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Publications (10 of 203) Show all publications
Olofsson, M., Lindmark, K., Stålhammar, J., Törnblom, M., Lundberg, A., Wikström, G. & Boman, K. (2023). Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study. ESC Heart Failure, 10(1), 295-302
Open this publication in new window or tab >>Characteristics and management of very elderly patients with heart failure: a retrospective, population cohort study
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2023 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 10, no 1, p. 295-302Article in journal (Refereed) Published
Abstract [en]

Aims: Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18–84 years) with HF in Sweden.

Methods: Incidence of ≥2 HF diagnosis (ICD-10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010–2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality.

Results: Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co-morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)-related management after diagnosis in primary care (13.6% vs. 6.5%; P < 0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P < 0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all-cause admissions per patient: 1.9 vs. 2.3; P < 0.0001; CVD-related admissions per patient: 1.8 vs. 2.1; P = 0.0004) or prescribed an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β-blocker (45.2% vs. 56.9%; P < 0.0001) or an ACEI/ARB plus a β-blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P < 0.0001). One-year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3-32.7%) out of 1797 patients.

Conclusions: Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work-up and subsequent treatment highlight the inequality of care in this vulnerable population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Elderly, Heart failure, Hospitalization, Mortality, Sweden, Treatment
National Category
Cardiac and Cardiovascular Systems Geriatrics
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-200381 (URN)10.1002/ehf2.14191 (DOI)000865058000001 ()36208123 (PubMedID)2-s2.0-85139415660 (Scopus ID)
Available from: 2022-11-08 Created: 2022-11-08 Last updated: 2023-06-20Bibliographically approved
Shah, S. J., Fine, N., Garcia-Pavia, P., Klein, A., Fernandes, F., Weissman, N., . . . Elliott, P. (2023). Effect of Tafamidis on Cardiac Function in Patients With Transthyretin Amyloid Cardiomyopathy. JAMA cardiology
Open this publication in new window or tab >>Effect of Tafamidis on Cardiac Function in Patients With Transthyretin Amyloid Cardiomyopathy
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2023 (English)In: JAMA cardiology, ISSN 2380-6583, E-ISSN 2380-6591Article in journal (Refereed) Epub ahead of print
Abstract [en]

IMPORTANCE: Tafamidis has been shown to improve survival in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) compared with placebo. However, its effect on cardiac function has not been fully characterized.

OBJECTIVE: To examine the effect of tafamidis on cardiac function in patients with ATTR-CM.

DESIGN, SETTING, AND PARTICIPANTS: This was an exploratory, post hoc analysis of the Tafamidis in Transthyretin Cardiomyopathy Clinical Trial (ATTR-ACT), a multicenter, international, double-blind, placebo-controlled phase 3 randomized clinical trial conducted from December 2013 to February 2018. The ATTR-ACT included 48 sites in 13 counties and enrolled patients aged 18 to 90 years with ATTR-CM. Data were analyzed from July 2018 to September 2023.

INTERVENTION: Patients were randomized to tafamidis meglumine, 80 mg or 20 mg, or placebo for 30 months.

MAIN OUTCOMES AND MEASURES: Patients were categorized based on left ventricular (LV) ejection fraction at enrollment as having heart failure with preserved ejection fraction (≥50%), mildly reduced ejection fraction (41% to 49%), or reduced ejection fraction (≤40%). Changes from baseline to month 30 in LV ejection fraction, LV stroke volume, LV global longitudinal strain, and the ratio of early mitral inflow velocity to septal and lateral early diastolic mitral annular velocity (E/e′) were compared in patients receiving tafamidis, 80 mg, vs placebo.

RESULTS: A total of 441 patients were randomized in ATTR-ACT, and 436 patients had available echocardiographic data. Of 436 included patients, 393 (90.1%) were male, and the mean (SD) age was 74 (7) years. A total of 220 (50.5%), 119 (27.3%), and 97 (22.2%) had heart failure with preserved, mildly reduced, and reduced LV ejection fraction, respectively. Over 30 months, there was less pronounced worsening in 4 of the echocardiographic measures in patients receiving tafamidis, 80 mg (n = 176), vs placebo (n = 177) (least squares mean difference: LV stroke volume, 7.02 mL; 95% CI, 2.55-11.49; P = .002; LV global longitudinal strain, −1.02%; 95% CI, −1.73 to −0.31; P = .005; septal E/e′, −3.11; 95% CI, −5.50 to −0.72; P = .01; lateral E/e′, −2.35; 95% CI, −4.01 to −0.69; P = .006).

CONCLUSIONS AND RELEVANCE: Compared with placebo, tafamidis, 80 mg, attenuated the decline of LV systolic and diastolic function over 30 months in patients with ATTR-CM. Approximately half of patients had mildly reduced or reduced LV ejection fraction at enrollment, suggesting that ATTR-CM should be considered as a possible diagnosis in patients with heart failure regardless of underlying LV ejection fraction.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-218638 (URN)10.1001/jamacardio.2023.4147 (DOI)001106404200003 ()37966817 (PubMedID)2-s2.0-85179711552 (Scopus ID)
Funder
Pfizer AB
Available from: 2023-12-27 Created: 2023-12-27 Last updated: 2023-12-27Bibliographically approved
Hedman, M., Boman, K., Brännström, M. & Wennberg, P. (2021). Clinical profile of rural community hospital inpatients in Sweden: a register study. Scandinavian Journal of Primary Health Care, 39(1), 92-100
Open this publication in new window or tab >>Clinical profile of rural community hospital inpatients in Sweden: a register study
2021 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 1, p. 92-100Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals.

DESIGN: Retrospective register study.

SETTING: Community and general hospitals in Västerbotten and Norrbotten counties, Sweden.

PATIENTS: Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014.

OUTCOME MEASURES: Age, sex, number of admissions, main, secondary and total number of diagnoses.

RESULTS: We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001).

CONCLUSIONS: Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2021
Keywords
Rural health service, geriatrics, health services for the aged, health services research, hospital, inpatient, rural
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-180124 (URN)10.1080/02813432.2021.1882086 (DOI)000617184000001 ()33569976 (PubMedID)2-s2.0-85100975798 (Scopus ID)
Available from: 2021-02-15 Created: 2021-02-15 Last updated: 2024-02-05Bibliographically approved
Fryxell, J., Olofsson, M., Brännström, M. & Boman, K. (2021). Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study. World Journal of Cardiovascular Diseases, 11(1), 1-10
Open this publication in new window or tab >>Effect of Integrated, Person-Centred Palliative Advanced Home and Heart Failure Care on NT-proBNP Levels: A Substudy of the PREFER Study
2021 (English)In: World Journal of Cardiovascular Diseases, ISSN 2164-5329, Vol. 11, no 1, p. 1-10Article in journal (Refereed) Published
Abstract [en]

Objective: In 2012, we initiated a new person-centred model, integrated Palliative advanced home caRE and heart FailurE caRe (PREFER), to integrate specialised palliative home care with heart failure care. Natriuretic peptide-guided treatment is valuable for younger patients (age < 75 years), but its usefulness in palliative care is uncertain. We explored whether patients in PREFER reduced mean level of N-terminal pro B-type natriuretic peptide (NT-proBNP) more than the control group.

Design: A pre-specified, exploratory substudy, analysed within the prospective, randomised PREFER study, which had an open, non-blinded design.

Participants: Patients in palliative care with chronic heart failure, New York Heart Association class III-IV were randomly assigned to an intervention (n = 36; 26 males, 10 females, mean age: 81.9 years) or control group (n = 36; 25 males, 11 females, mean age:76.5 years). The intervention group received the PREFER intervention for 6 months. The control group received care as usual at a primary health care centre or heart failure clinic at the hospital. NT-proBNP was measured at the start and end of study.

Results: Plasma levels of NT-proBNP differed significantly between groups at baseline. By the end of the study, no significant difference was found between the groups. The mean value for NT-proBNP decreased by 35% in the PREFER group but was not statistically significant (P = 0.074); NT-proBNP increased 4% in the control group.

Conclusions: We found no statistically significant reductions of NT-proBNP levels neither between nor within the PREFER and the control group at the end of the study.

Place, publisher, year, edition, pages
Scientific Research Publishing, 2021
Keywords
Chronic Heart Failure, Palliative Care, Integrated Care, NT-proBNP, Elderly
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-178795 (URN)10.4236/wjcd.2021.111001 (DOI)
Available from: 2021-01-18 Created: 2021-01-18 Last updated: 2022-05-04Bibliographically approved
Rapezzi, C., Elliott, P., Damy, T., Nativi-Nicolau, J., Berk, J. L., Velazquez, E. J., . . . Maurer, M. S. (2021). Efficacy of Tafamidis in Patients With Hereditary and Wild-Type Transthyretin Amyloid Cardiomyopathy: Further Analyses From ATTR-ACT. JACC. Heart failure, 9(2), 115-123
Open this publication in new window or tab >>Efficacy of Tafamidis in Patients With Hereditary and Wild-Type Transthyretin Amyloid Cardiomyopathy: Further Analyses From ATTR-ACT
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2021 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 9, no 2, p. 115-123Article in journal (Refereed) Published
Abstract [en]

Objectives: Tafamidis is an effective treatment for transthyretin amyloid cardiomyopathy (ATTR-CM), this study aimed to determine whether there is a differential effect between variant transthyretin amyloidosis (ATTRv) and wild-type transthyretin (ATTRwt).

Background: ATTR-CM is a progressive, fatal disorder resulting from mutations in the ATTRv or the deposition of denatured ATTRwt.

Methods: In pre-specified analyses from ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial), baseline characteristics, all-cause mortality, and change from baseline to month 30 in 6-min walk test distance and Kansas City Cardiomyopathy Questionnaire Overall Summary score were compared in patients with ATTRwt and ATTRv.

Results: There were 335 patients with ATTRwt (201 tafamidis, 134 placebo) and 106 with ATTRv (63 tafamidis, 43 placebo) enrolled in ATTR-ACT. Patients with ATTRwt (vs. ATTRv) had less advanced disease at baseline and a lower rate of disease progression over the study. The reduction in all-cause mortality with tafamidis compared with placebo was not different between ATTRwt (hazard ratio: 0.706 [95% confidence interval (CI): 0.474 to 1.052]; p = 0.0875) and ATTRv (hazard ratio: 0.690 [95% CI: 0.408 to 1.167]; p = 0.1667). Tafamidis was associated with a similar reduction (vs. placebo) in the decline in 6-min walk test distance in ATTRwt (mean ± SE difference from placebo, 77.14 ± 10.78; p < 0.0001) and ATTRv (79.61 ± 29.83 m; p = 0.008); and Kansas City Cardiomyopathy Questionnaire Overall Summary score in ATTRwt (12.72 ± 2.10; p < 0.0001) and ATTRv (18.18 ± 7.75; p = 0.019).

Conclusions: Pre-specified analyses from ATTR-ACT confirm the poor prognosis of untreated ATTRv-related cardiomyopathy compared with ATTRwt, but show the reduction in mortality and functional decline with tafamidis treatment is similar in both disease subtypes. (Safety and Efficacy of Tafamidis in Patients With Transthyretin Cardiomyopathy [ATTR-ACT]; NCT01994889)

Place, publisher, year, edition, pages
Elsevier, 2021
Keywords
clinical trial, hereditary, tafamidis, transthyretin amyloid cardiomyopathy, wild-type
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-186297 (URN)10.1016/j.jchf.2020.09.011 (DOI)000632562500005 ()33309574 (PubMedID)2-s2.0-85098121530 (Scopus ID)
Funder
Pfizer ABNIH (National Institute of Health), AG K24AG036778, AG R21AG058348, HL HL139671-01
Available from: 2021-07-21 Created: 2021-07-21 Last updated: 2022-10-31Bibliographically approved
Boman, K., Lindmark, K., Stålhammar, J., Olofsson, M., Costa-Scharplatz, M., Fonseca, A. F., . . . Wikström, G. (2021). Healthcare resource utilisation and costs associated with a heart failure diagnosis: A retrospective, population-based cohort study in Sweden. BMJ Open, 11(10), Article ID e053806.
Open this publication in new window or tab >>Healthcare resource utilisation and costs associated with a heart failure diagnosis: A retrospective, population-based cohort study in Sweden
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 10, article id e053806Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine healthcare resource use (HRU) and costs among heart failure (HF) patients using population data from Sweden.

Design: Retrospective, non-interventional cohort study.

Setting: Two cohorts were identified from linked national health registers (cohort 1, 2005-2014) and electronic medical records (cohort 2, 2010-2012; primary/secondary care patients from Uppsala and Västerbotten).

Participants: Patients (aged ≥18 years) with primary or secondary diagnoses of HF (≥2 International Classification of Diseases and Related Health Problems, 10th revision classification) during the identification period of January 2005 to March 2015 were included.

Outcome measures: HRU across the HF phenotypes was assessed with logistic regression. Costs were estimated based on diagnosis-related group codes and general price lists.

Results: Total annual costs of secondary care of prevalent HF increased from SEK 6.23 (€0.60) to 8.86 (€0.85) billion between 2005 and 2014. Of 4648 incident patients, HF phenotype was known for 1715: reduced ejection fraction (HFrEF): 64.5%, preserved ejection fraction (HFpEF): 35.5%. Within 1 year of HF diagnosis, the proportion of patients hospitalised was only marginally higher for HFrEF versus HFpEF (all-cause (95% CI): 64.7% (60.8 to 68.4) vs 63.7% (60.8 to 66.5), HR 0.91, p=0.14; cardiovascular disease related (95% CI): 61.1% (57.1 to 64.8) vs 60.9% (58.0 to 63.7), HR 0.93, p=0.28). Frequency of hospitalisations and outpatient visits per patient declined after the first year. All-cause secondary care costs in the first year were SEK 122 758 (€12 890)/patient/year, with HF-specific care accounting for 69% of the costs. Overall, 10% of the most expensive population (younger; predominantly male; more likely to have comorbidities) incurred ~40% of total secondary care costs.

Conclusions: HF-associated costs and HRU are high, especially during the first year of diagnosis. This is driven by high hospitalisations rates. Understanding the profile of resource-intensive patients being at younger age, male sex and high Charlson comorbidity index scores at the time of the HF diagnosis is most likely a sign of more severe disease.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021
Keywords
adult cardiology, health economics, heart failure
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:umu:diva-189120 (URN)10.1136/bmjopen-2021-053806 (DOI)000709905900031 ()34667015 (PubMedID)2-s2.0-85117883228 (Scopus ID)
Available from: 2021-11-15 Created: 2021-11-15 Last updated: 2023-08-28Bibliographically approved
Lindmark, K., Boman, K., Stålhammar, J., Olofsson, M., Lahoz, R., Studer, R., . . . Wikström, G. (2021). Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study. ESC Heart Failure, 8(3), 2144-2153
Open this publication in new window or tab >>Recurrent heart failure hospitalizations increase the risk of cardiovascular and all-cause mortality in patients with heart failure in Sweden: a real-world study
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2021 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 8, no 3, p. 2144-2153Article in journal (Refereed) Published
Abstract [en]

Aims: Heart failure (HF) is a leading cause of hospitalization and is associated with high morbidity and mortality. We examined the impact of recurrent HF hospitalizations (HFHs) on cardiovascular (CV) mortality among patients with HF in Sweden.

Methods and results: Adults with incident HF were identified from linked national health registers and electronic medical records from 01 January 2005 to 31 December 2013 for Uppsala and until 31 December 2014 for Västerbotten. CV mortality and all-cause mortality were evaluated. A time-dependent Cox regression model was used to estimate relative CV mortality rates for recurrent HFHs. Assessment was also done for ejection fraction-based HF phenotypes and for comorbid atrial fibrillation, diabetes, or chronic renal impairment. Overall, 3878 patients with HF having an index hospitalization were included, providing 9691.9 patient-years of follow-up. Patients were relatively old (median age: 80 years) and were more frequently male (55.5%). Compared with patients without recurrent HFHs, the adjusted hazard ratio (HR [95% confidence interval; CI]) for CV mortality and all-cause mortality were statistically significant for patients with one, two, three, and four or more recurrent HFHs. The risk of CV mortality and all-cause mortality increased approximately six-fold in patients with four or more recurrent HFHs vs. those without any HFHs (HR [95% CI]: 6.26 [5.24–7.48] and 5.59 [4.70–6.64], respectively). Similar patterns were observed across the HF phenotypes and patients with comorbidities.

Conclusions: There is a strong association between recurrent HFHs and CV and all-cause mortality, with the risk increasing progressively with each recurrent HFH.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
Comorbidities, Heart failure, HF phenotypes, Hospitalization, Mortality
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-183509 (URN)10.1002/ehf2.13296 (DOI)000626715600001 ()2-s2.0-85105738197 (Scopus ID)
Available from: 2021-05-26 Created: 2021-05-26 Last updated: 2023-09-05Bibliographically approved
Eriksson, M. A., Söderberg, S., Nilsson, T. K., Eriksson, M., Boman, K. & Jansson, J.-H. (2020). Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men. Scandinavian Journal of Clinical and Laboratory Investigation, 80(4), 303-308
Open this publication in new window or tab >>Leptin levels are not affected by enalapril treatment after an uncomplicated myocardial infarction, but associate strongly with changes in fibrinolytic variables in men
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2020 (English)In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 80, no 4, p. 303-308Article in journal (Refereed) Published
Abstract [en]

Leptin, an adipocyte-derived hormone, is involved in the regulation of body weight and is associated with obesity-related complications, notably cardiovascular disease (CVD). A putative link between obesity and CVD could be induction of plasminogen activator inhibitor-1 (PAI-1) synthesis by leptin. In this study, we hypothesized that the beneficial effect of the angiotensin-converting enzyme inhibitor (ACE(i)) enalapril on PAI-1 levels is mediated by effects on leptin levels. The association between leptin and components of the fibrinolytic system was evaluated in a non-prespecified post hoc analysis of a placebo-controlled randomized, double-blind trial where the effect of the ACE(i) enalapril on fibrinolysis was tested. A total of 46 men and 37 women were randomized to treatment with enalapril or placebo after (median 12 months) an uncomplicated myocardial infarction. At baseline, the participants were stable and had no signs of congestive heart failure. Leptin and fibrinolytic variables (mass concentrations of PAI-1, tissue plasminogen activator (tPA) and tPA-PAI complex) were measured at baseline, and after 10 days, 6 months and 12 months. Enalapril treatment did not change leptin levels, which increased significantly during 1 year of follow-up (p = .007). Changes in leptin levels were strongly associated with changes of tPA mass (p = .001), tPA-PAI complex (p = .003) and of PAI-1 (p = .006) in men, but not in women. Leptin levels are not influenced by treatment with an ACE(i). In contrast, leptin associates strongly with changes in fibrinolytic variables notably with a sex difference, which could be of importance for obesity-related CVD.

Place, publisher, year, edition, pages
Taylor & Francis, 2020
Keywords
Leptin, ACE inhibitor, cardiovascular disease, PAI-1, fibrinolysis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-169047 (URN)10.1080/00365513.2020.1731848 (DOI)000518324100001 ()32125188 (PubMedID)2-s2.0-85080911409 (Scopus ID)
Available from: 2020-03-19 Created: 2020-03-19 Last updated: 2021-11-15Bibliographically approved
Talabani, N., Hellström Ängerud, K., Boman, K. & Brännström, M. (2020). Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study. BMJ Supportive & Palliative Care, 10(1), Article ID e9.
Open this publication in new window or tab >>Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study
2020 (English)In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368, Vol. 10, no 1, article id e9Article in journal (Refereed) Published
Abstract [en]

Objectives Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home.

Method Interviews were conducted with 12 patients with severe HF (New York Heart Association class III–IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis.

Results Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities.

Conclusions Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-138705 (URN)10.1136/bmjspcare-2016-001226 (DOI)000539493000009 ()28689185 (PubMedID)2-s2.0-85073260823 (Scopus ID)
Available from: 2017-08-28 Created: 2017-08-28 Last updated: 2023-03-24Bibliographically approved
Lindmark, K., Boman, K., Olofsson, M., Törnblom, M., Levine, A., Castelo-Branco, A., . . . Wikström, G. (2019). Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden. Clinical Epidemiology, 11, 231-244
Open this publication in new window or tab >>Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden
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2019 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, p. 231-244Article in journal (Refereed) Published
Abstract [en]

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

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

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

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

Place, publisher, year, edition, pages
Dove medical press, 2019
Keywords
diagnosis, heart failure, incidence rate, mortality, prevalence, real-world
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-158769 (URN)10.2147/CLEP.S170873 (DOI)000464038900001 ()30962724 (PubMedID)2-s2.0-85067565606 (Scopus ID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-0350-2132

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