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Hellström Ängerud, KarinORCID iD iconorcid.org/0000-0002-7918-6121
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Publications (10 of 35) Show all publications
Norberg, H., Andersson, T., Håkansson, E., Hellström Ängerud, K. & Lindmark, K. (2024). Assessment of a systematic approach for implementing novel medications in clinical practice: an observational study with dapagliflozin. European Journal of Clinical Pharmacology
Open this publication in new window or tab >>Assessment of a systematic approach for implementing novel medications in clinical practice: an observational study with dapagliflozin
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2024 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To assess a systematic implementation approach for introducing dapagliflozin to individuals with heart failure and reduced ejection fraction in an outpatient clinical setting.

Methods: Retrospective medical record data were analysed. All individuals diagnosed with heart failure who resided within the hospital catchment area and had visited cardiology or internal medicine department between 2010 and 2019 were screened by using the main inclusion criteria from the DAPA-HF trial. The effectiveness of the previously described seven-step systematic implementation approach was assessed by the proportion receiving information letter, dapagliflozin treatment, follow-ups at 2–12 weeks and 12 months post-dapagliflozin initiation, persistence on dapagliflozin, adverse events, and reasons for discontinuation.

Results: Of the 2433 individuals, 352 met the main DAPA-HF trial criteria in step 2. After exclusions in steps 3 and 4, 191 individuals remained. Of these, 158 were invited for eligibility discussion in step 5, with 107 having received an information letter beforehand. In step 6, dapagliflozin was prescribed to 69 individuals, and in step 7, follow-ups were conducted with 56 individuals at 2–12 weeks and 62 individuals at 12 months. Sixty out of 69 persisted on dapagliflozin after 12 months. Adverse events were reported by nine individuals. Discontinuation was attributed to reasons such as urinary tract infections, genital or abdominal discomfort, and hypotension.

Conclusion: The systematic introduction of dapagliflozin to heart failure patients was effective. Despite this, challenges in uniformly implementing procedures across patients were evident, emphasizing the necessity for a systematic implementation approach.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Systematic implementation, Healthcare quality improvement, Chronic disease managemen, t Dapagliflozin
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-226820 (URN)10.1007/s00228-024-03707-4 (DOI)001242747500001 ()38856725 (PubMedID)2-s2.0-85195542718 (Scopus ID)
Funder
Norrländska Hjärtfonden
Available from: 2024-06-20 Created: 2024-06-20 Last updated: 2024-06-24
Jutterström, L., Stenlund, A.-L., Otten, J., Lilja, M. & Hellström Ängerud, K. (2024). Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study. International Journal of Qualitative Studies on Health and Well-being, 19(1), Article ID 2294512.
Open this publication in new window or tab >>Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study
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2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2294512Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D).

METHOD: A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory.

RESULT: The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management.

CONCLUSION: Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Cardiovascular risk, patients’ experiences, primary health care, qualitative, risk awareness, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-218860 (URN)10.1080/17482631.2023.2294512 (DOI)001127543500001 ()38112175 (PubMedID)2-s2.0-85180420063 (Scopus ID)
Funder
Umeå UniversityRegion VästerbottenVisare NorrDiabetesfonden
Available from: 2024-01-05 Created: 2024-01-05 Last updated: 2024-01-05Bibliographically approved
Holmlund, L., Hörnsten, C., Valham, F., Olsson, K., Hörnsten, Å. & Hellström Ängerud, K. (2024). Illness perceptions and health-related quality of life in women and men with atrial fibrillation. Journal of Cardiovascular Nursing, 39(1), 49-57
Open this publication in new window or tab >>Illness perceptions and health-related quality of life in women and men with atrial fibrillation
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2024 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 39, no 1, p. 49-57Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Health-related quality of life (HRQoL) is worse in patients with atrial fibrillation (AF) compared with other populations. Factors affecting HRQoL in patients with AF are not fully clarified. Illness perceptions are important determinants of disease management and may affect HRQoL.

OBJECTIVE: The aims of this study were to describe illness perceptions and HRQoL in women and men with AF and to explore the relationship between illness perceptions and HRQoL in patients with AF.

METHODS: This cross-sectional study included 167 patients with AF. Patients completed the Revised Illness Perception Questionnaire and HRQoL questionnaires: Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias, the three-level version of the EuroQol 5-dimensional questionnaire, and EuroQol visual analog scale. Subscales of the Revised Illness Perception Questionnaire significant in correlation analysis with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias HRQoL total scale were included in a multiple linear regression model.

RESULTS: Mean age was 68.7 ± 10.4 years, and 31.1% were women. Women reported lower personal control (P = .039) and worse HRQoL measured with the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmias physical subscale (P = .047) and the EuroQol visual analog scale (P = .044) compared with men. Illness identity (P < .001), consequences (P = .031), emotional representation (P = .014), and timeline cyclical (P = .022) were related to and adversely affected HRQoL.

CONCLUSIONS: This study found a relationship between illness perceptions and HRQoL. Some subscales of illness perceptions negatively affected HRQoL in patients with AF, which indicates that efforts to change illness perceptions may be helpful in improving HRQoL. Patients should be given the opportunity to talk about the disease, their symptoms, their emotions, and the consequences of the disease to enable increased HRQoL. A challenge for healthcare will be to design support for each patient based on his/her illness perceptions.

Place, publisher, year, edition, pages
Wolters Kluwer, 2024
Keywords
atrial fibrillation, health-related quality of life, illness perceptions
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-206996 (URN)10.1097/JCN.0000000000000995 (DOI)37074949 (PubMedID)2-s2.0-85178651164 (Scopus ID)
Available from: 2023-04-25 Created: 2023-04-25 Last updated: 2024-04-26Bibliographically approved
Holmlund, L., Hörnsten, C., Hörnsten, Å., Olsson, K., Valham, F. & Hellström Ängerud, K. (2024). More positive patient-reported outcomes in patients newly diagnosed with atrial fibrillation: a comparative longitudinal study. European Journal of Cardiovascular Nursing
Open this publication in new window or tab >>More positive patient-reported outcomes in patients newly diagnosed with atrial fibrillation: a comparative longitudinal study
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2024 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aims: To compare patient-reported outcomes (PROs) in patients newly (<6 months) diagnosed with atrial fibrillation (AF) with those who have had a longer diagnosis (≥6 months) and to investigate whether or not these outcomes change over a 6-month period.

Methods and results: In this longitudinal survey study, 129 patients with AF completed the Revised Illness Perception Questionnaire, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia, and the Hospital Anxiety and Depression Scale at baseline and after 6 months. At baseline, patients newly diagnosed with AF (n = 53), compared with patients with a previous diagnosis (n = 76), reported AF as more temporary (P = 0.003) and had a higher belief in personal and treatment control (P = 0.004 and P = 0.041, respectively). At a 6-month follow-up, patients newly diagnosed reported a lower symptom burden (P = 0.004), better health-related quality of life (HRQoL); (P = 0.015), and a higher personal control (P < 0.001) than patients previously diagnosed. Over time, in patients newly diagnosed, symptom burden and the anxiety symptom score decreased (P = 0.001 and P = 0.014, respectively) and HRQoL improved (P = 0.002).

Conclusion: Patients newly diagnosed with AF reported more positive PROs both at baseline and at a 6-month follow-up than patients with a previous diagnosis of AF. Therefore, it is important to quickly capture patients newly diagnosed to support their belief in their own abilities. Such support may, alongside medical treatments, help patients manage the disease, which may lead to reduced symptom burden and better HRQoL over time.

Place, publisher, year, edition, pages
Oxford University Press, 2024
Keywords
Anxiety, Atrial fibrillation, Depression, Health-related quality of life, Newly diagnosed, Patient-reported outcomes, Symptom burden
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-222452 (URN)10.1093/eurjcn/zvad139 (DOI)
Funder
Umeå UniversitySwedish Heart Lung Foundation
Available from: 2024-03-18 Created: 2024-03-18 Last updated: 2024-04-26
Holmlund, L., Hellström Ängerud, K., Hörnsten, Å., Valham, F. & Olsson, K. (2023). Experiences of living with symptomatic atrial fibrillation. Nursing Open, 10(3), 1821-1829
Open this publication in new window or tab >>Experiences of living with symptomatic atrial fibrillation
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2023 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 10, no 3, p. 1821-1829Article in journal (Refereed) Published
Abstract [en]

AIM: To explore the experiences of living with symptomatic atrial fibrillation.

DESIGN: This study, with a descriptive qualitative adesign, was performed using semi-structured individual interviews.

METHOD: Six women and nine men with symptomatic atrial fibrillation were included. The transcribed interviews were analysed using qualitative content analysis. The COREQ checklist was followed.

RESULTS: The analysis resulted in a main theme, namely balancing life and included the themes striving for illness control, becoming a receiver or an active partner in care and dealing with changed self-image. The participants strived to understand their illness, prevent attacks and manage anxiety. Some of the participants were not involved in decision-making, were uninformed about self-care measures, reported a lack of continuity in care and felt that the doctors focused on information about the medical part of care.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
atrial fibrillation, experiences, interviews, qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-200942 (URN)10.1002/nop2.1442 (DOI)000875848500001 ()36309946 (PubMedID)2-s2.0-85141152075 (Scopus ID)
Available from: 2022-11-10 Created: 2022-11-10 Last updated: 2024-04-26Bibliographically approved
Hellström Ängerud, K., Ericsson, M., Brännström, M., Sederholm Lawesson, S., Strömberg, A. & Thylén, I. (2023). Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires. Journal of Cardiovascular Nursing, 38(2), 150-157
Open this publication in new window or tab >>Symptoms of Acute Myocardial Infarction as Described in Calls to Tele-Nurses and in Questionnaires
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2023 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 38, no 2, p. 150-157Article in journal (Refereed) Published
Abstract [en]

Background: Patient-reported symptoms of acute myocardial infarction (MI) may be affected by recall bias depending on when and where symptoms are assessed.

Aim: The aim of this study was to gain an understanding of patients' symptom description in more detail before and within 24 hours after a confirmed MI diagnosis.

Methods: A convergent parallel mixed-methods design was used to examine symptoms described in calls between the tele-nurse and the patient compared with symptoms selected by the patient from a questionnaire less than 24 hours after hospital admission. Quantitative and qualitative data were analyzed separately and then merged into a final interpretation.

Results: Thirty patients (median age, 67.5 years; 20 men) were included. Chest pain was the most commonly reported symptom in questionnaires (24/30). Likewise, in 19 of 30 calls, chest pain was the first complaint mentioned, usually described together with the symptom onset. Expressions used to describe symptom quality were pain, pressure, discomfort, ache, cramp, tension, and soreness. Associated symptoms commonly described were pain or numbness in the arms, cold sweat, dyspnea, weakness, and nausea. Bodily sensations, such as feeling unwell or weak, were also described. Fear and tiredness were described in calls significantly less often than reported in questionnaires (P = .01 and P = .02), whereas “other” symptoms were more often mentioned in calls compared with answers given in the questionnaire (P = .02). Some symptoms expressed in the calls were not listed in the questionnaire, which expands the understanding of acute MI symptoms. The results showed no major inconsistencies between datasets.

Conclusion: Patients' MI symptom descriptions in tele-calls and those reported in questionnaires after diagnosis are comparable and convergent.

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
Keywords
Advanced and Specialised Nursing, Cardiology and Cardiovascular Medicine
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-190169 (URN)10.1097/jcn.0000000000000873 (DOI)000942350000015 ()36156094 (PubMedID)2-s2.0-85147783172 (Scopus ID)
Available from: 2021-12-08 Created: 2021-12-08 Last updated: 2023-07-14Bibliographically approved
Ekerstad, N., Javadzadeh, D., Alexander, K. P., Bergström, O., Eurenius, L., Fredrikson, M., . . . Alfredsson, J. (2022). Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 11(2), 89-98
Open this publication in new window or tab >>Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
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2022 (English)In: European Heart Journal: Acute Cardiovascular Care, ISSN 2048-8726, E-ISSN 2048-8734, Vol. 11, no 2, p. 89-98Article in journal (Refereed) Published
Abstract [en]

Aims: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI.

Methods and results: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1–3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5–9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (allP < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30–4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI1.41–3.02).

Conclusion: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
Myocardial infarction, Clinical Frailty Scale, Risk prediction, Mortality
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-191685 (URN)10.1093/ehjacc/zuab114 (DOI)000753112100003 ()34905049 (PubMedID)2-s2.0-85128238129 (Scopus ID)
Available from: 2022-01-21 Created: 2022-01-21 Last updated: 2023-08-28Bibliographically approved
Ericsson, M., Thylén, I., Strömberg, A., Hellström Ängerud, K., Moser, D. K. & Sederholm Lawesson, S. (2022). Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders: an observational cross-sectional survey study. European Journal of Cardiovascular Nursing, 21(7), 694-701
Open this publication in new window or tab >>Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders: an observational cross-sectional survey study
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2022 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 21, no 7, p. 694-701Article in journal (Refereed) Published
Abstract [en]

AIMS: A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response.

METHODS AND RESULTS: A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20-90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86).

CONCLUSION: Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin.

Place, publisher, year, edition, pages
Oxford University Press, 2022
Keywords
Acute coronary syndrome, Care seeking, Decision-making, Pre-hospital delay, Symptom recognition, Symptom response
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-196924 (URN)10.1093/eurjcn/zvab124 (DOI)000764519500001 ()35165735 (PubMedID)2-s2.0-85140144207 (Scopus ID)
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2022-06-20 Created: 2022-06-20 Last updated: 2022-11-07Bibliographically approved
Olsson, K., Hörnsten, Å. & Hellström Ängerud, K. (2022). Treated with preventive anticoagulation therapy in atrial fibrillation: the patients’ perspective. Nursing Open, 9(6), 2657-2664
Open this publication in new window or tab >>Treated with preventive anticoagulation therapy in atrial fibrillation: the patients’ perspective
2022 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 9, no 6, p. 2657-2664Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore patients’ experiences of preventive anticoagulation therapy in atrial fibrillation.

Design: This was a descriptive qualitative study based on interviews.

Methods: Individual interviews with 15 patients, 6 women and 9 men, treated with preventive oral anticoagulant due to atrial fibrillation, were conducted. The interviews were analysed with qualitative content analysis.

Results: Based on the analysis, the theme Managing a necessary evil emerged. The theme comprised the three categories: Coping with anxiety and changes in daily life, Having confidence in care and Being a partner or only a receiver of treatment. Patients described it like being faced with a situation where a treatment perceived as vital was weighed against undesirable consequences and risks. Patients trusted caregivers and had confidence in care, but there was a risk of being a receiver of care instead of becoming a partner.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
atrial fibrillation, oral anticoagulation therapy, patients’ experiences, qualitative
National Category
Nursing Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-186280 (URN)10.1002/nop2.964 (DOI)000661815400001 ()34132062 (PubMedID)2-s2.0-85107920141 (Scopus ID)
Available from: 2021-07-20 Created: 2021-07-20 Last updated: 2022-12-19Bibliographically approved
Norberg, H., Bergdahl, E., Hellström Ängerud, K. & Lindmark, K. (2021). A systematic approach for introduction of novel treatments to a chronic patient group: sacubitril-valsartan as a case study. European Journal of Clinical Pharmacology, 77, 125-131
Open this publication in new window or tab >>A systematic approach for introduction of novel treatments to a chronic patient group: sacubitril-valsartan as a case study
2021 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 77, p. 125-131Article in journal (Refereed) Published
Abstract [en]

Purpose: To develop a model for systematic introduction and to test the feasibility in a chronic disease population. We also investigated how the approach was received by the patients.

Methods and results: The systematic introduction approach is a seven-step procedure: step 1, define a few main criteria; step 2, primary scan patients with the one or two main criteria using computerized medical records/databases/clinical registries; step 3, identify patients applying the other predefined criteria; step 4, evaluate if any examinations/laboratory test updates are required; step 5, summon identified patients to the clinic with an information letter; step 6, discuss treatment with the patient and prescribe if appropriate; and step 7, follow up on initiated therapy and evaluate the applied process. The model was tested in a case study during introduction of the new drug sacubitril-valsartan in a heart failure population. In total, 76 out of 1924 patients were identified to be eligible for sacubitril-valsartan and summoned to the clinic to discuss treatment. Patient experiences with the approach were investigated in an interview study with general inductive approach using qualitative content analysis. This resulted in three final categories: a good approach, role of the information letter, and trust in care.

Conclusions: The systematic introduction approach ensures that strict criteria are used in the selection process and that a treatment can be implemented in eligible patients within a specified population with limited resources and time. The model was effective in our case study and maintained the patient's confidence in healthcare.

Place, publisher, year, edition, pages
Springer, 2021
Keywords
Systematic implementation, Healthcare quality improvement, Chronic disease management, Sacubitril-valsartan
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-174719 (URN)10.1007/s00228-020-02979-w (DOI)000561701200001 ()32820363 (PubMedID)2-s2.0-85089688709 (Scopus ID)
Available from: 2020-09-14 Created: 2020-09-14 Last updated: 2023-03-24Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-7918-6121

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