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Johansson, Bengt
Publications (10 of 88) Show all publications
Larsson, L., Johansson, B., Wadell, K., Thilen, U. & Sandberg, C. (2019). Adults with congenital heart disease overestimate their physical activity level. IJC Heart & Vasculature, 22, 13-17
Open this publication in new window or tab >>Adults with congenital heart disease overestimate their physical activity level
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2019 (English)In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 13-17Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity reduces the risk of acquired cardiovascular disease, which is of great importance in patients with congenital heart disease (CHD). There are diverging data whether physical activity level (PAL) differs between patients with CHD and controls. Furthermore, it is unknown if PAL can be reliably assessed in patients with CHD using self-reported instruments.

Methods: Seventy-five patients with CHD (mean age 37.5 ± 15.5 years, women n = 29 [38.7%]) and 42 age and sex matched controls completed the International Physical Activity Questionnaire (IPAQ) and carried the activity monitor Actiheart over 4 days. Time spent at ≥3 METS ≥21.4 min/day, i.e. reaching the WHO recommendation for PAL to promote health, was used as the outcome measure. Data on PAL obtained from IPAQ were compared with Actiheart.

Results: The proportion of individuals reaching target PAL according to IPAQ was similar in patients with CHD and controls (70.7%vs.76.2%, p = 0.52) as well as between patients with simple and complex lesions. There was an overall difference between IPAQ and Actiheart in detecting recommended PAL (72.6%vs.51.3%, p b 0.001). In a subgroup analysis, this difference was also detected in patients but was borderline for controls. The negative predictive value for IPAQ in detecting insufficient PAL was higher in patients than in controls (73%vs.40%).

Conclusions: The proportion of persons reaching sufficient PAL to promote health was similar in patients and controls. The self-reported instrument overestimated PAL in relation to objective measurements. However, with a high negative predictive value, IPAQ is a potentially useful tool for detecting patients with insufficient PAL.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Physical activity level, IPAQ, Actiheart
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158111 (URN)10.1016/j.ijcha.2018.11.005 (DOI)000462184100003 ()30480085 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130472Swedish Heart Lung Foundation, 20150579Västerbotten County Council
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Larsson, L., Rinnström, D., Sandberg, C., Högström, G., Thilen, U., Nordström, P. & Johansson, B. (2019). Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects. International Journal of Cardiology, 280, 57-60
Open this publication in new window or tab >>Aerobic capacity in adolescence is associated with time to intervention in adult men with atrial septal defects
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2019 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 280, p. 57-60Article in journal (Refereed) Published
Abstract [en]

Background: Atrial septal defect (ASD) is a congenital heart lesion that often remains undiagnosed until adulthood. The reasons for this may be multifactorial. It is, however, known that closure of a hemodynamically significant ASD improves exercise capacity. This study aimed to explore whether the aerobic capacity in late adolescence is associated with time to diagnosis and intervention in adult men with late diagnosis of an atrial shunt.

Methods: The Swedish Military Conscription Service Register contains data on exercise tests performed in late adolescence. By linking these data with the National Patient Register, 254 men with a later intervention for an ASD were identified.

Results: Interventions were performed at a mean of 26.5 +/- 7.9 years after the initial exercise tests. The mean absolute workload among those with a later diagnosed ASD was similar to those without a later diagnosed ASD (274 +/- 51W vs. 276 +/- 52 W, p = 0.49). Men with a higher exercise capacity (>= 1 SD) had their intervention earlier (21.9 +/- 8.6 years vs. 27.5 +/- 7.4 years, p < 0.001).

Conclusions: The aerobic exercise capacity was similar in adolescent men with later interventions for ASD compared to the reference population. Furthermore, those with high exercise capacity appeared to be diagnosed earlier. Thus, low exercise capacity may not be a feature of ASD during adolescence, but rather develop later in life as a natural progression of the disease.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Congenital heart disease, Atrial septal defect
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-156856 (URN)10.1016/j.ijcard.2018.12.073 (DOI)000458491600013 ()30651192 (PubMedID)
Available from: 2019-03-13 Created: 2019-03-13 Last updated: 2019-03-13Bibliographically approved
Ljungberg, J., Johansson, B., Engström, K. G., Norberg, M., Bergdahl, I. A. & Söderberg, S. (2019). Arterial hypertension and diastolic blood pressure associate with aortic stenosis. Scandinavian Cardiovascular Journal, 53(2), 91-97
Open this publication in new window or tab >>Arterial hypertension and diastolic blood pressure associate with aortic stenosis
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2019 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 53, no 2, p. 91-97Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Due to age-related differences in aortic valve structure, it is likely that the pathophysiology of aortic stenosis (AS) and associated risk factors differ between age groups. Here we prospectively studied the influence of traditional cardiovascular risk factors on AS development requiring surgery among patients without concomitant coronary artery disease (CAD) and stratified for age.

DESIGN: This study included 322 patients, who had prior to surgery for AS participated in population-based surveys, and 131 of them had no visible CAD upon preoperative coronary angiogram. For each case, we selected four referents matched for age, gender, and geographic area. To identify predictors for surgery, we used multivariable conditional logistic regression with a model including arterial hypertension (or measured blood pressure and antihypertensive medication), cholesterol levels, diabetes, body mass index (BMI), and smoking.

RESULTS: In patients without CAD, future surgery for AS was associated with arterial hypertension and elevated levels of diastolic blood pressure in patients younger than 60 years at surgery (odds ratio [95% confidence interval]), (3.40 [1.45-7.93] and 1.60 [1.09-2.37], respectively), and with only impaired fasting glucose tolerance in patients 60 years or older at surgery (3.22 [1.19-8.76]).

CONCLUSION: Arterial hypertension and elevated diastolic blood pressure are associated with a risk for AS requiring surgery in subjects below 60 years of age. Strict blood pressure control in this group is strongly advocated to avoid other cardiovascular diseases correlated to hypertension. If hypertension and elevated diastolic blood pressure are risk factors for developing AS requiring surgery need further investigations. Notably, elevated fasting glucose levels were related to AS requiring surgery in older adults without concomitant CAD.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2019
Keywords
Aortic stenosis, bicuspid aortic valve, diabetes, hypertension, valve disease surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159471 (URN)10.1080/14017431.2019.1605094 (DOI)000469026200007 ()31109205 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140799Swedish Heart Lung Foundation, 20120631Swedish Heart Lung Foundation, 20100635Västerbotten County Council, VLL-548791
Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-06-17Bibliographically approved
Hedlund, M., Lindelöf, N., Johansson, B., Boraxbekk, C.-J. & Rosendahl, E. (2019). Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals. Frontiers in Physiology, 10, Article ID 590.
Open this publication in new window or tab >>Development and Feasibility of a Regulated, Supramaximal High-Intensity Training Program Adapted for Older Individuals
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2019 (English)In: Frontiers in Physiology, ISSN 1664-042X, E-ISSN 1664-042X, Vol. 10, article id 590Article in journal (Refereed) Published
Abstract [en]

Background: High-intensity training (HIT) with extremely short intervals (designated here as supramaximal HIT) is a time-efficient training method for health and performance. However, a protocol for regulation and control of intensity is missing, impeding implementation in various groups, such as older individuals.

Methods: This study presents the development and characteristics of a novel training protocol with regulated and controlled supramaximal intervals adapted for older people. Using both quantitative and qualitative analyses, we explored the feasibility of the program, performed in a group training setting, with physically active older individuals (aged 65–75, n = 7; five women). The developed supramaximal HIT program consisted of 10 × 6 s cycle sprint intervals with ∼1 min of active recovery with the following key characteristics: (1) an individual target power output was reached and maintained during all intervals and regulated and expressed as the percentage of the estimated maximum mean power output for the duration of the interval (i.e., 6 s); (2) pedaling cadence was standardized for all participants, while resistance was individualized; and (3) the protocol enabled controlled and systematic adjustments of training intensity following standardized escalation criteria.

Aim: Our aim was to test the feasibility of a novel training regimen with regulated and controlled supramaximal HIT, adapted for older people. The feasibility criteria for the program were to support participants in reaching a supramaximal intensity (i.e., power output > 100% of estimated VO2 max), avoid inducing a negative affective response, and have participants perceive it as feasible and acceptable.

Results: All feasibility criteria were met. The standardized escalation procedure provided safe escalation of training load up to a supramaximal intensity (around three times the power output at estimated VO2 max). The participants never reported negative affective responses, and they perceived the program as fun and feasible.

Conclusion: This novel program offers a usable methodology for further studies on supramaximal HIT among older individuals with different levels of physical capacity. Future research should explore the effects of the program in various populations of older people and their experiences and long-term adherence compared with other forms of training.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
sprint interval training, high-intensity interval training, affective state, perceived exertion, training intensity, aging
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:umu:diva-159855 (URN)10.3389/fphys.2019.00590 (DOI)000468572300001 ()
Available from: 2019-06-10 Created: 2019-06-10 Last updated: 2019-06-10Bibliographically approved
Bay, A., Lämås, K., Berghammer, M., Sandberg, C. & Johansson, B. (2019). Enablers and barriers for physical activity in adults with congenital heart disease. In: : . Paper presented at Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019..
Open this publication in new window or tab >>Enablers and barriers for physical activity in adults with congenital heart disease
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2019 (English)Conference paper, Oral presentation only (Refereed)
National Category
Cardiac and Cardiovascular Systems Nursing Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Caring Sciences
Identifiers
urn:nbn:se:umu:diva-156923 (URN)
Conference
Berzelius symposium 99, The Cardiac Patient from Birth to Adulthood, Stockholm, Sweden, 21-22 February 2019.
Available from: 2019-03-01 Created: 2019-03-01 Last updated: 2019-03-07Bibliographically approved
Otten, J., Andersson, J., Ståhl, J., Stomby, A., Saleh, A., Waling, M., . . . Olsson, T. (2019). Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 8(2), Article ID e010634.
Open this publication in new window or tab >>Exercise Training Adds Cardiometabolic Benefits of a Paleolithic Diet in Type 2 Diabetes Mellitus
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2019 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 2, article id e010634Article in journal (Refereed) Published
Abstract [en]

Background: The accumulation of myocardial triglycerides and remodeling of the left ventricle are common features in type 2 diabetes mellitus and represent potential risk factors for the development of diastolic and systolic dysfunction. A few studies have investigated the separate effects of diet and exercise training on cardiac function, but none have investigated myocardial changes in response to a combined diet and exercise intervention. This 12-week randomized study assessed the effects of a Paleolithic diet, with and without additional supervised exercise training, on cardiac fat, structure, and function.

Methods and Results: Twenty-two overweight and obese subjects with type 2 diabetes mellitus were randomized to either a Paleolithic diet and standard-care exercise recommendations ( PD ) or to a Paleolithic diet plus supervised exercise training 3 hours per week ( PD - EX ). This study includes secondary end points related to cardiac structure and function, ie, myocardial triglycerides levels, cardiac morphology, and strain were measured using cardiovascular magnetic resonance, including proton spectroscopy, at baseline and after 12 weeks. Both groups showed major favorable metabolic changes. The PD - EX group showed significant decreases in myocardial triglycerides levels (-45%, P=0.038) and left ventricle mass to end-diastolic volume ratio (-13%, P=0.008) while the left ventricle end-diastolic volume and stroke volume increased significantly (+14%, P=0.004 and +17%, P=0.008, respectively). These variables were unchanged in the PD group.

Conclusions: Exercise training plus a Paleolithic diet reduced myocardial triglycerides levels and improved left ventricle remodeling in overweight/obese subjects with type 2 diabetes mellitus.

Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01513798.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2019
Keywords
cardiovascular magnetic resonance imaging, diet, exercise, myocardial metabolism, type 2 diabetes mellitus
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157046 (URN)10.1161/JAHA.118.010634 (DOI)000460105800010 ()30652528 (PubMedID)
Available from: 2019-03-07 Created: 2019-03-07 Last updated: 2019-03-27Bibliographically approved
Sandström, A., Sandberg, C., Rinnström, D., Engström, K. G., Dellborg, M., Thilen, U., . . . Johansson, B. (2019). Factors associated with health-related quality of life among adults with tetralogy of Fallot. Open heart, 6(1), Article ID e000932.
Open this publication in new window or tab >>Factors associated with health-related quality of life among adults with tetralogy of Fallot
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2019 (English)In: Open heart, E-ISSN 2053-3624, Vol. 6, no 1, article id e000932Article in journal (Refereed) Published
Abstract [en]

Background: Due to improved care, the numbers of patients with tetralogy of Fallot (ToF) are increasing. However, long-term morbidity and need for reinterventions are concerns and also address issues of quality of life (QoL).

Methods: Patients with ToF and valid EuroQol-5 dimensions questionnaire (EQ-5D) were identified in the national Swedish register on congenital heart disease. EQ-5Dindex was calculated and dichotomised into best possible health-related QoL (EQ-5Dindex=1) or differed from 1.

Results: 288 patients met the criteria and were analysed. Univariate logistic regression showed a positive association between New York Heart Association (NYHA) class I (OR 8.32, 95% CI 3.80 to 18.21), physical activity >3 h/week (OR 3.34, 95% CI 1.67 to 6.66) and a better right ventricular function (OR 2.56, 95% CI 1.09 to 6.02). A negative association between symptoms (OR 0.23, 95% CI 0.13 to 0.42), cardiovascular medication (OR 0.31, 95% CI 0.18 to 0.53), age (OR 0.97, 95% CI 0.96 to 0.99) and EQ-5Dindex was observed. In multivariate logistic regression, NYHA I (OR 7.28, 95% CI 3.29 to 16.12) and physical activity >3 h/week (OR 2.27, 95% CI 1.07 to 4.84) remained associated with best possible health-related QoL. Replacing NYHA with symptoms in the model yielded similar results.

Conclusion: In this registry study, self-reported physical activity, staff-reported NYHA class and absence of symptoms were strongly associated with best possible health-related QoL measured by EQ-5D. Physical activity level is a potential target for intervention to improve QoL in this population but randomised trials are needed to test such a hypothesis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-161553 (URN)10.1136/openhrt-2018-000932 (DOI)000471922200023 ()30997127 (PubMedID)
Funder
Västerbotten County CouncilSwedish Heart Lung Foundation
Available from: 2019-07-10 Created: 2019-07-10 Last updated: 2019-07-10Bibliographically approved
Larsson, L., Johansson, B., Sandberg, C., Apers, S., Kovacs, A. H., Luyckx, K., . . . Moons, P. (2019). Geographical variation and predictors of physical activity level in adults with congenital heart disease. IJC Heart & Vasculature, 22, 20-25
Open this publication in new window or tab >>Geographical variation and predictors of physical activity level in adults with congenital heart disease
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2019 (English)In: IJC Heart & Vasculature, ISSN 2352-9067, Vol. 22, p. 20-25Article in journal (Refereed) Published
Abstract [en]

Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 h/week of physical activity exceeding 3 metabolic equivalents(METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin.

Methods: 3896 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within the APPROACH-IS project. For each patient, we calculated whether WHO recommendations were achieved or not. Associated factors were investigated using Generalized Linear Mixed Models.

Results: On average, 31% reached the WHO recommendations but with a great variation between geographical areas (India: 10%–Norway: 53%). Predictors for physical activity level in line with the WHO recommendations, with country of residence as random effect, were male sex (OR 1.78, 95%CI 1.52–2.08), NYHA-class I (OR 3.10, 95%CI 1.71–5.62) and less complex disease (OR 1.46, 95%CI 1.16–1.83). In contrast, older age (OR 0.97, 95%CI 0.96–0.98), lower educational level (OR 0.41, 95%CI 0.26–0.64) and being unemployed (OR 0.57, 95%CI 0.42–0.77) were negatively associated with reaching WHO recommendations.

Conclusions: A significant proportion of patients with CHD did not reach the WHO physical activity recommendations. There was a large variation in physical activity level by country of origin. Based on identified predictors, vulnerable patients may be identified and offered specific behavioral interventions.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Adult congenital heart disease, Physical activity level, Patient-reported outcome, Health-behaviour scale, Physical activity recommendation, Metabolic equivalent
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158110 (URN)10.1016/j.ijcha.2018.11.004 (DOI)000462184100005 ()30511012 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20130607
Available from: 2019-04-12 Created: 2019-04-12 Last updated: 2019-04-12Bibliographically approved
Ljungberg, J., Johansson, B., Bergdahl, I., Holmgren, A., Näslund, U., Hultdin, J. & Söderberg, S. (2019). Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis. Scandinavian Journal of Clinical and Laboratory Investigation, 79(7), 524-530
Open this publication in new window or tab >>Mild impairment of renal function (shrunken pore syndrome) is associated with increased risk for future surgery for aortic stenosis
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2019 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 7, p. 524-530Article in journal (Refereed) Published
Abstract [en]

Recently, a new approach was proposed to detect mild impairment in renal function: a reduced ratio between estimated glomerular filtration rate (eGFR) calculated by cystatin C and eGFR calculated by creatinine. We aimed to evaluate if this ratio is associated with aortic stenosis (AS) requiring surgery. We identified 336 patients that first participated in population surveys and later underwent surgery for AS (median age [interquartile range] 59.8 [10.3] years at survey and 68.3 [12.7] at surgery, 48% females). For each patient, two matched referents were allocated. Cystatin C and creatinine were determined in stored plasma. eGFR(cystatin C) and eGFR(creatinine) and their ratio were estimated. Conditional logistic regression analyses were used to estimate the risk (odds ratio (OR) with [95% confidence interval (CI)]) related to one (ln) standard deviation increase in the ratio between eGFR(cystatin C) and eGFR(creatinine). A high ratio was associated with lower risk for AS requiring surgery (OR [95% CI]) (OR 0.84 [0.73-0.97]), especially in women (0.74 [0.60-0.92] vs. 0.93 [0.76-1.13] in men). After further stratification for coronary artery disease (CAD), the association remained in women with CAD but not in women without CAD (0.60 [0.44-0.83] and 0.89 [0.65-1.23], respectively). In conclusion, a high ratio between eGFR(cystatin C) and eGFR(creatinine) was associated with lower risk for surgery for AS, especially in women. Mild impairment of renal function is thus associated with future risk for AS requiring surgery.

Place, publisher, year, edition, pages
Taylor & Francis, 2019
Keywords
Aortic stenosis, valvular replacement, renal insufficiency, creatinine, cystatin C
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-164404 (URN)10.1080/00365513.2019.1664761 (DOI)000486559100001 ()31522562 (PubMedID)
Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05Bibliographically approved
Van Bulck, L., Luyckx, K., Goossens, E., Apers, S., Kovacs, A. H., Thomet, C., . . . MacMillen, K. (2019). Patient-reported outcomes of adults with congenital heart disease from eight European countries: scrutinising the association with healthcare system performance. European Journal of Cardiovascular Nursing, 18(6), 465-473
Open this publication in new window or tab >>Patient-reported outcomes of adults with congenital heart disease from eight European countries: scrutinising the association with healthcare system performance
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2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 6, p. 465-473Article in journal (Refereed) Published
Abstract [en]

Background: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries' healthcare system performance are of importance for patient-reported outcomes. Aims: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease. Methods: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. Results: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes. Conclusion: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2019
Keywords
Healthcare system performance, heart defect, congenital, health services accessibility, patient ported outcome measures
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-162322 (URN)10.1177/1474515119834484 (DOI)000477647400005 ()30808198 (PubMedID)
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20Bibliographically approved
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