively, resulting in more daytime sleep and inactivity. In patients undergoing SAVR or TAVI, sleep evolves differently during the in-hospital postoperative phase.

  • 10.
    Arenhall, Eva
    et al.
    Örebro Universitet, Department of Cardiology, Örebro, Sweden.
    Eriksson, Mats
    Uddevalla Hospital, Department of Pediatrics, Uddevalla, Sweden.
    Nilsson, Ulrica
    Örebro Universitet, School of Health Sciences, Örebro, Sweden.
    Steinke, Elaine E.
    Wichita State University, School of Nursing, Wichita, United States.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Decreased sexual function in partners after patients’ first-time myocardial infarction2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 6, p. 521-526Article in journal (Refereed)
    Abstract [en]

    Background: A myocardial infarction event affects not only patients but also partners, although how it affects the partners’ sexual function is not studied.

    Aim: The purpose of this study was to describe and compare how partners experienced their sexual function one year before with one year after first-time myocardial infarction of their partner.

    Methods: A longitudinal and comparative design was used. Self-reported data on Watts Sexual Function Questionnaire was collected retrospectively at two occasions from 123 partners (87 women and 36 men), measuring the year prior to the first-time myocardial infarction and the year after. Data were analysed using descriptive and inferential statistics.

    Results: The total score for Watts Sexual Function Questionnaire showed a significant decrease over time. In all four subscales a decrease was found, which were statistically significant in three out of the four subscales (sexual desire, 19.39 vs 18.61; p<0.001, orgasm, 14.11 vs 13.64; p=0.027 and satisfaction, 12.61 vs 12.31; p=0.042). Twenty-six partners reported that their intercourse frequencies decreased over time, while six partners reported an increased intercourse frequency.

    Conclusions: Partners’ sexual function decreased after patients’ first-time myocardial infarction. It is important for health personnel to offer information and discussion about sexual function and concerns with both patients and partners after a first-time myocardial infarction. 

  • 11.
    Baker, Sinan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Alcharif, Odai
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Ekokardiografi: jämförelse av erfarenhetens betydelse vid mätningar av strain och strain rate i vänster kammare2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Echocardiography has a major role for assessment of the left ventricle. By using segmental and global longitudinal strain and strain rate both regional and global kinetics can be assessed. Segmental strain measures deformation of the myocardium as strain rate measures the velocity of the deformation. By summing the average from all segments, global longitudinal strain is obtained.

    Purpose:  To compare heart ultrasound-based segmental and global strain and strain rate in the left ventricle. Comparisons have been made between experienced biomedical laboratory scientist and less experienced biomedical laboratory scientist’s students.

    Method: Quantitative study were 10 test subjects have been examined echocardiographically. Imaging and measurements were collected with Siemens Acuson SC2000. Compilation of collected measurements were made on Microsoft Excel and Microsoft Word in charts and tables. For comparison of segmental and global strain and strain rate the analysis method Related-Samples Wilcoxon Signed Rank Test were used.

    Result: The result shows only one statistically significant difference (p <0.05) of segmental strain in the basal segments of apical projections between experienced biomedical laboratory scientist and student 1. 

    Conclusion: The data material is not enough to generalize the result to a larger population. Further studies are needed to draw a more secure conclusion.

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  • 12.
    Barmano, Neshro
    et al.
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Charitakis, Emmanouil
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Jan-Erik
    Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Nystrom, Fredrik H.
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Walfridsson, Håkan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Walfridsson, Ulla
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Predictors of improvement in arrhythmia-specific symptoms and health-related quality of life after catheter ablation of atrial fibrillation2018In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 42, no 2, p. 247-255Article in journal (Refereed)
    Abstract [en]

    Background: The primary goal of radiofrequency ablation (RFA) of atrial fibrillation (AF) is to improve symptoms and health-related quality of life (HRQoL). However, most studies have focused on predictors of AF recurrence rather than on predictors of improvement in symptoms and HRQoL.

    Hypothesis: We sought to explore predictors of improvement in arrhythmia-specific symptoms and HRQoL after RFA of AF, and to evaluate the effects on symptoms, HRQoL, anxiety, and depression. Methods: We studied 192 patients undergoing their first RFA of AF. The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), arrhythmia-specific questionnaire in tachycardia and arrhythmia (ASTA), and hospital anxiety and depression scale (HADS) questionnaires were filled out at baseline, at 4 months, and at a 1-year follow-up.

    Results: All questionnaire scale scores improved significantly over time. In the ASTA symptom scale score, female gender and > 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes and AF recurrence within 12 months after RFA were significant negative predictors (R2 = 0.18; P < 0.001). In the ASTA HRQoL scale score, the presence of heart failure and > 10 AF episodes the month before RFA were significant positive predictors of improvement, while diabetes, maximum left atrial volume and AF recurrence were significant negative predictors (R2 = 0.20; P < 0.001).

    Conclusion: Left atrial volume, gender, diabetes, heart failure, the frequency of AF attacks prior to RFA, and recurrence of AF after RFA were significant factors affecting improvement in symptoms and HRQoL after RFA of AF. Future studies are warranted to confirm these findings. 

  • 13.
    Barmano, Neshro
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Walfridsson, Ulla
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Walfridsson, Håkan
    Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden.
    Structured care of patients with atrial fibrillation improves guideline adherence2016In: Journal of Atrial Fibrillation, ISSN 1941-6911, Vol. 9, no 4Article in journal (Refereed)
    Abstract [en]

    There are many reports of lack of guideline adherence in the treatment of patients with atrial fibrillation (AF), and AF affects health-related quality of life (HRQo L) negatively. The aim of this study was to investigate whether structured care compared to standard care of a general AF population could improve guideline adherence and HRQo L, and reduce symptoms, anxiety and depression. In total, 176 patients were recruited to the intervention and 146 patients to the control group. The intervention consisted of a structured follow-up program, while patients serving as controls received standard care. The primary outcome was guideline adherence evaluated through: appropriate use of oral anticoagulants (OAC) and antiarrhythmics, whether echocardiogram and thyroid lab tests were performed, and patient-reported outcome measures (PROMs), assessed with the questionnaires SF-36, EQ-5D, HADS and ASTA at baseline and after one year Guideline adherence was significantly better in the intervention group, 91% vs. 63% (p < 0.01), mainly due to appropriate OAC treatment 94% vs. 74% (p < 0.01). Symptoms assessed with ASTA were less frequent and the negative impact of AF was reduced in the intervention group after one year/at follow-up. Five scales in SF-36, and the visual analogue scale for current health status in EQ-5D (EQ-VAS), improved significantly in both groups. Structured care of patients with AF significantly improved guideline adherence and patients reported fewer symptoms and a reduced negative impact on disease-specific HRQo L compared to standard care at one year follow-up.

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  • 14.
    Bekoh, Denis keji
    et al.
    Jönköping University, School of Health and Welfare.
    Gulas, Spyridon
    Jönköping University, School of Health and Welfare.
    Förändrad vardag för personer med hjärtsvikt: - En litteraturöversikt2021Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Summary 

    Daily life changed for people with heart failure

    Background: Heart failure is a common disease that is a widespread problem worldwide. In Sweden, two to three percent of people per year are diagnosed with heart failure. For someone with heart failure to receive the right support and treatment, an individual plan needs to be drawn in consultation between the nurse and the person with hearts failure. The task of nurses is to give advice a person with heart failure and follow up the individual in order know if person have a feeling of being part of a context. 

    Aims: The purpose was to describe experiences for people with heart failure in everyday life. 

    Method: A qualitative method with an inductive approach has been used. Twelve scientific articles were used for the result. The articles were retrieved from CINAHL, MEDLINE and PSYCINFO and quality reviewed with the quality review protocol from the School of Health Sciences, in Jönköping.  

    Results: The result consisted of two themes; to adapt to the physical challenges of everyday life (lack of energy in everyday life, lack of knowledge about heart failure, adapt to the disease and the need of family and friends), and to undergo emotional changes in everyday life (Uncertainty about the future, Social isolation, Questions about death and accepting their illness). 

    Conclusion: people with heart failure experience limitations in daily life. Lack of knowledge leads to difficulties in managing heart failure. The nurse in primary care should provide information and knowledge about heart failure in an understandable way based on the individual’s adaptation and have the conditions to manage their illness to improve the well-being of people with heart failure.

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  • 15.
    Björck, Hanna M.
    et al.
    Linköping University.
    Eriksson, Per
    Karolinska Institutet.
    Alehagen, Urban
    Linköping University.
    De Basso, Rachel
    Linköping University.
    Ljungberg, Liza U.
    Linköping University.
    Persson, Karin
    Linköping University.
    Dahlstrom, Ulf
    Linköping University.
    Länne, Toste
    Linköping University.
    Gender-Specific Association of the Plasminogen Activator Inhibitor-1 4G/5G Polymorphism With Central Arterial Blood Pressure2011In: American Journal of Hypertension, ISSN 0895-7061, E-ISSN 1941-7225, Vol. 24, no 7, p. 802-808Article in journal (Refereed)
    Abstract [en]

    BACKGROUND The functional plasminogen activator inhibitor-1 (PAI-1) 4G/5G polymorphism has previously been associated with hypertension. In recent years, central blood pressure, rather than brachial has been argued a better measure of cardiovascular damage and clinical outcome. The aim of this study was to investigate the possible influence of the 4G/5G polymorphism on central arterial blood pressure in a cohort of elderly individuals.

    METHODS We studied 410 individuals, 216 men and 194 women, aged 70-88. Central pressures and pulse waveforms were calculated from the radial artery pressure waveform by the use of the SphygmoCor system and a generalized transfer function. Brachial pressure was recorded using oscillometric technique (Dinamap, Critikon, Tampa, FL). PAI-1 antigen was determined in plasma.

    RESULTS The results showed that central pressures were higher in women carrying the PAI-1 4G/4G genotype compared to female carriers of the 5G/5G genotype, (P = 0.025, P = 0.002, and P = 0.002 for central systolic-, diastolic-, and mean arterial pressure, respectively). The association remained after adjustment for potentially confounding factors related to hypertension. No association of the PAI-1 genotype with blood pressure was found in men. Multiple regression analysis revealed an association between PAI-1 genotype and plasma PAI-1 levels (P = 0.048).

    CONCLUSIONS Our findings show a gender-specific association of the PAI-1 4G/5G polymorphism with central arterial blood pressure. The genotype effect was independent of other risk factors related to hypertension, suggesting that impaired fibrinolytic potential may play an important role in the development of central hypertension in women.

  • 16.
    Blomstrand, Peter
    et al.
    Department of Clinical Physiology, Faculty of Health Sciences, University Hospital, Linköping, Sweden..
    Engvall, J.
    Departments of Clinical Physiology, Linköping University, Sweden.
    Karlsson, J. E.
    Linköping University, Sweden.
    Björkholm, A.
    Faculty of Health Sciences, Linköping University, Sweden.
    Wallentin, L.
    Linköping University, Sweden.
    Wranne, B.
    Departments of Clinical Physiology, Linköping University, Sweden.
    Exercise echocardiography: a methodological study comparing peak‐exercise and post‐exercise image information1992In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 12, no 5, p. 553-565Article in journal (Refereed)
    Abstract [en]

    It is unclear whether echocardiography at peak bicycle exercise adds information to registrations obtained recumbent immediately after the test and what factors influence image quality. Therefore, exercise echocardiography was performed consecutively and prospectively in 66 men, unselected with regard to echocardiography, one month after an episode of unstable coronary artery disease. Of 594 segments (9 × 66), 569 (96%) were adequately visualized recumbent at rest. The corresponding figures recumbent directly after exercise, seated before exercise, and seated at peak exercise were 544 (92%), 474 (80%), and 428 (72%), respectively. In the majority of our patients, acceptable images at peak exercise were obtained for the septal region, while for the anterior, lateral, and inferior segments the success rate varied from 50 to 70%. Recumbent after exercise, the success rate was acceptable for most segments, possibly with the exception of the apical and lateral segments. Fifty‐five patients developed new wall motion abnormalities or worsening of wall motion in connection with exercise. Echocardiography at peak exercise provided more information than afterwards in patients with images of good quality. However, in patients with inferior image quality, the registrations obtained recumbent after the test revealed wall motion abnormalities which were not obtained seated at peak exercise. Patients with worse image quality had significantly higher respiratory rate and weight, and rated a higher degree of dyspnoea at peak exercise than those with good quality. We conclude that in middle aged men with coronary artery disease, image acquisition at peak bicycle exercise and immediately after exercise are of complementary value.

  • 17.
    Blomstrand, Peter
    et al.
    Linköping Heart Centre, University Hospital, Sweden.
    Engvall, J.
    Linköping Heart Centre, University Hospital, Sweden.
    Swahn, E.
    Linköping Heart Centre, University Hospital, Sweden.
    Säfström, K.
    Linköping Heart Centre, University Hospital, Sweden.
    Thulesius, O.
    Linköping Heart Centre, University Hospital, Sweden.
    Wranne, B.
    Linköping Heart Centre, University Hospital, Sweden.
    Cardiovascular effects of dobutamine stress testing in women with suspected coronary artery disease1996In: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 75, no 5, p. 463-468Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate the central and peripheral haemodynamic response to dobutamine stress testing in women with suspected ischaemic heart disease and to seek an explanation for the hypotension phenomenon. Design. 18 women aged 54-73 years were investigated with Doppler echocardiography and venous occlusion plethysmography during intravenous infusion of dobutamine 5-10 d after an episode of unstable angina. Results. An average peak dose of 33 (SD 9.7) μg/kg/min was given. Heart rate and cardiac output increased by 49% and 59%, respectively (P < 0.001). Total and leg peripheral vascular resistance decreased by 44% and 26%, respectively (P < 0.001). Four patients developed hypotension (decrease in systolic blood pressure > 10 mm Hg), one of whom had a paradoxical bradycardia and two a low increase in cardiac output. Patients with hypotension had a more pronounced decrease in total peripheral vascular resistance but a similar change in leg peripheral vascular resistance compared with patients without hypotension. Conclusions. Dobutamine infusion leads to marked peripheral vasodilatation and an increase in cardiac output. Some patients experience hypotension during the test for reasons which include paradoxical vasovagal reactions and diminished capacity for adequate increase in cardiac output. There is also a disparity between the pattern of total and leg peripheral vascular resistance in patients with hypotension which might reflect a baroreceptor mediated compensatory increase in vasoconstrictor tone of muscle vessels not matched in other vascular territories.

  • 18.
    Blomstrand, Peter
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. City Hospital Ryhov, Jönköping, Sweden.
    Engvall, Martin
    Linköping University.
    Festin, Karin
    Linköping University.
    Lindstrom, Torbjorn
    Linköping University.
    Länne, Toste
    Linköping University.
    Maret, Eva
    Karolinska University Hospital, Stockholm.
    Nyström, Fredrik H.
    Linköping University.
    Maret-Ouda, John
    Karolinska University Hospital, Stockholm.
    Östgren, Carl Johan
    Linköping University.
    Engvall, Jan
    Linköping University.
    Left ventricular diastolic function, assessed by echocardiography and tissue Doppler imaging, is a strong predictor of cardiovascular events, superior to global left ventricular longitudinal strain, in patients with type 2 diabetes2015In: European Heart Journal Cardiovascular Imaging, ISSN 2047-2404, E-ISSN 2047-2412, Vol. 16, no 9, p. 1000-1007Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the study was to determine whether left ventricular systolic function, in terms of global left ventricular longitudinal strain (GLS), and diastolic function, expressed as the ratio between early diastolic transmitral flow and mitral annular motion velocities (E/e'), can predict cardiovascular events in patients with diabetes mellitus type 2.

    Methods and results: We prospectively investigated 406 consecutive patients, aged 55-65 years, with diabetes mellitus, who participated in the CARDIPP study. Echocardiography, pulse pressure (pp), and glycosylated haemoglobin (HbA1c) were analysed. Twelve cases of myocardial infarction and seven cases of stroke were identified during the follow-up period of 67 +/- 17 months. Univariate Cox regression analysis showed that E/e' was a strong predictor of cardiovascular events (hazards ratio 1.12; 95% confidence interval 1.06-1.18, P < 0.001). E/e' was prospectively associated with cardiovascular events independent of age, sex, GLS, left ventricular ejection fraction (LVEF), pp, and HbA1c in multivariate analysis. Receiver operating characteristic curves showed that E/e' and HbA1c were the strongest predictors for cardiovascular events, both having an area under the curve (AUC) of 0.71 followed by LVEF with an AUC of 0.65 and GLS of 0.61. In a Kaplan-Meyer analysis, the cumulative probability of an event during the follow-up period was 8.6% for patients with an E/e' ratio >15 compared with 2.6% for patients with E/e' <= 15, P = 0.011.

    Conclusion: In middle-aged patients with type 2 diabetes, E/e' is a strong predictor of myocardial infarction and stroke, comparable with HbA1c and superior to GLS and LVEF.

  • 19.
    Blomstrand, Peter
    et al.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Karlsson, J. -K
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Engvall, J.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Nylander, E.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Björkholm, A.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Wallentin, L.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Wranne, B.
    Department of Clinical Physiology, University Hospital, Linköping, Sweden.
    Exercise echocardiography and thallium 201 single-photon emission computed tomography in male patients after an episode of unstable coronary artery disease1994In: American Journal of Cardiac Imaging, ISSN 0887-7971, Vol. 8, no 4, p. 283-289Article in journal (Refereed)
    Abstract [en]

    To compare modern, digital exercise echocardiography and thallium 201 single-photon emission computed tomography (SPECT) in patients with unstable coronary artery disease, 65 men unselected with regard to echocardiography were prospectively investigated 1 month after an episode of unstable angina or non-Q-wave myocardial infarction. Exercise echocardiography and 201Tl SPECT were performed on consecutive days in connection with a standard symptom-limited upright bicycle test and analyzed in a 9-segment model. Coronary angiography was performed in all but 1 patient and 60 patients had significant coronary lesions. Wall motion abnormalities were seen in 53 patients (81%) at rest and perfusion defects in 57 patients (88%) at the redistribution images. New or worsening of wall motion abnormalities were seen in 55 patients, either seated at peak exercise or recumbent after exercise, and 43 patients had reversible or partially reversible 201Tl scintigraphic defects (P = .02). The segmental agreement between wall motion abnormalities and scintigraphic defects was low (58%). The additional value of exercise echocardiography and 201Tl SPECT to exercise test was greatest in patients with one-vessel disease. Thus, 1 month after an episode of unstable coronary artery disease in men, there is a high incidence of significant coronary stenoses as well as signs of ischemia shown both by wall motion abnormalities during exercise echocardiography and by postexercise studies with 201Tl SPECT. Exercise echocardiography gives a higher diagnostic yield regarding occurrence of reversible ischemia.

  • 20.
    Blomstrand, Peter
    et al.
    Department of Clinical Physiology, Linköping Heart Centre, University of Linköping, Sweden; Department of Clinical Physiology, Länssjukuset Ryhov, Jönköping, Sweden.
    Kongstad, O.
    Department of Cardiology, Linköping Heart Centre, University of Linköping, Sweden.
    Broqvist, M.
    Department of Cardiology, Linköping Heart Centre, University of Linköping, Sweden.
    Dahlström, U.
    Department of Cardiology, Linköping Heart Centre, University of Linköping, Sweden.
    Wranne, B.
    Department of Clinical Physiology, Linköping Heart Centre, University of Linköping, Sweden.
    Assessment of left ventricular diastolic function from mitral annulus motion, a comparison with pulsed Doppler measurements in patients with heart failure1996In: Clinical Physiology, ISSN 0144-5979, E-ISSN 1365-2281, Vol. 16, no 5, p. 483-493Article in journal (Refereed)
    Abstract [en]

    Mitral and pulmonary venous flow velocity recordings are often used for the assessment of left ventricular diastolic function. These curves are, however, also influenced by other factors. To investigate whether mitral annulus motion carries additional information in this context, mitral annulus motion was compared to Doppler registrations of mitral and pulmonary flow velocities in 38 patients with heart failure (NYHA II-III) after myocardial infarction. Patients with an increased atrial contribution to mitral annulus motion (> 57%, n = 12) had a higher mitral late-to-early flow velocity ratio (A/E) and pulmonary systolic to diastolic filling ratio (< 0.01). Patients with atrial displacement above average for the group (≤ 5.1 mm, n = 19) had a higher mitral A/E ratio and pulmonary systolic to diastolic filling ratio than patients with a lower than average atrial component (P < 0.05). There was a significant correlation between a/T ratio and A/E ratio (r = 0.61, P < 0.001) and between pulmonary flow and transmitral flow (= 0.76, P < 0.001). We conclude that an increased atrial displacement of the mitral annulus is a frequent finding in patients with signs of left ventricular relaxation abnormality. There is a significant correlation between a/T ratio and A/E ratio but the information contained in the two indices are not identical.

  • 21.
    Blomstrand, Peter
    et al.
    County Hospital Ryhov, Jönköping, Sweden.
    Maret, Eva
    County Hospital Ryhov, Jönköping, Sweden.
    Ohlsson, Jan
    County Hospital Ryhov, Jönköping, Sweden.
    Scheike, Morten
    Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Karlsson, Jan-Erik
    County Hospital Ryhov, Jönköping, Sweden.
    Säfström, Kåge
    Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Swahn, Eva
    Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Engvall, Jan
    Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Pulsed tissue Doppler imaging for the detection of myocardial ischaemia, a comparison with myocardial perfusion SPECT2004In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 24, no 5, p. 289-295Article in journal (Refereed)
    Abstract [en]

    In order to compare the diagnostic ability of pulsed tissue Doppler and myocardial perfusion Single Photon Emission Computed Tomography (SPECT) in patients with a history of unstable coronary artery disease, CAD, 26 patients, 22 men and four women, age 47-76 years, were investigated in a prospective study, 5-10 day after an episode of unstable angina. Tissue Doppler and two-dimensional echocardiography were performed during dobutamine stress testing and myocardial scintigraphy after bicycle exercise and at rest. Patients with a normal SPECT had higher peak systolic velocity during dobutamine infusion, 18.9 ± 4.1 cm s-1, than patients with ischaemia, 12.2 ± 3.8 cm s-1 (P&lt;0.001) or scar, 8.8 ± 3.0 cm s-1 (P&lt;0.01). In a territorial analysis the difference in peak systolic velocity between areas with a normal and abnormal SPECT was less apparent. Failure to achieve ≥13 cm s-1 in mean-peak systolic velocity was the most accurate criterion for detection of significant CAD on SPECT. We conclude that pulsed tissue Doppler can be used for objective quantification of left ventricular wall motion during dobutamine stress testing and for identification of patients with CAD on SPECT but not for identification of regional ischaemia.

  • 22.
    Blomstrand, Peter
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. County Hospital Ryhov, Department of Clinical Physiology, Jönköping, Sweden.
    Sjöblom, Peter
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Nilsson, Mats
    Futurum, Academy for Health and Care, Jönköping, Sweden.
    Wijkman, Magnus
    Linköping University, Department of Internal Medicine and Department of Medical and Health Sciences, Norrköping, Sweden.
    Engvall, Martin
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Länne, Toste
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Nyström, Fredrik H.
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Engvall, Jan
    Linköping University, Department of Medical and Health Sciences, Linköping, Sweden.
    Overweight and obesity impair left ventricular systolic function as measured by left ventricular ejection fraction and global longitudinal strain2018In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 17, no 1, article id 113Article in journal (Refereed)
    Abstract [en]

    Aims

    Obesity is associated with type 2 diabetes mellitus, left ventricular diastolic dysfunction and heart failure but it is unclear to which extent it is related to left ventricular systolic dysfunction. The aim of the study was to explore the effects of overweight and obesity on left ventricular systolic function in patients with type 2 diabetes mellitus and a control group of non-diabetic persons.

    Methods

    We prospectively investigated 384 patients with type 2 diabetes mellitus, and 184 controls who participated in the CARDIPP and CAREFUL studies. The participants were grouped according to body mass index (normal weight < 25 kg/m2, overweight 25–29 kg/m2, and obesity ≥ 30 kg/m2). Echocardiography was performed at the beginning of the study and after 4-years in the patient group.

    Results

    Univariable and multivariable regression analysis revealed that variations in left ventricular ejection fraction, global longitudinal strain, left ventricular mass and diastolic function expressed as E/é (the ratio between early diastolic mitral flow and annular motion velocities) all are related to body mass index. The mean and standard deviation of left ventricular ejection fraction and global longitudinal strain values were 57% (8%) vs. − 18.6% (2.3%) for normal weight patients, 53% (8%) vs. − 17.5% (2.3%) for overweight, and 49% (9%) vs. − 16.2% (3.0%) for obese (p < 0.05 vs. p < 0.05). Corresponding results in the control group were 58% (6%) vs. − 22.3% (3.0%), 55% (7%) vs. − 20.8% (3.1%) and 54% (8%) − 19.6% (4.0%) (p < 0.05 vs. p < 0.05). Patients who gained weight from baseline to follow-up changed left ventricular ejection fraction (median and interquartile range) by − 1.0 (9.0) % (n = 187) and patients who lost weight changed left ventricular ejection fraction by 1.0 (10.0) % (n = 179) (p < 0.05).

    Conclusion

    Overweight and obesity impair left ventricular ejection fraction and global longitudinal strain in both patients with type 2 diabetes mellitus and non-diabetic persons.

  • 23.
    Blomstrand, Peter
    et al.
    Department of Clinical Physiology, Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Thulesius, O.
    Department of Clinical Physiology, Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Wranne, B.
    Department of Clinical Physiology, Linköping Heart Centre, University Hospital, Linköping, Sweden.
    Cardiovascular effects of dobutamine stress testing in healthy women1995In: Clinical Cardiology, ISSN 0160-9289, E-ISSN 1932-8737, Vol. 18, no 11, p. 659-663Article in journal (Refereed)
    Abstract [en]

    Dobutamine echocardiography is frequently used for detection of coronary artery disease. The circulatory response in patients is known to some extent, but studies in normals are lacking. Hypotensive response during the test is a common side effect, the cause of which is unclear. The aim of this study was, therefore, to investigate the hemodynamic response to dobutamine in women without cardiovascular disease and interfering medications. Eleven healthy women, age 53–71 years, were investigated with Doppler echocardiography and venous occlusion plethysmography during intravenous infusion of increasing doses of dobutamine according to a standardized protocol. An average peak dose of 22 ± 7.5 μMu kg‐1 min‐1 was administered. Cardiac output increased by 93%, heart rate by 68%, and stroke volume by 15%, while peripheral vascular resistance decreased by approximately 50%. Systolic blood pressure remained unchanged and diastolic blood pressure decreased by 21%. One subject demonstrated a decreased systolic blood pressure exceeding 10 mmHg. Outflow obstruction from the left ventricle was seen in two subjects, one of whom had a slight decrease of 10 mmHg in systolic blood pressure. Subjects &gt; 65 years demonstrated a less pronounced increase in heart rate, cardiac output, and decrease in peripheral vascular resistance compared with those &lt; 65 years.

  • 24.
    Carlsson, Emma
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden.
    Rundqvist, Louise
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Blomstrand, Peter
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform. Department of Clinical Physiology, Region Jönköping County, Jönköping, Sweden.
    Faresjö, Maria
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Enhanced immune response to a potent type 1 diabetes-related autoantigen is observed in endurance-trained boysManuscript (preprint) (Other academic)
  • 25.
    Chahrour, Fatme
    et al.
    Jönköping University, School of Health and Welfare.
    To, Johnny
    Jönköping University, School of Health and Welfare.
    Sjuksköterskans pedagogiska omvårdnad för egenvård hos patienter med kronisk hjärtsvikt: En kvantitativ litteraturöversikt2022Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Hjärtsvikt är en vanligt förekommande folksjukdom i Sverige, och egenvård är en central del i patienternas vardag. För att minska risken av försämring i sin sjukdom är det därmed väsentligt för patienterna att få adekvat patientundervisning om hur egenvården främjas. Syfte: Syftet med litteraturöversikten var att beskriva effekter av sjuksköterskans pedagogiska omvårdnad för upprätthållandet av en god egenvård hos patienter med kronisk hjärtsvikt. Metod: En kvantitativ litteraturöversikt innehållande 11 artiklar från Cinahl och Medline genomfördes. Resultat: En strukturerad pedagogisk omvårdnad visade förbättring på patienters symtomuppfattning, egenvårdshantering, egenvårdsbeteenden och minskade återinläggningar. Patienterna visade dessutom förbättrad kunskap om mat- och vätskerestriktioner, läkemedelsföljsamhet och fysisk aktivitet. Slutsats: Sjuksköterskans pedagogiska omvårdnad kan vara fördelaktig i arbetet med att befrämja egenvården hos patienter med kronisk hjärtsvikt.

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  • 26.
    Dahl, Julia
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Olander, Lisa
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine.
    Bestämning av ejektionsfraktion i vila med ekokardiografi och myokardscintigrafi: En metodjämförelse2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 27.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Benzein, Eva
    School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Sandgren, Anna
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Managing uncertainty in couples living with atrial fibrillation2014In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, no 3, p. E1-E10Article in journal (Refereed)
    Abstract [en]

    Background: Living with a chronic disease such as atrial fibrillation (AF) not only affects the patient but also has implications for the partner. There is a lack of research on couples living with AF and, in particular, how they experience and deal with the disease.

    Objective: The aim of this study was to explore couples’ main concerns when one of the spouses is afflicted with AF and how they continually handle it within their partner relationship.

    Methods: Classical grounded theory was used throughout the study for data collection and analysis. Interviews were conducted with 12 couples (patient and partner together). There were follow-up interviews with 2 patients and 2 partners separately.

    Results: Couples living with AF experience uncertainty as a common main concern. This uncertainty was fundamentally rooted in not knowing the cause of AF and apprehension about AF episodes. Couples managed this uncertainty by either explicitly sharing concerns related to AF or through implicitly sharing their concerns. Explicit sharing incorporated strategies of mutual collaboration and finding resemblance, whereas implicit sharing incorporated strategies of keeping distance and tacit understanding. Time since diagnosis and time being symptom-free were factors influencing afflicted couples’ shifting between implicit and explicit sharing.

    Conclusions: Atrial fibrillation affects the partner relationship by bringing uncertainty into couples’ daily lives. Even though this study shares similarities with previous studies on couples living with chronic disease, it contributes to the existing knowledge by presenting a set of strategies used by couples in managing uncertainty when living with AF.

  • 28.
    Dalteg, Tomas
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Sandberg, Jonas
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare).
    Sandgren, Anna
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    Benzein, Eva
    Linnaeus University, The Center for Collaborative Palliative Care, Vaxjo, Sweden.
    The heart is a representation of life: an exploration of illness beliefs in couples living with atrial fibrillation2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S41-S41, article id 116Article in journal (Refereed)
    Abstract [en]

    Background: Beliefs are the lenses through which we view the world, guiding our behaviour and constructing our lives. Couples evolve an ecology of beliefs from their interaction whereby their actions and choices arise from their beliefs. Atrial fibrillation is a common cardiac arrhythmia that has implications for both patients and partners. A couple’s illness beliefs play an important role in convalescence and illness management, and no previous studies have examined illness beliefs in couples living with AF.

    Purpose: To explore illness beliefs in couples where one spouse has atrial fibrillation.

    Methods: Data collection constituted in-depth interviews with nine couples (patient and partner together). Hermeneutic philosophy as described by Gadamer was used to interpret and to understand illness beliefs in couples living with AF.

    Results: The findings revealed both core illness beliefs and secondary illness beliefs. From the core illness belief “Theheart is a representation of life,” two secondary illness beliefs were derived: atrial fibrillation is a threat to life and atrial fibrillation can and must be explained. From the core illness belief “Change is an integral part of life,” two secondary illness beliefs were derived: atrial fibrillation is a disruption in our lives and atrial fibrillation will not interfere with our lives. Finally, from the core illness belief “Adaptation is fundamental in life,” two secondary illness beliefs were derived: atrial fibrillation entails adjustment in daily life and atrial fibrillation entails confidence in and adherence to professional care.

    Conclusion: Couples’ interaction has developed mutual illness beliefs regarding atrial fibrillation that guide them in their daily lives and influence their decisions. The adoption of a family-centred perspective in cardiovascular care settings is warranted.

  • 29.
    De Basso, Rachel
    et al.
    Jönköping Hospital.
    Åstrand, Håkan
    Jönköping Hospital.
    Ahlgren, Åsa Rydén
    Lund University.
    Sandgren, Thomas
    Capio Lundby Hospital, Gothenburg, Sweden.
    Länne, Toste
    Linköping University.
    Low wall stress in the popliteal artery: Other mechanisms responsible for the predilection of aneurysmal dilatation?2014In: Vascular Medicine, ISSN 1358-863X, E-ISSN 1477-0377, Vol. 19, no 2, p. 131-136Article in journal (Refereed)
    Abstract [en]

    The popliteal artery (PA) is, after aorta, the most common site for aneurysm formation. Why the PA is more susceptible than other peripheral muscular arteries is unknown. We hypothesized that the wall composition, which in turn affects wall properties, as well as the circumferential wall stress (WS) imposed on the arterial wall, might differ compared to other muscular arteries. The aim was to study the WS of the PA in healthy subjects with the adjacent, muscular, common femoral artery (CFA) as a comparison. Ninety-four healthy subjects were included in this study (45 males, aged 10-78 years and 49 females, aged 10-83 years). The diameter and intima-media thickness (IMT) in the PA and CFA were investigated with ultrasound. Together with blood pressure the WS was defined according to the law of Laplace adjusted for IMT. The diameter increased with age in both PA and CFA (p<0.001), with males having a larger diameter than females (p<0.001). IMT increased with age in both PA and CFA (p<0.001), with higher IMT values in males only in PA (p<0.001). The calculated WS was unchanged with age in both arteries, but lower in PA than in CFA in both sexes (p<0.001). In conclusion, this study shows that the PA and CFA WS is maintained during aging, probably due to a compensatory remodelling response with an increase in arterial wall thickness. However, the stress imposed on the PA wall is quite low, indicating that mechanisms other than WS contribute to the process of pathological arterial dilatation in the PA.

  • 30.
    Debasso, Rachel
    et al.
    Department of Medicine and Care, University of Linköping, Sweden; Department of Clinical Physiology, Jönköping Hospital, Länssjukhuset Ryhov, Jönköping, Sweden.
    Åstrand, H.
    Department of Medicine and Care, University of Linköping, Sweden.
    Bjarnegård, N.
    Department of Medicine and Care, University of Linköping, Sweden.
    Ahlgren, Å. R.
    Department of Clinical Physiology, Malmö University Hospital, Sweden.
    Sandgren, T.
    Department of Surgery, Helsingborg Hospital, Sweden.
    Länne, T.
    Department of Medicine and Care, University of Linköping, Sweden.
    The popliteal artery, an unusual muscular artery with wall properties similar to the aorta: Implications for susceptibility to aneurysm formation?2004In: Journal of Vascular Surgery, ISSN 0741-5214, E-ISSN 1097-6809, Vol. 39, no 4, p. 836-842Article in journal (Refereed)
    Abstract [en]

    Objective: The popliteal artery is, after the aorta, the most common site for aneurysm formation. Why the popliteal artery is more susceptible than other peripheral muscular arteries is unknown. An important factor may be differences in arterial wall composition as compared with other peripheral muscular arteries, which in turn affect wall properties. These are however unknown. We studied the mechanical wall properties of the popliteal artery in healthy subjects.

    Material and Methods: An ultrasound echo-tracking system was used to measure pulsatile changes in popliteal diameter in 108 healthy subjects (56 female, 52 male; age range, 9-82 years). In combination with blood pressure, stiffness (0), strain, cross-sectional artery wall compliance coefficient (CC), and distensibility coefficient (DC) were calculated. Intima-media thickness (IMT) was registered with a Philips P700 ultrasound scanner.

    Results: The popliteal diameter increased with age, and was larger in male subjects than in female subjects (P < .001). Fractional diameter change (strain) decreased with age (P < .001), and strain values were lower in male subjects than in female subjects (P < .01). Accordingly, stiffness increased with age (P < .001), with higher stiffness values in male subjects (P < .01). DC decreased with age (P < .001), with lower DC values in male subjects (P < .01). CC decreased with age, with no difference between genders (P < .001). IMT increased with age (P < .001), with higher IMT values in male subjects (P < .001). The increase in IMT did not affect distensibility.

    Conclusion: The wall properties of the popliteal artery are affected by age and gender, not only with an increase in diameter, but also with an age-related decrease in distensibility, with male subjects having lower distensibility than in female subjects. This seems not to be the behavior of a true muscular artery, but of a central elastic artery, such as the aorta, and might have implications for susceptibility to arterial dilatation, as well as the association of aneurysm formation between the aorta and the popliteal artery.

    Clinical Relevance: The popliteal artery is, after the abdominal aorta, the most common location for aneurysm formation in the arterial system. Why it is more susceptible than other arteries is unknown. This study shows that the wall function of the popliteal artery differs from other peripheral arteries, and instead show striking similarities to the abdominal aorta, indicating that the functional arrangement of arterial wall components are similar in the two arteries. This may have implications for the susceptibility to aneurysm formation, as well as the association of dilating disease between the popliteal artery and the abdominal aorta.

  • 31.
    Dybjer, Elin
    et al.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, School of Health Sciences, University of Skövde, Skövde, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nilsson, Erik D.
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nägga, Katarina
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nilsson, Peter M.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
    Type 1 diabetes, cognitive ability and incidence of cardiovascular disease and death over 60 years of follow-up time in men2022In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 39, no 8, article id e14806Article in journal (Refereed)
    Abstract [en]

    Aims: There are few cohorts of type 1 diabetes that follow individuals over more than half a century in terms of health outcomes. The aim of this study was to examine associations between type 1 diabetes, diagnosed before age 18, and long-term morbidity and mortality, and to investigate whether cognitive ability plays a role in long-term morbidity and mortality risk.

    Methods: In a Swedish cohort, 120 men with type 1 diabetes and 469 without type 1 diabetes were followed between 18 and 77 years of age as regards morbidity and mortality outcomes, and impact of cognitive ability at military conscription for the outcomes. In Cox regression analyses and Kaplan-Meier analyses with log-rank tests, associations between diabetes and cognitive ability respectively, and outcomes (mortality, cardiovascular morbidity and diabetes complications) were investigated.

    Results: Men with type 1 diabetes suffered from dramatically higher mortality (HR 4.62, 95% CI: 3.56–5.60), cardiovascular mortality (HR 5.60, 95% CI: 3.27–9.57), and cardiovascular events (HR 3.97, 95% CI: 2.79–5.64) compared to men without diabetes. Higher cognitive ability at military conscription was associated with lower mortality in men without diabetes, but was not associated with any outcome in men with diabetes.

    Conclusions: In this historical cohort study with 60 years of follow-up time and a less effective treatment of diabetes than today, mortality rates and cardiovascular outcomes were high for men with type 1 diabetes. Morbidity or mortality did not differ between those that had low to normal or high cognitive ability among men with type 1 diabetes.

    What’s new 

    • There is little data from Scandinavia on the long-term prognosis of type 1 diabetes before 1970, and no studies that investigate cognitive ability early in life as a predictor of long-term morbidity and mortality in type 1 diabetes.
    • Men with type 1 diabetes followed for 60 years had a 4.6 times higher risk of all-cause mortality than men without diabetes. Cognitive ability at 18 years significantly predicted mortality in men without, but not with, type 1 diabetes.
    • The results add to the literature describing the prognosis of type 1 diabetes in Scandinavia during the time period from 1934 until today.
  • 32.
    Eide, L. S. P.
    et al.
    Bergen University College, Faculty of Health and Social Sciences, Bergen, Norway.
    Ranhoff, A. H.
    Haraldsplass Diakonale Hospital, Kavli Research Center for Geriatrics and Dementia, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Haaverstad, R.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Hufthammer, K. O.
    Haukeland University Hospital, Centre for Clinical Research, Bergen, Norway.
    Lauck, S.
    St Paul’s Hospital, Centre for Heart Valve Innovation, Vancouver, Canada.
    Norekval, T. M.
    Bergen University College, Faculty of Health and Social Sciences, Bergen, Norway.
    Urinary catheter use and delirium after aortic valve therapy2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S3-S4Article in journal (Refereed)
    Abstract [en]

    Background: Indwelling urinary catheters (IUC) are valuable devices that help to control and monitor urine output under and after invasive procedures. However, adverse outcomes might arise following use of IUC, and several studies show that IUC can be a risk factor for postoperative delirium. Delirium is an acute and fluctuating change in attention and cognition that might lead to extended hospital stay, and more morbidity and mortality. The association between delirium and the duration of IUC use in octogenarians after Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Implantation (TAVI) remains to be established.

    Purpose: To determine if the duration of IUC use after SAVR or TAVI predicts the development of delirium in older people.

    Methods: This is a prospective cohort study of octogenarian patients (N=136) in a tertiary university hospital. Inclusion criteria: ⩾80 years, severe aortic stenosis, and elective TAVI or SAVR. Exclusion criteria: Inability to speak Norwegian or declined consent to participate in the study. The Mini-Mental State examination was used to evaluate global cognitive function at baseline. The Confusion Assessment Method allowed the identification of delirium during five postoperative days. The duration of IUC use was collected from patients’ medical records. The predictive effect of IUC in the development of delirium was examined using multiple regression.

    Results: The majority (57%) of patients was female, and 46% received TAVI. Patients in the TAVI group were older (85 vs. 82 years-old, P<0.001), had more comorbidities (2.5 vs.1.8, P=0.001) and higher logistic EuroSCORE (19.6 vs. 9.4,P<0.001). Delirium was present in 66% of patients treated with SAVR vs. 44% of those receiving TAVI. The average duration of IUC use in SAVR patients with delirium was 66 hours (SD=29) compared to 59 hours (SD=27) in those without delirium (P=0.307), and in TAVI patients with delirium was 58 hours (SD=38) compared to 32 hours (SD=15) for those without delirium (P=0.001). Multivariate regression analysis shows that lower cognitive function (P=0.040), type of aortic valve treatment (P=0.043) and longer of IUC use (P=0.002) predicted the development of delirium.

    Conclusion: In octogenarian patients undergoing aortic valve treatment, the duration of IUC use can predict delirium. Further research is needed to mitigate the risks of delirium in patients undergoing aortic valve treatment.

  • 33.
    Eide, Leslie S. P.
    et al.
    Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, Rune
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan Erik
    Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
    Norekval, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway .
    Readmissions and mortality in delirious versus non-delirious octogenarian patients after aortic valve therapy: A prospective cohort study2016In: BMJ Open, E-ISSN 2044-6055, Vol. 6, no 10, article id e012683Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine whether postoperative delirium predicts first-time readmissions and mortality in octogenarian patients within 180 days after aortic valve therapy with surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI), and to determine the most common diagnoses at readmission.

    Design: Prospective cohort study of patients undergoing elective SAVR or TAVI.

    Setting: Tertiary university hospital that performs all SAVRs and TAVIs in Western Norway.

    Participants: Patients 80+ years scheduled for SAVR or TAVI and willing to participate in the study were eligible. Those unable to speak Norwegian were excluded. Overall, 143 patients were included, and data from 136 are presented. Primary and secondary outcome measures: The primary outcome was a composite variable of time from discharge to first all-cause readmission or death. Secondary outcomes were all-cause first readmission alone and mortality within 180 days after discharge, and the primary diagnosis at discharge from first-time readmission. Delirium was assessed with the confusion assessment method. First-time readmissions, diagnoses and mortality were identified in hospital information registries.

    Results: Delirium was identified in 56% of patients. The effect of delirium on readmissions and mortality was greatest during the first 2 months after discharge (adjusted HR 2.9 (95% CI 1.5 to 5.7)). Of 30 first-time readmissions occurring within 30 days, 24 (80%) were patients who experienced delirium. 1 patient (nondelirium group) died within 30 days after therapy. Delirious patients comprised 35 (64%) of 55 first-time readmissions occurring within 180 days. Circulatory system diseases and injuries were common causes of first-time readmissions within 180 days in delirious patients. 8 patients died 180 days after the procedure; 6 (75%) of them experienced delirium. Conclusions: Delirium in octogenarians after aortic valve therapy might be a serious risk factor for postoperative morbidity and mortality. Cardiovascular disorders and injuries were associated with first-time readmissions in these patients.

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  • 34.
    Fernberg, Ulrika
    et al.
    Orebro Univ, Fac Med & Hlth, Cardiovasc Res Ctr, Fak Gatan 1, SE-70182 Orebro, Sweden..
    Fernstrom, Maria
    GIH, Dept Phys Act & Hlth, Swedish Sch Sport & Hlth Sci, S-11433 Stockholm, Sweden..
    Hurtig-Wennlöf, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Orebro Univ, Fac Med & Hlth, Cardiovasc Res Ctr, Fak Gatan 1, SE-70182 Orebro, Sweden.;Jonkoping Univ, Sch Hlth & Welf, Dept Nat Sci & Biomed, Biomed Platform, S-55111 Jonkoping, Sweden..
    Higher Total Physical Activity is Associated with Lower Arterial Stiffness in Swedish, Young Adults: The Cross-Sectional Lifestyle, Biomarkers, and Atherosclerosis Study2021In: Vascular Health and Risk Management, ISSN 1176-6344, E-ISSN 1178-2048, Vol. 17, p. 175-185Article in journal (Refereed)
    Abstract [en]

    Purpose: Arterial stiffness describes the rigidity of the arterial walls and is associated with risk factors for cardiovascular disease (CVD). Arterial stiffness predicts future events and mortality, and the predictive value is stronger in younger versus older subjects. The aims of the present study were, firstly, to present data on physical activity (PA) and time spent sedentary, in the population of Swedish, young adults. Secondly, to explore the association between PA and arterial stiffness. Material and Methods: Self-reported healthy, non-smoking, Swedish, young adults, 18-25 years old, participated in the cross-sectional Lifestyle, Biomarkers and Atherosclerosis (LBA) study. The daily PA was objectively measured with an accelerometer for 1 week. Of the 834 participants, 658 individuals had valid registrations. The arterial stiffness measures, pulse wave velocity (PWV) and augmentation index (AIx) were measured with applanation tonometry. Results: Women were on overall more physically active than men, they spent 214 min/day in light PA (LPA) compared to men who spent 202 min/day. Women took significantly more steps per day than men, 7796 vs 7336 steps/day, and spent less time sedentary, 523 min/day, compared to men who spent 547 min/day sedentary. In total, 76% of the individuals spent on average at least 30 minutes per day in the recommended moderate and vigorous PA (MVPA). Lower arterial stiffness was associated with more MVPA and total PA in the total population. Conclusion: We conclude that in this age group of young, self-reported healthy adults 18-25 years, it is important to highlight the health-enhancing possibilities of time spent in physical activity on the vascular function, measured as PWV and AIx. It is of high relevance in a public health perspective to expand preventive efforts beyond the high-risk groups and encourage young adults to be physically active.

  • 35.
    Fransen, Karin
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Pettersson, Carolina
    Clinical Research Laboratory, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hurtig-Wennlöf, Anita
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine.
    CRP levels are significantly associated with CRP genotype and estrogen use in The Lifestyle, Biomarker and Atherosclerosis (LBA) study2022In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 22, no 1, article id 170Article in journal (Refereed)
    Abstract [en]

    Background

    The C-reactive protein (CRP) is an important biomarker for atherosclerosis and single nucleotide polymorphisms (SNPs) in the CRP locus have been associated with altered CRP levels and associated with risk for cardiovascular disease. However, the association between genetic variations in the CRP gene, estrogen use and CRP levels or early signs of atherosclerosis in young healthy individuals is not fully characterized. We aimed to evaluate the influence of five genetic variants on both plasma CRP levels and carotid intima-media thickness (cIMT) values, including aspects on estrogen containing contraceptive use in females.

    Methods

    Genotyping was performed with TaqMan real time PCR and compared with high sensitivity CRP serum levels in 780 Swedish young, self-reported healthy individuals. Haplotypes of the SNPs were estimated with the PHASE v 2.1. The cIMT was measured by 12 MHz ultrasound. The contraceptive use was self-reported.

    Results

    Strong associations between CRP and genotype were observed for rs3091244, rs1800947, rs1130864, and rs1205 in women (all p < 0.001). In men, only rs1800947 was associated with CRP (p = 0.029). The independent effect of genotypes on CRP remained significant also after adjustment for established risk factors. Female carriers of the H1/ATGTG haplotype had higher CRP than non-carriers. This was specifically pronounced in the estrogen-using group (p < 0.001), and they had also higher cIMT (p = 0.002) than non-carriers but with a small cIMT difference between the haplotype groups (0.02 mm). In parallel, a significant correlation between CRP and cIMT in the estrogen using group was observed (r = 0.194; p = 0.026).

    Conclusions

    Estrogen use, genotypes and haplotypes in the CRP locus are significantly associated with CRP levels. Based on an observed interaction effect between sex/estrogen use and the H1/ATGTG haplotype on CRP, and a marginally thicker cIMT in the estrogen using group, our data suggest that both genotypes and estrogen usage could be involved in arterial wall structural differences. The causality between CRP levels and cIMT remains unclear, and the observed difference in cIMT is not clinically relevant in the present state. Future larger and longitudinal studies may shed further light on the role of more long-term estrogen use and early atherosclerosis.

  • 36.
    Frantzen, A.
    et al.
    Haukeland Hospital, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Eide, L. S. P.
    University of Bergen, Norway.
    Haaverstad, R.
    Haukeland Hospital, Bergen, Norway.
    Hufthammer, K. O.
    Haukeland Hospital, Bergen, Norway.
    Kuiper, K. K. J.
    Haukeland Hospital, Bergen, Norway.
    Ranhoff, A.
    University of Bergen, Norway.
    Norekval, T. M.
    Haukeland Hospital, Bergen, Norway.
    Change in frailty status in octogenarians with severe symptomatic aortic stenosis after aortic valve replacement2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, p. 788-789Article in journal (Other academic)
  • 37.
    Fålun, Nina
    et al.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Heart Disease, Haukeland University Hospital, Norway.
    Schaufel, Margrethe A.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Schei, Edvin
    Department of Global Public Health and Primary Care, University of Bergen, Norway.
    Norekvål, Tone M.
    Department of Heart Disease, Haukeland University Hospital, Norway.
    Patients’ goals, resources, and barriers to future change: A qualitative study of patient reflections at hospital discharge after myocardial infarction2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 7, p. 495-503Article in journal (Refereed)
    Abstract [en]

    Background: Myocardial infarction (MI) patients may find it challenging to adhere to lifestyle advice and medications. Understanding motivational factors and barriers to change is crucial. However, empirical evidence on patients’ ability to effect lifestyle changes at the time of discharge is limited.

    Aim: The aim of this study was to identify at the time of hospital discharge the goals, resources, and barriers to future change in MI patients.

    Methods: We conducted a qualitative interview study with a purposive sample of 20 MI patients (eight women) in a cardiac department at a university hospital in Norway. All interviews were conducted before hospital discharge, transcribed verbatim, and analysed using qualitative content analysis.

    Findings: Three themes suggested that, at the time of discharge, patients’ views of their MI were complex and diverse. Patients were motivated to change their lifestyle and contemplated taking their life in new directions, adopting a change of life perspective. Frequently, patients struggled to understand the context of living with an MI, manage symptoms, and understand the precipitating causes of MI. There were also patients who wanted to maintain their present lifestyle and live as normal as possible. They just wanted to keep going.

    Conclusions and implications: There is a need for a different approach to communicating with MI patients at the time of discharge. Person-centred care that allows personal narratives to emerge may enable health-care professionals to offer more individualised guidance to MI patients that will help them cope with the everyday challenges they experience after discharge.

  • 38.
    Gabrielson, Marike
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Vorkapic, Emina
    Department of Medical and Health Sciences, Linköping University.
    Folkesson, Maggie
    Department of Medical and Health Sciences, Linköping University.
    Welander, Martin
    Department of Medical and Health Sciences, Linköping University.
    Matussek, Andreas
    Department of Laboratory Services, County Hospital Ryhov.
    Dimberg, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Länne, Toste
    Department of Medical and Health Sciences, Linköping University.
    Skogberg, Josefin
    Division of Vascular Biology, Department of Medical Biochemistry and Biophysics, Karolinska Institutet, Stockholm.
    Wågsäter, Dick
    Department of Medical and Health Sciences, Linköping University.
    Altered PPARγ coactivator-1 alpha expression in abdominal aortic aneurysm: Possible effects on mitochondrial biogenesis2016In: Journal of Vascular Research, ISSN 1018-1172, E-ISSN 1423-0135, Vol. 53, no 1-2, p. 17-26Article in journal (Refereed)
    Abstract [en]

    Introduction: Abdominal aortic aneurysm (AAA) is a complex and deadly vascular disorder. The pathogenesis of AAA includes destruction and phenotypic alterations of the vascular smooth muscle cells (VSMCs) and aortic tissues. PPARγ coactivator-1 alpha (PGC1α) regulates VSMC migration and matrix formation and is a major inducer of mitochondrial biogenesis and function, including oxidative metabolism. Methods: Protein and gene expression of PGC1α and markers for mitochondria biogenesis and cell type-specificity were analysed in AAA aortas from humans and mice and compared against control aortas. Results: Gene expression of PPARGC1A was decreased in human AAA and angiotensin (Ang) II-induced AAA in mice when compared to control vessels. However, high expression of PGC1α was detected in regions of neovascularisation in the adventitia layer. In contrast, the intima/media layer of AAA vessel exhibited defective mitochondrial biogenesis as indicated by low expression of PPARGC1A, VDAC, ATP synthase and citrate synthase. Conclusion: Our results suggest that mitochondrial biogenesis is impaired in AAA in synthetic SMCs in the media, with the exception of newly formed supporting vessels in the adventitia where the mitochondrial markers seem to be intact. To our knowledge, this is the first study investigating PGC1α and mitochondria biogenesis in AAA.

  • 39.
    Gullvag, M.
    et al.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Gjeilo, K. H.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Falun, N.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Norekval, T. M.
    Haukeland University Hospital, Department of Heart Disease, Bergen, Norway.
    Mo, R.
    St Olavs Hospital, Department of Cardiology, Trondheim, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Sleepless nights and sleepy days - a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep disordered breathing2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S57-S58Article in journal (Refereed)
    Abstract [en]

    Background: Sleep disordered breathing (SDB) is a pathologic, nocturnal breathing pattern present in at least 50% of patients with chronic heart failure (CHF). SDB is categorized as central or obstructive, and both are associated with worsened prognosis, affects physical and mental capacity and influences quality of life. Knowledge of how SDB is experienced by patients with CHF is limited, and has not previously been addressed in qualitative studies.

    Purpose: The aim of this study was to explore the experiences of patients with CHF and newly verified and untreated SDB.

    Methods: The study used an inductive descriptive design, collecting data through semi-structured interviews analysed with qualitative content analysis. Twelve participants (9 men and 3 women, mean age 62 (range 41-80)) diagnosed with CHF and a newly objectively verified (i.e., by polygraphy) SDB (6 obstructive, 5 central and 1 mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    Results: The participants’ descriptions fell into five categories: Sleep disruption causing troublesome nights: Disruptive nights with sleep onset latency, frequent arousals and early morning awakenings caused frustration and a longing for a night of uninterrupted sleep. Daily life challenges due to daytime sleepiness: Excessive tiredness led to a need for sleep during the day, overactivity to avoid tiredness, extra care when operating a vehicle, and a feeling that concentration and memory were impaired. Involvement of a partner: The partners were described as being more affected by the sleep apnea than the participants, and it was apparent that the apneas caused fear and worry for the partners. Self-care strategies: Use of a dark, quiet and well-ventilated bedroom and avoidance of actions that could impair sleep; i.e. daytime naps, coffee, or heavy meals before bedtime were described. Some participants discussed their  sleep problems with their GP, but experienced that the problems were not examined in detail and sleep medication was a common, however unwanted, solution. Awareness of SDB: Some participants were relieved as the finding of the SDB finally gave an explanation to their problems, while others were surprised by the result.

    Conclusion: Patients with CHF and SDB experienced that sleep disturbances influenced their daily life. Raised awareness on sleep is needed for these patients. Possible underlying causes for disruptive sleep, such as SDB, should be identified in order to establish proper treatment strategies and follow-up care for the individual. Future studies on both medical and nursing strategies to improve sleep for patients with CHF and SDB are needed, and intervention studies should be prioritized.

  • 40.
    Gullvåg, Marianne
    et al.
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Gjeilo, Kari Hanne
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Fålun, Nina
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Norekvål, Tone M.
    Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Mo, Rune
    Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
    Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep-disordered breathing.2019In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 3, p. 750-759Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sleep-disordered breathing, including obstructive sleep apnoea and central sleep apnoea, is a common disorder among patients with chronic heart failure. Obstructive sleep apnoea is often treated with continuous positive airway pressure, but central sleep apnoea lacks a clear treatment option. Knowledge of how sleep-disordered breathing is experienced (e.g. difficulties and care needs) and handled (e.g. self-care actions) by the patients is limited, but needed, to provide patient-centred care.

    AIM: To explore how newly verified sleep-disordered breathing is experienced by patients with chronic heart failure.

    METHODS: Data were collected through semi-structured interviews and analysed with qualitative content analysis. Seventeen participants (14 men, three women), mean age 60 years (range 41-80) diagnosed with chronic heart failure and objectively verified sleep-disordered breathing (nine obstructive, seven central and one mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals.

    RESULTS: Patients with chronic heart failure and newly verified sleep-disordered breathing (SDB) described experiences of poor sleep that had consequences for their daily life and their partners. Different self-care strategies were revealed, but they were based on 'common sense' and were not evidence-based. The awareness of having SDB was varied; for some, it gave an explanation to their trouble while others were surprised by the finding.

    CONCLUSION: Patients with chronic heart failure and sleep-disordered breathing experienced reduced sleep quality, influencing their daily life. Possible underlying causes of disrupted sleep, such as sleep-disordered breathing, should be identified to establish proper patient-centred treatment strategies. There is a need for new strategies to approach patients with chronic heart failure (i.e. those with central sleep apnoea) who are not subject to continuous positive airway pressure treatment for their sleep-disordered breathing.

  • 41.
    Hayashi, S Y
    et al.
    Royal Institute of Technology, Stockholm, Sweden.
    Bjällmark, Anna
    Royal Institute of Technology, Stockholm, Sweden.
    Larsson, M
    Royal Institute of Technology, Stockholm, Sweden.
    Nascimento, MM
    Karolinska Institute, Stockholm, Sweden.
    Lindholm, B
    Karolinska Institute, Stockholm, Sweden.
    Lind, B
    Royal Institute of Technology, Stockholm, Sweden.
    Seeberger, A
    Karolinska Institute, Stockholm, Sweden.
    Nowak, J
    Karolinska Institute, Stockholm, Sweden.
    Riella, MC
    Pro­Renal Foundation, Curitiba, Brazil.
    Brodin, LA
    Royal Institute of Technology, Stockholm, Sweden.
    Ultrasonographic 2D strain imaging in common carotid artery, a new approach to the evaluation of arterial stiffness in patients with chronic kidney disease2010In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 11, no suppl_2, p. ii12-ii41, article id P367Article in journal (Refereed)
  • 42.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Malm, Dan
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Karlsson, J. E. K.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Arestedt, K. A.
    Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Ryhov County Hospital, Jonkoping, Sweden, Department of Medicine, Jonkoping, Sweden.
    Factors associated with involvement in risk communication and confidence in shared decision making among patients with atrial fibrillation.2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S74-S75Article in journal (Refereed)
    Abstract [en]

    Background: Atrial fibrillation (AF) is a highly prevalent arrhythmia. Effective communication of risks (e.g., risk for stroke) and benefits to patients (e.g., treatment with oral anticoagulants) is crucial for shared decision making. Knowledge about how patients experience confidence and satisfaction in communication in relation to their health status is limited.

    Aim: The aim was to explore factors associated with involvement in risk communication and confidence in shared decision making among patients with AF.

    Method: A cross-sectional design was used and 322 patients (39 % women), mean age 67 years (SD 10.3 years) with AF were included at four hospitals in Sweden. Clinical examinations and self-rating scales for risk communication (COMRADE), uncertainty in illness (MUIS-C), depressive symptoms (HADS), mastery of daily life (MDL), as well as physical and mental health (SF-36) were used to collect data after a follow-up visit at the outpatient clinic 3 months post an AF episode.

    Results: Paroxysmal, persistent and permanent AF occurred among 32%, 34% and 7% of the patients, respectively. Patients whom had undergone DC-conversion (53%) and had anticoagulants (37%). Seven percent had been treated by a percutan ablation. Heart failure (15%) and ischemic heart disease (12%) were the most common co-morbidities. CHA2DS2-VASc >2 were seen among 62% of the patients. Overall, multiple regression analyses showed that uncertainty in illness and mastery of daily life were significantly associated with confidence in decisions and uncertainty in illness and hypertension were significantly associated with satisfaction in communication. Higher uncertainty in illness and poorer mastery of daily life were associated with poor confidence in decisions. Higher uncertainty in illness and occurrence of hypertension were associated with poor satisfaction in communication. Clinical AF variables (i.e.,symptom or treatment related) or depressive symptoms were not significantly associated with satisfaction in communication or confidence in decisions in the multiple regression analysis. The final models explained 29% and 30% of the variance in confidence in decision making and satisfaction in communication.

    Conclusion: In this cross-sectional study, including patients with AF, confidence in decision making and satisfaction in communication are associated with uncertainty in illness, mastery of daily life and hypertension.

  • 43.
    Hedberg, Berith
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Futurum, Region Jönköpings län.
    Malm, Dan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Ryhov County Hospital, Region Jönköpings län Jönköping, Sweden.
    Karlsson, Jan-Erik
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Department of Internal Medicine, Department of Medical and Health Sciences, Linköping University, Sweden.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Broström, Anders
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT. Department of Clinical Neurophysiology, Linköping University Hospital, Sweden.
    Factors associated with confidence in decision making and satisfaction with risk communication among patients with atrial fibrillation2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, no 5, p. 446-455Article in journal (Refereed)
    Abstract [en]

    Background:

    Atrial fibrillation is a prevalent cardiac arrhythmia. Effective communication of risks (e.g. stroke risk) and benefits of treatment (e.g. oral anticoagulants) is crucial for the process of shared decision making.

    Aim:

    The aim of this study was to explore factors associated with confidence in decision making and satisfaction with risk communication after a follow-up visit among patients who three months earlier had visited an emergency room for atrial fibrillation related symptoms.

    Methods:

    A cross-sectional design was used and 322 patients (34% women), mean age 66.1 years (SD 10.5 years) with atrial fibrillation were included in the south of Sweden. Clinical examinations were done post an atrial fibrillation episode. Self-rating scales for communication (Combined Outcome Measure for Risk Communication and Treatment Decision Making Effectiveness), uncertainty in illness (Mishel Uncertainty in Illness Scale–Community), mastery of daily life (Mastery Scale), depressive symptoms (Hospital Anxiety and Depression Scale) and vitality, physical health and mental health (36-item Short Form Health Survey) were used to collect data.

    Results:

    Decreased vitality and mastery of daily life, as well as increased uncertainty in illness, were independently associated with lower confidence in decision making. Absence of hypertension and increased uncertainty in illness were independently associated with lower satisfaction with risk communication. Clinical atrial fibrillation variables or depressive symptoms were not associated with satisfaction with confidence in decision making or satisfaction with risk communication. The final models explained 29.1% and 29.5% of the variance in confidence in decision making and satisfaction with risk communication.

    Conclusion:

    Confidence in decision making is associated with decreased vitality and mastery of daily life, as well as increased uncertainty in illness, while absence of hypertension and increased uncertainty in illness are associated with risk communication satisfaction.

  • 44.
    Hjelmfors, A-L
    et al.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Sandgren, A. S.
    Linnaeus University, Department of Healthc and Caring Sciences, Kalmar, Sweden.
    Stromberg, A. S.
    Linkoping University, Department of Medical and Health Sciences, Linkoping, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    Jaarsma, T. J.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Friedrichsen, M. F.
    Linkoping University, Department of Social and Welfare Studies, Linkoping, Sweden.
    Patient perspectives of prognosis communication2017In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no Suppl. 1, p. S65-S66Article in journal (Refereed)
    Abstract [en]

    Background: Several studies describe that patients with heart failure (HF) find it important to discuss prognosis and that they want to be informed about the expectations about the illness progression. However, little is known about their actual preferences for professional communication about prognosis.

    Purpose: to explore patient’s perspectives regarding communication with health care professionals about the HF prognosis.

    Methods: 15 patients participated in focus group interviews and a further 9 patients completed individual semi-structured interviews. The patients (75% men, 52-87 years of age) were in NYHA I-III, and were not diagnosed with any other major life threatening disease. Data was analysed using thematic analysis to identify and interpret patterns in the data.

    Results: One overarching theme was identified: “The tension between hoping for the best and preparing for the worst” with three sub-themes. Ignorance is bliss. Describes how patients preferred to avoid thinking about the HF prognosis because they did not want to lose hope for the future. They lived one day at the time, focusing on here and now, wanting to forget about the illness altogether. Patients also preferred to decide themselves whether they wanted to talk about the prognosis with professionals or not. Nothing but the truth. Describes how patients wanted to know the objective and absolute truth about their illness and its’ prognosis and were afraid to live under false expectations. The truth about their prognosis was that they might die because of their illness. Even though the truth may hurt, they believed that knowing the truth was necessary to live as good as possible. Good news only. Patients described that they knew that HF was a chronic illness but they were ambivalent in their approach towards discussing prognosis. They wanted to know the truth about their prognosis, but at the same time they did not want to know anything since they fear they might hear something they do not want to, as this may hurt. They only wanted to receive “good” and positive information from the professionals, since they perceived such information to be something that they can benefit from.

    Conclusions: This study shows that patients have different preferences for communication about prognosis and uses different approaches in order to cope living with a serious condition such as heart failure. Professionals need to respect the strategies a patient uses, and be ready to support the patient according to their needs, preferences and life situation.

  • 45.
    Hjelmfors, Anna-Lisa
    et al.
    Linköping University.
    Van der Wal, M. H. L.
    Linköping University.
    Strömberg, A.
    Linköping University.
    Friedrichsen, M.
    Linköping University.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Linköping University.
    Challenges in discussing prognosis and end-of-life care with heart failure patients2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, p. 351-351Article in journal (Other academic)
  • 46.
    Hjelmfors, L.
    et al.
    Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden..
    Stromberg, A.
    Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden..
    Friedrichsen, M.
    Vrinnevi Hosp, Palliat Educ & Res Ctr Reg Ostergotland, Norrkoping, Sweden..
    Sandgren, A.
    Linnaeus Univ, Dept Hlth Med & Caring Sci, Vaxjo, Sweden..
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, T.
    Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden..
    Van der Wal, M. H. L.
    Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden..
    Optimizing a communication tool to improve discussion about the heart failure trajectory in Sweden and the Netherlands2020In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 19, no 1 SUPPL, p. S24-S25Article in journal (Refereed)
  • 47.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 17, p. 23-23Article in journal (Other academic)
  • 48.
    Hjelmfors, Lisa
    et al.
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Strömberg, Anna
    Department of Medical and Health Sciences, Division of Nursing, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Friedrichsen, Maria
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Sandgren, Anna
    Department of Health and Caring Sciences, Center for Collaborative Palliative Care, Linnaeus University, Växjö, Sweden.
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Jaarsma, Tiny
    Department of Social and Welfare Studies (ISV), Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018In: BMC Palliative Care, E-ISSN 1472-684X, Vol. 17, no 1, article id 85Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper was to describe the development of an intervention that is developed to improve communication about the heart failure (HF) trajectory and end-of-life care. We also present data that provides a first insight in specific areas of feasibility of the intervention.

    Methods: Co-design was used and patients, family members and health care professionals were constructive participants in the design process of the intervention. Feasibility of the intervention was tested in two areas; acceptability and limited efficacy.

    Results: Two communication tools were designed and evaluated; 1) a Question Prompt List (QPL) for patients and family members and 2) a communication course for professionals which was web -based with one face-to-face training day with simulation. Data on feasibility was collected with questionnaires that were developed for this study, from the 13 participants who completed the course (all nurses). They reported improved knowledge, confidence and skills to discuss the HF trajectory and end-of-life care. The QPL was evaluated to be a useful tool in communication with patients and family members.

    Conclusions: In a co-design process, future users identified the need for a QPL and a communication course. These communication tools can be used as a dual intervention to improve communication about the HF trajectory and end-of-life care. The QPL can help patients and families to ask questions about the HF trajectory and end-of-life care. The communication course can prepare the professionals to be knowledgeable, confident and skilled to discuss the questions in the QPL. Before the tools are ready for implementation in clinical practice, further studies testing the feasibility of the intervention are needed, including also patients and their families. 

  • 49.
    Hult, L.
    et al.
    Linkoping Univ Hosp, Dept Hlth Med & Caring Sci, Linkoping, Sweden.;Linkoping Univ Hosp, Dept Clin Physiol, Linkoping, Sweden..
    Kylhammar, D.
    Linkoping Univ Hosp, Dept Hlth Med & Caring Sci, Linkoping, Sweden.;Linkoping Univ Hosp, Dept Clin Physiol, Linkoping, Sweden..
    Engvall, J.
    Linkoping Univ Hosp, Dept Hlth Med & Caring Sci, Linkoping, Sweden.;Linkoping Univ Hosp, Dept Clin Physiol, Linkoping, Sweden..
    Ostgren, C. J.
    Linkoping Univ Hosp, Dept Hlth Med & Caring Sci, Linkoping, Sweden..
    Nystrom, F.
    Blomstrand, Peter
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Biomedical Platform.
    Hedman, K.
    Linkoping Univ Hosp, Dept Hlth Med & Caring Sci, Linkoping, Sweden.;Linkoping Univ Hosp, Dept Clin Physiol, Linkoping, Sweden..
    Post systolic shortening by speckle tracking echocardiography as a predictor for cardiovascular events in patients with type 2 diabetes2022In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 43, p. 923-923Article in journal (Refereed)
    Abstract [en]

    Background: Post systolic shortening (PSS), measured by speckle tracking echocardiography has emerged as a novel method to evaluate left ventricular function and has been linked to adverse outcomes. Purpose: Our aim was to assess if the presence of pathological PSS had prognostic value in the prediction of major cardiovascular events in a cohort of patients with type-II diabetes (T2D). Method: Three-hundred-and-sixty-four patients with T2D in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) underwent echocardiography between 2005 and 2009. All patients were evaluated with strain analysis by speckle tracking. PSS was defined as any myocardial contraction occurring after aortic valve closure (Figure 1). Pathological PSS was defined as a post systolic index (PSI) >5% where PSI was calculated as: (peak global longitudinal strain – peak systolic longitudinal strain) / (peak global longitudinal strain) x 100. The composite endpoint of any major cardiovascular event (MACE) was defined as the diagnosis of or death in heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and were adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events and HbA1c. Results: Mean follow-up time was 11.2±2.3 years. Patients with pathological PSS had an increased unadjusted risk of MACE, (HR 3.73, 95% CI 2.06–6.76), which persisted after adjustment (HR 2.20, 95% CI 1.11–4.37) as compared to subjects without pathological PSS. When adding PSS to a risk prediction model including Global Longitudinal Strain (GLS), the adjusted HR (95% CI) for MACE was 2.94 (1.33–6.52) for subjects with reduced GLS (lower limit of normal −16%) and PSI >5%, compared to those with normal GLS and PSI ≤5%. Adverse events were more common in subjects with the combination of pathological PSS and GLS (Figure 2). Conclusions: Our results suggest that PSS may provide important additional prognostic information in patients with T2D.

  • 50.
    Jaarsma, T. Tiny
    et al.
    Linkoping Univ, Linkoping, Sweden..
    Kato, N. Perkio
    Linkoping Univ, Linkoping, Sweden..
    Klompstra, L.
    Linkoping Univ, Linkoping, Sweden..
    Ben Gal, T.
    Rabin Med Ctr, Heart Failure Clin, Petah Tiqwa, Israel..
    Vellone, E.
    Univ Roma Tor Vergata, Dept Biomed & Prevent, Rome, Italy..
    Mårtensson, Jan
    Jönköping University, School of Health and Welfare, HHJ, Department of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Hagglund, E.
    Karolinska Inst, Stockholm, Sweden..
    Boyne, J.
    Acad Hosp Maastricht, Maastricht, Netherlands..
    Evangelista, L.
    Univ Nevada, Las Vegas, NV USA..
    Hagenow, A.
    Ctr Internal Med Elsterwerda, Elsterwerda, Germany..
    Stromberg, A.
    Linkoping Univ, Linkoping, Sweden..
    Changes over time in patient-reported outcomes in patients with heart failure2023In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 25, p. 275-275Article in journal (Refereed)
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