Background: The aim of this study was to assess gender differences in admission level of care, management and outcome in patients with non ST-elevation acute coronary syndromes (NSTE-ACS), initially ...admitted to either coronary care units (CCU) or general wards. Method: Patients admitted to CCUs were routinely registered in the RIKS-HIA registry. In addition, patients admitted to general wards with suspected ACS were also identified and registered. Multivariable regression analysis was used to adjust for baseline differences between the genders. Results: We included 570 consecutive patients with a discharge diagnosis of NSTE-ACS. Women were less likely to be admitted to coronary care units (56% versus 69%, P=0.002), even after adjustment (odds ratio (OR), 0.65; 95% confidence interval (CI): 0.43-0.98). After adjustment for differences in baseline characteristics, women were treated similarly to men. We found no significant differences in crude short-, or long-term mortality between the genders. However, adjustment for background characteristics revealed lower one-year mortality in women (OR: 0.58; 95% CI: 0.34-0.99). Conclusion: In this study on patients with NSTE-ACS, women were less likely to be admitted to coronary care units. However, the overall treatment was as intensive for women as for men. Moreover, after adjustment, one-year mortality was lower in women.
Abstract
There is debate whether early treatment with GpIIb/IIIa inhibitors is of clinical benefit in primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). ...This study explored the effects of early given abciximab on coronary blood flow and major adverse cardiac events (MACE) in patients with STEMI treated with primary PCI and adjunctive abciximab. We studied all consecutive patients from our catchment area with STEMI undergoing acute angiography with the intention of primary PCI during 2005. Abciximab was given as early pre-treatment before, (n = 133) or at the cath. lab. after a diagnostic angiography (n = 109). Pre-procedural TIMI 2-3 flow was observed in 45.9 % of patients in the early group versus 20.2 % in the cath. lab. group, P = 0.0001. Mortality rates were 3.8 % versus 3.7% inhospital and 8.3 % versus 7.3% at one year in the early respectively the cath. lab. group, both P = NS. The MACE rate (death, non fatal myocardial infarction, unplanned revascularization) at one year was 19.5 % (early group) and 26.6 % (cath. lab. group), P = 0.19. CONCLUSION: In this single centre registry study of unselected patients with STEMI early given abciximab was associated with a significantly higher rate of TIMI 2-3 flow compared to abciximab given after the acute angiography.
Background: Non ST-elevation Acute Coronary Syndromes are the most frequent manifestations of acute ischemic heart disease. Gender differences in treatment intensity, including differences in level ...of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. The aims of the studies in this thesis were to assess differences between the genders in baseline characteristics, level of care, medical treatment and non-invasive and invasive cardiac procedures. The aims were also to determine gender differences in short and long-term mortality, including impact of level of care, and to determine differences between the genders in benefit from an invasive strategy, with special reference to benefit in women. Method: We used prospectively collected data from the RIKS-HIA registry in two studies (Paper I and IV). In one study we merged data from patients admitted to general wards in the south-east region of Sweden (The AKUT registry), with data from patients admitted to CCU´s (RIKS-HIA) at participating hospitals during the same time (Paper II). We also randomly assigned women to a routine invasive or a selective invasive treatment strategy, and performed a meta-analysis, to determine gender differences in benefit from a routine invasive strategy (Paper III). Results: Women were older than men and more likely to have a history of diabetes and hypertension, while men were more likely to have a history of myocardial infarction and revascularisation. Women were also more likely to have normal coronary arteries on the angiogram. After adjustment for baseline differences there were only minor, and directionally inconsistent, differences between women and men in pharmacological treatment. Men were more often referred for coronary angiography, even after adjustment. While CABG-rate was lower in women, after adjustment PCI-rate was similar or even higher compared to men. After adjustment for differences in age, longterm outcome was better in women. In our small but randomised trial there was no benefit from a routine invasive strategy in women. A meta-analysis indicated interaction between gender and treatment strategy, with lack of benefit in women, in contrast to in men. However, our large observational study indicated no gender difference with an invasive strategy. Moreover, benefit was similar in women and men with invasive treatment. Conclusion: There are substantial differences between women and men in baseline characteristics that affect management and outcome more than gender per se. After adjustment women have better long-term outcome than men. There appear to be a difference in benefit from a routine invasive strategy between the genders, with less benefit in women, but in routine clinical management there was no difference between women and men managed with an invasive strategy.
Cardiovascular disease is the leading cause of death in both men and women in the developed world. Non-ST-elevation acute coronary syndromes (NSTE-ACS) are the most prevalent acute manifestations of ...coronary heart disease. Revascularisation is performed in the NSTEACS setting to relieve symptoms and prevent progression to myocardial ischaemia and death. Today, early invasive treatment with coronary angiography and revascularisation if feasible has become the strategy of choice in patients with NSTE-ACS, and is a class 1 recommendation in both American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines on NSTE-ACS, at least for patients with medium- or high-risk indications. However, gender differences in terms of benefit from an early invasive strategy have been intensively debated and the data are conflicting. In this article, we will discuss possible gender differences in randomised trials addressing this matter.
Syftet med vår studie är att kartlägga och förklara hur transparenta svenska börsbolag är vid redovisningen av utfallet samt bakgrunden till kortsiktig rörlig ersättning för den verkställande ...direktören, samt att identifiera potentiella förklaringar och bakomliggande orsaker till transparensen. Vi har valt att studera de 29 bolag som representerar de 30 mest omsatta aktierna på Stockholmsbörsens Large Cap lista (OMXS30). Metodmässigt kan studien delas in i två huvudsakliga delar. I den ena delen av studien använder vi en kvantitativ ansats och tillämpar ett positivistiskt synsätt. I den andra delen av studien använder vi en kvalitativ ansats och tillämpar ett hermeneutiskt synsätt. Vid insamlingen av datamaterialet har vi inspirerats av en tvärsnittsdesign där huvudsakliga syftet har varit att samla in relevant information för att kunna bedöma transparensen utifrån en egen framtagen modell. Modellen utgörs av fem kriterier inspirerade av Ersättningsakademiens riktlinjer för rapportering av ersättning och syftar till att ge en samlad bedömning av de studerade bolagens transparens. Vi har även identifierat ett antal potentiella förklarande variabler utifrån vilka vi har studerat orsakssamband till transparensen. Vi har dessutom analyserat kommunikationen utifrån ett legitimitetsperspektiv med avsikt att få en förståelse för bolagens val av rapportering. Utifrån resultatet av vår studie kan vi finna stöd till den kritik som riktats mot en bristande transparens vid rapportering av rörlig ersättning till verkställande direktören. Vi kan även se tendenser till att det orsakssamband som tidigare studier belyst mellan transparens och styrelsens oberoende, kan gälla även för svenska börsnoterade bolag.
The purpose of this study is to describe and explain the transparency of Swedish public companies when it comes to the reporting of short term bonus payment to the chief executive officer. Furthermore we intend to identify possible explanations and underlying causes regarding the transparency. We have selected the 29 companies that represent the 30 most traded stocks on the Stockholm Stock Exchange (OMXS30). Methodology, the study can be divided into two primary parts. In the first part of the study we use a quantitative approach and apply a positivistic view. In the second part of the study we use a qualitative approach and apply a hermeneutic view. When it comes to collecting data we have been inspired by a cross section design and the primary focus has been to collect relevant information to allow an assessment of the transparency with a model we have developed. This model consists of five criteria inspired by the Ersättningsakademiens (Compensation Academy) guidelines regarding the reporting of compensation and is designed to provide an overall assessment of the studied company’s transparency. We have also identified a number of possible explanatory variables from which we have studied underlying causes to the transparency. Furthermore we have analyzed the communication from a perspective of legitimacy with the intent to obtain an understanding regarding the company’s choice of reporting. From the result of the study we find support to previous criticism regarding lacking transparency on the matter of the reporting of short term bonus payments to the CEO. We can also see tendencies to the fact that the causation that previous studies pointed out between transparency and the independence of the board, may exist in Swedish publicly traded companies as well.
Frailty is a concept that is better than multimorbidity at identifying older people in need of special multidimensional care. Frailty denotes a state of accelerated biological aging in which the body ...gradually loses the ability to handle physical, mental and social stress. It is a dynamic condition which can be partly prevented and treated with physical exercise, nutrition and appropriate medication. They are many validated and simple screening tools for frailty. Some of these screening tools can assess the degree of frailty and thereby provide a risk stratification in for example a medical emergency. This can be used to support decisions to offer relevant medical intervention to chronologically old but biologically young people as well as to refrain from treatment in chronologically young but biologically older people.
Objective
The study objective was to identify subgroups of patients with rheumatoid arthritis (RA) based on their health status 3 years after diagnosis and to assess potential associations to ...clinical presentation at diagnosis.
Methods
This observational study included patients with RA with 3‐year follow‐up data from the Swedish Epidemiological Investigation of RA study, collected from 2011 to 2018. Hierarchical agglomerative cluster analysis, based on symptoms of pain, fatigue, sleep quality, mood disturbances, and overall health‐related quality of life (HRQoL), was used to identify subgroups 3 years after diagnosis. Modified Poisson regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for the associations between the subgroups and patient characteristics at diagnosis.
Results
A total of 1055 individuals constituted the study population, of whom 1011 had complete data on the clustering variables and were therefore eligible for analysis (73% women, median age 58 years). The following three clusters were identified: cluster 1 (466 patients with good health status), cluster 2 (398 patients in an intermediate group), and cluster 3 (147 patients with high levels of pain and fatigue together with markedly impaired HRQoL). Cluster 3 was associated to higher baseline pain (RR: 3.71 95% CI: 2.14‐6.41), global health (RR: 6.60 95% CI: 3.53‐12.33), and the Stanford Health Assessment Questionnaire (RR: 4.40 95% CI: 2.46‐7.87), compared with cluster 1 (highest compared with lowest quartiles). An inverse association was seen for baseline swollen joint count (RR: 0.51 95% CI: 0.34‐0.85).
Conclusion
A subgroup of patients with RA experience high levels of pain, fatigue, and psychosocial distress 3 years after diagnosis. This subgroup already displayed pronounced pain and functional disabilities at diagnosis.
