Umeå University's logo

umu.sePublications
Change search
Link to record
Permanent link

Direct link
Publications (10 of 49) 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
Show others...
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
Hagström, H., Nyström Hagfors, L., Tellström, A., Hedelin, R. & Lindmark, K. (2023). Low carbohydrate high fat-diet in real life assessed by diet history interviews. Nutrition Journal, 22(1), Article ID 14.
Open this publication in new window or tab >>Low carbohydrate high fat-diet in real life assessed by diet history interviews
Show others...
2023 (English)In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 22, no 1, article id 14Article in journal (Refereed) Published
Abstract [en]

Background: Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet.

Methods: A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed.

Results: The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits.

Conclusions: Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Low carbohydrate diet, Low Carbohydrate High Fat, LCHF, Diet history interview, Saturated fatty acids, Cholesterol, Fiber
National Category
Nutrition and Dietetics
Research subject
Nutrition
Identifiers
urn:nbn:se:umu:diva-205602 (URN)10.1186/s12937-023-00847-8 (DOI)000942804500001 ()36864479 (PubMedID)2-s2.0-85149275759 (Scopus ID)
Available from: 2023-03-09 Created: 2023-03-09 Last updated: 2023-09-05Bibliographically approved
Hamilton, E., Desta, L., Lundberg, A., Alfredsson, J., Christersson, C., Erlinge, D., . . . Jernberg, T. (2023). Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction. ESC Heart Failure, 10(2), 1347-1357
Open this publication in new window or tab >>Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction
Show others...
2023 (English)In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 10, no 2, p. 1347-1357Article in journal (Refereed) Published
Abstract [en]

Aims: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population.

Methods and results: In patients with MI included in the Swedish web-system for enhancement and development of evidence-based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF) < 50% and/or pulmonary congestion (subset 1); EF < 40% and/or pulmonary congestion (subset 2); EF < 40% and/or pulmonary congestion and at least one high-risk feature (subset 3, PARADISE-MI like); and EF < 50% and no diabetes mellitus (subset 4, DAPA-MI like). Subsets 1, 2, 3, and 4 constituted 31.6%, 15.0%, 12.8%, and 22.8% of all patients with MI (n = 87 177), respectively. The age and prevalence of different co-morbidities varied between subsets. For median age, 70 to 77, for diabetes mellitus, 22 to 33%; for chronic kidney disease, 22 to 38%, for prior MI, 17 to 21%, for atrial fibrillation, 7 to 14%, and for ST-elevations, 38 to 50%. The cumulative incidence of death or heart failure hospitalization at 3 years was 17.4% (95% CI: 17.1-17.7%) in all MIs; 26.9% (26.3-27.4%) in subset 1; 37.6% (36.7-38.5%) in subset 2; 41.8% (40.7-42.8%) in subset 3; and 22.6% (22.0-23.2%) in subset 4.

Conclusions: Depending on the definition, LV systolic dysfunction or pulmonary congestion is present in 13-32% of all patients with MI and is associated with a two to three times higher risk of subsequent death or HF admission. There is a need to optimize management and improve outcomes for this high-risk population.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
Keywords
Heart failure, Left ventricular dysfunction, Mortality, Myocardial infarction, Prevalence
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-204673 (URN)10.1002/ehf2.14301 (DOI)000924517500001 ()36732932 (PubMedID)2-s2.0-85147179498 (Scopus ID)
Available from: 2023-02-10 Created: 2023-02-10 Last updated: 2023-07-13Bibliographically approved
Katsoularis, I., Jerndal, H., Kalucza, S., Lindmark, K., Fonseca Rodriguez, O. & Fors Connolly, A.-M. (2023). Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study. European Heart Journal Open, 3(6), Article ID oead120.
Open this publication in new window or tab >>Risk of arrhythmias following COVID-19: nationwide self-controlled case series and matched cohort study
Show others...
2023 (English)In: European Heart Journal Open, E-ISSN 2752-4191, Vol. 3, no 6, article id oead120Article in journal (Refereed) Published
Abstract [en]

Aims: COVID-19 increases the risk of cardiovascular disease, especially thrombotic complications. There is less knowledge on the risk of arrhythmias after COVID-19. In this study, we aimed to quantify the risk of arrhythmias following COVID-19.

Methods and Results: This study was based on national register data on all individuals in Sweden who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021. The outcome was incident cardiac arrhythmias, defined as international classification of diseases (10th revision) codes in the registers as follows: atrial arrhythmias; paroxysmal supraventricular tachycardias; bradyarrhythmias; and ventricular arrhythmias. A self-controlled case series study and a matched cohort study, using conditional Poisson regression, were performed to determine the incidence rate ratio and risk ratio, respectively, for an arrhythmia event following COVID-19.A total of 1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias, and bradyarrhythmias was significantly increased up to 60, 180, and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during Days 1–30 following COVID-19/index date was 12.28 (10.79–13.96), 5.26 (3.74–7.42), and 3.36 (2.42–4.68), respectively, for the three outcomes. The risks were generally higher in older individuals, in unvaccinated individuals, and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

1 057 174 exposed (COVID-19) individuals were included in the study as well as 4 074 844 matched unexposed individuals. The incidence rate ratio of atrial tachycardias, paroxysmal supraventricular tachycardias and bradyarrhythmias was significantly increased up to 60, 180 and 14 days after COVID-19, respectively. In the matched cohort study, the risk ratio during day 1-30 following COVID-19/index date was 12.28 (10.79-13.96), 5.26 (3.74-7.42) and 3.36 (2.42-4.68), respectively for the three outcomes. The risks were generally higher in older individuals, unvaccinated individuals and in individuals with more severe COVID-19. The risk of ventricular arrhythmias was not increased.

Conclusion: There is an increased risk of cardiac arrhythmias following COVID-19, and particularly increased in elderly vulnerable individuals, as well as in individuals with severe COVID-19.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
COVID-19, SARS-CoV-2, cardiology, arrhythmia, atrial arrhythmias, paroxysmal supraventricular tachycardias, bradyarrhythmias, ventricular arrhythmias, nationwide study, matched cohort study, self-controlled case series study
National Category
Clinical Medicine
Research subject
Infectious Diseases; Public health; Epidemiology; Cardiology
Identifiers
urn:nbn:se:umu:diva-217231 (URN)10.1093/ehjopen/oead120 (DOI)2-s2.0-85180103321 (Scopus ID)
Projects
Risks of arrhythmias after covid-19: nationwide self-controlled cases series and matched cohort studyCardiovascular complications following covid-19: population-based register studies
Funder
Region Västerbotten, RV-967545Region Västerbotten, RV-967738Region Västerbotten, RV-982300Swedish Research Council, 2021-06536Swedish Heart Lung Foundation, 20220179Swedish Heart Lung Foundation, 202207232The Swedish Heart and Lung Association, FA 2022/6The Kempe Foundations, SMK21-0014Hedlund foundation, M-2022-1753
Note

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Available from: 2023-11-27 Created: 2023-11-27 Last updated: 2023-12-27Bibliographically approved
Katsoularis, I., Fonseca Rodriguez, O., Jerndal, H., Kalucza, S., Lindmark, K. & Fors Connolly, A.-M. (2023). Risk of atrial tachycardias after covid-19: nationwide self-controlled cases series and matched cohort study. Paper presented at ESC Congress 2023, Amsterdam, the Netherlands, August 25–28, 2023. European Heart Journal, 44(Suppl. 2), Article ID ehad655.449.
Open this publication in new window or tab >>Risk of atrial tachycardias after covid-19: nationwide self-controlled cases series and matched cohort study
Show others...
2023 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 44, no Suppl. 2, article id ehad655.449Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: COVID-19 is a multiorgan disease. We previously identified COVID-19 as a risk factor for myocardial infarction, stroke (1), venous thromboembolism and bleeding (2). Less evidence exists on the risk of arrhythmias after COVID-19. Previous studies included mainly hospitalized patients with severe COVID-19, and there are no nationwide studies published.

Purpose: The aim of this study was to estimate the risk of atrial tachycardias (atrial fibrillation and atrial flutter) following COVID-19, including all individuals tested positive for SARS-CoV-2 in Sweden, regardless of disease severity.

Method: COVID-19 has been a notifiable disease in Sweden. All individuals in Sweden who were tested positive for SARS-CoV-2 between February 1, 2020 and May 25, 2021 were included in the study. We identified four control individuals for each COVID-19 individual matched on age, sex, and county of residence. Using Personal Identification Numbers, we cross-linked data from national registries: COVID-19 registry; Inpatient and Outpatient Registry; Cause of Death Registry; Prescribed Pharmaceutical Registry and Intensive Care Registry. Outcomes are cardiovascular events, defined using ICD-10 diagnosis codes for atrial fibrillation and atrial flutter in the registries. We performed a ‘’first-ever event’’ analysis, i.e., we excluded individuals with events before the study period. The self-controlled case series (SCCS) method was used to determine the incidence rate ratio (IRR) of a first atrial tachycardia during the risk periods 1-7, 8-14, 15-30, 31-60, 61-90, and 91-180 days after COVID-19. In the matched cohort study (MCS), Poisson regression was performed to calculate the risk ratio (RR) of a first arrhythmia event in the risk period 1-30 days following COVID-19, after adjusting for the effect of confounders, such as cardiac disease, treatment with antiarrhythmics, comorbidities and vaccination status.

Results: 1 057 174 cases and 4 074 844 controls were included in the study. In the SCCS, the risk of first atrial tachycardia was significantly increased up to 60 days following COVID-19. Specifically, during days 1-7 and 8-14 post-COVID-19 the IRRs were approximately 12 and 10 respectively. Similarly, in the MCS the RR for the first atrial tachycardia during day 1-30 post-COVID-19 was approximately 11. The risks were higher in patients with more severe COVID-19; and during the first pandemic wave compared to the second and third wave.

Conclusions: This study suggests that COVID-19 is a risk factor for atrial tachycardias, based on information obtained on all people who tested positive for SARS-CoV-2 in Sweden, regardless of disease severity. These results could impact recommendations on diagnostic and prophylactic strategies against atrial tachycardias after COVID-19. The importance of preventive strategies, such as risk factor control; vaccination to prevent severe COVID-19; and early review of high-risk individuals after COVID-19, is indicated.

Place, publisher, year, edition, pages
Oxford University Press, 2023
Keywords
COVID-19, SARS-CoV-2, cardiology, arrhythmia, atrial tachycardias, nationwide study, matched cohort study, self-controlled case series study
National Category
Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology Infectious Medicine
Research subject
Epidemiology; Cardiology; Infectious Diseases
Identifiers
urn:nbn:se:umu:diva-216866 (URN)10.1093/eurheartj/ehad655.449 (DOI)
Conference
ESC Congress 2023, Amsterdam, the Netherlands, August 25–28, 2023
Projects
Cardiovascular complications following covid-19: population-based register studies
Available from: 2023-11-21 Created: 2023-11-21 Last updated: 2023-11-21Bibliographically approved
Truedson, P., Ott, M., Lindmark, K., Ström, M., Maripuu, M., Lundqvist, R. & Werneke, U. (2022). Effects of toxic lithium levels on ECG: findings from the LiSIE retrospective cohort study. Journal of Clinical Medicine, 11(19), Article ID 5941.
Open this publication in new window or tab >>Effects of toxic lithium levels on ECG: findings from the LiSIE retrospective cohort study
Show others...
2022 (English)In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 19, article id 5941Article in journal (Refereed) Published
Abstract [en]

(1) Background: Few studies have explored the impact of lithium intoxication on the heart.

(2) Methods: We examined electrocardiogram (ECG) changes associated with lithium intoxication in the framework of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. We analysed ECGs before, during, and after intoxication.

(3) Results: Of the 1136 patients included, 92 patients had experienced 112 episodes of lithium intoxication. For 55 episodes, there was an ECG available at the time; for 48 episodes, there was a reference ECG available before and/or after the lithium intoxication. Lithium intoxication led to a statistically significant decrease in heart rate from a mean 76 beats/min (SD 16.6) before intoxication to 73 beats/min (SD 17.1) during intoxication (p = 0.046). QTc correlated only weakly with lithium concentration (ρ = 0.329, p = 0.014). However, in 24% of lithium intoxication episodes, there were QT prolongations. In 54% of these, QTc exceeded 500 ms; patients with chronic intoxications being more affected.

(4) Conclusions: Based on summary statistics, effects of lithium intoxication on HR and QTc seem mostly discrete and not clinically relevant. However, QT prolongation can carry a risk of becoming severe. Therefore, an ECG should always be taken in patients presenting with lithium intoxication.

Place, publisher, year, edition, pages
MDPI, 2022
Keywords
lithium, drug-related side effects and adverse reactions, toxicity, long QT syndrome, electrocardiography
National Category
Psychiatry Cardiac and Cardiovascular Systems
Research subject
Medicine; Cardiology; Psychiatry
Identifiers
urn:nbn:se:umu:diva-201264 (URN)10.3390/jcm11195941 (DOI)000866822000001 ()36233807 (PubMedID)2-s2.0-85139754027 (Scopus ID)
Funder
Norrbotten County Council, NLL-931604Norrbotten County Council, NLL-941888Norrbotten County Council, NLL-969413
Available from: 2022-11-24 Created: 2022-11-24 Last updated: 2023-05-25Bibliographically approved
Jonsson, A., Wessberg, G., Norberg, H., Söderström, A., Valham, F., Bergdahl, E. & Lindmark, K. (2022). Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population. Open heart, 9(2), Article ID e002022.
Open this publication in new window or tab >>Motives, frequency, predictors and outcomes of MRA discontinuation in a real-world heart failure population
Show others...
2022 (English)In: Open heart, E-ISSN 2053-3624, Vol. 9, no 2, article id e002022Article in journal (Refereed) Published
Abstract [en]

Introduction: Mineralocorticoid receptor antagonists (MRAs) reduce mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF), but are largely underused. We evaluated the frequency, motives, predictors and outcomes of MRA discontinuation in a real-world heart failure population.

Methods and results: This was a single-centre, retrospective cohort study where medical record-based data were collected on patients with HFrEF between 2010 and 2018. In the final analysis, 572 patients were included that comprised the continued MRA group (n=275) and the discontinued MRA group (n=297). Patients that discontinued MRA were older, had a higher comorbidity index and a lower index estimated glomerular filtration rate (eGFR). Predictors of MRA discontinuations were increased S-potassium, lower eGFR, lower systolic blood pressure, higher frequency of comorbidities and a higher left ventricular ejection fraction. The most common reason for MRA discontinuation was renal dysfunction (n=97, 33%) with 59% of these having an eGFR <30 mL/min/1.73m 2, and elevated S-potassium (n=71, 24%) with 32% of these having an S-potassium >5.5 mmol/L. Discontinuation of MRA increased the adjusted risk of all-cause mortality (HR 1.48; 95% CI 1.07 to 2.05; p=0.019).

Conclusions: Half of all patients with HFrEF initiated on MRA discontinued the treatment. A substantial number of patients discontinued MRA without meeting the guideline-recommended levels of eGFR and S-potassium where mild to moderate hyperkalaemia seems to be the most decisive predictor. Further, MRA discontinuation was associated with increased adjusted risk of all-cause mortality.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
drug monitoring, heart failure, pharmacology, clinical
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-199838 (URN)10.1136/openhrt-2022-002022 (DOI)000850226900003 ()2-s2.0-85137936079 (Scopus ID)
Available from: 2022-10-03 Created: 2022-10-03 Last updated: 2023-05-22Bibliographically approved
Katsoularis, I., Fonseca-Rodríguez, O., Farrington, P., Jerndal, H., Häggström Lundevaller, E., Sund, M., . . . Fors Connolly, A.-M. (2022). Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study. The BMJ, 377, Article ID e069590.
Open this publication in new window or tab >>Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study
Show others...
2022 (English)In: The BMJ, E-ISSN 1756-1833, Vol. 377, article id e069590Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To quantify the risk of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19.

DESIGN: Self-controlled case series and matched cohort study.

SETTING: National registries in Sweden.

PARTICIPANTS: 1 057 174 people who tested positive for SARS-CoV-2 between 1 February 2020 and 25 May 2021 in Sweden, matched on age, sex, and county of residence to 4 076 342 control participants.

MAIN OUTCOMES MEASURES: Self-controlled case series and conditional Poisson regression were used to determine the incidence rate ratio and risk ratio with corresponding 95% confidence intervals for a first deep vein thrombosis, pulmonary embolism, or bleeding event. In the self-controlled case series, the incidence rate ratios for first time outcomes after covid-19 were determined using set time intervals and the spline model. The risk ratios for first time and all events were determined during days 1-30 after covid-19 or index date using the matched cohort study, and adjusting for potential confounders (comorbidities, cancer, surgery, long term anticoagulation treatment, previous venous thromboembolism, or previous bleeding event).

RESULTS: Compared with the control period, incidence rate ratios were significantly increased 70 days after covid-19 for deep vein thrombosis, 110 days for pulmonary embolism, and 60 days for bleeding. In particular, incidence rate ratios for a first pulmonary embolism were 36.17 (95% confidence interval 31.55 to 41.47) during the first week after covid-19 and 46.40 (40.61 to 53.02) during the second week. Incidence rate ratios during days 1-30 after covid-19 were 5.90 (5.12 to 6.80) for deep vein thrombosis, 31.59 (27.99 to 35.63) for pulmonary embolism, and 2.48 (2.30 to 2.68) for bleeding. Similarly, the risk ratios during days 1-30 after covid-19 were 4.98 (4.96 to 5.01) for deep vein thrombosis, 33.05 (32.8 to 33.3) for pulmonary embolism, and 1.88 (1.71 to 2.07) for bleeding, after adjusting for the effect of potential confounders. The rate ratios were highest in patients with critical covid-19 and highest during the first pandemic wave in Sweden compared with the second and third waves. In the same period, the absolute risk among patients with covid-19 was 0.039% (401 events) for deep vein thrombosis, 0.17% (1761 events) for pulmonary embolism, and 0.101% (1002 events) for bleeding.

CONCLUSIONS: The findings of this study suggest that covid-19 is a risk factor for deep vein thrombosis, pulmonary embolism, and bleeding. These results could impact recommendations on diagnostic and prophylactic strategies against venous thromboembolism after covid-19.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
National Category
Cardiac and Cardiovascular Systems Surgery
Research subject
Surgery; Surgery
Identifiers
urn:nbn:se:umu:diva-193662 (URN)10.1136/bmj-2021-069590 (DOI)000784456300002 ()35387772 (PubMedID)2-s2.0-85127678172 (Scopus ID)
Available from: 2022-04-11 Created: 2022-04-11 Last updated: 2023-09-05Bibliographically 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
Fonseca-Rodríguez, O., Connolly-Andersen, A.-M., Katsoularis, I., Lindmark, K. & Farrington, P. (2021). Avoiding bias in self-controlled case series studies of coronavirus disease 2019. Statistics in Medicine, 40(27), 6197-6208
Open this publication in new window or tab >>Avoiding bias in self-controlled case series studies of coronavirus disease 2019
Show others...
2021 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 40, no 27, p. 6197-6208Article in journal (Refereed) Published
Abstract [en]

Many studies, including self-controlled case series (SCCS) studies, are being undertaken to quantify the risks of complications following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). One such SCCS study, based on all COVID-19 cases arising in Sweden over an 8-month period, has shown that SARS-CoV-2 infection increases the risks of AMI and ischemic stroke. Some features of SARS-CoV-2 infection and COVID-19, present in this study and likely in others, complicate the analysis and may introduce bias. In the present paper we describe these features, and explore the biases they may generate. Motivated by data-based simulations, we propose methods to reduce or remove these biases.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
bias, cardiovascular disease, COVID-19, epidemiological methods, mortality, self-controlled case series
National Category
Infectious Medicine
Identifiers
urn:nbn:se:umu:diva-187393 (URN)10.1002/sim.9179 (DOI)000691970600001 ()34470078 (PubMedID)2-s2.0-85114030870 (Scopus ID)
Available from: 2021-09-14 Created: 2021-09-14 Last updated: 2023-09-01Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5756-7791

Search in DiVA

Show all publications