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Boman, Kurt
Publications (10 of 189) Show all publications
Lindmark, K., Boman, K., Olofsson, M., Törnblom, M., Levine, A., Castelo-Branco, A., . . . Wikström, G. (2019). Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clinical Epidemiology, 11, 231-244
Open this publication in new window or tab >>Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden
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2019 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, p. 231-244Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden.

Methods: Adults with incident HF (>= 2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Vasterbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed.

Results: Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged >= 85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time).

Conclusion: The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.

Place, publisher, year, edition, pages
Dove medical press, 2019
Keywords
diagnosis, heart failure, incidence rate, mortality, prevalence, real-world
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158769 (URN)10.2147/CLEP.S170873 (DOI)000464038900001 ()30962724 (PubMedID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-08Bibliographically approved
Markgren, R., Brännström, M., Lundgren, C. & Boman, K. (2019). Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial. BMJ Supportive & Palliative Care, 9(1), Article ID e10.
Open this publication in new window or tab >>Impacts of person-centred integrated chronic heart failure and palliative home care on pharmacological heart failure treatment: a substudy of a randomised trial
2019 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 9, no 1, article id e10Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Patients with chronic heart failure (CHF) may be insufficiently treated pharmacologically. Recently, we presented a person-centred integrated Palliative advanced homecaRE and heart FailurE caRe (PREFER) strategy and compared it with usual care (control). Patients managed according to PREFER had improved health-related quality of life and markedly reduced hospitalisations compared with the control group. We hypothesised that these improvements may have been partly due to better drug treatments within the PREFER strategy. Thus, our aim in this study was to explore the management of drug treatments in the PREFER group compared with the control group.

METHODS: Doses and numbers of drugs and the number of patients receiving the target doses based on current guidelines were measured and compared between the groups at the start and finish of the study.

RESULTS: The percentages of ACE inhibitors (ACEIs) or mineralocorticoid receptor antagonists (MRAs) increased, while loop diuretics decreased in the PREFER arm during the study, although the differences were not significant. Beta-receptor blockers (BBs) decreased somewhat in both groups. The number of patients treated with MRAs differed the most between groups, and increased from 10 (28%) to 15 (48%) in the PREFER arm compared with 13 (35%) vs 13 (39%) in the control group. The change in patients receiving full target doses (+8 vs. +1) of the ACEIs/angiotensin receptor blockers, BBs and MRAs were significantly higher (p=0009) in the PREFER arm than in the control arm.

CONCLUSIONS: Person-centred integrated care of patients with severe CHF was associated with increased evidence-based drug treatments, especially MRAs.

CLINICAL TRIAL NUMBER: NCT01304381.

Place, publisher, year, edition, pages
London: BMJ Publishing Group Ltd, 2019
Keywords
Chronic heart failure, Palliative care, Person-centred, Pharmacology
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-115214 (URN)10.1136/bmjspcare-2015-000894 (DOI)000471863100010 ()26792391 (PubMedID)2-s2.0-85061865428 (Scopus ID)
Funder
Swedish Heart Lung Foundation
Available from: 2016-02-01 Created: 2016-02-01 Last updated: 2019-07-10Bibliographically approved
Wang, A., Arver, S., Boman, K., Gerstein, H. C., Lee, S. F., Hess, S., . . . Mellbin, L. G. (2019). Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial. European Journal of Preventive Cardiology, 26(8), 847-854
Open this publication in new window or tab >>Testosterone, sex hormone-binding globulin and risk of cardiovascular events: A report from the Outcome Reduction with an Initial Glargine Intervention trial
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2019 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 26, no 8, p. 847-854Article in journal (Refereed) Published
Abstract [en]

Aims: Testosterone and its binding protein sex hormone-binding globulin have been associated with cardiovascular disease and dysglycaemia. However, information on the prognostic implication in patients at high cardiovascular risk with dysglycaemia is inconsistent. The study objective was to determine whether testosterone and/or sex hormone-binding globulin predict cardiovascular events or death in dysglycaemic patients.

Methods: Dysglycaemic males at high cardiovascular risk (n = 5553) who participated in the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial and provided baseline blood samples were studied. Testosterone and sex hormone-binding globulin were measured at baseline and used to estimate free testosterone. Low levels of total and free testosterone were defined as ≤300 ng/dl and ≤7 ng/dl, respectively. Patients were followed for six years for cardiovascular events (defined as the composite of cardiovascular death, non-fatal myocardial infarction or stroke) and all-cause mortality.

Results: The mean total and free testosterone levels were 416.6 ng/dl and 8.4 ng/dl, and low levels were present in 13% and 37% of the patients. The median sex hormone-binding globulin level was 35 nmol/l. In Cox regression models adjusted for age, previous diseases and pharmacological treatment, neither total nor free testosterone predicted cardiovascular events. However, a one-standard-deviation increase in sex hormone-binding globulin predicted both cardiovascular events (hazard ratio 1.07; 95% confidence interval 1.00–1.14; p = 0.03) and all-cause mortality (hazard ratio 1.13; 95% confidence interval 1.06–1.21; p < 0.01).

Conclusion: Sex hormone-binding globulin, but not total testosterone, predicts cardiovascular disease and all-cause mortality in dysglycaemic males at high cardiovascular risk.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Testosterone, sex hormone-binding globulin, cardiovascular, prognosis, diabetes, glucose intolerance
National Category
Endocrinology and Diabetes Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-160312 (URN)10.1177/2047487318819142 (DOI)000469002800011 ()30567457 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20150747Stockholm County Council, 20160178
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
Hägglund, L., Boman, K. & Brännström, M. (2018). A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older. Nursing Open, 5(2), 176-185
Open this publication in new window or tab >>A mixed methods study of Tai Chi exercise for patients with chronic heart failure aged 70 years and older
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 176-185Article in journal (Refereed) Published
Abstract [en]

Aims and objectives

This study aimed to evaluate Tai Chi group training among patients with chronic heart failure (CHF) aged 70 years and older.

Background

Physical activity is recommended for CHF treatment. Tai Chi is found to be beneficial to different patient groups, although few studies focus on older patients with CHF.

Design

A mixed methods study. Participants were randomly assigned to Tai Chi training twice a week for 16 weeks (= 25) or control (= 20). Quantitative data were collected at baseline, at the end of the training period and 6 months after training, assessing self-rated fatigue and quality of life, natriuretic peptides and physical performance. Individual qualitative interviews were conducted with participants (= 10) in the Tai Chi training group.

Results

No statistical differences between the Tai Chi training group and the control group in quality of life or natriuretic peptides was found. After 16 weeks, the training group tended to rate more reduced activity and the control group rated more mental fatigue. Participants in the training group rated increased general fatigue at follow-up compared with baseline. Qualitative interviews showed that Tai Chi training was experienced as a new, feasible and meaningful activity. The importance of the leader and the group was emphasized. Improvements in balance were mentioned and there was no physical discomfort.

Conclusion

Tai Chi was experienced as a feasible and meaningful form of physical exercise for patients with CHF aged over 70 years despite lack of achieved health improvement. Further investigations, using feasibility and meaningfulness as outcome variables seems to be useful.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
chronic heart failure, elderly, group training, mixed methods, Tai Chi
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-145128 (URN)10.1002/nop2.127 (DOI)000428455600009 ()29599993 (PubMedID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2019-05-16Bibliographically approved
Hellström Ängerud, K., Boman, K. & Brännström, M. (2018). Areas for quality improvements in heart failure care: quality of care from the family members' perspective. Scandinavian Journal of Caring Sciences, 32(1), 346-353
Open this publication in new window or tab >>Areas for quality improvements in heart failure care: quality of care from the family members' perspective
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 346-353Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The complex needs of people with chronic heart failure (HF) place great demands on their family members, and it is important to ask family members about their perspectives on the quality of HF care.

OBJECTIVE: To describe family members' perceptions of quality of HF care in an outpatient setting.

METHODS: A cross-sectional study using a short form of the Quality from Patients' Perspective (QPP) questionnaire for data collection. The items in the questionnaire measure four dimensions of quality, and each item consists of both the perceived reality of the care and its subjective importance. The study included 57 family members of patients with severe HF in NYHA class III-IV.

RESULTS: Family members reported areas for quality improvements in three out of four dimensions and in dimensionless items. The lowest level of perceived reality was reported for treatment for confusion and loss of appetite. Treatment for shortness of breath, access to the apparatus and access to equipment necessary for medical care were the items with the highest subjective importance for the family members.

CONCLUSION: Family members identified important areas for quality improvement in the care for patients with HF in an outpatient setting. In particular, symptom alleviation, information to patients, patient participation and access to care were identified as areas for improvements. Thus, measuring quality from the family members' perspective with the QPP might be a useful additional perspective when it comes to the planning and implementation of changes in the organisation of HF care.

Place, publisher, year, edition, pages
Hoboken: John Wiley & Sons, 2018
Keywords
heart failure, Quality from patients' Perspective questionnaire, family members' perspective, quality of care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-139041 (URN)10.1111/scs.12468 (DOI)000426524200035 ()28543624 (PubMedID)
Available from: 2017-09-05 Created: 2017-09-05 Last updated: 2018-06-09Bibliographically approved
Greve, A. M., Bang, C. N., Boman, K., Egstrup, K., Forman, J. L., Kesäniemi, Y. A., . . . Wachtell, K. (2018). Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study). American Journal of Cardiology, 121(6), 739-745
Open this publication in new window or tab >>Effect Modifications of Lipid-Lowering Therapy on Progression of Aortic Stenosis (from the Simvastatin and Ezetimibe in Aortic Stenosis [SEAS] Study)
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2018 (English)In: American Journal of Cardiology, ISSN 0002-9149, E-ISSN 1879-1913, Vol. 121, no 6, p. 739-745Article in journal (Refereed) Published
Abstract [en]

Observational studies indicate that low-density lipoprotein (LDL) cholesterol acts as a primary contributor to an active process leading to aortic stenosis (AS) development. However, randomized clinical trials have failed to demonstrate an effect of lipid lowering on impeding AS progression. This study explored if pretreatment LDL levels and AS severity altered the efficacy of lipid-lowering therapy. The study goal was evaluated in the analysis of surviving patients with baseline data in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial of 1,873 asymptomatic patients with mild-to-moderate AS. Serially measured peak aortic jet velocity was the primary effect estimate. Linear mixed model analysis adjusted by baseline peak jet velocity and pretreatment LDL levels was used to assess effect modifications of treatment. Data were available in 1,579 (84%) patients. In adjusted analyses, lower baseline peak aortic jet velocity and higher pretreatment LDL levels increased the effect of randomized treatment (p >= 0.04 for interaction). As such, treatment impeded progression of AS in the highest quartile of LDL among patients with mild AS at baseline (0.06 m/s per year slower progression vs placebo in peak aortic jet velocity, 95% confidence interval 0.01 to 0.11, p = 0.03), but not in the 3 other quartiles of LDL. Conversely, among patients with moderate AS, there was no detectable effect of treatment in any of the pretreatment LDL quartiles (all p In conclusion, in a non prespecified post hoc analysis, the efficacy of lipid-lowering therapy on impeding AS progression increased with higher pretreatment LDL and lower peak aortic jet velocity (SEAS study: NCT00092677). 

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146569 (URN)10.1016/j.amjcard.2017.12.011 (DOI)000428102100012 ()29361285 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-06-09Bibliographically approved
Hodges, G. W., Bang, C. N., Forman, J. L., Olsen, M. H., Boman, K., Ray, S., . . . Wachtell, K. (2018). Effect of simvastatin and ezetimibe on suPAR levels and outcomes. Atherosclerosis, 272, 129-136
Open this publication in new window or tab >>Effect of simvastatin and ezetimibe on suPAR levels and outcomes
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2018 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 272, p. 129-136Article in journal (Refereed) Published
Abstract [en]

Background and aims: Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory marker associated with cardiovascular disease. Statins lower both low-density lipoprotein (LDL)-cholesterol and C-reactive protein (CRP), resulting in improved outcomes. However, whether lipid-lowering therapy also lowers suPAR levels is unknown.& para;& para;Methods: We investigated whether treatment with Simvastatin 40 mg and Ezetimibe 10 mg lowered plasma suPAR levels in 1838 patients with mild-moderate, asymptomatic aortic stenosis, included in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, using a pattern mixture model. A 1-year Cox analysis, adjusted for established cardiovascular risk factors, allocation to study treatment, peak aortic valve velocity and baseline suPAR, was performed to evaluate relationships between change in suPAR with all-cause mortality and the composite endpoint of major cardiovascular events (MCE) composed of ischemic cardiovascular events (ICE) and aortic valve related events (AVE).& para;& para;Results: After 4.3 years of follow-up, suPAR levels had increased by 9.2% (95% confidence interval [CI]: 7.0%-11.5%) in the placebo group, but only by 4.1% (1.9%-6.2%) in the group with lipid-lowering treatment (p<0.001). In a multivariate 1-year analysis, 1-year suPAR was strongly associated with all-cause mortality, hazard ratio (HR) = 2.05 (1.17-3.61); MCE 1.40 (1.01-1.92); and AVE 1.42 (1.02-1.99) (all p<0.042) for each doubling of suPAR; but was not associated with ICE.& para;& para;Conclusions: Simvastatin and Ezetimibe treatment impeded the progression of the time-related increase in plasma suPAR levels. Year-1 suPAR was associated with all-cause mortality, MCE, and AVE irrespective of baseline levels (SEAS study: NCT00092677). (C) 2018 Elsevier B.V. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2018
Keywords
Atherosclerosis, Biomarker, Cardiovascular disease, Cardiovascular risk, Inflammation, Statins, SuPAR
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-150715 (URN)10.1016/j.atherosclerosis.2018.03.030 (DOI)000430383800019 ()29602140 (PubMedID)2-s2.0-85044452064 (Scopus ID)
Available from: 2018-08-16 Created: 2018-08-16 Last updated: 2018-08-16Bibliographically approved
Alvariza, A., Årestedt, K., Boman, K. & Brännström, M. (2018). Family members' experiences of integrated palliative advanced home and heart failure care: a qualitative study of the PREFER intervention. Palliative & Supportive Care, 16(3), 278-285
Open this publication in new window or tab >>Family members' experiences of integrated palliative advanced home and heart failure care: a qualitative study of the PREFER intervention
2018 (English)In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 3, p. 278-285Article in journal (Refereed) Published
Abstract [en]

Objective: Chronic heart failure is a disease with high morbidity and symptom burden for patients, and it also places great demands on family members. Patients with heart failure should have access to palliative care for the purpose of improving quality of life for both patients and their families. In the PREFER randomized controlled intervention, patients with New York Heart Association classes III–IV heart failure received person-centered care with a multidisciplinary approach involving collaboration between specialists in palliative and heart failure care. The aim of the present study was to describe family members' experiences of the intervention, which integrated palliative advanced home and heart failure care.

Method: This study had a qualitative descriptive design based on family member interviews. Altogether, 14 family members participated in semistructured interviews for evaluation after intervention completion. The data were analyzed by means of content analysis.

Results: Family members expressed gratitude and happiness after witnessing the patient feeling better due to symptom relief and empowerment. They also felt relieved and less worried, as they were reassured that the patient was being cared for properly and that their own responsibility for care was shared with healthcare professionals. However, some family members also felt as though they were living in the shadow of severe illness, without receiving any support for themselves.

Significance of results: Several benefits were found for family members from the PREFER intervention, and our results indicate the significance of integrated palliative advanced home and heart failure care. However, in order to improve this intervention, psychosocial professionals should be included on the intervention team and should contribute by paying closer attention and providing targeted support for family members.

Place, publisher, year, edition, pages
New York: Cambridge University Press, 2018
Keywords
Family members, Heart failure, Intervention, Palliative care, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-134551 (URN)10.1017/S1478951517000256 (DOI)000435649400005 ()28464977 (PubMedID)2-s2.0-85018388784 (Scopus ID)
Available from: 2017-05-08 Created: 2017-05-08 Last updated: 2018-09-21Bibliographically approved
Boman, K., Thormark Fröst, F., Bergman, A.-C. R. & Olofsson, M. (2018). NTproBNP and ST2 as predictors for all-cause and cardiovascular mortality in elderly patients with symptoms suggestive for heart failure. Biomarkers, 23(4), 373-379
Open this publication in new window or tab >>NTproBNP and ST2 as predictors for all-cause and cardiovascular mortality in elderly patients with symptoms suggestive for heart failure
2018 (English)In: Biomarkers, ISSN 1354-750X, E-ISSN 1366-5804, Vol. 23, no 4, p. 373-379Article in journal (Refereed) Published
Abstract [en]

Background: A new biomarker, suppression of tumorigenicity 2 (ST2) has been introduced as a marker for fibrosis and hypertrophy. Its clinical value in comparison with N-terminal pro-hormone of brain natriuretic peptide /Amino-terminal pro-B-type natriuretic peptide (NTproBNP) in predicting mortality in elderly patients with symptoms of heart failure (HF) is still unclear.

Aim: To evaluate the prognostic value for all-cause- and cardiovascular mortality of ST2 or NTproBNP and the combination of these biomarkers.

Patients and methods: One hundred seventy patients patients with clinical symptoms of HF (77 (45%) were with verified HF) were recruited from one selected primary health care center (PHC) in Sweden and echocardiography was performed in all patients. Blood samples were obtained from 159 patients and stored frozen at -70 degrees C. NTproBNP was analyzed at a central core laboratory using a clinically available immunoassay. ST2 was analyzed with Critical Diagnostics Presage ST2 ELISA immunoassay.

Results: We studied 159 patients (mean age 778.3years, 70% women). During ten years of follow up 78 patients had died, out of which 50 deaths were for cardiovascular reasons. Continuous NTproBNP and ST2 were both significantly associated with all-cause mortality (1.0001; 1.00001-1.0002, p=0.04 and 1.03; 1.003-1.06, p=0.03), NTproBNP but not ST2 remained significant for cardiovascular mortality after adjustments (1.0001; 1.00001-1.0002, p=0.03 and 1.01; 0.77-1.06, p=0.53), respectively. NTproBNP above median (>328ng/L) compared to below median was significantly associated with all-cause mortality(HR: 4.0; CI :2.46-6.61; p<0.001) and cardiovascular mortality (HR: 6.1; CI: 3.11-11.95; p<0.001). Corresponding analysis for ST2 above median (25.6ng/L) was not significantly associated neither with all-cause mortality (HR; 1.4; CI: 0.89-2.77) nor cardiovascular mortality (HR: 1.3; CI: 0.73-2.23) and no significant interaction of NTproBNP and ST2 (OR: 1.1; CI: 0.42-3.12) was found.

Conclusion: In elderly patients with symptoms of heart failure ST2 was not superior to NTproBNP to predict all cause or cardiovascular mortality. Furthermore, it is unclear if the combination of ST2 and NTproBNP will improve long-term prognostication beyond what is achieved by NTproBNP alone.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
NTproBNP, ST2, elderly, heart failure, morbidity, mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-148038 (URN)10.1080/1354750X.2018.1431692 (DOI)000431689700009 ()29355441 (PubMedID)
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2019-05-16Bibliographically approved
Hodges, G. W., Bang, C. N., Eugen-Olsen, J., Olsen, M. H., Boman, K., Ray, S., . . . Wachtell, K. (2018). SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis. Open heart, 5(1), Article ID e000743.
Open this publication in new window or tab >>SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis
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2018 (English)In: Open heart, E-ISSN 2053-3624, Vol. 5, no 1, article id e000743Article in journal (Refereed) Published
Abstract [en]

Background We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery.

Methods Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Cox analyses were used to evaluate suPAR in relation to all-cause mortality and the composite endpoint of postoperative complications (all-cause mortality, congestive heart failure, stroke and renal impairment) occurring in the 30-day postoperative period.

Results Patients with initially higher levels of suPAR were at increased risk of postoperative mortality with a HR of 3.5 (95% CI 1.4 to 9.0, P=0.008) and postoperative complications with a HR of 2.7 (95% CI 1.5 to 5.1, P=0.002), per doubling in suPAR. After adjusting for the European System for Cardiac Operative Risk Evaluation or Society of Thoracic Surgeons risk score, suPAR remained associated with postoperative mortality with a HR 3.2 (95% CI 1.2 to 8.6, P=0.025) and 2.7 (95% CI 1.0 to 7.8, P=0.061); and postoperative complications with a HR of 2.5 (95% CI 1.3 to 5.0, P=0.007) and 2.4 (95% CI 1.2 to 4.8, P=0.011), respectively.

Conclusion Higher baseline suPAR levels are associated with an increased risk for postoperative complications and mortality in patients with mild-moderate, asymptomatic AS undergoing later AVR surgery. Further validation in other subsets of AS individuals are warranted.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Surgery Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146446 (URN)10.1136/openhrt-2017-000743 (DOI)000427076500032 ()29387432 (PubMedID)
Available from: 2018-05-03 Created: 2018-05-03 Last updated: 2018-09-26Bibliographically approved
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