Biomedical subjects

U Dahlström

Publications and source records attributed to U Dahlström.

At least 19 recordsLinked to original sources

PubMed2005

The risk of cardiovascular death in elderly patients with possible heart failure. Results from a 6-year follow-up of a Swedish primary care population.

UNLABELLED: Little is known about the prognosis and clinical variables influencing the prognosis among elderly patients in primary health care with mild to moderate heart failure. AIM: To evaluate the risk of cardiovascular mortality in elderly patients with symptoms of heart failure with respect to systolic and diastolic function, and functional impairment. To evaluate prognostic determinants and to risk-stratify the patients. METHODS: A cardiologist examined 510 patients, out of 548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema and assessed New York Heart Association (NYHA) functional class. Examination by Doppler echocardiography was done in 454 patients, 56 patients being excluded because of, e.g., atrial fibrillation. Abnormal systolic function was defined as ejection fraction<40%. The diastolic function was evaluated using the mitral inflow and pulmonary venous flow variables. Different clinical and echocardiographic variables were analysed using a Cox regression analysis to identify those most influencing the risk of cardiovascular mortality. CONCLUSION: Abnormal systolic and/or diastolic function was found in 219 patients (48% of the 454 patients who could be echocardiographically completely investigated). The follow-up period was 6 years. Total mortality was 20%, and cardiovascular mortality was 14% (70% of total mortality). Cardiovascular mortality was high in patients with severely impaired functional capacity and ejection fraction<40% at the start of the study. Risk variables identified were male gender, diabetes mellitus, impaired functional capacity and abnormal cardiac function by echocardiography. A prognostic score model using simple clinical variables (gender, NYHA class, cardiac function) was developed to assess the risk of cardiovascular death in order to identify patients with high, moderate or low risk. In a ROC curve analysis, the AUC for clinical variables was only 0.75, whereas the AUC for clinical variables and echocardiography was 0.78, indicating that the additional prognostic information obtained by Doppler echocardiography was rather small.

Aged↗

PubMed2005

Risk of cardiovascular death in elderly patients with possible heart failure. B-type natriuretic peptide (BNP) and the aminoterminal fragment of ProBNP (N-terminal proBNP) as prognostic indicators in a 6-year follow-up of a primary care population.

UNLABELLED: Heart failure is common in the elderly population and carries a serious prognosis. We evaluated EDTA-plasma B-type natriuretic peptide (brain natriuretic peptide, BNP) and the aminoterminal fragment of proBNP (N-terminal proBNP) as prognostic markers in elderly primary care patients with symptoms of heart failure. METHODS: From 474 patients attending primary care for symptoms of dyspnea, fatigue and/or peripheral edema, blood was sampled in plastic tubes containing EDTA to measure BNP by non-extraction immunoradiometric assay and N-terminal proBNP by non-extraction radioimmunoassay. Patients were evaluated with respect to history and function by NYHA classification and Doppler echocardiography. Follow-up time was 6 years. Cox regression analysis was performed to identify the weight of risk variables. CONCLUSION: Total 6-year mortality was 20% (102 patients out of 510), and cardiovascular (CV) mortality was 14% (71 patients, 70% of total mortality). BNP and N-terminal proBNP were essentially equally useful as prognostic markers. In patients with the highest quartiles of plasma concentration of BNP and N-terminal proBNP, respectively, the risk of cardiovascular mortality was 10 and 4.8 times, respectively, higher than that in those in the lowest quartile. Peptide concentrations varied widely within all functional groups including those with normal echocardiographic findings. Plasma concentrations of BNP and N-terminal proBNP give important prognostic information concerning risk of cardiovascular mortality. Cost-effective "clinical pathways" should be outlined for patients with elevated peptide concentrations.

Aged↗

PubMed2005

Patients with heart failure in primary health care: effects of a nurse-led intervention on health-related quality of life and depression.

AIMS: To determine the effects of a nurse-led intervention designed to improve self-management of patients with heart failure in a primary health care setting regarding health-related quality of life and depression. METHODS: Patients at eight primary health care centres were screened by the Diagnosis Related Groups registry for the diagnosis of heart failure and eligibility for a cluster randomised study. A total of 153 patients were included (n=78 in the intervention group, 54% males, mean age 79 years, 59% in New York Heart Association class III-IV). The intervention involved patient and family education about heart failure and self-management and monthly telephone follow-up during 12 months by a primary health care nurse. RESULTS: The effects of the nurse-led intervention were limited. Significant differences were found in the physical dimension measured by the SF-36 health survey, and in depression measured by the Zung Self-rating Depression Scale. In comparison within groups at the 3 and 12-month follow-up, the intervention group significantly maintained their health-related quality of life measured by the SF-36 health survey, and their experience of depression measured by the Zung Self-rating Depression Scale to a greater extent than in the control group, especially among women. CONCLUSION: A nurse-led intervention directed toward patients with heart failure in a primary health care setting resulted in limited effects between the groups, although the physical and mental status were retained during 12 months of follow-up to a greater extent than in the control group.

Aged↗

PubMed2005

Detection of the third heart sound using a tailored wavelet approach: method verification.

Heart sounds can be considered as mechanical fingerprints of myocardial function. The third heart sound normally occurs in children but disappears with maturation. The sound can also appear in patients with heart failure. The sound is characterised by its low-amplitude and low-frequency content, which makes it difficult to identify by the traditional use of the stethoscope. A wavelet-based method has recently been developed for detection of the third heart sound. This study investigated if the third heart sound could be identified in patients with heart failure using this detection method. The method was also compared with auscultation using conventional phonocardiography and with characterisation of the patients with echocardiography. In the first study, 87% of the third heart sounds were detected using the wavelet method, 12% were missed, and 6% were false positive. In study 2, the wavelet-detection method identified 87% of the patients using the third heart sound, and regular phonocardiography identified two (25%) of the subjects.

Adult↗

PubMed2004

Can natriuretic peptides be used for the diagnosis of diastolic heart failure?

Many patients with heart failure have stiff hearts with an increased wall thickness and small volumes leading to diastolic dysfunction. Different definitions for diastolic heart failure have been proposed but today there is no generally accepted definition and there are few large controlled studies telling us how it should be managed. Natriuretic peptides (BNP or NT-proBNP) might be used to detect patients with diastolic dysfunction especially in those patients having a restrictive filling pattern or pseudo-normalised mitral flow pattern and in those, who are symptomatic. However, patients with relaxation abnormalities and mild symptoms or asymptomatic may have normal levels of the natriuretic peptides indicating no or only slight elevation of the left ventricular filling pressures. Thus low levels cannot be used as a rule out diagnosis of diastolic dysfunction.

Aged↗

PubMed2004

Effect of carvedilol on diastolic function in patients with diastolic heart failure and preserved systolic function. Results of the Swedish Doppler-echocardiographic study (SWEDIC).

AIM: The purpose of this study was to investigate the effects of carvedilol on diastolic function (DF) in heart failure patients with preserved left ventricular (LV) systolic function and abnormal DF. PATIENTS AND METHODS: We randomised 113 patients with diastolic heart failure (DHF) (symptomatic, with normal systolic LV function and abnormal DF) into a double blind multi-centre study. The patients received either carvedilol or matching placebo in addition to conventional treatment. After uptitration, treatment was continued for 6 months. Two-dimensional and Doppler echocardiography were used for quantification of LV function at baseline and at follow-up. Four different DF variables were evaluated by Doppler echocardiography: mitral flow E:A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and the ratio of systolic/diastolic pulmonary venous flow velocity (pv-S/D). Primary endpoint was change in the integrated quantitative assessment of all four variables during the study. RESULTS: Ninety-seven patients completed the study. A mitral flow pattern reflecting a relaxation abnormality was recorded in 95 patients. There was no effect on the primary endpoint, although a trend towards a better effect in carvedilol treated patients was noticed in patients with heart rates above 71 beats per minute. At the end of the study, there was a statistically significant improvement in E:A ratio in patients treated with carvedilol (0.72 to 0.83) vs. placebo (0.71 to 0.76), P<0.05. CONCLUSIONS: Treatment with carvedilol resulted in a significant improvement in E:A ratio in patients with heart failure due to a LV relaxation abnormality. E:A ratio was found to be the most useful variable to identify diastolic dysfunction in this patient population. This effect was observed particularly in patients with higher heart rates at baseline.

Adrenergic beta-Antagonists↗

PubMed2003

Nurse-led heart failure clinics improve survival and self-care behaviour in patients with heart failure: results from a prospective, randomised trial.

AIM: The aim of this trial was to prospectively evaluate the effect of follow-up at a nurse-led heart failure clinic on mortality, morbidity and self-care behaviour for patients hospitalised due to heart failure for 12 months after discharge. METHODS: A total of 106 patients were randomly assigned to either follow-up at a nurse-led heart failure clinic or to usual care. The nurse-led heart failure clinic was staffed by specially educated and experienced cardiac nurses, delegated the responsibility for making protocol-led changes in medications. The first follow-up visit was 2-3 weeks after discharge. During the visit the nurse evaluated the heart failure status and the treatment, gave education about heart failure and social support to the patient and his family. RESULTS: There were fewer patients with events (death or admission) after 12 months in the intervention group compared to the control group (29 vs 40, p=0.03) and fewer deaths after 12 months (7 vs 20, p=0.005). The intervention group had fewer admissions (33 vs 56, p=0.047) and days in hospital (350 vs 592, p=0.045) during the first 3 months. After 12 months the intervention was associated with a 55% decrease in admissions/patient/month (0.18 vs 0.40, p=0.06) and fewer days in hospital/patient/month (1.4 vs 3.9, p=0.02). The intervention group had significantly higher self-care scores at 3 and 12 months compared to the control group (p=0.02 and p=0.01). CONCLUSIONS: Follow up after hospitalisation at a nurse-led heart failure clinic can improve survival and self-care behaviour in patients with heart failure as well as reduce the number of events, readmissions and days in hospital.

Aged↗

PubMed2001

[Better treatment of heart failure by measurements of natriuretic peptides. There are still remaining problems when it comes to the interpretation of measurement levels].

The heart is increasingly being recognised as a major endocrine organ involved in haemodynamic homeostasis. Natriuretic peptides, i.e. atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), affect renal, adrenal and central nervous system functions as well as vessel tonus and permeability thus causing decreased preload and afterload. Natriuretic peptides, BNP in particular, are independent risk factors for morbidity and mortality. They also have high negative predictive values for cardiac insufficiency indicating high diagnostic sensitivity for heart failure in outpatient practice. Monitoring of therapy for heart failure may be improved if BNP measurement is used in conjunction with clinical assessment. However, several problems remain to be solved, such as optimal decision limits in relation to sex and age for the assessment of heart failure.

Atrial Natriuretic Factor↗

PubMed2001

Nurse-led heart failure clinics in Sweden.

OBJECTIVE: The aim of this study was to describe the nurse-led heart failure care in Sweden. METHODS: A postal questionnaire was sent to all 86 hospitals in Sweden treating heart failure patients. All hospitals completed the questionnaire, which contained 20 questions about heart failure nurses, patient education, heart failure clinics, co-operation with primary healthcare and care programmes. RESULTS: Sixty-nine percent of all hospitals (n=86) had nurses specialised in taking care of heart failure patients, in total 148 heart failure nurses. The nurses were involved in patient education and follow-up. There were nurse-led heart failure clinics in 66% of the hospitals. The clinics provided follow-up after hospitalisation, telephone counselling and drug titration. The majority of the heart failure nurses had been delegated the responsibility for making protocol-led changes in medications. Most clinics registered the number of annual visits to the clinic, and the largest clinic had up to 1000 visits. Approximately half of the hospitals had a special care plan for patients with heart failure and an organised co-operation with primary healthcare. CONCLUSION: The first nurse-led heart failure clinic started in Sweden in 1990 and since then the model has been spread to two-thirds of the Swedish hospitals.

Heart Failure↗

PubMed2001

Patients with congestive heart failure and their conceptions of their sleep situation.

AIM: To describe, from a nursing perspective, how patients with CHF conceived their sleep situation. BACKGROUND: Sleep disturbances are very common in patients with congestive heart failure (CHF). Polysomnographic studies have shown that the total duration of sleep is shorter and the sleep structure disturbed, with frequent arousals and sleep stage changes. METHODS: A qualitative descriptive design inspired by a phenomenographic approach was employed. Conceptions were collected through interviews with 20 strategically chosen CHF patients. FINDINGS: The findings showed that the patients' sleep was affected by their daily activities, the disease itself and cardiac symptoms. The sleep disturbances gave effects such as fatigue, listlessness, loss of concentration and loss of temper. These effects led to a need for daytime sleep, seclusion, counselling and information. Patients handled their sleep disturbances through coping mechanisms related to developed patterns of daily life and through support from their psychosocial environment. CONCLUSIONS: Through an increased awareness of the causes of sleep disturbances in CHF patients, nurses can more effectively meet their caring needs and reduce the psychological stressors that patients develop. Information and education, both to patients and the next of kin, about the disease and the sleep situation, especially good sleeping habits, can help patients to better cope with sleep disturbances.

Adaptation, Psychological↗

PubMed2001

Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences.

OBJECTIVE: The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseases and management, and to evaluate whether there is a difference between the genders. DESIGN: Descriptive retrospective investigation. SETTING: Atvidaberg community situated in southeast Sweden, 12 400 inhabitants. PATIENTS: 256 patients treated for symptomatic HF. MAIN OUTCOME MEASURES: Prevalence, aetiology, diagnostic procedures and management of HF and differences between the genders. RESULTS: The diagnosis of HF was based on an objective evaluation of cardiac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy included diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) and digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objective diagnostic test (echocardiography) in only 20%. Women were prescribed ACE inhibitors to a lesser extent (43%) than men (64%) and with a lower optimal dose (44% versus 56% in men). CONCLUSION: There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not generally based on an objective evaluation of cardiac function and where the treatment to a lesser extent than in men includes ACE inhibitors.

Adult↗

PubMed2001

Heart failure clinics: organization, development, and experiences.

The number of patients with heart failure is continuously increasing in western society, and the cost of hospitalizations causes a major financial burden on the health care system. Many patients do not receive a correct diagnosis, and only a minority have an optimized medication according to guidelines. Information and education are poor in heart failure patients, leading to an increased number of readmissions due to low compliance. Because of all these problems in treating patients with heart failure, it is justified to build special heart failure clinics led by nurses and doctors to verify diagnosis, optimize treatment, and improve information and education for patients and family members. This review presents the current status of heart failure units.

Ambulatory Care Facilities↗

PubMed2000

Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center.

OBJECTIVE: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center. DESIGN: A prospective study from February 1993 to June 1999. SETTING: A university hospital. PARTICIPANTS: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3). INTERVENTIONS: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period. MEASUREMENTS AND MAIN RESULTS: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended. CONCLUSIONS: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.

Adolescent↗

PubMed2000

The value of repeated echocardiographic evaluation in patients with idiopathic dilated cardiomyopathy during treatment with metoprolol or captopril.

Serial echocardiographic investigations were carried out on patients with idiopathic dilated cardiomyopathy, to evaluate treatment effects on left ventricular (LV) performance during therapy with either metoprolol or captopril. Thirty-two patients (23 males and 9 females) with mild to moderate symptoms of heart failure (NYHA II-III) and a mean age of 49 years were included in the investigation. The patients were investigated with Doppler echocardiography before treatment, after 3 and 6 months of treatment (either metoprolol or captopril) and 1 month after withdrawal of treatment. Intra- and inter-investigator reproducibility was acceptable, with a coefficient of variation of less than 5% for LV dimensions. A reduction in LV dimensions was seen in both treatment groups. In the metoprolol group there was also an increase in LV stroke volume and fractional shortening. The non-invasive data were in accordance with invasive measurements of stroke volume and LV filling pressure. In patients with idiopathic dilated cardiomyopathy and mild to moderate symptoms of heart failure, echocardiography seemed to be sufficiently reproducible to be used for determination of treatment effects in a longitudinal heart failure study. Both metoprolol and captopril were well tolerated and had favourable effects on LV performance.

Adult↗

PubMed1999

The effects of metoprolol and captopril on heart rate variability in patients with idiopathic dilated cardiomyopathy.

BACKGROUND: The effects of treatment with captopril or metoprolol on heart rate variability (HRV) were investigated in 38 patients (29 men and 9 women) with mild to moderate symptoms of heart failure due to idiopathic dilated cardiomyopathy (DCM). HYPOTHESIS: The aim of the study was to investigate and compare the effects of the angiotensin-converting enzyme inhibitor captopril with those of the selective beta-adrenergic receptor blocker metoprolol on HRV in patients with idiopathic DCM. METHODS: Heart rate variability was analyzed in the time and frequency domains from 18th of Holter monitoring before randomized treatment was started, after 6 months of therapy, and 1 month after therapy was stopped. RESULTS: Captopril treatment increased HRV expressed as total power and low-frequency power in the frequency domain. There was no change in the time domain. In the metoprolol group, there was a pronounced increase in both time- and frequency-domain indices of HRV. The increase in total power was partly maintained 1 month after therapy was stopped in both treatment groups. CONCLUSION: Treatment with captopril and metoprolol increases HRV in patients with DCM. This effect seems to be maintained for at least 1 month after therapy is stopped. The increase in HRV seems to be more pronounced with metoprolol, and the two different pharmacologic approaches may have additive effects that are of prognostic importance in patients with heart failure.

Adrenergic beta-Antagonists↗

PubMed1999

The circulating renin-angiotensin system during treatment with metoprolol or captopril in patients with heart failure due to non-ischaemic dilated cardiomyopathy.

OBJECTIVE: To investigate the effects of beta-blocker (metoprolol) or angiotensin-converting enzyme inhibitor (captopril) treatment on neurohormonal function in a randomized prospective study on patients with heart failure due to dilated cardiomyopathy. PATIENTS: Fifty-four patients (42 men and 12 women, mean age 50 years) were studied. There were three patients in NYHA (New York Heart Association) functional class I, 32 patients in class II and 19 patients in class III. METHODS: Measurements of plasma renin activity (PRA). plasma angiotensin II (A II) concentration and plasma atrial natriuretic peptide (ANP) concentration were made at rest and also in a subgroup (n = 32) during exercise. The urinary excretion of aldosterone was also determined. Investigations were performed at baseline, and after 3 and 6 months. Therapy was then stopped and the patients were re-investigated 1 month thereafter. RESULTS: The mean level of PRA was normal at baseline, reduced during therapy with metoprolol, and increased during therapy with captopril. The mean plasma concentration of A II was reduced during exercise and there was a trend towards a reduction even at rest in the metoprolol group, but not in the captopril group. The urinary excretion of aldosterone decreased in both groups. The mean plasma concentration of ANP was elevated at baseline and declined during exercise in the metoprolol group. CONCLUSION: In patients with dilated cardiomyopathy and only a partly activated renin-angiotensin system, both metoprolol and captopril reduced urinary excretion of aldosterone. Furthermore, metoprolol suppressed the exercise-induced increase in ANP, suggesting a favourable effect on ventricular performance.

Adrenergic beta-Antagonists↗

PubMed1998

Treatment with ramipril improves systolic function even in patients with mild systolic dysfunction and symptoms of heart failure after acute myocardial infarction.

BACKGROUND: Clinical signs of heart failure such as pulmonary rales and dyspnea, ventricular dysfunction, and ventricular arrhythmia are independent predictors of a poor prognosis after acute myocardial infarction (AMI). HYPOTHESIS: The study aimed to assess the effect of ramipril treatment on mildly depressed left ventricular (LV) systolic function, assessed by atrioventricular (AV) plane displacement in patients with congestive heart failure after AMI. METHODS: The study was a substudy in the Acute Infarction Ramipril Efficacy Study, a double-blind, randomized, place-bo-controlled trial of ramipril versus placebo in patients with symptoms of heart failure after AMI. In all, 56 patients were included in the main study, 4 refused to participate in the substudy, and 4 were excluded for logistical reasons. Echocardiography was performed at entry and after 6 months. Patients who underwent coronary artery bypass grafting during the follow-up period were excluded. RESULTS: At baseline, the patients had modest LV dysfunction, and mean AV plane displacement of 9.7 mm. During follow-up, AV plane displacement increased in ramipril-treated patients from 9.5 to 10.9 mm (p < 0.01). No statistically significant changes were seen in the placebo group. CONCLUSIONS: Ramipril improves LV systolic function in patients with clinical signs of heart failure and only modest systolic dysfunction after AMI. Measurement of AV plane displacement is a simple and reproducible method for detection of small changes in systolic function and may be used instead of ejection fraction in patients with poor image quality.

Adult↗

PubMed1997

More favourable haemodynamic effects from metoprolol than from captopril in patients with dilated cardiomyopathy.

AIM: The object of this study was to investigate and compare the haemodynamic effects of treatment with a beta receptor blocker (metoprolol) or an angiotensin-converting-enzyme inhibitor (captopril) in 54 patients with idiopathic dilated cardiomyopathy. METHOD: All patients had cardiac catheterization performed at rest and during exercise, before and after 3 months of treatment. RESULTS: The mean dose of metoprolol was 135 mg.day-1 and of captopril 98 mg.day-1. After treatment there was a significant reduction in left ventricular filling pressure both at rest (from 16 to 12 mmHg) and during exercise (from 27 to 20 mmHg) in the metoprolol group. In the captopril group a significant reduction was seen only during exercise (25 to 20 mmHg), compared to baseline. The stroke volume increased significantly after 3 months of therapy in the metoprolol group, both at rest (53 to 70 ml) and during exercise (56 to 79 ml). In the captopril group the increase reached significance only during exercise (72 to 79 ml). Cardiac output was maintained in both groups. CONCLUSION: There were positive effects on left ventricular function in the metoprolol group as well as in the captopril group. Metoprolol reduced left ventricular filling pressure at rest and increased stroke volume both at rest and during exercise significantly more than captopril.

Adrenergic beta-Antagonists↗