umu.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Nilsson, Johan
Alternative names
Publications (10 of 23) Show all publications
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2019). Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation. European Journal of Cardiovascular Nursing, 18(7), 593-600
Open this publication in new window or tab >>Hope and despair: patients' experiences of being ineligible for transcatheter aortic valve implantation
2019 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 18, no 7, p. 593-600Article in journal (Refereed) Published
Abstract [en]

Background: Transcatheter aortic valve implantation may be indicated for patients with aortic stenosis and high risk of postoperative mortality. The assessment of suitability for transcatheter aortic valve implantation requires consensus agreement of a team of cardiologists and cardiac surgeons. The burden of comorbidities, frailty and cognitive impairment are factors included when risks for transcatheter aortic valve implantation are balanced against the expected benefits. Although transcatheter aortic valve implantation is a possibility for many, there are still ineligible patients. Knowledge of their experiences of being deemed ineligible are lacking. Aim: The aim of this study was to explore patients' experiences of being considered for transcatheter aortic valve implantation but judged ineligible. Methods: Individual in-depth interviews were performed with eight persons, and qualitative content analysis was used for the analysis. Results: Being ineligible for transcatheter aortic valve implantation may induce both hope and despair. Hope was linked to experiences of acceptance, relief of symptoms, support and control; despair was associated with feelings of being missed and abandoned, and of grief and insecurity. Some expressed great anxiety, since their incurable heart disease meant an imminent death. Others were more concerned over practical problems that affected everyday life. Conclusion: Being ineligible for transcatheter aortic valve implantation does not necessarily lead to despair. Hope is built through relationships, continuity and support. A combination of person-centred care and palliative care during the end-of-life phase should be offered to patients in order to help clients re-conceptualise hope during this stage of their illness. Cardiovascular nurses in the transcatheter aortic valve implantation team are suitable to facilitate continued care based on the patient's needs, desires and local conditions.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Aortic stenosis, transcatheter aortic valve implantation, incurable, hope, person-centred care
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-164036 (URN)10.1177/1474515119852209 (DOI)000487801400010 ()31113221 (PubMedID)
Available from: 2019-10-16 Created: 2019-10-16 Last updated: 2019-10-16Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2018). Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study. Nursing Open, 5(2), 149-157
Open this publication in new window or tab >>Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study
2018 (English)In: Nursing Open, E-ISSN 2054-1058, Vol. 5, no 2, p. 149-157Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design: A qualitative approach where in-depth interviews were used. Method: Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results: The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
aortic stenosis, coping, hope, qualitative study, recovery, supportive nursing, transcatheter aortic valve implantation
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-148639 (URN)10.1002/nop2.124 (DOI)000428455600006 ()29599990 (PubMedID)
Available from: 2018-06-25 Created: 2018-06-25 Last updated: 2018-06-25Bibliographically approved
Varenhorst, C., Lindholm, M., Sarno, G., Olivecrona, G., Jensens, U., Nilsson, J., . . . Lagergvist, B. (2018). Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents. Clinical Research in Cardiology, 107(9), 816-823
Open this publication in new window or tab >>Stent thrombosis rates the first year and beyond with new- and old-generation drug-eluting stents compared to bare metal stents
Show others...
2018 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 107, no 9, p. 816-823Article in journal (Refereed) Published
Abstract [en]

Objectives: Old-generation drug-eluting coronary stents (o-DES) have despite being safe and effective been associated with an increased propensity of late stent thrombosis (ST). We evaluated ST rates in o-DES, new-generation DES (n-DES) and bare metal stents (BMS) the first year (< 1 year) and beyond 1 year (> 1 year).

Methods: We evaluated all implantations with BMS, o-DES (Cordis Cypher, Boston Scientific Taxus Libert, and Medtronic Endeavor) and n-DES in the Swedish coronary angiography and angioplasty registry (SCAAR) between 1 January 2007 and 8 January 2014 (n = 207 291). All cases of ST (n = 2 268) until 31 December 2014 were analyzed.

Results: The overall risk of ST was lower in both n-DES and o-DES compared with BMS up to 1 year (n-DES versus BMS: adjusted risk ratio (RR) 0.48 (0.41-0.58) and o-DES versus BMS: 0.56 (0.46-0.67), both p < 0.001). From 1 year after stent implantation and onward, the risk for ST was higher in o-DES compared with BMS [adjusted RR, 1.82 (1.47-2.25], p < 0.001). N-DES were associated with similar low ST rates as BMS from 1 year and onward [adjusted RR 1.21 (0.94-1.56), p = 0.135].

Conclusion: New-generation DES were associated with lower ST rates in comparison to BMS during the first-year post-stenting. After 1 year, n-DES and BMS were associated with similar ST rates.

Trial Registration: This study was a retrospective observational study and as such did not require clinical trial database registration.

Place, publisher, year, edition, pages
Springer Berlin/Heidelberg, 2018
Keywords
Bare metal stents, Drug-eluting stents, Stent thrombosis, Percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-151544 (URN)10.1007/s00392-018-1252-0 (DOI)000442201300010 ()29667015 (PubMedID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2018-09-11Bibliographically approved
Fröbert, O., Götberg, M., Angerås, O., Jonasson, L., Erlinge, D., Engstrøm, T., . . . Pernow, J. (2017). Design and rationale for the Influenza vaccination After Myocardial Infarction (IAMI) trial: a registry-based randomized clinical trial. American Heart Journal, 189, 94-102
Open this publication in new window or tab >>Design and rationale for the Influenza vaccination After Myocardial Infarction (IAMI) trial: a registry-based randomized clinical trial
Show others...
2017 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 189, p. 94-102Article in journal (Refereed) Published
Abstract [en]

Background Registry studies and case-control studies have demonstrated that the risk of acute myocardial infarction (AMI) is increased following influenza infection. Small randomized trials, underpowered for clinical end points, indicate that future cardiovascular events can be reduced following influenza vaccination in patients with established cardiovascular disease. Influenza vaccination is recommended by international guidelines for patients with cardiovascular disease, but uptake is varying and vaccination is rarely prioritized during hospitalization for AMI. Methods/design The Influenza vaccination After Myocardial Infarction (IAMI) trial is a double-blind, multicenter, prospective, registry-based, randomized, placebo-controlled, clinical trial. A total of 4,400 patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI undergoing coronary angiography will randomly be assigned either to in-hospital influenza vaccination or to placebo. Baseline information is collected from national heart disease registries, and follow-up will be performed using both registries and a structured telephone interview. The primary end point is a composite of time to all cause death, a new AMI, or stent thrombosis at 1 year. Implications The IAMI trial is the largest randomized trial to date to evaluate the effect of in-hospital influenza vaccination on death and cardiovascular outcomes in patients with STEMI or non-STEMI. The trial is expected to provide highly relevant clinical data on the efficacy of influenza vaccine as secondary prevention after AMI.

Place, publisher, year, edition, pages
Elsevier, 2017
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-137793 (URN)10.1016/j.ahj.2017.04.003 (DOI)000404205000011 ()28625387 (PubMedID)
Available from: 2017-07-27 Created: 2017-07-27 Last updated: 2018-06-09Bibliographically approved
Olsson, K., Nilsson, J., Hörnsten, Å. & Näslund, U. (2017). Patients’ self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement. European Journal of Cardiovascular Nursing, 16(3), 213-221
Open this publication in new window or tab >>Patients’ self-reported function, symptoms and health-related quality of life before and 6 months after transcatheter aortic valve implantation and surgical aortic valve replacement
2017 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 3, p. 213-221Article in journal (Refereed) Published
Abstract [en]

Background: Aortic stenosis is the most common valve disease in western countries and has poor prognosis without treatment. Surgical aortic valve replacement (SAVR) is the gold standard, and transcatheter aortic valve implantation (TAVI) is a new method that is used in high-risk patients who are denied surgery. The purpose of treatment is not only to save life, but also to reduce symptoms and increase health-related quality of life (HRQoL).

Objective: The aim of this study was to describe patients’ self-reported outcomes in terms of physical function, symptoms, dependence, HRQoL, and cognitive function after TAVI and SAVR.

Methods: All patients treated with TAVI during 1 year (n = 24) and age-matched patients treated with SAVR (n = 24) were included. Data were collected on the day before and at 6 months after treatment using structural questionnaires.

Results: Self-rated function was low before treatment and increased at follow-up. A quarter of all patients reported syncope at baseline, and none reported this at follow-up. Breathlessness was reported by all patients to be the most limiting cardiac symptom, but the TAVI patients reported more severe symptoms. At 6 months’ follow-up, symptoms were reduced, but breathlessness and fatigue were still common, especially in the TAVI group. HRQoL, which was very low in the TAVI group at baseline, increased in all dimensions except social function.

Conclusion: We found no change in cognitive function or dependence at follow-up. There was no difference in the size of improvement between groups. The results could be helpful when informing future patients in order to give them realistic expectations.

Keywords
Aortic valve stenosis, transcatheter aortic valve implantation, surgical aortic valve replacement, self-rated outcome
National Category
Nursing
Research subject
Medicine, cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-127870 (URN)10.1177/1474515116650342 (DOI)000398178900005 ()27169460 (PubMedID)2-s2.0-85012079897 (Scopus ID)
Available from: 2016-11-21 Created: 2016-11-20 Last updated: 2018-06-09Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2016). Experiences of and Coping With Severe Aortic Stenosis Among Patients Waiting for Transcatheter Aortic Valve Implantation. Journal of Cardiovascular Nursing, 31(3), 255-261
Open this publication in new window or tab >>Experiences of and Coping With Severe Aortic Stenosis Among Patients Waiting for Transcatheter Aortic Valve Implantation
2016 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 3, p. 255-261Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Aortic stenosis (AS) is the most common valve disease in Western countries. Transcatheter aortic valve implantation (TAVI) has made it possible to treat patients with higher surgical risks. These patients are informed about their poor prognosis with only months or a few years to live without treatment. Because of their severe symptoms, limitations, and suffering, patients awaiting TAVI need special attention.

OBJECTIVE: The aim of this study is to describe patients' experiences of coping with severe AS and of waiting for TAVI.

METHODS: Swedish participants (n = 24; 9 women, 15 men) with a mean (SD) age of 80 (7.4) years who had been offered TAVI all agreed to participate in a presurgical interview. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis.

RESULTS: The participants' experiences of coping with AS and awaiting TAVI were described by the main theme "living on the edge, but trying to stay in control," which comprised 3 categories: "trying to cope with physical symptoms and anxiety," "trying to preserve self and self-esteem despite life-threatening illness," and "trying to process the decision to undergo TAVI."

CONCLUSIONS: Patients with AS and awaiting TAVI must cope with increasing symptoms and limitations in their social lives but still wish to be seen as the people they always have been. These patients may need extra support from healthcare personnel to process their experiences, which could help them to attach personal meaning to clinical information about the condition and its treatment that they could include in their decision about whether to undergo TAVI. Listening to patients' stories could help nurses and physicians to ensure that disease and treatment are meaningfully understood by the patient.

Keywords
aortic stenosis, coping, experiences, symptoms, transcatheter aortic valve implantation
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-120742 (URN)10.1097/JCN.0000000000000231 (DOI)000375047600011 ()25658189 (PubMedID)
Available from: 2016-05-20 Created: 2016-05-19 Last updated: 2019-04-26Bibliographically approved
Olsson, K., Näslund, U., Nilsson, J. & Hörnsten, Å. (2016). Patients' Decision Making About Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis. Journal of Cardiovascular Nursing, 31(6), 523-528
Open this publication in new window or tab >>Patients' Decision Making About Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis
2016 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 6, p. 523-528Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Aortic stenosis is the most common valve disease in Western countries, and its prevalence is increasing because of the aging population. Some patients, denied surgery because of high risk, can be offered transcatheter aortic valve implantation (TAVI). These patients are old and have comorbidities, and it is not always easy for them to make the decision about accepting TAVI.

OBJECTIVE: The aim of this study was to describe the decision-making process about undergoing TAVI treatment among people with severe aortic stenosis who are denied surgery.

METHODS: The Swedish participants (n = 24) with a mean age of 80 years who had been offered TAVI all agreed to participate in a presurgical interview. The interviews were recorded, transcribed verbatim, and analyzed using qualitative content analysis.

RESULTS: Three patterns in the decision-making process about TAVI treatment-ambivalent, obedient, and reconciled-were identified. The ambivalent patient is unsure of the value of treatment and aware of the risks; the obedient patient is unsure of the value of one's own decision and wants to leave the decision to others; the reconciled patient has reached a point where there is no choice anymore and is always sure that the decision to undergo TAVI is right.

CONCLUSIONS: People with aortic stenosis who are offered TAVI need to discuss the risks and benefits in order to participate in decision making about the treatment. They have different patterns in decision making and would benefit from healthcare professionals being observant of them to support them in this process in a manner consistent with their values.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2016
Keywords
aortic stenosis, decision making, transcatheter aortic valve implantation
National Category
Cardiac and Cardiovascular Systems Nursing
Identifiers
urn:nbn:se:umu:diva-120771 (URN)10.1097/JCN.0000000000000282 (DOI)000386979500019 ()26110543 (PubMedID)
Available from: 2016-05-20 Created: 2016-05-20 Last updated: 2019-04-26Bibliographically approved
Sarno, G., Lagerqvist, B., Nilsson, J., Frobert, O., Hambraeus, K., Varenhorst, C., . . . James, S. K. (2014). Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI. Journal of the American College of Cardiology, 64(1), 16-24
Open this publication in new window or tab >>Stent thrombosis in new-generation drug-eluting stents in patients with STEMI undergoing primary PCI
Show others...
2014 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 64, no 1, p. 16-24Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Some concerns still have not been resolved about the long-term safety of drug-eluting stents (DES) in patients with acute STEMI. OBJECTIVES The aim of this study was to evaluate the stent thrombosis (ST) rate up to 3 years in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) with new-generation drug-eluting stents (n-DES) compared with bare-metal stents (BMS) and old-generation drug-eluting stents (o-DES) enrolled in the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). METHODS From January 2007 to January 2013, 34,147 patients with STEMI were treated by PCI with n-DES (n = 4,811), o-DES (n = 4,271), or BMS (n = 25,065). The risks of early/late (up to 1 year) and very late definite ST (after 1 year) were estimated. RESULTS Cox regression landmark analysis showed a significantly lower risk of early/late ST in patients treated with n-DES (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.43 to 0.99; p 0.04) and o-DES (HR: 0.60; 95% CI: 0.41 to 0.89; p = 0.01) compared with the BMS group. The risk of very late ST was similar between the n-DES and BMS groups (HR: 1.52; 95% CI: 0.78 to 2.98; p = 0.21), whereas a higher risk of very late ST was observed with o-DES compared with BMS (HR: 2.88; 95% CI: 1.70 to 4.89; p < 0.01). CONCLUSIONS Patients treated with n-DES have a lower risk of early/late ST than patients treated with BMS. The risk of very late ST is low and comparable between n-DES and BMS up to 3 years of follow-up, whereas o-DES treatment is associated with an increased risk of very late ST. The current STEMI guidelines might require an update in light of the results of this and other recent studies.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
drug-eluting stent(s), percutaneous coronary intervention, ST-segment elevation myocardial infarction
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-91841 (URN)10.1016/j.jacc.2014.04.022 (DOI)000339337700003 ()
Available from: 2014-08-27 Created: 2014-08-18 Last updated: 2018-06-07Bibliographically approved
Hambraeus, K., Held, C., Johansson, P., Svennberg, L., Cider, A., James, S., . . . Jernberg, T. (2014). SWEDEHEART Annual Report 2012. Scandinavian Cardiovascular Journal, 48(S63), 1-129
Open this publication in new window or tab >>SWEDEHEART Annual Report 2012
Show others...
2014 (English)In: Scandinavian Cardiovascular Journal, ISSN 1401-7431, E-ISSN 1651-2006, Vol. 48, no S63, p. 1-129Article in journal (Refereed) Published
Abstract [en]

The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART) supports continuous monitoring and improvement of care for coronary artery disease, catheter-based and surgical coronary interventions, secondary prevention as well as catheter based and surgical valve intervention, by providing extensive data on base-line, diagnostic, procedural and outcome variables. Design. This national quality registry collects information from all Swedish hospitals treating patients with acute coronary artery disease and all patients undergoing coronary angiography, catheter-based interventions or heart surgery. Combination with other national mandatory official registries enables complete follow-up of all individuals regarding myocardial infarction, new interventional procedures, death and all-cause hospitalizations. The registry is governed by an independent steering committee and funded by the Swedish National Health care provider. The software is developed by Uppsala Clinical Research Center. Results. The SWEDEHEART Quality Index reflects overall quality of care for coronary artery disease including secondary prevention. In comparison with 2011, an improvement of the index occurred in 2012 overall. There was however, still a wide range in performance between individual centers, emphasizing the need for continuous monitoring of quality of care at a national as well as on a center level.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-93233 (URN)10.3109/14017431.2014.931551 (DOI)000340428500001 ()
Available from: 2014-12-22 Created: 2014-09-15 Last updated: 2018-06-07Bibliographically approved
Sarno, G., Lagerqvist, B., Carlsson, J., Olivecrona, G., Nilsson, J., Calais, F., . . . James, S. (2013). Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). International Journal of Cardiology, 167(1), 146-150
Open this publication in new window or tab >>Initial clinical experience with an everolimus eluting platinum chromium stent (Promus Element) in unselected patients from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)
Show others...
2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, no 1, p. 146-150Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The safety and efficacy of the Promus Element stent have been recently demonstrated in a selected population from one randomized trial. The aim of this study was to describe the initial clinical experience with the everolimus eluting platinum chromium stent (Promus Element) in unselected patients from a real life nationwide registry. METHODS: The Promus Element DES was compared to all other DES implanted in Sweden (with more than 500 implants) from November 2009 to March 2011. The results were assessed using Cox regression. RESULTS: A total of 13,577 stents (Promus Element, n=2724, Cypher, n=782; Endeavor, n=747; Taxus Liberté, n=1393, Xience V/Promus, n=4832, Resolute, n=1566, Xience Prime, n=4832) were implanted at 8375 procedures. At one year the restenosis rate in the Promus Element was not significantly different from the overall DES group (2.8% vs. 2.7%, adjusted HR:1.17, 95% CI: 0.75-1.75). A significantly lower restenosis rate was observed in the Promus Element when compared with Endeavor (2.8% vs. 5.8%; adjusted HR: 0.44; 95% CI: 0.26-0.74). The stent thrombosis (ST) rate at one year was not significantly different in the Promus Element as compared with the overall DES group (0.2% vs. 0.5% adjusted HR: 0.59; 95% CI: 025-1.40). ST rate was significantly lower as compared with Endeavor stent (0.2% vs. 0.8%; HR: 0.24; 95% CI: 0.08-0.67). CONCLUSIONS: In a large unselected population the Promus Element stent appears to be safe and effective with a low risk of restenosis and ST.

Keywords
Drug-eluting stents, Stent thrombosis, Restenosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-65097 (URN)10.1016/j.ijcard.2011.12.057 (DOI)000320603100032 ()22244480 (PubMedID)
Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2018-06-08Bibliographically approved
Organisations

Search in DiVA

Show all publications