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Biomedical subjects

Ulf Dahlström

Publications and source records attributed to Ulf Dahlström.

At least 19 recordsLinked to original sources
PubMed2006

Feature extraction for systolic heart murmur classification.

Heart murmurs are often the first signs of pathological changes of the heart valves, and they are usually found during auscultation in the primary health care. Distinguishing a pathological murmur from a physiological murmur is however difficult, why an "intelligent stethoscope" with decision support abilities would be of great value. Phonocardiographic signals were acquired from 36 patients with aortic valve stenosis, mitral insufficiency or physiological murmurs, and the data were analyzed with the aim to find a suitable feature subset for automatic classification of heart murmurs. Techniques such as Shannon energy, wavelets, fractal dimensions and recurrence quantification analysis were used to extract 207 features. 157 of these features have not previously been used in heart murmur classification. A multi-domain subset consisting of 14, both old and new, features was derived using Pudil's sequential floating forward selection (SFFS) method. This subset was compared with several single domain feature sets. Using neural network classification, the selected multi-domain subset gave the best results; 86% correct classifications compared to 68% for the first runner-up. In conclusion, the derived feature set was superior to the comparative sets, and seems rather robust to noisy data.

Aged↗
PubMed2006

Computer-based education for patients with chronic heart failure. A randomised, controlled, multicentre trial of the effects on knowledge, compliance and quality of life.

OBJECTIVE: To evaluate the effects of a single-session, interactive computer-based educational program on knowledge, compliance and quality of life in heart failure patients with special emphasis on gender differences. METHODS: One hundred and fifty-four patients, mean age 70 years, from five heart failure clinics were randomised to either receiving only standard education (n=72) or standard education and additional computer-based education (n=82). RESULTS: Knowledge was increased in both groups after 1 month with a trend towards higher knowledge (P=0.07) in the computer-based group. The increase in knowledge was significantly higher in the computer-based group after 6 months (P=0.03). No differences were found between the groups with regard to compliance with treatment and self-care or quality of life. The women had significantly lower quality of life and did not improve after 6 months as the men did (P=0.0001). CONCLUSION: Computer-based education gave increased knowledge about heart failure. PRACTICE IMPLICATIONS: Computers can be a useful tool in heart failure education, but to improve compliance a single-session educational intervention is not sufficient. Gender differences in learning and quality of life should be further evaluated.

Adult↗
PubMed2006

The measurement and prevalence of depression in patients with chronic heart failure.

Chronic heart failure is a common disease accompanied by poor mental health and depression. The diagnosis of depression is based on the presence of affective, cognitive, and somatic symptoms assessed by categoric or dimensional instruments. Depression is prominent and high rates are found with dimensional instruments in hospitalized heart failure patients. Categoric instruments seem to be more reliable but are more complex to use. Because of poor outcomes, attention should also be paid to subthreshold depression. In screening for such cases, dimensional instruments might be preferable because of the risk for underestimation by categoric instruments. Dimensional instruments might also be easier to implement in daily practice but, to reduce bias, cutoff scores might need refinement according to the clinical setting. Therefore, studies that evaluate different cutoff values are needed to find a critical level of burden from a depressive symptomatology on outcomes such as mortality, hospitalizations, and quality of life.

Chronic Disease↗
PubMed2006

Consequences and predictors of depression in patients with chronic heart failure: implications for nursing care and future research.

Depression is common among patients with chronic heart failure (HF) and leads to more symptoms of HF, decreased quality of life, and an increased risk for premature death. Depressed HF patients also use more health care resources, which increases the economic burden on the health care system. The assessment of risk factors of depression such as age younger than 60-65 years, poor physical functioning, previous depression, poor self-efficacy, living alone, and distressful relationships, in combination with the use of depression instruments, can be helpful in detecting depression in HF patients. Unfortunately, interventions on how to relieve depression in patients with HF have not been investigated thoroughly; however, depression agents as well as HF education, social support, exercise therapy, stress management, and relaxation have been shown to be useful interventions. Because of poor outcomes, studies that examine the effectiveness and/or side effects of pharmacologic as well as nonpharmacologic interventions on depressed patients with HF are needed.

Activities of Daily Living↗
PubMed2005

Factors and interventions influencing health-related quality of life in patients with heart failure: a review of the literature.

INTRODUCTION: Because of the lack of a cure for patients with chronic heart failure (HF), there has been a progressive interest in the use of health-related quality of life (Hr-QoL) as complementary end-point to mortality and morbidity. AIM: The aim of this review was from a nursing perspective to describe Hr-QoL and the influencing factors of Hr-QoL, as well as to identify interventions aimed at influencing Hr-QoL in HF patients. METHOD: Medline, Cinahl and PsycInfo databases were searched from 1995 to 2004. A total of 58 papers were included. RESULTS: HF symptoms and activity status influence Hr-QoL negatively. However, several individual characteristics such as personality, gender and age must also be taken into consideration because different values might exist regarding what constitutes a good Hr-QoL. Nurse led interventions based on education, support and exercise can influence Hr-QoL positively. There is also a need of more studies about the effects of depression, sleep disturbances, support as well as education on Hr-QoL. There is also a need of exercise studies with larger sample sizes and older patients in higher NYHA classes. CONCLUSION: Several individual factors impact Hr-QoL, therefore, must nursing interventions are individually adapted to the patient's resources.

Activities of Daily Living↗
PubMed2005

Frequent non-cardiac comorbidities in patients with chronic heart failure.

Heart failure (HF) in elderly patients is associated with more diffuse symptoms and signs due to the presence of other noncardiac comorbidities. This can cause difficulties in assessing the correct diagnosis and initiating appropriate therapy. The four most frequently occurring noncardiac comorbidities and therapies used to treat them are discussed in the present paper. Hypertension is an important precursor of HF, and is still the most common risk factor for HF in the general population. About 50% of patients with untreated hypertension will develop HF. Pressure overload leads to the development of left ventricular hypertrophy (LVH) and diastolic dysfunction. Diabetes, which occurs in about 20-30% of patients with HF, is an important comorbidity resulting in morphological and metabolic disturbances affecting myocardial blood flow and hormonal regulation leading to a poor outcome and necessitating aggressive conventional treatment. Chronic obstructive pulmonary disease (COPD), occurs in approximately 20-30% of heart failure patients, and may complicate HF treatment, it is therefore important to recognize and treat it effectively. Finally, the early detection of anemia, which occurs in 20-30% of HF patients, is important since it is associated with functional impairment and increased mortality and morbidity. Combined treatment with erythropoietin and intravenous iron has shown beneficial effects on clinical symptoms and morbidity. In conclusion early detection of concomitant diseases in patients with HF is important and should be considered carefully when initiating therapy.

Aged↗
PubMed2005

Cost of heart failure in Swedish primary healthcare.

OBJECTIVES: To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. DESIGN: Retrospective study of all available patient data during a period of one year. SETTING: Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. SUBJECTS: A total of 115 patients with a diagnosis of HF. MAIN OUTCOME MEASURES: The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. RESULTS: The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. CONCLUSION: Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0-6.7 billion according to this calculation, which is higher than previously known.

Aged↗
PubMed2004

Effects of losartan and captopril on left ventricular systolic and diastolic function after acute myocardial infarction: results of the Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan (OPTIMAAL) echocardiographic substudy.

BACKGROUND: Angiotensin-converting enzyme inhibitors have been shown to attenuate adverse remodeling after acute myocardial infarction (AMI), and the same has been suggested for angiotensin II type 1 receptor antagonists in animal models. Therefore the aim of the study was to compare the effects of losartan and captopril on regional systolic, diastolic, and overall left ventricular (LV) function after AMI. METHODS: Two hundred twenty-five patients aged > or =50 years with documented AMI and heart failure and/or LV dysfunction were randomly assigned treatment with either losartan (50 mg/d) or captopril (50 mg 3 times/d). Echocardiography was performed at randomization and after 3 months; echocardiograms were analyzed blinded at the core laboratory. Main outcome measures were changes in wall motion score index (WMSI), E-wave deceleration time (E-DT), and Tei index of overall LV function. RESULTS: WMSI decreased in both groups (losartan 1.58 +/- 0.23 to 1.52 +/- 0.26, P =.009, captopril 1.60 +/- 0.24 to 1.48 +/- 0.22, P <.001), although the decrease was greater in patients allocated to captopril (captopril -0.12 +/- 0.17 vs losartan -0.05 +/- 0.19, P =.007). In both groups E-DT increased, although the increase was significant only in patients treated with captoril (193 +/- 61 ms to 208 +/- 70 ms, P =.05). The change in E-DT was not different between treatment groups (captopril 14 +/- 74 ms vs losartan 7 +/- 80 ms, P =.52). Tei index decreased in both groups (losartan 0.59 +/- 0.13 to 0.55 +/- 0.15, P =.04, captopril 0.62 +/- 0.15 to 0.55 +/- 0.13, P <.001). However, the reduction was significantly greater in patients treated with captopril (captopril -0.08 +/- 0.14 vs losartan -0.03 +/- 0.14, P =.01). CONCLUSION: Losartan and captopril improve systolic and overall LV function after AMI, but the benefit is greater for patients treated with captopril.

Aged↗
PubMed2004

Measurement of health-related quality of life in chronic heart failure, from a nursing perspective-a review of the literature.

BACKGROUND: Living with chronic heart failure (CHF) is distressful and affects daily life. Because of the lack of a cure for CHF, there has been a progressive interest in using health-related quality of life (Hr-QoL) as an outcome measurement of the treatment in patients with CHF. OBJECTIVE: The aim of this review was to describe the instruments/questionnaires used in different studies in the measurement of Hr-QoL in patients with CHF, and how they were put into operation as seen from a nursing perspective. METHOD: MEDLINE and CINAHL databases were searched from January 1995 to June 2002, by using the keywords CHF, heart failure, QoL and Hr-QoL. A total of 33 articles were analysed. RESULTS: Thirty-two different Hr-QoL questionnaires were found. Generic, disease-specific and battery approaches were different ways used to measure Hr-QoL. To assess/describe Hr-QoL, evaluate the impact of interventions and examine relations/predictors were three main objectives. However, different aspects of the concept Hr-QoL, influencing factors, how to implement the questionnaires and a lack of unified CHF criteria existed. CONCLUSIONS: To create a guideline for the measurement of Hr-QoL in CHF patients is of great importance for nurses and might generate homogeneity in the measurement methods and promote the scientific approach in the nursing care process.

Health Status↗
PubMed2004

Elevated circulating levels of thioredoxin and stress in chronic heart failure.

BACKGROUND: Chronic heart failure (CHF) is a complex syndrome, in which reactive oxygen species and inflammatory cytokines are important stressors that contribute to the pathogenesis. AIM: We have studied physiological stress response parameters in CHF, in particular the redox-active regulator thioredoxin. SUBJECTS: A case-control study was conducted including a consecutive sample of CHF patients (n=27) of NYHA class II and III; comparison control subjects (n=29) were recruited from an association for retired people. METHOD: Baseline levels of Trx, lipid peroxides (oxidative stress), TNF and IL-6 cytokines, platelet-activation marker P-selectin, cortisol (as peripheral effector of HPA axis), and the potent antioxidant selenoprotein Trx-reductase were assessed. RESULTS: Mean (+/-S.E.M.) plasma levels of Trx were significantly higher in patients with CHF (32+/-3 ng/ml), than in the healthy subjects (12+/-3 ng/ml, P<0.0001). Trx levels increased in proportion to severity of disease (NYHA class III>NYHA class II) and degree of stress. Trx elevation correlated well with increased oxidative stress (lipid peroxides, P<0.0001), circulatory P-selectin (P<0.0001), morning level of free salivary cortisol (P=0.0002), and serum creatinine (P=0.0417), but not with pro-inflammatory cytokines TNF and IL-6. CONCLUSION: Trx was strikingly elevated in heart failure cases compared with controls, signifying an adaptive stress response that is higher the more severe the disease.

Aged↗
PubMed2004

Elevated D-dimer level is an independent risk factor for cardiovascular death in out-patients with symptoms compatible with heart failure.

D-dimer, a marker of fibrin turnover, exhibits many interesting properties as a biological marker of thrombosis. Some of the properties of D-dimer might also be used to provide additional information about patients with heart failure. In this study, we evaluate the prognostic information acquired from D-dimer concerning increased risk of cardiovascular mortality in an elderly population with symptoms associated with heart failure. A cardiologist examined 458 elderly patients, out of 548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema and assessed NYHA functional class and cardiac function. Abnormal systolic function was defined as EF <40% on Doppler echocardiography. Abnormal diastolic function was defined as reduced E/A ratio and/or an abnormal pattern of pulmonary venous flow. Blood samples were drawn, and BNP and D-dimer were analysed. D-dimer was analysed using an automated micro-latex assay. A statistical analysis was performed to identify the prognostic value of increased plasma concentration of D-dimer. Results showed that during a median follow-up period of 5.5 years, 68 (14%) patients died of cardiovascular disease. No gender difference was noted. A plasma concentration of D-dimer >0.25mg/L increased the risk almost 4-fold. In conclusion, D-dimer is an independent risk factor for cardiovascular mortality that may be used to risk-stratify patients with heart failure.

Age Factors↗
PubMed2003

Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis.

Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple. The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation. A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden. Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems. An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.

Adaptation, Psychological↗
PubMed2003

Utility of the amino-terminal fragment of pro-brain natriuretic peptide in plasma for the evaluation of cardiac dysfunction in elderly patients in primary health care.

BACKGROUND: The aims of this study were to measure the N-terminal fragment of pro-brain natriuretic peptide (proBNP) in plasma in medical conditions commonly found in primary care and to evaluate the utility of these measurements in identifying impaired cardiac function in elderly patients with symptoms associated with heart failure. METHODS: We studied 415 patients (221 men and 194 women; mean age, 72 years) who had contacted a primary healthcare center for dyspnea, fatigue, and/or peripheral edema. One cardiologist evaluated the patients in terms of history, physical examination, functional capacity, electrocardiography, and suspicion of heart failure. Plasma N-terminal proBNP was measured by an in-house RIA. An ejection fraction < or =40% by Doppler echocardiography was regarded as reduced cardiac function. Abnormal diastolic function was defined as an abnormal mitral inflow defined as reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio), or as abnormal pulmonary venous flow pattern. RESULTS: Patients with impaired functional capacity, impaired systolic function, and/or impaired renal function had significantly increased N-terminal proBNP concentrations. By multiple regression analysis, N-terminal proBNP concentrations were also influenced by ischemic heart disease, cardiac enlargement, and certain medications but not by increased creatinine. No gender differences were observed. Patients with isolated diastolic dysfunction attributable to relaxation abnormalities had lower concentrations than those with normal cardiac function, whereas those with pseudonormal E/A ratios or restrictive filling patterns had higher concentrations. CONCLUSIONS: Plasma N-terminal proBNP concentrations increase as a result of impaired systolic function, age, impaired renal function, cardiac ischemia and enlargement, and certain medications. Values are high in diastolic dysfunction with pseudonormal patterns, but not in patients with relaxation abnormalities. An increase in plasma N-terminal proBNP might be an earlier sign of abnormal cardiac function than abnormalities identified by currently used echocardiographic measurements.

Aged↗
PubMed2002

[Cost-effectiveness of bisoprolol in chronic heart failure].

The cost-effectiveness of adding the beta blocker bisoprolol to standard treatment in patients with congestive heart failure was investigated, based on data from the Cardiac Insufficiency Bisoprolol Study II (CIBIS II). The medical resource consumption from CIBIS II was combined with Swedish cost data for medication and hospitalisations. Costs of added years of life, i.e. consumption net of production, were also included in the analysis. The health effects were measured in terms of gained years of life. The results of the analysis show that the cost-effectiveness of bisoprolol compares favourably with that of other cardiovascular treatments. Without the inclusion of costs of added years of life, the cost-effectiveness was in the range of SEK 3,351-13,096 per gained year of life, and with the costs of added years of life included, the cost-effectiveness was in the range of SEK 137,533-147,278 per gained year of life.

Adrenergic beta-Antagonists↗
PubMed2002

Interactive education on CD-ROM-a new tool in the education of heart failure patients.

The study aimed to develop and evaluate whether a computer-based program for patients with heart failure was user-friendly, could be operated by elderly patients and gave sufficient information about heart failure. The program was developed by a multidisciplinary group and designed with large, clear illustrations and buttons. A total of 42 patients aged 51-92 years tested the program and completed afterwards a questionnaire. Three heart failure nurses evaluated how the patients used the program and their attitudes towards the computer. All patients could use the program, despite the fact that only six had used a computer before. The patients were satisfied with the computer-based information and appreciated that the program was interactive, flexible and contained a self-test. They thought it was a better way of receiving information than reading a booklet or watching a video about heart failure. The nurses reported that the patients were positive towards the computer and seemed to understand the information and that the patient education was less time-consuming, when the patients could seek knowledge on their own.

Aged↗