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Mooe, Thomas
Publications (10 of 49) Show all publications
Nilsson, G., Soderstrom, L., Alverlind, K., Samuelsson, E. & Mooe, T. (2019). Hand-held cardiac ultrasound examinations performed in primary care patients by nonexperts to identify reduced ejection fraction. BMC Medical Education, 19, Article ID 282.
Open this publication in new window or tab >>Hand-held cardiac ultrasound examinations performed in primary care patients by nonexperts to identify reduced ejection fraction
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2019 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, article id 282Article in journal (Refereed) Published
Abstract [en]

BackgroundEarly identification of patients with reduced left ventricular ejection fraction (LVEF) could facilitate the care of patients with suspected heart failure (HF). We examined if (1) focused cardiac ultrasound (FCU) performed with a hand-held device (Vscan 1.2) could identify patients with LVEF <50%, and (2) the distribution of HF types among patients with suspected HF seen at primary care clinics.MethodsFCU performed by general practitioners (GPs)/GP registrars after a training programme comprising 20 supervised FCU examinations were compared with the corresponding results from conventional cardiac ultrasound by specialists. The agreement between groups of estimated LVEF <50%, after visual assessment of global left ventricular function, was compared. Types of HF were determined according to the outcomes from the reference examinations and serum levels of natriuretic peptides (NT-proBNP).ResultsOne hundred patients were examined by FCU that was performed by 1-4 independent examiners as well as by the reference method, contributing to 140 examinations (false positive rate, 19.0%; false negative rate, 52.6%; sensitivity, 47.4% [95% confidence interval [CI]: 27.3-68.3]; specificity, 81.0% [95% CI: 73.1-87.0]; Cohen's kappa measure for agreement=0.22 [95% CI: 0.03-0.40]). Among patients with false negative examinations, 1/7 had HF with LVEF <40%, while the others had HF with LVEF 40-49% or did not meet the full criteria for HF. In patients with NT-proBNP >125ng/L and fulfilling the criteria for HF (68/94), HF with preserved LVEF (>= 50%) predominated, followed by mid-range (40-49%) or reduced LVEF (<40%) HF types (53.2, 11.7 and 7.4%, respectively).ConclusionsThere was poor agreement between expert examiners using standard ultrasound equipment and non-experts using a handheld ultrasound device to identify patients with reduced LVEF. Asides from possible shortcomings of the training programme, the poor performance of non-experts could be explained by their limited experience in identifying left ventricular dysfunction because of the low percentage of patients with HF and reduced ejection fraction seen in the primary care setting.Trial registrationThe study was registered at ClinicalTrials.gov (NCT02939157). Registered 19 October 2016.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Echocardiography, Heart failure, Primary care, Clinical trial
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-161987 (URN)10.1186/s12909-019-1713-9 (DOI)000477596100003 ()31345207 (PubMedID)
Available from: 2019-08-14 Created: 2019-08-14 Last updated: 2019-08-14Bibliographically approved
Henriksson, R., Ulvenstam, A., Soderstrom, L. & Mooe, T. (2019). Increase in ticagrelor use over time is associated with lower rates of ischemic stroke following myocardial infarction. BMC Cardiovascular Disorders, 19(1), 1-11, Article ID 51.
Open this publication in new window or tab >>Increase in ticagrelor use over time is associated with lower rates of ischemic stroke following myocardial infarction
2019 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 19, no 1, p. 1-11, article id 51Article in journal (Refereed) Published
Abstract [en]

ObjectivesTo evaluate the impact of a rapid change in preferred treatment from clopidogrel to ticagrelor on the risk of ischemic stroke following acute myocardial infarction (AMI).MethodsData for AMI patients treated with either clopidogrel or ticagrelor were obtained from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions (RIKS-HIA). Patients were divided into two cohorts, each covering a two-year time period; the initial prescription of ticagrelor (20 Dec 2011) was used as a cut-off point. Patients in the early cohort (n=23,447) were treated with clopidogrel, while those in the later cohort (n=24,227), were treated with either clopidogrel (47.9%) or ticagrelor (52.1%). Kaplan-Meier analyses were used to assess the risk of ischemic stroke over time, with multivariable Cox regression analyses used to identify predictors of ischemic stroke.ResultsOf 47,674 patients, there were 1203 cases of ischemic stroke. Cumulative Kaplan-Meier incidence estimates of ischemic stroke after one year were 2.8% vs. 2.4% for the early and late cohorts, respectively (p=0.001). Older age, hypertension, diabetes, previous stroke, congestive heart failure, atrial fibrillation, and ST-elevation myocardial infarction were associated with an increased risk of ischemic stroke. Percutaneous coronary intervention and statins at discharge were associated with a decreased risk of ischemic stroke, as was higher estimated glomerular filtration rate. Membership of the late cohort correlated with a 13% reduction in the relative risk of ischemic stroke.ConclusionsThe introduction of ticagrelor as well as an improved management of AMI was associated with a lower rate of ischemic stroke in a relatively unselected AMI population.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Ischemic stroke, Secondary prevention, Acute myocardial infarction, Antiplatelet therapy
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-157516 (URN)10.1186/s12872-019-1030-6 (DOI)000460510400002 ()30832574 (PubMedID)
Available from: 2019-04-05 Created: 2019-04-05 Last updated: 2019-04-05Bibliographically approved
Irewall, A.-L., Ögren, J., Bergström, L., Laurell, K., Söderström, L. & Mooe, T. (2019). Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study. Trials, 20, Article ID 52.
Open this publication in new window or tab >>Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a randomized controlled trial sub-study
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2019 (Swedish)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 20, article id 52Article in journal (Refereed) Published
Abstract [en]

Background: The objective of this study was to analyze the impact of two forms of secondary preventive followup on the association between education level and levels of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) after stroke/transient ischemic attack (TIA).

Methods: We included a population-based cohort of 771 stroke and TIA patients randomly assigned (1:1) to secondary preventive follow-up within primary health care (control) or nurse-led, telephone-based follow-up (intervention) between January 1, 2010, and December 31, 2013, as part of the NAILED (nurse-based ageindependent intervention to limit evolution of disease) stroke risk factor trial. We compared BP and LDL-C levels 12 months after hospital discharge in relation to education level (low, ≤10 years; high, >10 years) separately for the intervention and control groups.

Results: Among controls, systolic BP (SBP) decreased only among the highly educated (−2.5 mm Hg, 95% confidence interval (CI) −0.2 to −4.8), whereas LDL-C increased in the low-education group (0.2 mmol/L, 95% CI 0.1 to 0.3). At 12 months, controls with low education not more than 70 years of age had higher SBP than controls of the same age with high education (5.8 mm Hg, 95% CI 1.0 to 10.6). In contrast, SBP in the intervention group decreased similarly regardless of education level, LDL-C decreased among those with low education (−0.3 mmol/L, 95% CI −0.2 to −0.4) and, in the subgroup not more than 70 years old, low-educated participants had lower LDL-C at 12 months than those with high education (0.3 mmol/L, 95% CI 0.1 to 0.5).

Conclusions: Nurse-led, telephone-based secondary preventive follow-up led to comparable improvements in BP across education groups, while routine follow-up disfavored those with low education.

Trial registration: ISRCTN Registry ISRCTN23868518, June 19, 2012 - Retrospectively registered

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Secondary prevention, Stroke, Transient ischemic attack, Socioeconomic position
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-130496 (URN)10.1186/s13063-018-3131-4 (DOI)000455819200001 ()30646948 (PubMedID)
Note

Originally included in thesis in manuscript form with title: Nurse-led, telephone-based secondary preventive follow-up benefits stroke/TIA patients with low education: a prospective cohort study

Available from: 2017-01-20 Created: 2017-01-20 Last updated: 2019-09-04Bibliographically approved
Huber, D., Wikén, C., Henriksson, R., Söderström, L. & Mooe, T. (2019). Statin treatment after acute coronary syndrome: Adherence and reasons for non-adherence in a randomized controlled intervention trial. Scientific Reports, 9, Article ID 12079.
Open this publication in new window or tab >>Statin treatment after acute coronary syndrome: Adherence and reasons for non-adherence in a randomized controlled intervention trial
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 12079Article in journal (Refereed) Published
Abstract [en]

Studies of secondary prevention for cardiovascular disease show low fulfilment of guidelinere-commended targets. This study explored whether nurse-led follow-up could increase adherence to statins over time and reasons for discontinuation. All patients admitted for acute coronary syndrome at Ostersund hospital between 2010-2014 were screened for the randomized controlled NAILED-ACS trial. The trial comprises two groups, one with nurse-led annual follow-up and medical titration by telephone to reach set intervention targets and one with usual care. All discontinuations of statins were recorded prospectively for at least 36 months and categorized as avoidable or unavoidable. Kaplan-Meier estimates were conducted for first and permanent discontinuations. Predictors for discontinuation were analysed using multivariate Cox regression, statin type and mean LDL-C at end of follow-up. Female gender was a predictor for discontinuation. Allocation in the intervention group predicted increased risk for a first but decreased risk for permanent discontinuation. A nurse-led telemedical secondary prevention programme in a relatively unselected ACS cohort leads to increased adherence to statins over time, greater percentage on potent treatment and lower LDL-C compared to usual care. An initially increased tendency toward early discontinuation in the intervention group stresses the importance of a longer duration of structured follow-up.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-163065 (URN)10.1038/s41598-019-48540-3 (DOI)000481590200120 ()31427637 (PubMedID)
Available from: 2019-10-17 Created: 2019-10-17 Last updated: 2019-10-17Bibliographically approved
Henriksson, R., Björklund, F. & Mooe, T. (2019). The introduction of ticagrelor is associated with lower rates of recurrent ischemic stroke after myocardial infarction. PLoS ONE, 14(5), Article ID e0216404.
Open this publication in new window or tab >>The introduction of ticagrelor is associated with lower rates of recurrent ischemic stroke after myocardial infarction
2019 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 5, article id e0216404Article in journal (Refereed) Published
Abstract [en]

Background: Previous ischemic stroke is a predictor of recurrent ischemic stroke after an acute myocardial infarction (AMI). Dual antiplatelet therapy, including a P2Y12-inhibitor, is important in secondary prevention after AMI. Ticagrelor, a P2Y12-inhibitor, is more potent than the commonly used clopidogrel. Here, we evaluated the impact of ticagrelor on the risk of ischemic stroke following AMI in patients with previous ischemic stroke.

Methods: Data for patients with AMI that had a previous ischemic stroke were obtained from the Swedish Registry of Information and Knowledge about Swedish Heart Intensive Care Admissions. Patients were assigned to early and late cohorts, each covering a two-year time period before and after, respectively, the introduction of ticagrelor prescriptions (20 Dec 2011). Patients in the early cohort (n = 1633) were treated with clopidogrel (100%); those in the late cohort (n = 1642) were treated with either clopidogrel (66.3%) or ticagrelor (33.7%). We assessed the risk of ischemic stroke and intracranial bleeding over time with Kaplan-Meier analyses. We identified predictors of ischemic stroke with multivariable Cox regression analyses.

Results: Of 3275 patients, 311 experienced ischemic stroke after AMI. Cumulative Kaplan-Meier incidence estimates of ischemic stroke within one year after AMI were 12.1% versus 8.6% for the early and late cohorts, respectively (p<0.01). Intracranial bleeding incidences (1.2% versus 1.5%) were similar between the two cohorts.

Conclusions: Ticagrelor introduction was associated with a lower rate of ischemic stroke, with no increase in intracranial bleeding, in an AMI population with a history of ischemic stroke.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-159382 (URN)10.1371/journal.pone.0216404 (DOI)000466886300045 ()31059535 (PubMedID)
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-06-12Bibliographically approved
Graipe, A., Söderström, L. & Mooe, T. (2018). Increased Use of Ticagrelor After Myocardial Infarction Is Not Associated With Intracranial Hemorrhage: Results From a Nationwide Swedish Registry. Stroke, 49(12), 2877-2882
Open this publication in new window or tab >>Increased Use of Ticagrelor After Myocardial Infarction Is Not Associated With Intracranial Hemorrhage: Results From a Nationwide Swedish Registry
2018 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 49, no 12, p. 2877-2882Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: Guidelines recommend dual antiplatelet treatment with ticagrelor instead of clopidogrel after acute myocardial infarction. Ticagrelor increases major and minor noncoronary artery bypass graft bleeding compared with clopidogrel, but whether the risk of intracranial hemorrhage (ICH) increases is unknown. We aimed to examine any association between ticagrelor and ICH and to identify predictors of ICH among unselected patients after acute myocardial infarction.

Methods: Patients with acute myocardial infarction were identified using the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions, and the data were combined with the Swedish National Patient Registry to identify ICH occurrence. To avoid obvious selection bias related to the choice of dual antiplatelet treatment, we divided the study cohorts into 2 time periods of similar length using the first prescription of ticagrelor as a cutoff point (December 20, 2011). The risk of ICH during the first period (100% clopidogrel treatment) versus the second period (52.1% ticagrelor and 47.8% clopidogrel treatment) was assessed using Kaplan-Meier analysis. Cox proportional-hazards regression analyses, with assessment of interactions between all significant variables, were used to identify predictors of ICH.

Results: The analysis included 47 674 patients with acute myocardial infarction. The cumulative incidence of ICH during the first period was 0.59% (91 cases [95% CI, 0.49-0.69]) versus 0.52% (97 cases [95% CI, 0.43-0.61]) during the second period (P=0.83). In multivariable Cox analysis, study period (second versus first period) was not predictive of ICH. Interaction analyses showed that age and prior cardiovascular morbidities were of importance in predicting the risk of ICH.

Conclusions: The increased use of ticagrelor was not associated with ICH, whereas age and prior cardiovascular morbidities were related to the risk of ICH and interacted significantly.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
acute coronary syndrome, intracranial hemorrhages, myocardial infarction, purinergic P2Y receptor tagonists, risk factors
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
urn:nbn:se:umu:diva-156336 (URN)10.1161/STROKEAHA.118.022970 (DOI)000456427700025 ()30571411 (PubMedID)
Available from: 2019-02-13 Created: 2019-02-13 Last updated: 2019-05-17Bibliographically approved
Ulvenstam, A., Henriksson, R., Söderström, L. & Mooe, T. (2018). Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention. European Journal of Preventive Cardiology, 25(11), 1219-1230
Open this publication in new window or tab >>Ischemic stroke rates decrease with increased ticagrelor use after acute myocardial infarction in patients treated with percutaneous coronary intervention
2018 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 25, no 11, p. 1219-1230Article in journal (Refereed) Published
Abstract [en]

Aims: It is unknown whether dual antiplatelet therapy with ticagrelor instead of clopidogrel reduces the risk of ischaemic stroke in acute myocardial infarction patients that undergo percutaneous coronary intervention. This study investigated whether the introduction of dual antiplatelet therapy with ticagrelor was associated with reduced ischaemic stroke risk in a real-world population.

Methods and results: Patients with ischaemic stroke after acute myocardial infarction from 8 December 2009-31 December 2013 were identified using the Register for Information and Knowledge on Swedish Heart Intensive Care Admissions and the Swedish National Patient Register. The study period was divided into two similar periods using the date of the first prescription of ticagrelor as the cut-off. The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients during the first period (100% clopidogrel treatment) versus the second period (60.7% ticagrelor treatment) was assessed using Kaplan-Meier analysis. Variables associated with ischaemic stroke were identified using a multivariable Cox proportional hazards model. There were 686 ischaemic stroke events (2.0%) among 34931 percutaneous coronary intervention-treated acute myocardial infarction patients within one year, 366 (2.2%) during the first period and 320 (1.8%) during the second period (p=0.004). The Cox model showed a 21% relative risk reduction in ischaemic stroke in the second period versus the first one (hazard ratio 0.79, 95% confidence interval, 0.68-0.92; p=0.003). The independent predictors of increased stroke risk were older age, hypertension, diabetes mellitus, atrial fibrillation, heart failure during hospitalization, previous ischaemic stroke, and ST-segment elevation myocardial infarction.

Conclusion: The risk of ischaemic stroke in percutaneous coronary intervention-treated acute myocardial infarction patients decreased after the introduction of ticagrelor in Sweden.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
dual antiplatelet therapy, ischemic stroke, percutaneous coronary intervention, acute myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-150373 (URN)10.1177/2047487318784082 (DOI)000439593500019 ()29929389 (PubMedID)2-s2.0-85049029726 (Scopus ID)
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2019-05-21Bibliographically approved
Ögren, J., Irewall, A.-L., Söderström, L. & Mooe, T. (2018). Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial. BMC Neurology, 18, Article ID 153.
Open this publication in new window or tab >>Long-term, telephone-based follow-up after stroke and TIA improves risk factors: 36-month results from the randomized controlled NAILED stroke risk factor trial
2018 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 18, article id 153Article in journal (Refereed) Published
Abstract [en]

Background: Strategies are needed to improve adherence to the blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) level recommendations after stroke and transient ischemic attack (TIA). We investigated whether nurse-led, telephone-based follow-up that included medication titration was more efficient than usual care in improving BP and LDL-C levels 36 months after discharge following stroke or TIA.

Methods: All patients admitted for stroke or TIA at Ostersund hospital that could participate in the telephone-based follow-up were considered eligible. Participants were randomized to either nurse-led, telephone-based follow-up (intervention) or usual care (control). BP and LDL-C were measured one month after discharge and yearly thereafter. Intervention group patients who did not meet the target values received additional follow-up, including lifestyle counselling and medication titration, to reach their treatment goals (BP < 140/90 mmHg, LDL-C < 2.5 mmol/L). The primary outcome was the systolic BP level 36 months after discharge.

Results: Out of 871 randomized patients, 660 completed the 36-month follow-up. The mean systolic and diastolic BP values in the intervention group were 128.1 mmHg (95% CI 125.8-1305) and 75.3 mmHg (95% CI 73.8-76.9), respectively. This was 6.1 mmHg (95% CI 3.6-8.6, p < 0.001) and 3.4 mmHg (95% CI 1.8-5.1, p < 0.001) lower than in the control group. The mean LDL-C level was 22 mmol/L in the intervention group, which was 03 mmol/L (95% CI 0.2-0.5, p < 0.001) lower than in controls. A larger proportion of the intervention group reached the treatment goal for BP (systolic: 79.4% vs. 55.3%, p < 0.001; diastolic 90.3% vs. 77.9%, p < 0.001) as well as for LDL-C (69.3% vs. 48.9%, p < 0.001).

Conclusions: Compared with usual care, a nurse-led telephone-based intervention that included medication titration after stroke or TIA improved BP and LDL-C levels and increased the proportion of patients that reached the treatment target 36 months after discharge.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Stroke, TIA, Secondary prevention, Modifiable risk factors, Blood pressure, Cholesterol, Randomized ntrolled study, Telemedicine, Nurses
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
urn:nbn:se:umu:diva-152399 (URN)10.1186/s12883-018-1158-5 (DOI)000445259000001 ()30241499 (PubMedID)
Funder
Swedish Heart Lung Foundation, 20140541
Available from: 2018-10-05 Created: 2018-10-05 Last updated: 2019-05-20Bibliographically approved
Ögren, J., Irewall, A.-L., Söderström, L. & Mooe, T. (2018). Serious hemorrhages after ischemic stroke or TIA - Incidence, mortality, and predictors. PLoS ONE, 13(4), Article ID e0195324.
Open this publication in new window or tab >>Serious hemorrhages after ischemic stroke or TIA - Incidence, mortality, and predictors
2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 4, article id e0195324Article in journal (Refereed) Published
Abstract [en]

Background: Data are lacking on the risk and impact of a serious hemorrhage on the prognosis after ischemic stroke (IS) or transient ischemic attack (TIA). We aimed to estimate the incidence of serious hemorrhage, analyze the impact on mortality, and identify predictors of hemorrhage after discharge from IS or TIA.

Methods and findings: All patients admitted to Östersund Hospital for an IS or TIA in 2010–2013 were included (n = 1528, mean age: 75.1 years). Serious hemorrhages were identified until 31st December 2015. Incidence rates were calculated. The impact on mortality (stratified by functional level) was determined with Kaplan-Meier analysis. Non-parametric estimation under the assumption of competing risk was performed to assess the cumulative incidence and predictors of serious hemorrhages. The incidence rates of serious (n = 113) and intracranial hemorrhages (n = 45) after discharge from IS and TIA were 2.48% and 0.96% per year at risk, respectively. Patients with modified Rankin Scale (mRS) scores of 3–5 exhibited 58.9% mortality during follow-up and those with mRS scores of 0–2 exhibited 18.4% mortality. A serious hemorrhage did not affect mortality in patients with impaired functional status, but it increased the risk of death in patients with mRS scores of 0–2. Hypertension was associated with increased risk of serious hemorrhage.

Conclusions: We found that, after discharge from an IS or TIA, serious hemorrhages were fairly common. Impairments in function were associated with high mortality, but serious hemorrhages only increased the risk of mortality in patients with no or slight disability. Improved hypertension treatment may decrease the risk of serious hemorrhage, but in patients with low functional status, poor survival makes secondary prevention challenging.

Place, publisher, year, edition, pages
Public library science, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-147304 (URN)10.1371/journal.pone.0195324 (DOI)000429206800061 ()29621285 (PubMedID)
Available from: 2018-05-28 Created: 2018-05-28 Last updated: 2019-05-20Bibliographically approved
Huber, D., Wiken, C., Henriksson, R. & Mooe, T. (2018). Statin treatment after acute coronary syndrome: long-term persistence and reasons for non-persistence. Paper presented at European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY. European Heart Journal, 39, 1102-1103
Open this publication in new window or tab >>Statin treatment after acute coronary syndrome: long-term persistence and reasons for non-persistence
2018 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 39, p. 1102-1103Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Secondary prevention after acute coronary syndrome (ACS) is crucial to prevent recurrent events. Multiple studies however show that patients often end treatments and for reasons unknown. Our aims in this study were to perform a prospective follow-up of persistence to statin treatment in a population based patient cohort after ACS, to explore the reasons for discontinuation, and to determine whether a nurse-based follow-up could improve persistence.

Methods: We studied patients recruited between 2010–2014 in the ongoing randomised controlled NAILED-ACS trial. All patients admitted with ACS at our County Hospital were eligible and exclusion criteria limited to inability to adhere to the study concept or participation in another trial. We randomised participants either to an intervention group with nurse-based telephone follow-up or to a control group with follow-up by a general practitioner (usual care). All participants were interviewed and screened yearly for blood pressure and blood lipids. The intervention group also got yearly counselling on healthy living and individualised titration of medicines to reach target values for blood pressure and blood lipids. We forwarded the measurements for the control group to the general practitioner for assessment. We collected information on adherence to statin treatment at the yearly interview and by review of medical records. Each reason for treatment discontinuation were recorded and classified as temporary or permanent.

Results: Out of 963 patients, 89.3% (n=434) in the intervention and 82.0% (n=391) in the control group were persistent to statin treatment after a median of 3.9 years of follow-up (p=0.001). The most prevalent reason for permanent discontinuation in the intervention group was advanced disease (27.5%, n=14) while in the control group it was side effects without a compelling relation to treatment (32.8%, n=22). A total of 27.8% (n=135) of the patients in the intervention group and 20.5% (n=98) in the control group discontinued treatment at some point during the period (p=0.009). The most common reasons for a first discontinuation were in both arms side effects without a compelling relation to treatment and lack of treatment motivation.

Conclusion: A nurse-based, long-term follow-up by telephone after an ACS with individualised medical adjustments results in a higher persistence to statin treatment than usual care.

Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-157618 (URN)10.1093/eurheartj/ehy566.P5378 (DOI)000459824003469 ()
Conference
European-Society-of-Cardiology Congress, AUG 25-29, 2018, Munich, GERMANY
Note

Supplement: 1

Meeting Abstract: P5378

Available from: 2019-03-26 Created: 2019-03-26 Last updated: 2019-03-26Bibliographically approved
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