1
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Fernstad J, Svennberg E, Aberg P, Kemp-Gudmundsdottir K, Jansson A, Rosenqvist M, Engdahl J. Validation of a novel smartphone-based photoplethysmographic method for ambulatory heart rhythm diagnostics. Europace 2022. [DOI: 10.1093/europace/euac053.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Vinnova - The Swedish Agency for Innovation Systems.
Region Stockholm Innovation Fund.
Introduction
Devices for long-term and ambulatory recording of heart rhythm have limited availability within health care systems worldwide, potentially leading to missed diagnoses and limitations in peri-procedural heart rhythm management. As smartphones are becoming ubiquitous the availability of heart rhythm diagnostics and management of atrial fibrillation (AF) using smartphone photoplethysmography (PPG) compared to electrocardiography (ECG) is increasing. Previous validation studies of smartphone-PPG applications have all been performed under supervision in healthcare settings. In addition, no previous study has validated smartphone-PPG compared to simultaneous ECG recordings, with manual heart rhythm interpretation of the PPG recordings nor have they included patients with atrial flutter (AFL).
Purpose
The aim of this study was to validate a novel smartphone-PPG method for heart rhythm diagnostics in patients with AF and/or AFL when in use unsupervised in an ambulatory setting.
Methods
Unselected patients undergoing direct current cardioversion at a University Hospital for treatment of AF or AFL were asked to perform one-minute heart rhythm recordings post-treatment at least twice daily for 30 days in their home environment. All included were provided with an unmodified iPhone 7 smartphone running the CORAI Heart Monitor PPG application simultaneously with a single-lead ECG recording (KardiaMobile). PPG and ECG recordings were interpreted independently by two readers.
Results
In total 280 patients, with median age of 69.0 years (31% women) were included from November 2018 to July 2020 and registered 18 005 simultaneous PPG and ECG recordings. Of the PPG recordings 96.9% had sufficient quality for diagnosis compared to 95.1% of the ECG recordings (p < 0.001). Precardioversion ECG recordings were interpreted as AF in 82.1%, AFL in 14.3% and as having insufficient quality for diagnosis in 3.6% of the patients. After removal of recordings with insufficient quality 69.7% of ECG recordings were interpreted as sinus rhythm, 28.2% as AF and 2.1 % as AFL. Manual interpretation of the PPG recordings diagnosed AF/AFL (sensitivity) in 97.7% and sinus rhythm (specificity) in 99.4% of the recordings compared to manually interpreted ECG recordings, with an overall accuracy of 98.9%. Results excluding recordings interpreted as AFL on ECG or PPG diagnosed AF (sensitivity) in 99.0% and sinus rhythm (specificity) in 99.7% of the recordings, with an overall accuracy of 99.5%.
Conclusion
A novel smartphone-PPG method can be used by patients unsupervised in their home environment for accurate heart rhythm diagnostics of AF and AFL with high sensitivity and specificity.
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Affiliation(s)
- J Fernstad
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - E Svennberg
- Karolinska Institutet, Dept of Medicine, Huddinge, Karolinska University Hospital, Stockholm, Sweden
| | - P Aberg
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - K Kemp-Gudmundsdottir
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - A Jansson
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
| | - J Engdahl
- Karolinska Institutet, Dept of Clinical Sciences, Danderyd University Hospital, Stockholm, Sweden
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Lund I, Engdahl J, Rosenqvist M, Puererfellner H, Sieghartsleitner S, Hendrikx T, Lillqvist J, Pervez Sheikh A, Bech Jensen J, Dixen U. Prevalence of silent atrial fibrillation in high-risk patients - preliminary results from a European three-country handheld ECG-screening study. Europace 2021. [DOI: 10.1093/europace/euab116.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Helsefonden Lilly and Herbert Hansens Foundation
Introduction
Patients with atrial fibrillation (AF) should in most cases be offered prophylactic anticoagulation treatment to prevent a stroke. However, the arrhythmia can appear without symptoms, so-called silent AF. Even without symptoms AF constitutes a risk for stroke.
Purpose
To screen high-risk patients with diabetes type 2 (DMII) or heart failure (CHF) for silent AF.
Methods
We included patients > 64 years with either DMII or CHF from out-patient clinics and local health centers. Exclusion criteria were known AF, anticoagulation treatment, recent stroke, or an implanted pacemaker or ICD. Patients were recruited from a total of eleven study centers in three countries. All underwent 14-days of intermittent ECG screening with a handheld ECG recording four times each day; the recordings were digitally stored. AF was diagnosed in cases of irregular heart rhythm and absence of P waves on at least one recording (thirty seconds) or on at least two recordings for a minimum of ten seconds.
Results
In total, 813 patients were included, 541 of these with DMII. The mean age was 73,4 years ± 5,8 SD, 40,7% of the patients were female.
In the DMII group thirteen patients (2.4%) were diagnosed with silent AF and offered anticoagulation. In the CHF group six (2.2%) patients had diagnosed silent AF on the handheld ECG. The prevalence of AF increased with increasing age, see Table 1. Thus, in the youngest group AF was diagnosed in 1.3% of the patients compared to 3.9 % in the age group 75 years or older.
Conclusions
Screening for silent AF in high-risk patients with DMII or CHF seems worthwhile, especially in patients 75 years or older. Abstract Figure. ECG with atrial fibrillation
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Affiliation(s)
- I Lund
- Hvidovre Hospital - Copenhagen University Hospital, Hvidovre, Denmark
| | - J Engdahl
- Karolinska Institutet, Department of Clinical Science, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institutet, Department of Clinical Science, Stockholm, Sweden
| | - H Puererfellner
- Ordensklinikum Linz Elisabethinen, Department of Cardiology, Linz, Austria
| | - S Sieghartsleitner
- Ordensklinikum Linz Elisabethinen, Department of Cardiology, Linz, Austria
| | - T Hendrikx
- Umea University Hospital, Family Medicine, Department of Public Health and Medicine, Umea, Sweden
| | - J Lillqvist
- Umea University Hospital, Family Medicine, Department of Public Health and Medicine, Umea, Sweden
| | - A Pervez Sheikh
- Hvidovre Hospital - Copenhagen University Hospital, Hvidovre, Denmark
| | - J Bech Jensen
- Hvidovre Hospital - Copenhagen University Hospital, Hvidovre, Denmark
| | - U Dixen
- Hvidovre Hospital - Copenhagen University Hospital, Hvidovre, Denmark
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Engdahl J, Rosenqvist M. Large-scale screening studies for atrial fibrillation - is it worth the effort? J Intern Med 2021; 289:474-492. [PMID: 33411987 PMCID: PMC8048511 DOI: 10.1111/joim.13217] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF) is a common disease with increasing prevalence, approximately 3.2% in the adult population. In addition, about one third of AF cases are considered asymptomatic. Due to increased longevity, increased detection and increased prevalence of risk factors, the prevalence of AF is expected to at least double by the year 2060. Patients with AF have an increased risk for ischaemic stroke, heart failure, death and cognitive decline. Treatment with oral anticoagulation reduces the risk of ischaemic stroke and mortality, and the effect on cognitive decline is being studied. Based on the increasing prevalence of AF, its often asymptomatic and paroxysmal presentation and the efficacy of oral anticoagulation treatment, screening for AF has been proposed. AF seems to fulfil most of the Wilson-Jungner criteria for screening issued by the World Health Organization, but some knowledge gaps remain, gaps that will be addressed by several ongoing studies. The knowledge gaps in AF screening consist of the magnitude of the net benefit or net harm inflicted by AF screening because the oral anticoagulation treatment will also increase the risk of bleeding, and the psychological effects of AF screening are not very well studied. So far, the AF screening recommendations issued by the European Society of Cardiology have had limited impact on national and regional AF screening activities. Several large-scale AF screening studies will report results on hard endpoints within the next few years, and these results will hopefully manifest AF as a cardiovascular disease which we need to pay more attention to.
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Affiliation(s)
- J Engdahl
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - M Rosenqvist
- From the, Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
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4
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Ghazal F, Al-Khalili F, Rosenqvist M. P6538Validity of two weeks daily self pulse-palpation for opportunistic screening for atrial fibrillation among patients 65 years and older. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pulse-palpation is recommended (ESC IA) for single time-point screening for atrial fibrillation (AF). AF may, however, be paroxysmal which can make AF detection difficult to detect on single time-point measurement. Intermittent ECG recording is a sensitive method to detect AF. However, the role of pulse-palpation for AF detection has not been validated against simultaneous ECG recordings.
Purpose
To study the validity of AF detection using self pulse-palpation simultaneously with hand-hold ECG recording 3 times daily for two weeks for AF.
Method
Patients 65 years and older visiting four primary health care centers, four any reason, were invited to AF screening from July 2017 to December 2018. Hand-held intermittent ECG recordings, 30 seconds three times a day, was offered to participants without AF for a period of 2 weeks. Patients were instructed how to take their own pulse, simultaneously with intermittent ECG measurement and in written to note whether it was irregular or not.
Results
A total of 1010 patients (mean age 73 years, 61% women) participated in the study, 27 new cases of AF (mostly paroxysmal) were detected. Totally 53 782 simultaneous ECG-recordings and pulse-measurements were registered. AF was verified in 311 ECG-recordings but the pulse was palpated as irregular only in 77 of these recordings (25% sensitivity per measurement-occasion). Of those 27 detected AF cases, 15 cases felt their pulse as irregular at least at once occasion (56% sensitivity per individuals). 187 individuals without AF felt their pulse as irregular in at least one occasion. The specificity per measurement-occasion and per individuals were 98% and 81% respectively. Diagnostic odds ratio was 5.3.
AF 27 patients No AF 983 patients Irregular pulse 202 individuals 15 187 Regular pulse 808 individuals 12 796 Sensitivity 56% Specificity 81% Positive Predictive Value 7% Negative Predictive Value 99% AF 311 measurements No AF 53471 measurements Irregular pulse 1046 measurements 77 969 Regular pulse 52,736 measurements 234 52,502 Sensitivity 25% Specificity 98% Positive Predictive Value 7% Negative Predictive Value 99%
Conclusion
AF screening using own pulse-palpation 3 times daily for two weeks is feasible but has a low sensitivity for AF detection.
Acknowledgement/Funding
This study was supported by the Swedish Heart and Lung Foundation, Pfizer, Boehringer-Ingelheim and Bayer
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Affiliation(s)
- F Ghazal
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - F Al-Khalili
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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5
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Kemp Gudmundsdottir K, Svennberg E, Al-Khalili F, Fredriksson T, Frykman V, Friberg L, Rosenqvist M, Engdahl J. 1359Mass screening for atrial fibrillation using n-terminal pro b-type natriuretic peptide - preliminary results from the strokestop 2 study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - E Svennberg
- Danderyd University Hospital, Stockholm, Sweden
| | | | | | - V Frykman
- Danderyd University Hospital, Stockholm, Sweden
| | - L Friberg
- Karolinska Institute, Stockholm, Sweden
| | | | - J Engdahl
- Danderyd University Hospital, Stockholm, Sweden
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6
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Fredriksson T, Kemp Gudmundsdottir K, Al-Khalili F, Frykman V, Friberg L, Rosenqvist M, Engdahl J, Svennberg E. P1932A comparison of intermittent and continuous event recording in population screening for atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Fredriksson
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - K Kemp Gudmundsdottir
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - F Al-Khalili
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - V Frykman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - L Friberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - J Engdahl
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - E Svennberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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7
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Al-Khalili F, Gudmundsdottir K, Svennberg E, Fredriksson T, Frykman V, Friberg L, Rosenqvist M, Engdahl J. P2797Clinical characteristics of an elderly population with screening-detected elevated NT-proBNP levels without previous diagnosis of heart failure or atrial fibrillation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F Al-Khalili
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - K Gudmundsdottir
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - E Svennberg
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - T Fredriksson
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - V Frykman
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - L Friberg
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
| | - J Engdahl
- Karolinska Institute, Dept. of Clinical Sciences, Danderyd Hospital., Stockholm, Sweden
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8
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Kemp Gudmundsdottir K, Svennberg E, Al-Khalili F, Fredriksson T, Frykman V, Friberg L, Rosenqvist M, Engdahl J. P6625Pulse palpation and history of palpitations in atrial fibrillation screening - preliminary results from the strokestop 2 study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - E Svennberg
- Danderyd University Hospital, Stockholm, Sweden
| | | | | | - V Frykman
- Danderyd University Hospital, Stockholm, Sweden
| | - L Friberg
- Karolinska Institute, Stockholm, Sweden
| | | | - J Engdahl
- Danderyd University Hospital, Stockholm, Sweden
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9
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Scorza R, Rosenqvist M, Frykman V. P603The role of magnetic resonance in patients with premature ventricular contractions and normal findings at echocardiography. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- R Scorza
- Danderyd University Hospital, Cardiology, Stockholm, Sweden
| | - M Rosenqvist
- Danderyd University Hospital, Cardiology, Stockholm, Sweden
| | - V Frykman
- Danderyd University Hospital, Cardiology, Stockholm, Sweden
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10
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Ghazal F, Theobald H, Rosenqvist M, Al-Khalili F. P1933Assessment of N-terminal pro-brain natriuretic peptide level in the screening for atrial fibrillation in the primary health care. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Ghazal
- Karolinska Institute, Section for Gerneral Praction, Stockholm, Sweden
| | - H Theobald
- Karolinska Institute, Section for Gerneral Praction, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - F Al-Khalili
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
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11
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Ringh M, Hollenberg J, Palsgaard-Moeller T, Svensson L, Rosenqvist M, Lippert FK, Wissenberg M, Malta Hansen C, Claesson A, Viereck S, Zijlstra JA, Koster RW, Herlitz J, Blom MT, Kramer-Johansen J, Tan HL, Beesems SG, Hulleman M, Olasveengen TM, Folke F. The challenges and possibilities of public access defibrillation. J Intern Med 2018; 283:238-256. [PMID: 29331055 DOI: 10.1111/joim.12730] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society.
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Affiliation(s)
- M Ringh
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - J Hollenberg
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - T Palsgaard-Moeller
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - L Svensson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - M Rosenqvist
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - F K Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - M Wissenberg
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - C Malta Hansen
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - A Claesson
- Department for Medicine, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - S Viereck
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - J A Zijlstra
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - R W Koster
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Herlitz
- Institute of Internal Medicine, Department of Metabolism and Cardiovascular Research, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M T Blom
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - J Kramer-Johansen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Air Ambulance Department, Oslo, Norway.,Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - H L Tan
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - S G Beesems
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - M Hulleman
- Department of Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - T M Olasveengen
- Department of Anaesthesiology Oslo University Hospital and University of Oslo, Oslo, Norway
| | - F Folke
- Emergency Medical Services Copenhagen, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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Sobocinski-Doliwa P, Corander JM, Rosenqvist M, Spaak J. P867Yield of targeted AF screening in a high-risk cohort with chronic kidney disease, diabetes mellitus and cardiovascular disease. Europace 2018. [DOI: 10.1093/europace/euy015.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P Sobocinski-Doliwa
- Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - J M Corander
- Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden
| | - J Spaak
- Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences, Stockholm, Sweden
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13
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Engdahl J, Holmen A, Rosenqvist M, Stromberg U. P376A prospective five-year follow-up after population-based systematic screening for atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Engdahl
- Danderyd University Hospital, Karolinska Institutet, Dept. of Clinical Sciences, Cardiology Unit, Stockholm, Sweden
| | - A Holmen
- Halmstad Central County Hospital, Research and Development, Region Halland, Halmstad, Sweden
| | - M Rosenqvist
- Danderyd University Hospital, Karolinska Institutet, Dept. of Clinical Sciences, Cardiology Unit, Stockholm, Sweden
| | - U Stromberg
- Sahlgrenska Academy, Health Metrics Unit, Department of Public Health and Community Medicine, Institute of Medicine, Gothenburg, Sweden
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14
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Giesecke P, Frykman V, Wallin G, Lönn S, Discacciati A, Törring O, Rosenqvist M. All-cause and cardiovascular mortality risk after surgery versus radioiodine treatment for hyperthyroidism. Br J Surg 2017; 105:279-286. [DOI: 10.1002/bjs.10665] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/24/2017] [Accepted: 07/09/2017] [Indexed: 11/05/2022]
Abstract
Abstract
Background
Little is known about the long-term side-effects of different treatments for hyperthyroidism. The few studies previously published on the subject either included only women or focused mainly on cancer outcomes. This register study compared the impact of surgery versus radioiodine on all-cause and cause-specific mortality in a cohort of men and women.
Methods
Healthcare registers were used to find hyperthyroid patients over 35 years of age who were treated with radioiodine or surgery between 1976 and 2000. Comparisons between treatments were made to assess all-cause and cause-specific deaths to 2013. Three different statistical methods were applied: Cox regression, propensity score matching and inverse probability weighting.
Results
Of the 10 992 patients included, 10 250 had been treated with radioiodine (mean age 65·1 years; 8668 women, 84·6 per cent) and 742 had been treated surgically (mean age 44·1 years; 633 women, 85·3 per cent). Mean duration of follow-up varied between 16·3 and 22·3 years, depending on the statistical method used. All-cause mortality was significantly lower among surgically treated patients, with a hazard ratio of 0·82 in the regression analysis, 0·80 in propensity score matching and 0·85 in inverse probability weighting. This was due mainly to lower cardiovascular mortality in the surgical group. Men in particular seemed to benefit from surgery compared with radioiodine treatment.
Conclusion
Compared with treatment with radioiodine, surgery for hyperthyroidism is associated with a lower risk of all-cause and cardiovascular mortality in the long term. This finding was more evident among men.
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Affiliation(s)
- P Giesecke
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - V Frykman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - G Wallin
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - S Lönn
- Department of Research and Development, Region Halland, Halmstad, Sweden
| | - A Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - O Törring
- Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden
| | - M Rosenqvist
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Gibbs H, Freedman B, Rosenqvist M, Al Mahmeed W, Ambrosio G, Camm A, Connolly S, Gao H, Jacobson B, Jerjes-Sanchez C, Kayani G, Oto A, Panchenko E, Ragy H, Kakkar A. P4602Similar clinical outcomes of asymptomatic and symptomatic patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H. Gibbs
- The Alfred Hospital, Melbourne, Australia
| | - B. Freedman
- Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - M. Rosenqvist
- Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - W. Al Mahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - G. Ambrosio
- University of Perugia School of Medicine, Perugia, Italy
| | - A.J. Camm
- St George's University of London, London, United Kingdom
| | | | - H. Gao
- Thrombosis Research Institute, London, United Kingdom
| | - B. Jacobson
- Johannesburg Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - C. Jerjes-Sanchez
- Instituto de Cardiologia y Medicina Vascular, TEC Salud, Tecnolόgico de Monterrey, Monterrey, Mexico
| | - G. Kayani
- Thrombosis Research Institute, London, United Kingdom
| | - A. Oto
- Hacettepe University, Ankara, Turkey
| | - E. Panchenko
- Cardiology Research and Production Center, Moscow, Russian Federation
| | - H. Ragy
- Hayat Hospital, Cairo, Egypt
| | - A.K. Kakkar
- Thrombosis Research Institute and University College London, London, United Kingdom
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Savarese G, Friberg L, Rosenqvist M, Dahlstrom U, Lund L. 1014Impact of CHA2DS2-VASc and HAS-BLED SCORES on oral anticoagulant use and outcomes in patients with atrial fibrillation and concomitant heart failure: an analysis of 22,055 patients from the SwedeHF. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Friberg L, Rosenqvist M. 5714Higher risk of dementia without oral anticoagulation in atrial fibrillation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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White A, Ng HX, Ng WY, Ng EKX, Fook-Chong S, Kua PHJ, Ong MEH, Steensberg AT, Andersen LB, Eriksen MM, Hendriksen OM, Thougaard T, Claesson A, Lennartsson J, Svensson L, Ringh M, Hollenberg J, Nordberg P, Rosenqvist M, Djarv T, Österberg S, Fredman D, Ban Y, Löwe AS, Nielsen J, Zimling M, Schmidt J, Lippert F, Ersbøll AK, Møller TP, Jørgensen MD, Lippert F, Hamilton A, Steinmetz J, Wissenberg M, Torp-Pedersen C, Lippert F, Hove L, Lohse N, Thorsager B, Bonde H, Rasmussen MB, Østergaard D, Hansen CS, Brabrand M, Lassen A, Hansen CS, Brabrand M, Lassen A, Kjer C, Holgersen M, Viggers S, Pedersen CK, Bøtker MT, Riddervold IS, Terkelsen CJ, Nystøyl DS, Hunskaar S, Zakariassen E, Fredman D, Svensson L, Ban Y, Jonsson M, Hollenberg J, Nordberg P, Ringh M, Rosenqvist M, Lundén M, Claesson A, Fredman D, Jonsson M, Haas J, Svensson L, Ban Y, Claesson A, Ribeiro F, Newton M, Freitas P, Rocha D, Leal E, Santos N, Cortez T, Allmark S, Marsden J, Linderoth G, Lippert F, Møller TP, Østergaard D, Thomas G, Nielsen AM, Øllgaard G, Inaba H, Yamashita A, Maeda T, Bakke HK, Steinvik T, Angell J, Wisborg T, Bakke HK, Steinvik T, Ruud H, Wisborg T, Haug IA, Birkenes TS, Myklebust H, Kramer-Johansen J, Funder KS, Rasmussen LS, Hesselfeldt R, Siersma V, Lohse N, Sonne A, Wulffeld S, Steinmetz J, Funde AS, Rasmussen LS, Lohse N, Hesselfeldt R, Siersma V, Pedersen F, Hendriksen OM, Lippert FK, Steinmetz J, Sol-A K, Shin SD, Lee K, Lee EJ, Ro YS, Hong KJ, Kim YJ, Jeong J, Ho PJ, Binderup LG, Mikkelsen S, de Muckadell CS, Lossius HM, Toft P, Lassen AT, Thompson L, Hill M, Hov MR, Lindner T, Franer E, Monstad A, Lund CG, Betzer M, Lyngby RM, Jousi M, Nurmi J, Kruse N, Barfod C, Raaber N, Bøtker MT, Seidenfaden SC, Riddervold IS, Simpson P, Thyer L, van Nugteren B, Seidenfaden SC, Riddervold IS, Kirkegaard H, Juul N, Bøtker MT, Zwisler T, Rønnov C, Mieritz HB, Mikkelsen S, Jørgensen G, Ångerman-Haasmaa S, Länkimäki S, Nurmi J, Mikkelsen S, Lossius HM, Toft P, Lassen AT, Viereck S, Møller TP, Rothman JP, Folke F, Lippert FK, Filipescu T, Gray A, Williams TA, Ho KM, Tohira H, Fatovich D, Brink D, Bailey P, Perkins GD, Finn J, Møller TP, Viereck S, Folke F, Lippert F, Møller TP, Ersbøll AK, Kjærulff TM, Østergaard D, Tolstrup JS, Andersen JT, Overton J, Rasmussen LS, Folke F, Lippert F, Jensen TW, Møller TP, Viereck S, Roland J, Folke F, Lassen JF, Østergaard D, Lippert F, Puolakka T, Länkimäki S, Puolakka J, Hallikainen J, Rantanen K, Kuisma M. Meeting abstracts from the first European Emergency Medical Services congress (EMS2016). Scand J Trauma Resusc Emerg Med 2017. [PMCID: PMC5356044 DOI: 10.1186/s13049-017-0358-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Claesson A, Svensson L, Nordberg P, Ringh M, Rosenqvist M, Djarv T, Samuelsson J, Hernborg O, Dahlbom P, Jansson A, Hollenberg J. Drones may be used to save lives in out of hospital cardiac arrest due to drowning. Resuscitation 2017; 114:152-156. [PMID: 28110000 DOI: 10.1016/j.resuscitation.2017.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/12/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Drowning leading to out-of-hospital cardiac arrest (OHCA) and death is a major public health concern. Submersion with duration of less than 10min is associated with favorable neurological outcome and nearby bystanders play a considerable role in rescue and resuscitation. Drones can provide a visual overview of an accident scene, their potential as lifesaving tools in drowning has not been evaluated. AIM The aim of this simulation study was to evaluate the efficiency of a drone for providing earlier location of a submerged possible drowning victim in comparison with standard procedure. METHOD This randomized simulation study used a submerged manikin placed in a shallow (<2m) 100×100-m area at Tylösand beach, Sweden. A search party of 14 surf-lifeguards (control) was compared to a drone transmitting video to a tablet (intervention). Time from start to contact with the manikin was the primary endpoint. RESULTS Twenty searches were performed in total, 10 for each group. The median time from start to contact with the manikin was 4:34min (IQR 2:56-7:48) for the search party (control) and 0:47min (IQR 0:38-0:58) for the drone-system (intervention) respectively (p<0.001). The median time saved by using the drone was 3:38min (IQR 2:02-6:38). CONCLUSION A drone transmitting live video to a tablet is feasible, time saving in comparison to traditional search parties and may be used for providing earlier location of submerged victims at a beach. Drone search can possibly contribute to earlier onset of CPR in drowning victims.
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Affiliation(s)
- A Claesson
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden.
| | - L Svensson
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
| | - P Nordberg
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
| | - M Ringh
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
| | - M Rosenqvist
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
| | - T Djarv
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
| | - J Samuelsson
- Swedish Maritime Administration, Rescue Helicopter Unit, Göteborg Sweden
| | - O Hernborg
- Helicopter Emergency Medical Services, Jämtland Härjedalen Region, Sweden
| | - P Dahlbom
- Swedish Lifesaving Society, Surf Lifesaving Club Tylösand, Sweden
| | - A Jansson
- Swedish Lifesaving Society, Surf Lifesaving Club Tylösand, Sweden
| | - J Hollenberg
- Karolinska Institutet, Department of Medicine, Center for Resuscitation Science, Stockholm, Sweden
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Claesson A, Fredman D, Svensson L, Ringh M, Hollenberg J, Nordberg P, Rosenqvist M, Djarv T, Österberg S, Lennartsson J, Ban Y. Unmanned aerial vehicles (drones) in out-of-hospital-cardiac-arrest. Scand J Trauma Resusc Emerg Med 2016; 24:124. [PMID: 27729058 PMCID: PMC5059909 DOI: 10.1186/s13049-016-0313-5] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background The use of an automated external defibrillator (AED) prior to EMS arrival can increase 30-day survival in out-of-hospital cardiac arrest (OHCA) significantly. Drones or unmanned aerial vehicles (UAV) can fly with high velocity and potentially transport devices such as AEDs to the site of OHCAs. The aim of this explorative study was to investigate the feasibility of a drone system in decreasing response time and delivering an AED. Methods Data of Global Positioning System (GPS) coordinates from historical OHCA in Stockholm County was used in a model using a Geographic Information System (GIS) to find suitable placements and visualize response times for the use of an AED equipped drone. Two different geographical models, urban and rural, were calculated using a multi-criteria evaluation (MCE) model. Test-flights with an AED were performed on these locations in rural areas. Results In total, based on 3,165 retrospective OHCAs in Stockholm County between 2006–2013, twenty locations were identified for the potential placement of a drone. In a GIS-simulated model of urban OHCA, the drone arrived before EMS in 32 % of cases, and the mean amount of time saved was 1.5 min. In rural OHCA the drone arrived before EMS in 93 % of cases with a mean amount of time saved of 19 min. In these rural locations during (n = 13) test flights, latch-release of the AED from low altitude (3–4 m) or landing the drone on flat ground were the safest ways to deliver an AED to the bystander and were superior to parachute release. Discussion The difference in response time for EMS between urban and rural areas is substantial, as is the possible amount of time saved using this UAV-system. However, yet another technical device needs to fit into the chain of survival. We know nothing of how productive or even counterproductive this system might be in clinical reality. Conclusions To use drones in rural areas to deliver an AED in OHCA may be safe and feasible. Suitable placement of drone systems can be designed by using GIS models. The use of an AED equipped drone may have the potential to reduce time to defibrillation in OHCA.
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Affiliation(s)
- A Claesson
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden.
| | - D Fredman
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - L Svensson
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - M Ringh
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - J Hollenberg
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - P Nordberg
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - M Rosenqvist
- Department of Clinical Science, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - T Djarv
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - S Österberg
- Department of Medicine, Karolinska Institutet, Solna Center for Resuscitation Science, Stockholm, Sweden
| | - J Lennartsson
- Department of urban planning and environment, division of geoinformatics, The Royal institute of technology (KTH), school of architecture and the built environment, Stockholm, Sweden
| | - Y Ban
- Department of urban planning and environment, division of geoinformatics, The Royal institute of technology (KTH), school of architecture and the built environment, Stockholm, Sweden
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Sivakumar S, Taccone FS, Desai KA, Lazaridis C, Skarzynski M, Sekhon M, Henderson W, Griesdale D, Chapple L, Deane A, Williams L, Strickland R, Lange K, Heyland D, Chapman M, Rowland MJ, Garry P, Westbrook J, Corkill R, Antoniades CA, Pattinson KT, Fatania G, Strong AJ, Myers RB, Lazaridis C, Jermaine CM, Robertson CS, Rusin CG, Hofmeijer J, Sondag L, Tjepkema-Cloostermans MC, Beishuizen A, Bosch FH, van Putten MJAM, Carteron L, Patet C, Solari D, Oddo M, Ali MA, Dias C, Almeida R, Vaz-Ferreira A, Silva J, Monteiro E, Cerejo A, Rocha AP, Elsayed AA, Abougabal AM, Beshey BN, Alzahaby KM, Pozzebon S, Ortiz AB, Cristallini S, Lheureux O, Brasseur A, Vincent JL, Creteur J, Taccone FS, Hravnak M, Yousef K, Chang Y, Crago E, Friedlander RM, Abdelmonem SA, Tahon SA, Helmy TA, Meligy HS, Puig F, Dunn-Siegrist I, Pugin J, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Tomar DS, Shafi M, Harne R, Arora DP, Talwar N, Mazumdar S, Papakrivou EE, Makris D, Manoulakas E, Tsolaki B, Karadodas B, Zakynthinos E, Garcia IP, Martin AD, Encinares VS, Ibañez MP, Montero JG, Labrador G, Cangueiro TC, Poulose V, Koh J, Kam JW, Yeter H, Stepinska J, Pérez AG, Ordoñez PF, Giribet A, Cuervo MAA, Cuervo RA, Esteban MAR, Fraile LI, Mittelbrum CP, Albaiceta GM, Kara A, Koeze J, Keus F, Dieperink W, van der Horst ICC, van Meurs M, Zijlstra JG, Roberts S, Caballero CH, Isgro G, Hall D, Aktepe O, Beitland S, Trøseid AMS, Brusletto BS, Waldum-Grevbo BE, Berg JP, Sunde K, Huertas DG, Manzano F, Quintana MMJ, Osuna A, Topeli A, Santiago-Ruiz F, Rodríguez-Mejías C, Wangensteen R, Jamaati HR, Masjedi M, Zand F, Hashemian SMR, Sabetian G, Abbasi G, Khaloo V, Tsolakoglou I, Tabei SH, Kafilzadeh A, Bakhodaei HH, Diaz JA, Silva R, Garcia DJ, Luis E, Gomez MN, Soriano R, Gonzalez PL, Intas G, Ibrahim IA, Rafik MM, Al-Ansary AM, Algendi MA, Ali AA, Fuhrmann V, Roedl K, Horvatits T, Drolz A, Rutter K, Stergiannis P, Benten D, Kluwe J, Siedler S, Kluge S, Adedugbe I, Bird GT, Kennedy RM, Sharma S, Butler MB, Yugi G, Kolaros AA, Haroon BA, Witter T, Khaliq W, Singer M, Havaldar AA, Krishna B, Sriram S, Espinoza EDV, Pozo MO, Edul VSK, Chalari E, Furche M, Motta MF, Vazquez AR, Birri PNR, Ince C, Dubin A, Dogliotti A, Ramos A, Lovesio C, Delile E, Athanasiadou E, Nevière R, Thiébaut PA, Maupoint J, Mulder P, Coquerel D, Renet S, do Rego JC, Rieusset J, Richard V, Tamion F, Martika A, Khaliq W, Andreis DT, Singer M, Smit B, Smulders YM, de Waard MC, van Straaten HMO, Girbes ARJ, Eringa EC, Man AMESD, Fildisis G, Alegría L, Soto D, Luengo C, Gomez J, Jarufe N, Bruhn A, Castro R, Kattan E, Tapia P, Rebolledo R, Faivre V, Achurra P, Ospina-Tascón G, Bakker J, Hernández G, Bertini P, Guarracino F, Baldassarri R, Pinsky MR, Alegría L, Vera M, Mengelle C, Dreyse J, Carpio D, Henriquez C, Gajardo D, Bravo S, Castro R, Ospina-Tascón G, Bakker J, Hernández G, Kim S, Favier B, Lee M, Park SY, So S, Lee H, Kačar MB, Kačar SM, Uddin I, Belhaj AM, Aydın MA, Avsec D, Payen D, Kapuağası A, Kaymak Ç, Kovach L, Şencan İ, Meço B, Özçelik M, Ünal N, Lazaridis C, Jenni-Moser B, Jeitziner MM, Poppe A, Galassi MS, Sales FL, de Moraes KCL, Batista CL, Júnior JADS, Marcari TB, Lobato R, Castro CSAA, de Souza LM, Rodrigues FFP, Winkler MS, Correa NG, Pelegrini AM, Eid RAC, Timenetsky KT, Cazati D, Lobato M, Diniz PS, Rocha LL, Cavalheiro AM, Lucinio NM, Mudersbach E, Santos ER, Norrenberg M, Gleize A, Preiser JC, Simón IF, Carmona SA, Valhonrat IL, Domínguez JP, Abellán AN, Almudévar PM, Schreiber J, Dávila F, Rubio JJ, Ramos AJ, Reina ÁJR, López NP, Pérez MA, Apolo DXC, Villén LM, López FMP, García IP, Wruck ML, Izurieta JRN, Guerrero JJE, Calvert S, Quint M, Adeniji K, Young R, Shevill DD, Robertson E, Garside P, Walter E, Schwedhelm E, Isotti P, De Vecchi MM, Perduca AE, Negro A, Villa G, Manara DF, Cabrini L, Zangrillo A, Frencken JF, van Baal L, Kluge S, Peelen LM, Donker DW, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL, Menard CE, Kumar A, Rimmer E, Zöllner C, Doucette S, Turgeon AF, Houston BL, Houston DS, Zarychanski R, Pinto BB, Carrara M, Ferrario M, Bendjelid K, Nunes J, Tavladaki T, Diaz P, Silva G, Escórcio S, Chaves S, Jardim M, Fernandes N, Câmara M, Duarte R, Pereira CA, Vieira J, Spanaki AM, Nóbrega JJ, Robles CMC, de Oca-Sandoval MAM, Sánchez-Rodríguez A, Joya-Galeana JG, Correa-Morales A, Camarena-Alejo G, Aguirre-Sánchez J, Franco-Granillo J, Soliman M, Dimitriou H, Al Azab A, El Hossainy R, Nagy H, Nirmalan M, Crippa IA, Cavicchi FZ, Vincent JL, Creteur J, Taccone FS, Chaari A, Kondili E, Hakim KA, Hassanein H, Etman M, El Bahr M, Bousselmi K, Khalil ES, Kauts V, Casey WF, Imahase H, Sakamoto Y, Choulaki C, Inoue S, Yamada KC, Koami H, Miike T, Nagashima F, Iwamura T, Boscolo A, Lucchetta V, Piasentini E, Bertini D, Meleti E, Manesso L, Spiezia L, Simioni P, Ori C, Souza RB, Martins AM, Liberatore AMA, Kang YR, Nakamae MN, Vieira JCF, Kafetzopoulos D, Koh IHJ, Hanslin K, Wilske F, Skorup P, Sjölin J, Lipcsey M, Long WJ, Zhen CE, Vakalos A, Avramidis V, Georgopoulos D, Wu SH, Shyu LJ, Li CH, Yu CH, Chen HC, Wang CH, Lin KH, Aray ZE, Gómez CF, Tejero AP, Briassoulis G, Monge DD, Losada VM, Tarancón CM, Cortés SD, Gutiérrez AM, Álvarez TP, Rouze A, Jaffal K, Six S, Stolz K, la Torre AGD, Cattoen V, Nseir S, Arnal JM, Saoli M, Novotni D, Garnero A, Becher T, Buchholz V, Schädler D, Frerichs I, de la Torre-Prados MV, Weiler N, Eronia N, Mauri T, Gatti S, Maffezzini E, Bronco A, Alban L, Sasso T, Marenghi C, Grasselli G, Tsvetanova-Spasova T, Pesenti A, Bellani G, Al-Fares A, Del Sorbo L, Anwar S, Facchin F, Azad S, Zamel R, Ferguson N, Cypel M, Nuevo-Ortega P, Keshavjee S, Fan E, Durlinger E, Spoelstra-de Man A, Smit B, de Grooth HJ, Girbes A, Straaten HOV, Smulders Y, Alfaro MA, Rueda-Molina C, Parrilla F, Meli A, Pellegrini M, Rodriguez N, Goyeneche JM, Morán I, Aguirre H, Mancebo J, Heines SJH, Strauch U, Fernández-Porcel A, Bergmans DCJJ, Blankman P, Shono A, Hasan D, Gommers D, Chung WY, Lee KS, Jung YJ, Park JH, Sheen SS, Camara-Sola E, Park KJ, Worral R, Denham S, Isherwood P, Rees SE, Larraza S, Dey N, Spadaro S, Brohus JB, Winding RW, Salido-Díaz L, Volta CA, Karbing DS, Ampatzidou F, Vlachou A, Kehagioglou G, Karaiskos T, Madesis A, Mauromanolis C, Michail N, Drossos G, García-Alcántara A, Saraj N, Rijkenberg S, Feijen HM, Endeman H, Donnelly AAJ, Morgan E, Garrard H, Buckley H, Russell L, Haase N, Tavladaki T, Perner A, Goh C, Mouyis K, Woodward CLN, Halliday J, Encina GB, Ros J, Lagunes L, Tabernero J, Bosch F, Spanaki AM, Rello J, Huertas DG, Manzano F, Morente-Constantin E, Rivera-Ginés B, Colmenero-Ruiz M, Abellán AN, Pérez LP, Lucendo AP, Almudévar PM, Dimitriou H, Domínguez JP, Villamizar PR, Sanz JG, Simon IF, Valbuena BL, Carmona SA, Pais M, Ramalingam S, Díaz C, Fox L, Kondili E, Santafe M, Barba P, García M, Leal S, Pérez M, Pérez MLP, Abellán AN, Lucendo AP, Almudevar PM, Domínguez JP, Choulaki C, Villamizar PR, Veganzones J, Simón IF, Valbuena BL, Martínez N, 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Schwarzkopf D, Fleischmann C, Reinhart K, Suwanpasu S, Sattayasomboon Y, Filho NMF, Oliveira JCA, Ballalai CS, De Lucia CV, Araponga GP, Veiga LN, Silva CS, Garrido ME, Ramos BB, Ricaldi EF, Gomes SS, Gemmell L, MacKay A, Wright C, Docking RI, Doherty P, Black E, Stenhouse P, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Yatabe T, Inoue S, Sakaguchi M, Egi M, Abdelhamid YA, Plummer MP, Finnis ME, Phillips LK, Kar P, Bihari S, Biradar V, Moodie S, Horowitz M, Shaw JE, Deane AM, Hokka M, Egi M, Mizobuchi S, Kar P, Plummer M, Abdelhamid YA, Giersch E, Summers M, Hatzinikolas S, Heller S, Chapman M, Jones K, Horowitz M, Deane A, Schweizer R, Jacquet-Lagreze M, Portran P, Junot S, Allaouchiche B, Fellahi JL, Guerci P, Ergin B, Kapucu A, Ince C, Cioccari L, Luethi N, Crisman M, Bellomo R, Mårtensson J, Shinotsuka CR, Fagnoul D, Brasseur A, Orbegozo D, Vincent JL, Preiser JC, Preiser JC, Lheureux O, Thooft A, Brimioulle S, Vincent JL, Iwasaka H, Tahara S, Nagamine M, Ichigatani A, Cabrera AR, Zepeda EM, Granillo JF, Sánchez JSA, Montoya AAT, Montenegro AP, Blanco GAG, Robles CMC, Drolz A, Horvatits T, Roedl K, Rutter K, Kluge S, Funk GC, Schneeweiss B, Fuhrmann V, Sabetian G, Pooresmaeel F, Zand F, Ghaffaripour S, Farbod A, Tabei H, Taheri L, Anandanadesan R, Metaxa V, Teixeira C, Pereira SM, Hernández-Marrero P, Carvalho AS, Beckmann M, Hartog CS, Schwarzkopf D, Raadts A, Robertsen A, Førde R, Skaga NO, Helseth E, Honeybul S, Ho K, Lopez PM, Gonzalez MN, Ortega PN, Sola EC, Spasova T, de la Torre-Prados MV, Kopecky O, Rusinova K, Waldauf P, Cepeplikova Z, Balik M, Domínguez JP, Almudevar PM, Carmona SA, Muñoz JJR, Castañeda DP, Abellán AN, Villamizar PR, Ramos JV, Pérez LP, Lucendo AP, Ejarque MC, Estella A, Camps VL, Martín MC, Masnou N, Barbosa S, Varela A, Palma I, Cristina L, Nunes E, Pereira I, Campello G, Granja C, Pande R, Pandey M, Varghese S, Chanu M, Van Dam MJ, Ter Braak EWMT, Estella A, Gracia M, Viciana R, Recuerda M, Fontaiña LP, Tharmalingam B, Kovari F, Rose L, Mcginlay M, Amin R, Burns K, Connolly B, Hart N, Jouvet P, Katz S, Leasa D, Mawdsley C, Mcauley D, Schultz M, Blackwood B, Denham S, Worrall R, Arshad M, Isherwood P, Khadjibaev A, Sabirov D, Rosstalnaya A, Parpibaev F, Sharipova V, Blanco GAG, Guzman CIO, Sánchez JSA, Granillo JF, Gupta S, Govil D, Srinivasan S, Patel SJ, N JK, Gupta A, Shafi M, Tomar DS, Harne R, Arora DP, Talwar N, Mazumdar S, Cha YS, Lee SJ, Tyagi N, Rajput RK, Taneja S, Singh VK, Sharma SC, Mittal S, Rao BK, Ayachi J, Fraj N, Romdhani S, Khedher A, Meddeb K, Sma N, Azouzi A, Bouneb R, Chouchene I, El Ghardallou M, Boussarsar M, Jennings R, Walter E, Ribeiro JM, Moniz I, Marçal R, Santos AC, Candeias C, e Silva ZC, Gomez SEZ, Nieto ORP, Gonzalez JAC, Cuellar AIV, Mildh H, Pettilä V, Korhonen AM, Karlsson S, Ala-Kokko T, Reinikainen M, Vaara ST, Zaleska-Kociecka M, Grabowski M, Dąbrowski M, Wozniak S, Piotrowska K, Banaszewski M, Imiela J. ESICM LIVES 2016: part two. Intensive Care Med Exp 2016. [PMCID: PMC5042923 DOI: 10.1186/s40635-016-0099-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Levin LA, Husberg M, Sobocinski PD, Kull VF, Friberg L, Rosenqvist M, Davidson T. A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke. Europace 2014; 17:207-14. [DOI: 10.1093/europace/euu213] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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Sjoblom J, Kalm T, Gadler F, Ljung L, Frykman V, Rosenqvist M, Platonov P, Borgquist R. Efficacy of primary preventive ICD therapy in an unselected population of patients with reduced left ventricular ejection fraction. Europace 2014; 17:255-61. [DOI: 10.1093/europace/euu219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lewalter T, Kanagaratnam P, Schmidt B, Rosenqvist M, Nielsen-Kudsk JE, Ibrahim R, Albers BA, Camm AJ. Ischaemic stroke prevention in patients with atrial fibrillation and high bleeding risk: opportunities and challenges for percutaneous left atrial appendage occlusion. Europace 2014; 16:626-30. [DOI: 10.1093/europace/euu069] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Fredman D, Svensson L, Jonsson M, Beltzikoff J, Ringh M, Nordberg P, Hollenberg J, Rosenqvist M. Intrahospital Dissemination of Automatic External Defibrillators Decrease Time to Defibrillation of In-Hospital Cardiac Arrests. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.52015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rosenqvist M. Acute direct current cardioversion: how 'dangerous' is it? Europace 2013; 15:1387-8. [DOI: 10.1093/europace/eut221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Svennberg CE, Engdahl J, Frykman-Kull V, Friberg L, Levin LA, Rosenqvist M. Mass screening for silent atrial fibrillation in high risk patients - preliminary results from the STROKESTOP trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.4382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sjoblom J, Lawo T, Bocker D, Lacroix D, Pietersen A, Puererfellner H, Jenniskens I, Garutti C, Rosenqvist M. Do we know the cause of death in patients with implantable defibrillators? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Cardiac disease is the most common cause of mortality in Western countries, with most deaths due to out-of-hospital cardiac arrest (OHCA). In Sweden, 5000-10 000 OHCAs occur annually. During the last decade, the time from cardiac arrest to start of cardiopulmonary resuscitation (CPR) and defibrillation has increased, whereas survival has remained unchanged or even increased. Resuscitation of OHCA patients is based on the 'chain-of-survival' concept, including early (i) access, (ii) CPR, (iii) defibrillation, (iv) advanced cardiac life support and (v) post-resuscitation care. Regarding early access, agonal breathing, telephone-guided CPR and the use of 'track and trigger systems' to detect deterioration in patients' condition prior to an arrest are all important. The use of compression-only CPR by bystanders as an alternative to standard CPR in OHCA has been debated. Based on recent findings, guidelines recommend telephone-guided chest compression-only CPR for untrained rescuers, but trained personnel are still advised to give standard CPR with both compressions and ventilation, and the method of choice for this large group remains unclear and demands for a randomized study. Data have shown the benefit of public access defibrillation for dispatched rescuers (e.g. police and fire fighters) but data are not as strong for the use of automated defibrillators (AEDs) by trained or untrained rescuers. Postresuscitation, use of therapeutic hypothermia, the importance of specific prognostic survival factors in the intensive care unit and the widespread use of percutaneous coronary intervention have all been considered. Despite progress in research and improved treatment regimens, most patients do not survive OHCA. Particular areas of interest for improving survival include (i) identification of high-risk patients prior to their arrest (e.g. early warning symptoms and genes); (ii) increased use of bystander CPR training (e.g. in schools) and simplified CPR techniques; (iii) better identification of high-incidence sites and better recruitment of AEDs (via mobile phone solutions?); (iv) improved understanding of the use of therapeutic hypothermia; (v) determining which patients should undergo immediate coronary angiography on hospital admission; and (vi) clarifying the importance of extracorporeal membrane oxygenation during CPR.
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Affiliation(s)
- J Hollenberg
- Section of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
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Doliwa Sobocinski P, Anggardh Rooth E, Frykman Kull V, von Arbin M, Wallen H, Rosenqvist M. Improved screening for silent atrial fibrillation after ischaemic stroke. Europace 2012; 14:1112-6. [DOI: 10.1093/europace/eur431] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sjoblom J, Ljung L, Frick M, Rosenqvist M, Frykman V. Primary prevention of defibrillator implantation after myocardial infarction: clinical practice and compliance to guidelines. Europace 2011; 14:490-5. [DOI: 10.1093/europace/eur354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Almroth H, Andersson T, Fengsrud E, Friberg L, Linde P, Rosenqvist M, Englund A. The safety of flecainide treatment of atrial fibrillation: long-term incidence of sudden cardiac death and proarrhythmic events. J Intern Med 2011; 270:281-90. [PMID: 21635583 DOI: 10.1111/j.1365-2796.2011.02395.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the safety of long-term treatment with flecainide in patients with atrial fibrillation (AF), particularly with regard to sudden cardiac death (SCD) and proarrhythmic events. DESIGN Retrospective, observational cohort study. SETTING Single-centre study at Örebro University Hospital, Sweden. Subjects. A total of 112 patients with paroxysmal (51%) or persistent (49%) AF (mean age 60 ± 11 years) were included after identifying all patients with AF who initiated oral flecainide treatment (mean dose 203 ± 43 mg per day) between 1998 and 2006. Standard exclusion/inclusion criteria for flecainide were used, and flecainide treatment was usually combined with an atrioventricular-blocking agent (89%). MAIN OUTCOME MEASURE Death was classified as sudden or nonsudden according to standard definitions. Proarrhythmia was defined as cardiac syncope or life-threatening arrhythmia. RESULTS Eight deaths were reported during a mean follow-up of 3.4 ± 2.4 years. Compared to the general population, the standardized mortality ratios were 1.57 (95% confidence interval (CI) 0.68-3.09) for all-cause mortality and 4.16 (95% CI 1.53-9.06) for death from cardiovascular disease. Three deaths were classified as SCDs. Proarrhythmic events occurred in six patients (two each with wide QRS tachycardia, 1 : 1 conducted atrial flutter and syncope during exercise). CONCLUSION We found an increased incidence of SCD or proarrhythmic events in this real-world study of flecainide used for the treatment of AF. The findings suggest that further investigation into the safety of flecainide for the treatment of patients with AF is warranted.
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Affiliation(s)
- H Almroth
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden.
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Wieloch M, Sjalander A, Frykman V, Rosenqvist M, Eriksson N, Svensson PJ. Anticoagulation control in Sweden: reports of time in therapeutic range, major bleeding, and thrombo-embolic complications from the national quality registry AuriculA. Eur Heart J 2011; 32:2282-9. [DOI: 10.1093/eurheartj/ehr134] [Citation(s) in RCA: 195] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Friberg L, Rosenqvist M. Cardiovascular hospitalization as a surrogate endpoint for mortality in studies of atrial fibrillation: report from the Stockholm Cohort Study of Atrial Fibrillation. Europace 2011; 13:626-33. [DOI: 10.1093/europace/eur001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Fredman D, Svensson L, Hollenberg J, Ringh M, Rosenqvist M. Improving care for in-hospital cardiac arrest patients—The rock study. Resuscitation 2010. [DOI: 10.1016/j.resuscitation.2010.09.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barthelemy O, Silvain J, Brieger D, Bellemain-Appaix A, Cayla G, Beygui F, Lancar R, Collet JP, Mercadier A, Montalescot G, Cha KS, Nam YH, Kim JH, Park SY, Park TH, Kim MH, Kim YD, Lee HC, Ahn MS, Hong TJ, Blanco R, Blanco F, Szarfer J, Garcia Escudero A, Gigena G, Gagliardi J, Rodriguez A, Sarmiento R, Affatatto S, Riccitelli M, Petris A, Datcu MD, Pop C, Radoi M, Arsenescu-Georgescu C, Petrescu I, Petrescu L, Serban L, Nechita E, Tatu-Chitoiu G, Tatu-Chitoiu G, Dorobantu M, Benedek I, Craiu E, Sinescu C, Ionescu DD, Radoi M, Pop C, Ginghina C, Minescu B, Izzo A, Mantovani P, Tomasi L, Dall'oglio L, Bonatti S, Rosiello R, Romano M, Agostini F, Zanini R, Zhao ZY, Wu YJ, Li JJ, Yany YJ, Qian HY, Tang YD, Timoteo AT, Toste A, Lousinha A, Ramos R, Oliveira JA, Ferreira ML, Ferreira RC, Cabades C, Diez Gil JL, Aguar P, Sanmiguel D, Lopez-March A, Marmol R, Guerra L, Girbes V, Ferrando J, Rincon De Arellano A, Timoteo AT, Ramos R, Toste A, Oliveira JA, Patricio L, Ferreira ML, Ferreira RC, Blondal M, Ainla T, Marandi T, Eha J, Timoteo AT, Oliveira MM, Silva MN, Cunha PS, Feliciano J, Silva S, Ferreira RC, Silva B, Oliveira R, Caires G, Drumond A, Araujo J, Suarez-Barrientos A, Vivas D, Castro-Ferreira F, Nunez-Gil I, Franco E, Kanovsky J, Garcia-Rubira JC, Fernandez-Ortiz A, Fuster V, Macaya C, Ibanez Cabeza B, Salinger S, Perisic Z, Milic D, Stanojlovic T, Apostolovic S, Kala P, Obradovic S, Djordjevic-Radojkovic D, Damjanovic M, Koracevic G, Kostic T, Khan MA, Vrapi F, Naeem K, Davar J, Hristova K, Parenica J, Hristova K, Pencheva G, Radeva R, Milanov S, Trambaiolo P, Poli M, De Luca M, Lukic V, Mustilli M, Corsi F, Poloczek M, Simonetti M, Ferraiuolo G, Fareed A, Oraby M, Nasr GM, Maklady F, Dupouy P, Sorensen JT, Terkelsen CJ, Lassen JF, Prymusova K, Trautner S, Christensen EF, Nielsen TT, Botker HE, Andersen HR, Thygesen KA, Checco L, Usmiani T, Sbarra PL, Boffini M, Kubkova L, Saviolo R, Grasso C, Conrotto F, Marchetti M, Rinaldi M, Marra S, Moscoso Costa F, Ferreira J, Raposo L, Aguiar C, Spinar J, Trabulo M, Silva JA, Faria R, Mimoso J, Marques N, Trigo J, Marques V, Gomes V, Swiatkowski A, Kowalczyk J, Olinic D, Lenarczyk R, Chodor P, Honisz G, Was T, Swierad M, Sredniawa B, Polonski L, Kalarus Z, Postadzhiyan AS, Velinov H, Homorodean C, Velchev V, Hazarbasanov D, Apostolova M, Finkov B, Petrovic M, Panic G, Jovelic A, Canji T, Srdanovic I, Popov T, Ober M, Golubovic M, Pavlovic K, Cemerlic-Adjic N, Bro-Jeppesen J, Kjaergaard J, Wanscher MC, Nielsen SL, Rasmussen LS, Hassager C, Bro-Jeppesen J, Olinic M, Kjaergaard J, Wanscher MC, Rasmussen LS, Hassager C, Khan M, Crolla E, Morley H, Akeroyd L, Beaini Y, Morley C, Andrioaia C, Dores H, Leal S, Rosario I, Abecasis J, Monge J, Correia MJ, Arroja I, Fonseca C, Aleixo A, Silva A, Condac A, Bekeredjian RH, Krumsdorf U, Rottbauer W, Katus HA, Pleger S, Providencia RA, Silva J, Barra S, Gomes PL, Seca L, Masmoudi M, Botelho A, Quintal N, Mota P, Leitao-Marques AM, Silva B, Santos N, Cafe H, Faria P, Serrao M, Gomes S, Berdaoui B, Oliveira R, Caires G, Drumond A, Araujo J, Roussel JC, Senage T, Perigaud C, Habash O, Michel M, Treilhaud M, Labidi S, Despins P, Trochu JN, Baron O, Duveau D, Kitsiou AN, Giannakopoulos K, Papadimitriou G, Karas S, Babic Z, Nikolic Heitzler V, Tapia Ballesteros C, Milicic D, Bergovec M, Raguz M, Mirat J, Strozzi M, Plazonic Z, Giunio L, Steiner R, Freynhofer M, Brozovic I, Hernandez Luis C, Bruno V, Leherbauer L, Djurkovic M, Jarai R, Willheim M, Huebl W, Wojta J, Huber K, Vogel B, Hahne S, Sandin MG, Kozanli I, Kalla K, Jarai R, Freynhofer M, Smetana P, Geppert A, Unger G, Huber K, Simoes Marques Assuncao Caetano AF, Barra S, Vegas JM, Silva J, Providencia R, Faustino C, Botelho A, Mota P, Leitao Marques A, Ariza Sole A, Sanchez Salado JC, Lorente Tordera V, Martinez Garcia V, Andion R, Salazar Mendiguchia Y Garcia J, Gomez Hospital JA, Maristany Daunert J, Berdejo Gago FJ, Esplugas Oliveras E, Brzozowska-Czarnek A, Urbanik A, Kakouros N, Kakouros S, Lekakis J, Martinez N, Rizos J, Kokkinos D, Venevtseva J, Melnikov A, Valiahmetov M, Gomova T, Perelomova I, Ferrer Hita JJ, Bosa-Ojeda F, Sanchez-Grande-Flecha A, Gonzalez IA, Yanes-Bowden G, Vargas-Torres MJ, Rodriguez-Gonzalez A, Rubio-Iglesias-Garcia C, Dominguez-Rodriguez A, Enjuanes-Grau C, Marrero-Rodriguez F, Parepa I, Suceveanu AI, Suceveanu A, Alvarado M, Mazilu L, Alexandrescu L, Dumitru E, Miu V, Jitari V, Craiu E, Voinea FL, Balachandran KP, Schofield R, Sankaranarayanan R, Amat IJ, Helm K, Crowe C, Singh R, Mcdonald J, Chuen MJ, Kobusiak-Prokopowicz M, Preglowska M, Mysiak A, Doi T, Sakoda T, San Roman JA, Akagami T, Naka T, Tsujino T, Masuyama T, Ohyanagi M, Kume N, Mitsuoka H, Hayashida K, Tanaka M, Biasucci LM, Garcia Gonzalez MJ, Della Bona R, Biasillo G, Leo M, Zaninotto M, Plebani M, Crea F, Biasucci LM, Dellabona R, Leo M, Biasillo G, Arroyo Ucar E, Zaninotto M, Plebani M, Crea F, Cavusoglu Y, Gok B, Birdane A, Demirustu C, Gorenek B, Unalir A, Ata N, Hernandez Garcia C, Timuralp B, Nikulina N, Yakushin SS, Nikulina N, Yakushin SS, Furmenko GI, Akinina SA, Dores H, Ingrid R, Leal S, Dorta Martin M, Correia MJ, Bronze L, Monge J, Arroja I, Fonseca C, Aleixo A, Silva A, Djambazov S, Zhivkov A, Maznev I, Marrero Rodriguez F, Ingeliev M, Slavov R, Cvetkova N, Patarinski V, Groch L, Horak J, Dimitrov N, Hayrapetyan HG, Raposeiras Roubin S, Abu-Assi E, Dragu R, Cabanas-Grandio P, Agra-Bermejo R, Garcia-Acuna JM, Pena-Gil C, Gonzalez-Juanatey JR, Barra SNC, Silva J, Providencia R, Seca L, Gomes P, Kapeliovich M, Leitao Marques A, Daly MJ, Mc Keag NA, Mc Cann CJ, Cardwell C, Young IS, Adgey AAJ, Mikhalchikova N, Burova N, Zaccaria M, Hammerman H, Palmisano P, Palumbo V, Ciccone MM, Favale S, Chen KC, Yin WH, Liu JH, Goncalves S, Santos JF, Amador P, Silva D, Soares LN, Zahidova K, Guliyev F, Zahidov N, Carrilho-Ferreira P, Cortez-Dias N, Marques JS, Silva D, Jorge C, Robalo Martins S, Cortez-Dias N, Almeida Ribeiro M, Calisto C, Carvalho De 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Motovska Z, Fischerova M, Osmancik P, Maly M, Widimsky P, Pavli E, Cerovic M, Dibra A, Mehilli J, Dibra L, Schoemig A, Kastrati A, Carmo P, Ferreira J, Aguiar C, Almeida M, Raposo L, Putnikovic B, Teles R, Goncalves P, Brito J, Silva A, D'ascenzo F, Gonella A, Longo G, Pullara A, Moretti C, Sciuto F, Neskovic A, Omede' P, Biondi Zoccai G, Trevi GP, Sheiban I, Santos N, Serrao M, Cafe H, Silva B, Oliveira R, Caires G, Rott D, Drumond A, Araujo J, Cafe HM, Silva B, Santos N, Faria P, Oliveira R, Pereira A, Caires G, Pereira D, Leibowitz D, Freitas D, Araujo J, Pittl U, Schratter A, Klemm T, Lehmann D, Demmin K, Mende M, Schuler G, Thiele H, Monhart Z, Salazar Mendiguchia Y Garcia J, Ariza Sole A, Martinez Garcia V, Sanchez Salado JC, Lorente Tordera V, Ortiz Berbel D, Rabasa Baraibar JM, Esplugas Oliveras E, Monge J, Leal S, Reissigova J, Dores H, Bronze Carvalho L, Rosario I, Abecasis J, Correia MJ, Leitao A, Aleixo A, Silva A, Leone AM, De Caterina A, Grunfeldova H, Aurelio A, Sciahbasi A, Lioy E, Trani C, Burzotta F, Porto I, Rebuzzi AG, Crea F, Trusinskis K, Juhnevica D, Jansky P, Strenge K, Sondore D, Kumsars I, Jegere S, Narbute I, Grave A, Zakke I, Erglis A, Mihaylov G, Marenzi G, Timoteo AT, Assanelli E, Ferrari C, Marana I, Lauri G, De Metrio M, Grazi M, Campodonico J, Moltrasio M, Bartorelli AL, Martins H, Valente B, Saraiva F, Baptista R, Jorge E, Mendes PL, Monteiro P, Costa S, Franco F, Providencia LA, Saeed M, Gaber R, Oliveira JA, Mornos C, Cozma D, Pescariu S, Dragulescu SI, Kamal HS, Abdelfattah A, Abdelbary AM, Elassar H, Naggar A, Khaled M, Ferreira ML, Fareed AM, Pernes JM, Gaux JC, Oraby M, Nasr GM, Maklady F, Dupouy P, Prull MW, Sasko B, Wirdemann H, Ferreira RC, Bittlinsky A, Butz T, Trappe HJ, Perazzolo Marra M, Cacciavillani L, Marzari A, De Lazzari M, Turri R, China P, Corbetti F, Villanueva Benito I, Iliceto S, Stazhadze LL, Spiridonova EA, Bulanova NA, Ermolaev AA, Savic L, Mrdovic I, Krljanac G, Perunicic J, Asanin M, Solla I, 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Salazar Mendigucha Garcia J, Ariza Sole A, Sanchez Salado JC, Lorente Tordera V, Homs Vila S, Gomez Hospital JA, Cequier Fillat A, Esplugas Oliveras E, Marques N, Andion Ogando R, Hernandez Luis C, Sandin Fuentes M, Tapia Ballesteros C, Vegas Valle JM, Gonzalez Garcia IA, Duro Aguado IA, Palomino Doza AJ, Gomez Salvador I, San Roman Calvar JA, Mimoso J, Nikishin AG, Mamarasulov TM, Pirnazarov MM, Koracevic G, Pavlovic M, Glasnovic J, Damjanovic M, Stojkovic A, Kostic T, Todorovic L, Gomes V, Petrovic S, Zivkovic M, Djordjevic-Radojkovic D, Cherneva ZCH, Denchev SD, Heltai K, Becker D, Merkely B, Nikulina N, Yakushin SS, Agra Bermejo RM, Akinina SA, Furmenko GI, Boytsov A, Yakushin SS, Nikulina NN, Furmenko GI, Akinina SA, Dores H, Leal S, Rosario I, Emad Abu Assi EAA, Bronze L, Abecasis J, Correia MJ, Arroja I, Fonseca C, Aleixo A, Silva A, Dores H, Leal S, Rosario I, Sergio Raposeiras Roubin SRR, Monge J, Abecasis J, Correia MJ, Bronze L, Arroja I, Aleixo A, Silva A, Rosario I, Leal 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Paulo C, Mascarenhas J, Patacho M, Pimenta J, Bettencourt P, Nardai S, Szabo GY, Berta B, Edes I, Merkely B, Delgado Silva J, Seca L, Baptista R, Providencia R, Mota P, Costa M, Leitao-Marques A, Faria R, Trigo J, Gago P, Mimoso J, Marques N, Gomes V, Gheorghe G, Nanea IT, Cristea A, Almarichi S, Martins H, Saraiva F, Baptista R, Jorge E, Mendes PL, Monteiro P, Costa S, Franco F, Providencia LA, Nanea T, Gheorghe GS, Visan S, Paun N, Gaber R, Gaber R, Delewi R, Nijveldt R, De Bruin HA, Hirsch A, Van Der Laan A, Bouma BJ, Tijssen JPG, Van Rossum AC, Zijlstra F, Piek JJ, Rus H, Radoi M, Donea M, Ciurea C, Ifteni G, Casolo G, Chioccioli M, Magnacca M, Del Meglio J, Comella A, Baratto M, Lera J, Salvadori L, Tessa C, Vignali C, Keca Z, Momcilov Popin T, Panic G, White R, Mateen F, Weaver A, Dragu R, Agmon Y, Kapeliovich M, Hammerman H, Timoteo AT, Lousinha A, Santos N, Oliveira JA, Ferreira ML, Ferreira RC, Okisheva E, Tsaregorodtsev D, Sulimov V, Amat Santos IJ, Gonzalez IA, Hernandez C, Sandin MG, Tapia C, Andion R, Alvarado M, Campo A, San Roman JA, Fredman D, Svensson L, Rosenqvist M, Tadel-Kocjancic S, Radsel P, Knafelj R, Gorjup V, Noc M, Zima E, Jenei ZS, Kovacs E, Osztheimer I, Szabo GY, Molnar L, Horvath A, Becker D, Geller L, Merkely B, Maggi R, Furukawa T, Viscardi V, Brignole M, Leal SRN, Dores H, Rosario I, Monge J, Carvalho MJ, Arroja I, Leitao A, Fonseca C, Aleixo A, Silva A, Keuleers S, Herijgers P, Herregods MC, Budts W, Dubois C, Meuris B, Verhamme P, Flameng W, Van De Werf F, Adriaenssens T, Badran H, Elnoamany M, Lolah T, Tatu-Chitoiu G, Dorobantu M, Benedek I, Craiu E, Sinescu C, Ionescu DD, Olariu C, Radoi M, Pop C, Macarie C, Mollik MAH, Hassan AI, Paul TK, Haque MZ, Jahan R, Rahmatullah M, Khatun MA, Rahman MT, Chowdhury MH, Bustamante Munguira J, Tamayo E, Garcia-Cuenca I, Bustamante E, Gualis J, Gomez-Martinez ML, Florez S, Gomez-Herreras JI, Ramirez Rodriguez R, Ramirez Rodriguez AM, Garcia-Bello MA, Hernadez Ortega E, Caballero Dorta E, Garcia Quintana A, Piro Mastraccio V, Medina Fernandez Aceytuno A, Assanelli E, De Metrio M, Rubino M, Lauri G, Cabiati A, Campodonico J, Grazi M, Moltrasio M, Marana I, Marenzi G, Lovlien M, Schei B, Picon-Heras R, Acebal C, Garcia Rubira JC, Vivas Balcones D, Nunez-Gil I, Ruiz-Mateos B, Ibanez B, Fernandez-Ortiz A, Vintila VD, Enescu OA, Stoicescu CI, Udroiu C, Cinteza M, Tatu - Chitoiu G, Vinereanu D, Fresco C, De Biasio M, Muser D, Sappa R, Morocutti G, Bernardi G, Proclemer A, Fontanella B, Affatato A, Ciccarese C, Sacchini M, Volpini M, Bianchetti F, Verzura G, Dei Cas L, Pudil R, Blaha V, Vojacek J, Paraskevaidis I, Ikonomidis I, Parissis J, Papadopoulos C, Stasinos V, Bistola V, Anastasiou-Nana M, Shochat M, Shotan A, Kazatsker M, Gurovich V, Asif A, Noiman E, Levy Y, Blondhaim D, Rabinovich P, Meisel S, Koracevic G, Stojkovic A, Petrovic S, Pavlovic M, Glasnovic J, Tomasevic M, Krstic N, Djordjevic-Radojkovic D, Sakac D, Obradovic S, Londono Sanchez O, Pacreu S, Torres L, Mihaylov G, Shaban GM, Trendafilova E, Krasteva V, Mudrov TS, Didon JP, Panageas V, Vlachos N, Pernat A, Radan I, Mozina H, Izzo A, Tomasi L, Mantovani P, Dall'oglio L, Pepi P, Romano M, Cionini F, Baccaglioni N, Zanini R, Viertel A, Havers J, Ballard G, Groenefeld G, Santos N, Branco LM, Oliveira JA, Ferreira L, Timoteo AT, Fiarresga A, Feliciano J, Ramos R, Ferreira RC, Izzo A, Tomasi L, Mantovani P, Pepi P, Lettieri L, Dall'oglio L, Reggiani A, Zanini R, Garcia Gonzalez MJ, Arroyo Ucar E, Hernandez Garcia C, Juarez Prera R, Blanco Palacios G, Dorta Martin M, Marrero Rodriguez F, Martin AC, Manzo Silberman S, Chaib A, Varenne O, Allouch P, Salengro E, Jegou A, Margot O, Spaulding C, Diego A, De Miguel A, Cuellas C, Fraile E, Martin J, Vega B, Bangueses R, Fernandez-Vazquez F, Perez De Prado A, Rosario I, Dores H, Leal S, Correia MJ, Monge JC, Arroja I, Abecasis J, Aleixo A, Silva A, Dragu R, Agmon Y, Kapeliovich M, Hammerman H, Garcia-Garcia C, Subirana I, Sala J, Bruguera J, Valle V, Sanz G, Fiol M, Aros F, Marrugat J, Elosua R, Barra SNC, Silva J, Gomes P, Providencia R, Seca L, Leitao Marques A, Zhao ZY, Wu YJ, Li JJ, Yang YJ, Xu B, Tang YD, Song GY, G RL, Panic M, Milicevic P, Stankovic I, Ilic I, Kafedzic S, Kalezic T, Milicevic D, Aleksic A, Putnikovic B, Neskovic A, Serpytis P, Rucinskas K, Kalinauskas A, Karvelyte N, Santos De Sousa CI, Ferreira S, Calaca J, Lousada N, Palma Reis R, Gualandro DM, Seguro LFBC, Braga FGM, Silvestre OM, Lage RL, Fabri J, Oliveira MT, Urbano Moral JA, Torres Llergo J, Solanilla Rodriguez R, Sanchez Gonzalez A, Martinez Martinez A, Den Uil CA, Lagrand WK, Van Der Ent M, Jewbali LSD, Cheng JM, Spronk PE, Simoons ML, Mornos C, Petrescu L, Dragulescu D, Ionac A, Guardado J, Azevedo O, Fernandes M, Canario-Almeida F, Sanfins V, Pereira A, Almeida J, Kaplunova VU, Belenkov YN, Privalova EV, Fomin AA, Suvorov AY, Goodkova A, Rubakova MG, Kuznetsova IA, Semernin EN, Keshavarzi F, Kojuri J, Mikhailov VM, Vezhenkova IV, Goodkova AYA, Jarai R, Pavlovic I, Farhan S, Schwarz M, Jakl G, Huber K, Jarai R, Schwarz M, Smetana P, Jakl G, Perkmann T, Farhan S, Huber K, Mayr A, Mair J, Klug G, Schocke M, Trieb T, Jaschke W, Pachinger O, Metzler B, Bronze Carvalho L, Azevedo J, Andrade ML, Arroja I, Relvas MJ, Coucello J, Monge J, Morais G, Seabra M, Aleixo A, Afamefule F, Luaces Mendez M, Teijeiro-Mestre R, Nunez-Gil IJ, Leco-Gil N, Madronal-Cerezo E, Zannin I, Ruiz J, Orynchak MA, Vakalyuk II, Vakalyuk IP, Berezin A, Panasenko T, Cavusoglu Y, Cavusoglu A, Unluoglu I, Tek M, Demirustu C, Gorenek B, Unalacak M, Birdane A, Yuksel F, Ata N, Lee WP, Halcox JPJ, Cavusoglu Y, Beyaztas A, Entok E, Demirustu C, Uslu I, Birdane A, Gorenek B, Ata N, Schaefer A, Flierl U, Seydelmann N, Bauersachs J, Calmac L, Craiu E, Ionescu DD, Nanea T, Pop C, Marinescu S, Macarie C, Tatu Chitoiu G, Fruntelata AG, Dorobantu M, Hamdi S, Maazoun Y, Neji A, Farhat O, Majdoub M, Ben Hamda K, Maatouk F, Balanescu SM, Benedek I, Nedelciuc I, Deleanu D, Dobreanu D, Olinic D, Petrescu L, Ortan F, Mot S, Tatu Chitoiu G, Sinnaeve PR, Moreels S, Adriaenssens T, Dubois C, Coosemans M, Vydt T, Desmet W, Sinnaeve PR, Moreels S, Vydt T, Dubois C, Adriaenssens T, Coosemans M, Desmet W, Poli M, Trambaiolo P, Corsi F, De Luca M, Mustilli M, Lukic V, Simonetti M, Ferraiuolo G, Tobing D, Rifnaldi R, Juzar D, Firdaus I, Dharma S, Irmalita I, Kalim H, Bejiqi R, Retkoceri R, Bejiqi H, Kryeziu L, Kelmendi M, Borovci SH, Victor SM, Gnanaraj A, Deshmukh R, Mullasari AS, Yahalom M, Kaiyal RS, Roguin N, Bornstein J, Atar S, Farah R, Seca LF, Faustino A, Silva J, Providencia R, Gomes P, Barra S, Caetano F, Costa M, Leitao Marques AM, Margato R, Sousa P, Ribeiro H, Rocha L, Correia A, Moreira JI, Carvalho HC, Afifi M, Abed N, Santos N, Serrao M, Cafe H. Abstracts. Eur Heart J Suppl 2010. [DOI: 10.1093/eurheartj/suq023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bohm K, Stålhandske B, Rosenqvist M, Ulfvarson J, Hollenberg J, Svensson L. Tuition of emergency medical dispatchers in the recognition of agonal respiration increases the use of telephone assisted CPR. Resuscitation 2009; 80:1025-8. [DOI: 10.1016/j.resuscitation.2009.06.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Revised: 05/25/2009] [Accepted: 06/04/2009] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Recent studies of patients with heart failure and of patients receiving intensive care indicate that digoxin may increase mortality if the patient has atrial fibrillation (AF). Objective To study which patients receive digoxin treatment for AF and what the prognosis is for patients given this treatment. METHOD 2824 patients with AF were studied prospectively for a mean of 4.6 years. Information about medication was obtained from the local hospital registry. Information about diagnoses, hospitalisations and deaths was obtained from national registries. Propensity score matching and Cox regression was used to account for confounding. RESULTS Factors associated with digoxin use were permanent AF (hazard ratio (HR) = 3.2, confidence interval (CI) 2.7 to 3.9), absence of pacemaker (HR = 2.3, CI 1.6 to 3.2), history of heart failure (HR = 2.0, CI 1.7 to 2.5), treatment in an internal medicine ward rather than a cardiology ward (HR = 1.6, CI 1.3 to 2.0), female sex (HR = 1.6, CI 1.3 to 1.9) and age >or=80 years (HR = 1.4, CI 1.1 to 1.7). More patients with than without digoxin died (51% vs 31%, p<0.001). After adjustment for covariates, however, no disadvantages related to digoxin use could be found for all-cause mortality, myocardial infarction, ischaemic stroke, time to readmission to hospital or days at hospital/year at risk. The only end point significantly associated with digoxin use was pacemaker implantations, which were more common in digoxin-treated patients (HR = 2.0, CI 1.2 to 3.4). CONCLUSION Digoxin is mainly given to an elderly and frailer subset of patients with AF and is thus associated with an increased mortality. When differences in patient characteristics are accounted for digoxin use seems to have a neutral effect on mortality and major cardiovascular events in patients with AF.
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Affiliation(s)
- L Friberg
- Department of Clinical Science and Education, Karolinska Institute at South Hospital, Stockholm, Sweden.
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Hollenberg J, Riva G, Bohm K, Nordberg P, Larsen R, Herlitz J, Pettersson H, Rosenqvist M, Svensson L. Dual dispatch early defibrillation in out-of-hospital cardiac arrest: the SALSA-pilot. Eur Heart J 2009; 30:1781-9. [DOI: 10.1093/eurheartj/ehp177] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bergfeldt L, Rosenqvist M. Atrial arrhythmias--the dominating cardiac problem in three patients with HLA B27 associated rheumatic disorders. Acta Med Scand 2009; 224:627-30. [PMID: 3264661 DOI: 10.1111/j.0954-6820.1988.tb19636.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Three young patients with atrial arrhythmias as the probable consequence of an HLA B27 associated inflammatory disease process are described. They are presented as an expansion of the spectrum of cardiac manifestations that can be seen in patients with HLA B27 associated rheumatic disorders, and as possible evidence of myocardial involvement of this disease process.
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Affiliation(s)
- L Bergfeldt
- Department of Medicine, Karolinska Institute at Huddinge Hospital, Stockholm, Sweden
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Friberg L, Hammar N, Edvardsson N, Rosenqvist M. The prognosis of patients with atrial fibrillation is improved when sinus rhythm is restored: report from the Stockholm Cohort of Atrial Fibrillation (SCAF). Heart 2009; 95:1000-5. [DOI: 10.1136/hrt.2008.149237] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Nordberg P, Hollenberg J, Herlitz J, Rosenqvist M, Svensson L. Aspects on the increase in bystander CPR in Sweden and its association with outcome. Resuscitation 2009; 80:329-33. [PMID: 19150163 DOI: 10.1016/j.resuscitation.2008.11.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 10/27/2008] [Accepted: 11/16/2008] [Indexed: 11/17/2022]
Abstract
AIM To describe changes in the proportion of bystanders performing cardiopulmonary resuscitation (CPR) in out of hospital cardiac arrest (OHCA) in Sweden and to study the impact of bystander CPR on ventricular fibrillation and on survival during various times. PATIENTS AND METHODS All patients who suffered from OHCA in Sweden in whom CPR was attempted and who were included in the Swedish cardiac arrest register (SCAR) between 1992 and 2005. Crew witnessed cases were excluded. RESULTS In all 34,125 patients were included in the survey. Among witnessed OHCA the proportion of patients receiving bystander CPR increased from 40% in 1992 to 55% in 2005 (p<0.0001). In non-witnessed OHCA the corresponding proportion increased from 22% to 44% (p<0.0001). There was a significant increase in bystander CPR regardless of age, sex and place. The increase was only found when CPR was performed by lay persons (21% in 1992 to 40% in 2005; p<0.0001). Bystander CPR was associated with an increased proportion of patients found in a shockable rhythm and a lower number of shocks to receive return of spontaneous circulation. Bystander CPR was associated with a similar increase in survival early and late in the evaluation. CONCLUSION There was a marked increase in bystander CPR in OHCA, when performed by lay persons, during the last 14 years in Sweden. Bystander CPR was associated with positive effects both on ventricular fibrillation and survival.
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Affiliation(s)
- P Nordberg
- Dept. of Cardiology, Karolinska Institute, South Hospital, SE-118 83 Stockholm, Sweden
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Almroth H, Hoglund N, Boman K, Englund A, Jensen S, Kjellman B, Tornvall P, Rosenqvist M. Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study. Eur Heart J 2008; 30:827-33. [DOI: 10.1093/eurheartj/ehp006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fored CM, Granath F, Gadler F, Blomqvist P, Rynder J, Linde C, Ekbom A, Rosenqvist M. Atrial vs. dual-chamber cardiac pacing in sinus node disease: a register-based cohort study. Europace 2008; 10:825-31. [DOI: 10.1093/europace/eun118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hollenberg J, Lindqvist J, Ringh M, Engdahl J, Bohm K, Rosenqvist M, Svensson L. An evaluation of post-resuscitation care as a possible explanation of a difference in survival after out-of-hospital cardiac arrest. Resuscitation 2007; 74:242-52. [PMID: 17363131 DOI: 10.1016/j.resuscitation.2006.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 12/08/2006] [Accepted: 12/14/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND A recently published study has shown that survival after out-of-hospital cardiac arrest (OHCA) in Göteborg is almost three times higher than in Stockholm. The aim of this study was to investigate whether in-hospital factors were associated with outcome in terms of survival. METHODS All patients suffering from OHCA in Stockholm and Göteborg between January 1, 2000 and June 30, 2002 were included. The two groups were compared with reference to patient characteristics, medical history, pre-hospital and hospital course (including in-hospital investigations and interventions) and mortality. All medical charts from patients admitted alive to the different hospitals were studied. Data from the Swedish National Register of Deaths regarding long-term survival were analysed. Pre-hospital data were collected from the Swedish Ambulance Cardiac Arrest Register. RESULTS In all, 1542 OHCA in Stockholm and 546 in Göteborg were registered during the 30-month study period. In Göteborg, 28% (153 patients) were admitted alive to the two major hospitals whereas in Stockholm 16% (253 patients) were admitted alive to the seven major hospitals (p<0.0001). On admission to the emergency rooms, a larger proportion of patients in Stockholm was unconscious (p=0.006), received assisted breathing (p=0.008) and ongoing CPR (p=0.0002). Patient demography, medical history, in-hospital investigations and interventions and in-hospital mortality (78% in Göteborg, 80% in Stockholm) did not differ between the two groups. Various pre-hospital time intervals were significantly longer in Stockholm than in Göteborg. Total survival to discharge after OHCA was 3.3% in Stockholm and 6.1% in Göteborg (p=0.01). CONCLUSION An almost 2-fold difference in survival after OHCA between Stockholm and Göteborg appears to be associated with pre-hospital factors only (predominantly in form of prolonged intervals in Stockholm), rather than with in-hospital factors or patient characteristics.
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Affiliation(s)
- J Hollenberg
- Department of Cardiology, Karolinska Institute, South Hospital, Stockholm SE-11883, Sweden.
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Abstract
OBJECTIVES Patients with bifascicular block (BFB) have a high mortality rate. The purpose of the present study was to identify high-risk patients in a BFB population by performing an extensive cardiac evaluation including noninvasive and invasive tests. DESIGN Population-based study. SUBJECTS A total of 100 patients with BFB, of whom 41 had a history of unexplained syncope, were prospectively studied. The mean age was 68 +/- 12. All patients were investigated with Holter-monitoring, an exercise test, an echocardiography, and an invasive electrophysiological study. The severity of congestive heart failure (CHF) was assessed by New York Heart Association (NYHA) classification. Patients in NYHA class IV were excluded. INTERVENTIONS Patients with syncope were recommended prophylactic pacemaker treatment, which was accepted by 31 patients (76%). Main outcome measures. All-cause mortality and sudden cardiac death (SCD). RESULTS During a median follow-up of 84 months, 33 patients died, of whom 14 in SCD. In a univariate analysis, high age, a previous myocardial infarction, and CHF were associated with a significantly increased risk of all-cause mortality and SCD. In a Cox multiple regression analysis, CHF was the only independent predictor of all-cause mortality and SCD (P < 0.01). CONCLUSION Patients with BFB have a poor long-term prognosis. The predictive value of noninvasive and invasive investigations is limited. The only independent predictor of all-cause mortality and SCD in this population was the presence of CHF.
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Affiliation(s)
- F Tabrizi
- Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden.
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Hollenberg J, Bång A, Lindqvist J, Herlitz J, Nordlander R, Svensson L, Rosenqvist M. Difference in survival after out-of-hospital cardiac arrest between the two largest cities in Sweden: a matter of time? J Intern Med 2005; 257:247-54. [PMID: 15715681 DOI: 10.1111/j.1365-2796.2004.01447.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dramatic differences in survival after out-of-hospital cardiac arrests (OHCA) reported from different geographical locations require analysis. We therefore compared patients with OHCA in the two largest cities in Sweden with regard to various factors at resuscitation and outcome. SETTING All patients suffering an OHCA in Stockholm and Goteborg between 1 January 2000 and 30 June 2001, in whom cardiopulmonary resuscitation (CPR) was attempted were included in this retrospective analysis. RESULTS All together, 969 OHCA in Stockholm and 398 in Goteborg were registered during the 18-month study period. There were no differences in terms of age, gender, and percentage of witnessed cases or percentage of patients who had received bystander CPR. However, the percentage of patients with ventricular fibrillation (VF) at arrival of the ambulance crew was 18% in Stockholm versus 31% in Goteborg (P <0.0001). The percentage of patients who were alive 1 month after cardiac arrest was 2.5% in Stockholm versus 6.8% in Goteborg (P=0.0008). Various time intervals such as cardiac arrest to calling for an ambulance, cardiac arrest to the start of CPR and calling for an ambulance to its arrival were all significantly longer in Stockholm than in Goteborg. CONCLUSION Survival was almost three times higher in Goteborg than in Stockholm amongst patients suffering an OHCA. This is primarily explained by a higher occurrence of VF at the time of arrival of the ambulance crew, which in turn probably is explained by shorter delays in Goteborg. The reason for the difference in time intervals is most likely multifactorial, with a significantly higher ambulance density in Goteborg as one possible explanation.
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Affiliation(s)
- J Hollenberg
- Department of Cardiology, Karolinska Institute, South Hospital, Stockholm, Sweden.
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Abstract
OBJECTIVES To evaluate the duration of anticoagulation treatment with warfarin sodium before elective DC-cardioversion and to identify clinical variables predicting short-term versus long-term waiting times. DESIGN Retrospective. SUBJECTS Patients with a known start date for warfarin sodium, a known duration of atrial fibrillation (AF) and who underwent DC-cardioversion were included. MAIN OUTCOME MEASURES Duration of treatment with warfarin sodium prior to DC-cardioversion. METHODS The hospital records of 288 consecutive patients with AF scheduled for elective cardioversion at two hospitals in Stockholm were reviewed. Only patients with a known start date for warfarin sodium and known duration of AF were included in the study. RESULTS The median age was 70 (26-85) years and the duration of AF at time of cardioversion were 18 weeks (5-273) weeks. The median treatment duration prior to cardioversion with warfarin sodium was 12 weeks. Sinus rhythm was established in 224 (78%) patients of which 90 (40%) remained in sinus rhythm 1 month after cardioversion. In multivariate analysis, the only independent predictor of short waiting times for cardioversion (8 vs. 15 weeks) was if a cardiologist instituted the treatment with warfarin sodium (P < 0.001, 95% CI 5.0-9.0). CONCLUSION The average waiting time from start of warfarin sodium treatment to elective cardioversion exceeds by far the recommended 3-4 weeks on therapeutic international normalized ratio (INR). In order to minimize the time period until cardioversion significant changes in the out-of-hospital care logistics has to be undertaken.
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Affiliation(s)
- J Ryman
- Department of Cardiology, South Hospital, Stockholm, Sweden
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Abstract
OBJECTIVE This prospective study was designed to investigate the differences between asymptomatic versus symptomatic arrhythmia as well as left ventricular dysfunction in a consecutive population of patients with persistent atrial fibrillation. DESIGN A total of 282 consecutive outpatients referred with persistent atrial fibrillation formed the study population. A structured medical history was obtained. A two-dimensional transthoracic echocardiography to assess the left ventricular function and a 24-h electrocardiogram (ECG) recording were performed. Irregularity of the heart rhythm was analysed with heart rate variability (HRV) in the time domain as well as maximum and minimum heart rate and the longest pause. SETTING Three university hospitals. RESULTS The mean age of the patients was 69 years and the mean duration of atrial fibrillation was 7 months. The prevalence of symptomatic patients was 68%, while 32% had no symptoms from atrial fibrillation, left ventricular dysfunction was observed in 20%. Asymptomatic subjects had more often lone atrial fibrillation than those with symptoms. Valvular heart disease was an independent predictor of symptoms while male gender, ischaemic heart disease and a high heart rate were independent predictors of impaired left ventricular function. CONCLUSION Valvular heart disease is related to symptoms in persistent atrial fibrillation. Ischaemic heart disease, male gender and a high heart rate are more common in patients with impaired left ventricular function. Compromised left ventricular function does, occur also in asymptomatic subjects underlining the importance of a careful investigation including echocardiography in all subjects with persistent atrial fibrillation.
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Affiliation(s)
- V Frykman
- Department of Cardiology, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
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