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[8,500 patients in clinical trials. Experiences from a study in primary health care]

https://arctichealth.org/en/permalink/ahliterature54911
Source
Lakartidningen. 1994 Mar 23;91(12):1236-8
Publication Type
Article
Date
Mar-23-1994

Cardiac arrhythmias and stroke: increased risk in men with high frequency of atrial ectopic beats.

https://arctichealth.org/en/permalink/ahliterature54147
Source
Stroke. 2000 Dec;31(12):2925-9
Publication Type
Article
Date
Dec-2000
Author
G. Engström
B. Hedblad
S. Juul-Möller
P. Tydén
L. Janzon
Author Affiliation
Department of Community Medicine, Malmö University Hospital (Sweden). Gunnar.Engstrom@smi.mas.lu.se
Source
Stroke. 2000 Dec;31(12):2925-9
Date
Dec-2000
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmia - diagnosis - epidemiology
Atrial Premature Complexes - diagnosis - epidemiology
Cause of Death
Cerebrovascular Accident - diagnosis - epidemiology - mortality
Comorbidity
Drug Resistance, Multiple
Electrocardiography, Ambulatory - statistics & numerical data
Humans
Incidence
Male
Prospective Studies
Registries
Research Support, Non-U.S. Gov't
Risk factors
Sampling Studies
Sex Factors
Sweden - epidemiology
Abstract
BACKGROUND AND PURPOSE: With the exception of atrial fibrillation (AF), little scientific attention has been given the associations between cardiac arrhythmias and incidence of stroke. We sought to study whether atrial and ventricular arrhythmias assessed during a 24-hour ambulatory ECG registration are associated with incidence of stroke. METHODS: The population-based cohort "Men Born in 1914" was examined with 24-hour ambulatory ECG registrations at 68 years of age. Four hundred two men without previous myocardial infarction or stroke were included, and 236 of them had hypertension (>/=160/95 mm Hg or treatment). Fourteen-year rates of stroke (fatal and nonfatal) and all-cause mortality were updated from national and regional registers. Frequent or complex ventricular arrhythmias was defined as Lown class 2 to 5. A high frequency of atrial ectopic beats (AEB) was defined as the fifth quintile (ie, >/=218 AEB per 24 hours). RESULTS: Fifty-eight men suffered a first stroke during the follow-up. Stroke rates (per 1000 person-years) among men with AF (n=14), with frequent AEB (n=77), and without AF or frequent AEB (n=311) were 34.5, 19.5, and 11.6, respectively. The corresponding values among men with hypertension were 40.7, 32.3, and 14.7, respectively. Frequent AEB (compared with absence of AF and frequent AEB) was significantly associated with stroke among all men (relative risk=1.9; 95% CI, 1.02 to 3.4; P:=0.04) and among hypertensive men (relative risk=2.5; 95% CI, 1.3 to 4.8; P:=0.009) after adjustments for potential confounders. The increased stroke rates among men with Lown class 2 to 5 did not reach statistical significance. CONCLUSIONS: A high frequency of AEB is associated with an increased incidence of stroke.
Notes
Comment In: Stroke. 2001 Jun;32(6):1443-811387515
PubMed ID
11108750 View in PubMed
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[Cardiologic referrals and heart surgery in a health care region]

https://arctichealth.org/en/permalink/ahliterature74364
Source
Lakartidningen. 1981 Oct 14;78(42):3688-92
Publication Type
Article
Date
Oct-14-1981

Increased mortality in men with ST segment depression during 24 h ambulatory long-term ECG recording. Results from prospective population study 'Men born in 1914', from Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature46701
Source
Eur Heart J. 1989 Feb;10(2):149-58
Publication Type
Article
Date
Feb-1989
Author
B. Hedblad
S. Juul-Möller
K. Svensson
B S Hanson
S O Isacsson
L. Janzon
S E Lindell
B. Steen
B W Johansson
Author Affiliation
Department of Medicine, General Hospital, Malmö, Sweden.
Source
Eur Heart J. 1989 Feb;10(2):149-58
Date
Feb-1989
Language
English
Publication Type
Article
Keywords
Aged
Ambulatory Care
Cohort Studies
Coronary Disease - diagnosis - mortality - physiopathology
Electrocardiography
Heart rate
Humans
Male
Monitoring, Physiologic
Myocardial Infarction - epidemiology
Prospective Studies
Research Support, Non-U.S. Gov't
Risk factors
Sweden
Time Factors
Abstract
'Men born in 1914', from Malmö, Sweden, is a cohort study of the morbidity and mortality of cardiovascular diseases among 68-year-old men in an urban population. Ambulatory long-term ECG recording was part of the health examination that these men were invited to undergo in 1982. Five hundred attended (80.5%) of the 621 invited. Ninety-eight of the 394 men in whom the ECG recording was technically satisfactory had at least one episode with horizontal or downsloping ST segment depression greater than or equal to 0.1 mV. The median total duration of ST segment depression was 135 min. 90% of these episodes were not preceeded by any increase in heart rate. In only eight of the 47 men who reported an occurrence of chest symptoms during the recording period did ST segment depression and chest symptoms occur simultaneously. 43 months after the health examination, 33 (8.4%) men had died. The mortality in men without ST segment depression and without any history of coronary heart disease was 6.5%. The incidence of fatal and non-fatal myocardial infarction in men without ST depression greater than or equal to 0.1 mV and without a history of IHD was 2.3%. Men with ST depression greater than or equal to 0.1 mV in comparison with this group had a 4.4 times greater relative risk. The risk in men with both ST segment depression greater than or equal to 0.1 mV and history of coronary heart disease was 16.0 times greater. This study shows that asymptomatic ST segment depression is a frequent finding in elderly men. The occurrence of asymptomatic ST segment depression is associated with an increased cardiovascular mortality. This increased mortality is independent of a history compatible with angina pectoris or previous myocardial infarction.
PubMed ID
2924784 View in PubMed
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Increased occurrence of arrhythmias in men with ischaemic type ST-segment depression during long-term ECG recording. Prognostic impact on ischaemic heart disease: results from the prospective population study 'Men born in 1914', Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature46640
Source
J Intern Med. 1991 Aug;230(2):143-9
Publication Type
Article
Date
Aug-1991
Author
S. Juul-Möller
B. Hedblad
L. Janzon
B W Johansson
Author Affiliation
Department of Medicine, Lund University, Malmö General Hospital, Sweden.
Source
J Intern Med. 1991 Aug;230(2):143-9
Date
Aug-1991
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Arrhythmia - complications - epidemiology - mortality
Coronary Disease - complications - mortality - physiopathology
Electrocardiography, Ambulatory
Humans
Incidence
Male
Prevalence
Prognosis
Proportional Hazards Models
Prospective Studies
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Abstract
The objective of this long-term ECG (LTER) study in 394 68-year-old men, selected at random from the general population of Malmö, Sweden, was to determine the prevalence and occurrence of cardiac arrhythmias and their impact on morbidity and mortality from IHD. According to Lown classification, 29.4% (116 men) had ventricular arrhythmia (VA) group 4-5. Serious ventricular arrhythmia (Lown group 4-5) was more common in men with asymptomatic ischaemic type ST-segment depression (STD) than in those without it (37.8% vs. 26.7%: P less than 0.05). During the mean follow-up period of 53.1 months there were seven IHD deaths (6%) among the 116 patients with VA, Lown 4-5, and nine IHD deaths (3.2%) among the 278 patients without serious VA, Lown 0-3, (P = 0.26). Six and three of these deaths, respectively, were considered to be sudden (P = 0.022). The increased cardiac event rate (fatal or non-fatal MI or deaths due to chronic IHD) associated with a serious ventricular arrhythmia disappeared when history of IHD at baseline and occurrence of STD during LTER were taken into account. The study did not provide any evidence to suggest that ventricular arrhythmia was triggered by myocardial ischaemia. Five of 9 (56%) deaths due to IHD in men with STD occurred among the 38% (37/98) of patients who belonged to Lown class 4-5. It is concluded that the prognostic information derived from LTER can be improved by combined monitoring of STD and ventricular arrhythmias.
PubMed ID
1865166 View in PubMed
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Influence of social support on cardiac event rate in men with ischaemic type ST segment depression during ambulatory 24-h long-term ECG recording. The prospective population study 'Men born in 1914', Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature46619
Source
Eur Heart J. 1992 Apr;13(4):433-9
Publication Type
Article
Date
Apr-1992
Author
B. Hedblad
P O Ostergren
B S Hanson
L. Janzon
B W Johansson
S. Juul-Möller
Author Affiliation
Department of Community Health Sciences, Lund University, Malmö General Hospital, Sweden.
Source
Eur Heart J. 1992 Apr;13(4):433-9
Date
Apr-1992
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Electrocardiography, Ambulatory - psychology
Follow-Up Studies
Humans
Male
Myocardial Infarction - mortality - psychology
Prospective Studies
Research Support, Non-U.S. Gov't
Risk factors
Social Environment
Social Support
Survival Rate
Sweden
Abstract
Three-hundred and ninety-four 68-year-old men, representing 60.3% of a cohort of men born in 1914, were examined with ambulatory ECG during 24 h in 1982-83. Ninety-eight (24.8%) men had one or more episodes of ischaemic type ST segment depression (greater than or equal to 0.10 mV), 79 of whom had no history of previous ischaemic heart disease (IHD). During 63 months follow-up, 17 of the 98 suffered a cardiac event, i.e. fatal or non-fatal myocardial infarction (MI) or death due to chronic IHD. The objective of this study was to assess the influence of psychosocial factors, such as social network and social support, on cardiac event rate in men with ischaemic ST segment depression. A higher risk was found among men with little material and informational support (i.e. access to practical services and material resources and access to guidance, advice and information (crude relative risk 4.8; 95% CI; 1.6-14.8) and men with low availability of emotional support (i.e. opportunity for care, encouragement of personal value and feelings of confidence and trust) (crude relative risk 4.3; 95% CI: 1.4-13.3). This association was independent of history of IHD and other known risk factors for myocardial infarction (MI).
Notes
Erratum In: Eur Heart J 1993 Aug;14(8):1152
PubMed ID
1600978 View in PubMed
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Occurrence and prognostic significance of ventricular arrhythmia is related to pulmonary function: a study from "men born in 1914," Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature53902
Source
Circulation. 2001 Jun 26;103(25):3086-91
Publication Type
Article
Date
Jun-26-2001
Author
G. Engström
P. Wollmer
B. Hedblad
S. Juul-Möller
S. Valind
L. Janzon
Author Affiliation
Departments of Community Medicine, Clinical Physiology, Malmö University Hospital, Malmö, Sweden. Gunnar.Engstrom@smi.mas.lu.se
Source
Circulation. 2001 Jun 26;103(25):3086-91
Date
Jun-26-2001
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmia - physiopathology
Follow-Up Studies
Humans
Lung - physiopathology
Male
Myocardial Infarction - mortality - pathology - physiopathology
Prognosis
Research Support, Non-U.S. Gov't
Respiratory Function Tests
Risk factors
Survival Rate
Sweden
Ventricular Dysfunction, Left - physiopathology
Abstract
BACKGROUND: Reduced lung function has been associated with increased rates of myocardial infarction. Whether the occurrence and prognostic significance of ventricular arrhythmia is related to lung function is largely unknown. METHODS AND RESULTS: We performed a population-based study of 68-year-old men without a history of stroke or myocardial infarction; 402 men participated. Mortality and coronary events (fatal or nonfatal) were studied in relation to ventricular arrhythmia during 24 hours, percentage of the predicted forced expiratory volume (FEV1(%pred)), vital capacity (VC(%pred)), and the FEV/VC ratio. During 14 years of follow-up, 181 men died and 87 experienced a coronary event. Occurrence of frequent or complex ventricular arrhythmia (Lown class 2 to 5) was significantly and inversely associated with FEV1(%pred). Men with Lown class 2 to 5 and a low FEV1(%pred) (below median) had significantly higher mortality (71.5 versus 26.8 per 1000 person-years; P
PubMed ID
11425773 View in PubMed
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Sotalol versus quinidine for the maintenance of sinus rhythm after direct current conversion of atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature12119
Source
Circulation. 1990 Dec;82(6):1932-9
Publication Type
Article
Date
Dec-1990
Author
S. Juul-Möller
N. Edvardsson
N. Rehnqvist-Ahlberg
Author Affiliation
Malmö General Hospital, Lund University, Stockholm, Sweden.
Source
Circulation. 1990 Dec;82(6):1932-9
Date
Dec-1990
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Arrhythmia - chemically induced
Atrial Fibrillation - mortality - physiopathology - therapy
Death, Sudden
Dose-Response Relationship, Drug
Electric Countershock
Electrocardiography
Heart Rate - drug effects
Humans
Male
Middle Aged
Prognosis
Quinidine - adverse effects - therapeutic use
Recurrence
Sotalol - adverse effects - therapeutic use
Abstract
This open, parallel-group study compares quinidine and sotalol treatment for maintenance of sinus rhythm after direct current conversion of patients with chronic atrial fibrillation. The patients from 15 centers in Sweden were randomized to sotalol (98 patients) or quinidine (85 patients) after 2 hours of sinus rhythm after direct current conversion. According to primary efficacy assessment, 52% of the patients in the sotalol group and 48% of the patients in the quinidine group remained in sinus rhythm during the following 6-month treatment period (NS). Furthermore, 34% of the patients treated with sotalol and 22% of the patients treated with quinidine relapsed into atrial fibrillation (NS). Heart rate after relapsing into atrial fibrillation was higher in the patients treated with quinidine (109 beats/min) than in the patients treated with sotalol (78 beats/min, p less than 0.001). Patients treated with sotalol were found to be less symptomatic at the time of relapse compared with relapsing patients in the quinidine group. In terms of safety, more patients were withdrawn from quinidine than from sotalol treatment (26% vs. 11%, p less than 0.05), and sotalol was generally better tolerated than quinidine. Twenty-eight percent of the patients treated with sotalol and 50% of the patients treated with quinidine reported side effects (p less than 0.01). The difference was primarily a result of early (within the first month of treatment) gastrointestinal and skin side effects in the group of patients treated with quinidine.(ABSTRACT TRUNCATED AT 250 WORDS)
Notes
Comment In: Circulation. 1990 Dec;82(6):2248-502146993
PubMed ID
2242519 View in PubMed
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Survival and incidence of myocardial infarction in men with ambulatory ECG-detected frequent and complex ventricular arrhythmias. 10 year follow-up of the 'Men born 1914' study in Malmö, Sweden.

https://arctichealth.org/en/permalink/ahliterature46379
Source
Eur Heart J. 1997 Nov;18(11):1787-95
Publication Type
Article
Date
Nov-1997
Author
B. Hedblad
L. Janzon
B W Johansson
S. Juul-Möller
Author Affiliation
Department of Community Medicine, Malmö University Hospital, Lund University, Sweden.
Source
Eur Heart J. 1997 Nov;18(11):1787-95
Date
Nov-1997
Language
English
Publication Type
Article
Keywords
Aged
Cohort Studies
Electrocardiography, Ambulatory
Health status
Humans
Male
Multivariate Analysis
Myocardial Infarction - epidemiology - mortality
Prognosis
Research Support, Non-U.S. Gov't
Risk factors
Sweden - epidemiology
Tachycardia, Ventricular - complications - diagnosis
Ventricular Premature Complexes - complications - diagnosis
Abstract
AIM: To assess to what extent do frequent or complex ventricular arrhythmias, detected during 24 h ambulatory electrocardiographic recording (ECG), influence prognosis with regard to survival and incidence of ischaemic heart disease. METHODS AND RESULTS: The study subjects were the 456 randomly selected men born in 1914, the population-based cohort study of 1982-83, in Malmö, Sweden. The main outcome measures were total mortality and incidence of cardiac event (myocardial infarction and death from ischaemic heart disease). Frequent or complex ventricular arrhythmias (Lown classes 2-5) were detected in 49% of the men with (n = 77), and in 35% of those without, a history of myocardial infarction or angina pectoris at baseline, P = 0.019. Independent of clinically evident coronary artery disease at baseline, and after adjustment for traditional atherosclerotic risk factors and use of digitalis or beta-blocker therapy, frequent or complex ventricular arrhythmias were associated with an increased mortality from ischaemic heart disease (relative risk (RR), 2.1; 95% confidence interval (CI), 1.2-3.9) and an increased cardiac event rate (RR, 1.6; 95% CI, 1.0-2.5)). Men free from both ischaemic-type ST depression and frequent or complex ventricular arrhythmias (used as the control group) had the lowest ischaemic heart disease death rate, 5.9 per 1000 person-years. The combination of ST depression and frequent or complex ventricular arrhythmias was associated with an ischaemic heart disease death rate of 20.9 per 1000 person-years. The cardiac event rate in these two groups was 15.6 and 76.1 per 1000 person-years, respectively (adjusted RR, 2.3; CI, 1.1-4.6). CONCLUSIONS: In elderly men without a history of myocardial infarction and angina pectoris, frequent or complex ventricular arrhythmias during ambulatory ECG recording is associated with an increased incidence of myocardial infarction and mortality. Men who, during ambulatory ECG recording, also demonstrate ST-segment depression have an even less favourable prognosis.
Notes
Comment In: Eur Heart J. 1997 Nov;18(11):1690-19402438
PubMed ID
9402454 View in PubMed
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Ventricular arrhythmias during 24-h ambulatory ECG recording: incidence, risk factors and prognosis in men with and without a history of cardiovascular disease.

https://arctichealth.org/en/permalink/ahliterature10562
Source
J Intern Med. 1999 Oct;246(4):363-72
Publication Type
Article
Date
Oct-1999
Author
G. Engström
B. Hedblad
L. Janzon
S. Juul-Möller
Author Affiliation
Department of Community Health Medicine, Malmö University, Sweden. Gunnar.Engstrom@smi.mas.lu.se
Source
J Intern Med. 1999 Oct;246(4):363-72
Date
Oct-1999
Language
English
Publication Type
Article
Keywords
Aged
Arrhythmia - diagnosis - epidemiology - mortality
Comorbidity
Coronary Disease - epidemiology
Electrocardiography, Ambulatory
Humans
Incidence
Male
Myocardial Ischemia - mortality
Prognosis
Proportional Hazards Models
Prospective Studies
Research Support, Non-U.S. Gov't
Risk assessment
Risk factors
Survival Analysis
Sweden - epidemiology
Abstract
OBJECTIVE: To study incidence, prognosis and risk factors of ventricular arrhythmias in men with and without asymptomatic non-invasively detected cardiovascular disease (CVD). DESIGN: Prospective cohort study with 11 years' follow-up. The subjects went through 24-h ambulatory electrocardiographic (ECG) registrations and non-invasive examinations of leg and carotid arteries at the baseline examination. SETTING: Malmö, Sweden. SUBJECTS: Four hundred and forty-three randomly selected 68-year-old men. MAIN OUTCOME MEASURES: Mortality and cardiac event rates during an 11-year period. RESULTS: Frequent or complex arrhythmias (Lown class 2-5) were common in men both with and without CVD. However, the associated prognoses were different. In men with CVD, frequent or complex arrhythmias were associated with increased cardiac event rates (P = 0.001) and increased mortality (P = 0.054). This pattern was also found in men with asymptomatic leg and carotid artery disease, although the frequency of arrhythmia in Lown class 2-5 was similar to that in men without CVD. Men with angina pectoris or previous myocardial infarction in combination with leg or carotid artery disease had the most arrhythmias and the worst prognosis. No relationship between frequent or complex arrhythmias and mortality or cardiac events was found in men without CVD. In a logistic regression, smoking and diabetes mellitus were significant and independent determinants of frequent or complex arrhythmias in men with CVD. High alcohol consumption was associated with arrhythmias in men without CVD. CONCLUSION: Ambulatory ECG recording is a feasible method to improve risk assessment in men with CVD. In this group, frequent or complex arrhythmias are associated with smoking and diabetes mellitus.
PubMed ID
10583707 View in PubMed
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10 records – page 1 of 1.