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Biomedical subjects

Max Köster

Publications and source records attributed to Max Köster.

5 recordsLinked to original sources

Differences between coronary disease and stroke in incidence, case fatality, and risk factors, but few differences in risk factors for fatal and non-fatal events.

AIMS: To compare incidence and mortality of coronary and stroke events, and risk factors for non-fatal and fatal events, respectively. METHODS AND RESULTS: Incidence and mortality were compared in all coronary (n=559 341) and stroke (n=530 689) events in Sweden from 1987 to 2001. Data from 28 years of follow-up of a random sample of 7400 men aged 47-55 and free of disease at baseline were used to compare risk factors. Incidence and 28 days of case fatality were considerably higher for coronary disease than for stroke, especially for men. Incidence of coronary disease decreased, especially for men (P=0.0001 for both sexes), and mortality declined for both men and women during 1987-2001 (P=0.0001 for both sexes). Stroke incidence declined slightly (P=0.0001 for both sexes), and there was a decline of mortality (P=0.0001 for both sexes). Out-of-hospital mortality during the first 28 days was higher than in-hospital mortality for coronary events, whereas for stroke, in-hospital mortality was higher (in men) or the same (in women) as out-of-hospital mortality. High serum cholesterol was a strong risk factor for coronary events, but not for stroke. High blood pressure was a stronger risk factor for stroke. About 50% of men with both stroke and coronary disease died from coronary disease. CONCLUSION: Several differences regarding incidence, mortality, prognosis, and risk factors for stroke and coronary disease point towards different pathologies.

Age Distribution↗

Decreasing one-year mortality and hospitalization rates for heart failure in Sweden; Data from the Swedish Hospital Discharge Registry 1988 to 2000.

AIMS: To investigate if improved treatment of coronary heart disease and hypertension, the major causes of chronic heart failure (CHF), in the last 20 years has had an impact on the incidence of CHF and survival. METHODS: National Swedish registers on hospital discharges and cause-specific deaths were used to calculate age- and sex-specific trends and sex ratios for heart failure admissions and deaths. The study included all men and women 45 to 84 years old hospitalized for the first time for heart failure in 19 Swedish counties between 1988 and 2000, a mean annual population 2.9 million. A total of 156?919 hospital discharges were included. RESULT: In 1988, a total of 267 men and 205 women per 100?000 inhabitants (age adjusted) were discharged for the first time with a principal diagnosis of heart failure. After 1993 a yearly decrease was observed, with 237 men and 171 women per 100?000 inhabitants discharged during 2000. The 30-day mortality decreased significantly. The decrease in 1-year mortality was more pronounced in the younger age groups, with a total reduction in mortality of 69% among men and 80% among women aged 45-54 years. The annual decrease was 9% among men and 10% among women aged 45-54 years (95% CI -7% to -12% and -6% to -14% respectively) and 4% among men and 5% among women (95% CI -4% to -5% for both) aged 75-84 years. CONCLUSION: The decrease in incidence and improved prognosis after a first hospitalization for heart failure coincides with the establishment of ACE-inhibitor therapy, the introduction of beta-blockers for treatment of heart failure, home-care programmes for heart failure, and more effective treatment and prevention of underlying diseases. Notwithstanding, despite considerable improvement, 1-year mortality after a first hospitalization for heart failure is still high.

Age Distribution↗

Inequality in access to coronary revascularization in Sweden.

OBJECTIVES: To investigate social and gender equality in access to coronary revascularization for those treated for coronary heart disease in Sweden between 1991 and 2000. DESIGN: All Swedish residents between 25 and 74 years old with a hospital stay for coronary heart disease were eligible for the study, in total about 153,000 persons. The Swedish Hospital Discharge Register from 1988 through 2000 was used to define the study population. Poisson regression analyses were used to estimate the effect of socio-economic status on the likelihood for coronary artery bypass grafting (CABG) within 2 years. In the analysis of gender differences, the likelihood for percutaneous coronary intervention (PCI) was also included. RESULTS: Males were 1.5 times more likely to undergo revascularization procedures than females even after adjusting for confounding factors and the fact that women are less eligible for interventions. The analyses also showed significant socio-economic inequalities in access to CABG among men, but not among women. CONCLUSIONS: There are gender and socio-economic inequalities in access to cardiac procedures in Sweden.

Adult↗

[Mortality after myocardial infarction has decreased in nearly all Swedish counties during the 1990's. Greatest improvement seen in those counties with the worst initial results].

In an international perspective, Sweden has a very low case fatality after acute myocardial infarction (AMI). The aim of this study was to present trends and regional differences in case fatality within 28 days of the first AMI for males and females in Sweden after adjusting for co-morbidity. Adjustments in order to remove random effects on the rank order of county councils were made. The study was based on national data on more than 500,000 cases of AMI. Between 1987 and 1999, case fatality after AMI decreased from 47% to 37% among men and from 44% to 34% among women. The case fatality in the individual counties varied from 29% to 37% for men and from 31% to 40% for women. Further analysis is needed in order to explain these variations.

Comorbidity↗