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Adherence and perception of medication in patients with chronic heart failure during a five-year randomised trial.

https://arctichealth.org/en/permalink/ahliterature83288
Source
Patient Educ Couns. 2006 Jun;61(3):348-53
Publication Type
Article
Date
Jun-2006
Author
Ekman Inger
Andersson Gull
Boman Kurt
Charlesworth Andrew
Cleland John G F
Poole-Wilson Philip
Swedberg Karl
Author Affiliation
The Sahlgrenska Academy, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg University, Box 457, SE 405 30, Göteborg, Sweden. inger.ekman@fhs.gu.se
Source
Patient Educ Couns. 2006 Jun;61(3):348-53
Date
Jun-2006
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Analysis of Variance
Carbazoles - therapeutic use
Chi-Square Distribution
Chronic Disease
Female
Follow-Up Studies
Health Knowledge, Attitudes, Practice
Health status
Heart Failure, Congestive - drug therapy - psychology
Humans
Male
Metoprolol - therapeutic use
Multicenter Studies
Patient Compliance - psychology - statistics & numerical data
Patient Education
Propanolamines - therapeutic use
Questionnaires
Randomized Controlled Trials
Severity of Illness Index
Stroke Volume
Sweden
Time Factors
Abstract
OBJECTIVE: Many patients with chronic heart failure (CHF) are thought to be non-adherent to their prescribed medications. The objective was to describe perceptions about and adherence to regular medicines and study medication at baseline and study end in CHF patients participating in a clinical trial. METHODS: In the carvedilol or metoprolol European trial (COMET), patients (N = 3029) with CHF were randomised and followed during a 58-month period. Patients at some Swedish centres answered a questionnaire at baseline and study end concerning their perception of their regular heart medication and study medication. Adherence was established through estimation of drug usage. RESULTS: In the Swedish sub-study, 302 patients responded once to the questionnaire while 107 patients responded both at baseline and at follow-up. At baseline, 94% of the patients stated that they believed that the study medication would make them feel better and 82% believed that their regular heart medication would do so. During the study, patients' belief in their regular cardiac medication significantly increased. Lack of belief in medication at the start of the study was a strong predictor of withdrawal from the trial (64% versus 6.8%; p
PubMed ID
16139468 View in PubMed
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Are elderly patients with suspected HF misdiagnosed? A primary health care center study.

https://arctichealth.org/en/permalink/ahliterature80811
Source
Cardiology. 2007;107(4):226-32
Publication Type
Article
Date
2007
Author
Olofsson Mona
Edebro Dan
Boman Kurt
Author Affiliation
Department of Medicine, Skellefteå County Hospital, Skellefteå, Sweden. mona.olofsson@vll.se
Source
Cardiology. 2007;107(4):226-32
Date
2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Diagnostic Errors
Female
Heart Failure, Congestive - diagnosis - etiology - physiopathology
Humans
Male
Primary Health Care
Sex Factors
Sweden
Ventricular Dysfunction, Left - physiopathology
Abstract
BACKGROUND: Few studies are published on heart failure patients in primary health care, in elderly in advanced age. OBJECTIVE: The purpose of this study was to examine the accuracy of the diagnosis of heart failure in all men and women with focus on age and gender. METHODS: The patients were recruited from one selected primary health care in the city of Skellefteå, Sweden. The general practitioners included all patients who had symptoms and signs indicating heart failure. The patients were then referred for an echocardiographic examination and a final cardiology consultation. RESULTS: The general practitioners identified 121 women and 49 men with suspected heart failure of whom 39% (51 women and 16 men) were above 80 years. Women were significantly older than men (mean age 78 and 75 years, respectively, p = 0.03). The main symptom was dyspnoea (80%). Confirmed heart failure was verified in 45% of the patients and was significantly more common in men than women (p = 0.02). Of all men and women above 80 years, 75% and 22%, respectively (p = 0.01) had a verified systolic heart failure, while there were no significant gender differences in patients younger than 80. In a multivariate regression analysis taking gender, age, smoking, atrial fibrillation, hypertension, angina, myocardial infarction and diabetes into account, myocardial infarction (OR = 4.3, CL = 1.8-10.6) hypertension (OR = 3.4, CI = 1.6-6.9) atrial fibrillation (OR = 2.8, CL = 1.0-7.9) remained significantly predictive of a confirmed diagnosis of heart failure. CONCLUSION: This study showed the difficulty of diagnosing heart failure accurately based only on clinical symptoms, especially in women above 80 years.
PubMed ID
16946601 View in PubMed
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Atorvastatin and persistent atrial fibrillation following cardioversion: a randomized placebo-controlled multicentre study.

https://arctichealth.org/en/permalink/ahliterature90101
Source
Eur Heart J. 2009 Apr;30(7):827-33
Publication Type
Article
Date
Apr-2009
Author
Almroth Henrik
Höglund Niklas
Boman Kurt
Englund Anders
Jensen Steen
Kjellman Björn
Tornvall Per
Rosenqvist Mårten
Author Affiliation
Department of Cardiology, Orebro University Hospital, Orebro, Sweden. henrik.almroth@orebroll.se
Source
Eur Heart J. 2009 Apr;30(7):827-33
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Aged
Anti-Arrhythmia Agents - adverse effects - therapeutic use
Atrial Fibrillation - drug therapy
Double-Blind Method
Electric Countershock
Female
Heptanoic Acids - adverse effects - therapeutic use
Humans
Male
Prospective Studies
Pyrroles - adverse effects - therapeutic use
Recurrence - prevention & control
Sweden
Treatment Outcome
Abstract
AIMS: To evaluate the effect of atorvastatin in achieving stable sinus rhythm (SR) 30 days after electrical cardioversion (CV) in patients with persistent atrial fibrillation (AF). METHODS AND RESULTS: The study included 234 patients. The patients were randomized to treatment with atorvastatin 80 mg daily (n = 118) or placebo (n = 116) in a prospective, double-blinded fashion. Treatment was initiated 14 days before CV and was continued 30 days after CV. The two groups were well-balanced with respect to baseline characteristics. Mean age was 65 +/- 10 years, 76% of the patients were male and 4% had ischaemic heart disease. Study medication was well-tolerated in all patients but one. Before primary endpoint 12 patients were excluded. In the atorvastatin group 99 patients (89%) converted to SR at electrical CV compared with 95 (86%) in the placebo group (P = 0.42). An intention-to-treat analysis with the available data, by randomization group, showed that 57 (51%) in the atorvastatin group and 47 (42%) in the placebo group were in SR 30 days after CV (OR 1.44, 95%CI 0.85-2.44, P = 0.18). CONCLUSION: Atorvastatin was not statistically superior to placebo with regards to maintaining SR 30 days after CV in patients with persistent AF.
PubMed ID
19202157 View in PubMed
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Being a close relative of a person with severe, chronic heart failure in palliative advanced home care -- a comfort but also a strain.

https://arctichealth.org/en/permalink/ahliterature84583
Source
Scand J Caring Sci. 2007 Sep;21(3):338-44
Publication Type
Article
Date
Sep-2007
Author
Brännström Margareta
Ekman Inger
Boman Kurt
Strandberg Gunilla
Author Affiliation
Department of Nursing, Umeå University, Umeå, Sweden. margareta.brannstrom@nurs.umu.se
Source
Scand J Caring Sci. 2007 Sep;21(3):338-44
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Caregivers - psychology
Female
Heart Failure - therapy
Home Care Services
Humans
Male
Middle Aged
Palliative Care
Professional-Family Relations
Sweden
Abstract
Within previous research on family care of terminally ill people, studies have only rarely been carried out concerning heart failure care. This study aims to illuminate meanings of being a close relative of a person with severe, chronic heart failure (CHF) in palliative advanced home care (PAHC). Narrative interviews were conducted with three close relatives, tape-recorded, transcribed verbatim and a phenomenological-hermeneutic method was used to interpret the text. Meanings of being a close relative is to follow the life-threatening ups and downs, the person with CHF is going through. This means being on primary call, always on standby to mediate security and pleasure. In the deepest downs it is also to call for the back-up call i.e. the PAHC team, trusting their ability to show up on time to alleviate in the worst downs i.e. ease suffering. This study reveals that to be the close relative that the ill person is dependent on 24 hours a day is both a comfort and a strain.
PubMed ID
17727546 View in PubMed
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Changes in plasma C-reactive protein and hemostatic factors prior to and after a first myocardial infarction with a median follow-up time of 8 years.

https://arctichealth.org/en/permalink/ahliterature89367
Source
Blood Coagul Fibrinolysis. 2009 Jul;20(5):340-6
Publication Type
Article
Date
Jul-2009
Author
Thøgersen Anna M
Nilsson Torbjörn K
Weinehall Lars
Boman Kurt
Eliasson Mats
Hallmans Göran
Jansson Jan-Håkan
Author Affiliation
Department of Public Health and Clinical Medicine, Umeå University Hospital, Umeå, Sweden. anmat@rn.dk
Source
Blood Coagul Fibrinolysis. 2009 Jul;20(5):340-6
Date
Jul-2009
Language
English
Publication Type
Article
Abstract
The objective of this study was to determine whether a first myocardial infarction leads to increased plasma levels of hemostatic factors and high sensitive C-reactive protein (hs-CRP) and whether the association between theses biomarkers and myocardial infarction was greater at follow-up compared with baseline. Of more than 36,000 persons screened in northern Sweden, 78 developed a first myocardial infarction (on average 18 months after sampling) in a population-based, prospective, nested patient-referent study. Fifty of these had participated in a follow-up health survey (on average 8 and a half years between surveys) and were sex-matched and age-matched with 56 referents. The mean increases in hs-CRP, tissue plasminogen activator (tPA) mass, plasminogen activator inhibitor-1 mass, and tPA/plasminogen activator inhibitor-1 complex concentration and von Willebrand factor among patients and referents were comparable during follow-up. Conditional logistic regression indicated that hs-CRP was not significantly associated with first myocardial infarction in a univariate analysis, whereas high plasma levels of tPA and creatinine were significantly associated with outcome at baseline and follow-up. tPA/plasminogen activator inhibitor-1 complex was not superior to tPA as a risk marker in this study. A first myocardial infarction did not in this study induce significantly different changes in plasma levels of hs-CRP and hemostatic factors among patients compared with referents during follow-up.
PubMed ID
19357504 View in PubMed
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Contribution of Swedish moist snuff to the metabolic syndrome: a wolf in sheep's clothing?

https://arctichealth.org/en/permalink/ahliterature79621
Source
Scand J Public Health. 2006;34(6):576-83
Publication Type
Article
Date
2006
Author
Norberg Margareta
Stenlund Hans
Lindahl Bernt
Boman Kurt
Weinehall Lars
Author Affiliation
Epidemiology and Public Health Sciences, Umeå University, Umeå, Sweden. margareta.norberg@epiph.umu.se
Source
Scand J Public Health. 2006;34(6):576-83
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Female
Follow-Up Studies
Health Surveys
Humans
Life Style
Longitudinal Studies
Male
Metabolic Syndrome X - blood - complications - etiology
Middle Aged
Prospective Studies
Questionnaires
Risk factors
Socioeconomic Factors
Sweden - epidemiology
Tobacco, Smokeless - adverse effects
Abstract
AIM: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between several lifestyle factors and MetSy, with a focus on the possible role of smokeless tobacco in the form of Swedish moist snuff (snus). METHODS: A population-based longitudinal cohort study within the Västerbotten Intervention Programme in Northern Sweden. All inhabitants at the ages of 30, 40, 50, and 60 are invited to participate in a health survey that includes a questionnaire on psychosocial conditions and lifestyle and measurement of biological variables. Individuals examined in 1990-94 (n = 24,230) and who also returned for follow-up after 10 years were included (total of 16,492 individuals: 46.6% men and 53.4% women). Regression analyses were performed. MetSy was the outcome and analyses were adjusted for age, sex, alcohol abuse, and family history of CVD and diabetes. RESULTS: Ten-year development of MetSy was associated with high-dose consumption of snus at baseline (OR 1.6 [95% CI 1.26-2.15]), low education (2.2 [1.92-2.63]), physical inactivity (1.5 [1.22-1.73]) and former smoking (1.2 [1.06-1.38]). Snus was associated with separate components of MetSy, including triglycerides (1.6, 1.30-1.95), obesity (1.7 [1.36-2.18]) but not hypertension, dysglycemia and low HDL cholesterol. CONCLUSIONS: MetSy is independently associated with high consumption of snus, even when controlling for smoking status. The finding is of public health interest in societies with widespread use of snus. More research is needed to better understand the mechanisms underlying this effect.
PubMed ID
17132590 View in PubMed
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Depression among elderly people with and without heart failure, managed in a primary healthcare setting.

https://arctichealth.org/en/permalink/ahliterature91739
Source
Scand J Caring Sci. 2008 Sep;22(3):376-82
Publication Type
Article
Date
Sep-2008
Author
Hägglund Lena
Boman Kurt
Lundman Berit
Brulin Christine
Author Affiliation
Department of Nursing, Umeå University, Umeå, Sweden. lena.hagglund@nurs.umu.se
Source
Scand J Caring Sci. 2008 Sep;22(3):376-82
Date
Sep-2008
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Case-Control Studies
Depression - epidemiology - physiopathology - therapy
Fatigue - epidemiology
Female
Humans
Interviews as Topic
Male
Myocardial Ischemia - complications - psychology
Odds Ratio
Primary Health Care
Sweden - epidemiology
Abstract
BACKGROUND AND RESEARCH OBJECTIVES: Depression is common among patients with heart failure (HF) and among elderly in general. Problems in diagnosing and care planning can arise as symptoms of HF, dyspnoea and especially fatigue, are nonspecific and also overlap with symptoms of depression. The objective of this study was to describe the prevalence and compare degrees of depression among patients with confirmed HF, patients with symptoms similar to HF (no heart failure, NHF) and a reference group in one primary healthcare centre (PHC), after adjusting for background characteristics and fatigue. SUBJECTS AND METHODS: A descriptive case-reference study was conducted in one PHC in a middle-sized city. Participants were 49 patients with confirmed HF, 59 patients with symptoms similar to HF (NHF) and 40 people in a reference group. After informed consent data were collected by structured interviews using the Geriatric Depression Scale and the Multidimensional Fatigue Inventory-20. Odds ratios for the outcomes HF vs. NHF, HF vs. reference group, and NHF vs. reference group were calculated. RESULTS: The HF and NHF groups had similar degrees of depression which were significantly higher than for the reference group. This difference between the groups did not remain significant when adjusting for physical fatigue. More patients in the NHF than in the HF group were living alone and there were more women in the NHF than in the reference group. CONCLUSIONS: Prevalence of depression and degrees of fatigue were higher among elderly from a PHC who experienced HF symptoms, independent of objectively measured heart function, compared with elderly without such symptoms. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences.
PubMed ID
18840221 View in PubMed
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The effects of commuting activity and occupational and leisure time physical activity on risk of myocardial infarction.

https://arctichealth.org/en/permalink/ahliterature79552
Source
Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):924-30
Publication Type
Article
Date
Dec-2006
Author
Wennberg Patrik
Lindahl Bernt
Hallmans Göran
Messner Torbjörn
Weinehall Lars
Johansson Lars
Boman Kurt
Jansson Jan-Håkan
Author Affiliation
Bureå Health Centre, Bureå, Sweden. patrik.wennberg@medforskskelet.se
Source
Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):924-30
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Chi-Square Distribution
Female
Humans
Leisure Activities
Logistic Models
Male
Middle Aged
Motor Activity
Myocardial Infarction - epidemiology
Occupations
Prospective Studies
Risk factors
Statistics, nonparametric
Sweden - epidemiology
Transportation
Abstract
BACKGROUND: Risk reduction of myocardial infarction has been shown for leisure time physical activity. The results of studies on occupational physical activity and risk of myocardial infarction are incongruous and studies on commuting activity are scarce. The aim of this study was to investigate how commuting activity, occupational physical activity and leisure time physical activity were associated with risk of future first myocardial infarction. DESIGN: We used a prospective incident case-referent study design nested in Västerbotten Intervention Program and the Northern Sweden MONICA study. METHODS: Commuting habits, occupational physical activity, leisure time physical activity and cardiovascular risk factors were assessed at baseline screening and compared in 583 cases (20% women) with a first myocardial infarction and 2098 matched referents. RESULTS: Regular car commuting was associated with increased risk of myocardial infarction versus commuting by bus, cycling or walking [odds ratio (OR) 1.74; 95% confidence interval (CI), 1.20-2.52] after multivariate adjustment. High versus low leisure time physical activity was associated with reduced risk of myocardial infarction (OR 0.69; 95% CI, 0.50-0.95) after adjustment for occupational physical activity and commuting activity, but the association was not statistically significant after further multivariate adjustment. After multivariate adjustment we observed a reduced risk for myocardial infarction in men with moderate (OR 0.70; 95% CI, 0.50-0.98) or high (OR 0.67; 95% CI, 0.42-1.08) versus low occupational physical activity. CONCLUSIONS: We found a clear association between car commuting and a first myocardial infarction and a corresponding inverse association with leisure time physical activity, while the impact of occupational physical activity on the risk of myocardial infarction was weaker.
PubMed ID
17143124 View in PubMed
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The experience of fatigue among elderly women with chronic heart failure.

https://arctichealth.org/en/permalink/ahliterature93648
Source
Eur J Cardiovasc Nurs. 2008 Dec;7(4):290-5
Publication Type
Article
Date
Dec-2008
Author
Hägglund Lena
Boman Kurt
Lundman Berit
Author Affiliation
Department of Nursing, Umeå University, Umeå, Sweden. lena.hagglund@nurs.umu.se
Source
Eur J Cardiovasc Nurs. 2008 Dec;7(4):290-5
Date
Dec-2008
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Adaptation, Psychological
Aged
Aged, 80 and over
Attitude to Health
Chronic Disease
Fatigue - etiology - prevention & control - psychology
Female
Health services needs and demand
Heart Failure - complications
Humans
Intention
Nursing Assessment
Nursing Methodology Research
Outpatients - psychology
Qualitative Research
Quality of Life - psychology
Questionnaires
Social Support
Sweden
Women - psychology
Abstract
BACKGROUND: Fatigue is a common and distressing symptom in chronic heart failure (CHF). Most of the current methods for evaluating patients' symptoms fail to consider the meaning or importance that these symptoms have for the patient. AIM: To illuminate the lived experience of fatigue among elderly women with CHF. METHOD: Narrative interviews were conducted with 10 women with CHF, aged 73-89 years. Interviews were analysed with qualitative content analysis. RESULTS: The findings are presented in two themes and five subthemes. The first theme, 'living with the loss of physical energy', was based on three subthemes describing the experience of fatigue: 'experiencing a substantial presence of feebleness and unfamiliar bodily sensations', 'experiencing unpredictable variations in physical ability', and 'needing help from others in daily life'. The second theme, 'striving for independence while being aware of deteriorating health', describes how the women managed their life situation; it was based on two subthemes: 'acknowledging one's remaining abilities', and 'being forced to adjust and struggle for independence'. CONCLUSIONS: Fatigue was experienced as loss of physical energy, leading to discrepancies between intention and capacity. The will to reduce dependency on others involved a daily struggle against fatigue.
PubMed ID
18262844 View in PubMed
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Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare.

https://arctichealth.org/en/permalink/ahliterature84391
Source
Eur J Cardiovasc Nurs. 2007 Sep;6(3):208-15
Publication Type
Article
Date
Sep-2007
Author
Hägglund Lena
Boman Kurt
Olofsson Mona
Brulin Christine
Author Affiliation
Department of Nursing, Umeå University, S-90187, Umeå, Sweden. lena.hagglund@nurs.umu.se
Source
Eur J Cardiovasc Nurs. 2007 Sep;6(3):208-15
Date
Sep-2007
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Attitude to Health
Case-Control Studies
Comorbidity
Fatigue - epidemiology - etiology - psychology
Female
Health status
Heart Failure - complications
Humans
Logistic Models
Male
Nursing Methodology Research
Primary Health Care
Quality of Life - psychology
Questionnaires
Risk factors
Severity of Illness Index
Sex Distribution
Sickness Impact Profile
Sweden - epidemiology
Abstract
BACKGROUND: Patients with heart failure (HF) in primary healthcare are in many respects not comparable to those in specialized care and the knowledge about different patient groups with and without HF is limited. AIMS: To compare fatigue and health-related quality of life (Hr-QoL) when adjusting for age, gender and social provision in patients with confirmed HF (n=49) to a group of patients with symptoms indicating HF but without HF (NHF, n=59) and to an age-and sex-matched control-group (n=40). METHOD: A questionnaire including the Multidimensional Fatigue Inventory, the SF-36, and the Social Provisions Scale was used. RESULTS: The average age in all groups was 78 years. Patients in the HF and NHF groups reported worse physical QoL and more general and physical fatigue than the control group. HF patients had worse general health than the NHF group. CONCLUSION: Elderly patients in primary healthcare with confirmed heart failure and patients with symptoms similar to heart failure perceived they had a significantly worse physical QoL and more general and physical fatigue than an age- and sex-matched control group. The similarities between the patient groups indicate the importance of the symptom experience for Hr-QoL.
PubMed ID
17092775 View in PubMed
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15 records – page 1 of 2.