13 results on '"Gudnadottir, Gudny"'
Search Results
2. End‐of‐life decision‐making in critically ill old patients with and without coronavirus disease 2019.
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Syrous, Alma Nordenskjöld, Gudnadottir, Gudny, Oras, Jonatan, Ferguson, Thalia, Lilja, David, Odenstedt Herges, Helena, Larsson, Emma, and Block, Linda
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COVID-19 , *OLDER patients , *CRITICALLY ill , *INTENSIVE care units , *ETHICAL decision making , *CORONAVIRUS diseases - Abstract
Background: There are few studies on the differences in end‐of‐life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID‐19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life‐sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID‐19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit. Methods: This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non‐invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals. Results: There were 394 patients included in this study, 131 in the non‐COVID‐19 group and 263 in the COVID‐19 group. For the non‐COVID‐19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life‐sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03–1.19) p =.009 and 1.06 (1.03–1.10) p <.001, respectively. For the COVID‐19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life‐sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life‐sustaining treatments, with an odds ratio of 1.26 (1.07–1.49), p =.006. Conclusion: Decisions to withdraw or withhold life‐sustaining treatments were based on other variables for the critically ill COVID‐19 cohort compared to those for the critically ill non‐COVID‐19 cohort. Further studies are warranted to forge a common path for ethical end‐of‐life decision‐making in critically ill patients. [ABSTRACT FROM AUTHOR]
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- 2024
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3. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
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Ekerstad, Niklas, Javadzadeh, Dariush, Alexander, Karen P., Bergström, Olle, Eurenius, Lars, Fredrikson, Mats, Gudnadottir, Gudny, Held, Claes, Ängerud, Karin Hellström, Jahjah, Radwan, Jernberg, Tomas, Mattsson, Ewa, Melander, Kjell, Mellbin, Linda, Ohlsson, Monica, Ravn-Fischer, Annica, Svennberg, Lars, Yndigegn, Troels, Alfredsson, Joakim, Ekerstad, Niklas, Javadzadeh, Dariush, Alexander, Karen P., Bergström, Olle, Eurenius, Lars, Fredrikson, Mats, Gudnadottir, Gudny, Held, Claes, Ängerud, Karin Hellström, Jahjah, Radwan, Jernberg, Tomas, Mattsson, Ewa, Melander, Kjell, Mellbin, Linda, Ohlsson, Monica, Ravn-Fischer, Annica, Svennberg, Lars, Yndigegn, Troels, and Alfredsson, Joakim
- Abstract
Aims Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI. Methods and results An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1-3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5-9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30-4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI 1.41-3.02). Conclusion Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.
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- 2022
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4. Gender differences in coronary angiography, subsequent interventions, and outcomes among patients with acute coronary syndromes
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Gudnadottir, Gudny Stella, Andersen, Karl, Thrainsdottir, Inga Sigurros, James, Stefan Karl, Lagerqvist, Bo, and Gudnason, Thorarinn
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- 2017
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5. Multimorbidity and readmissions in older people with acute coronary syndromes
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Gudnadottir, Gudny Stella, primary, Gudnason, Thorarinn, additional, Wilhelmson, Katarina, additional, and Ravn-Fischer, Annica, additional
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- 2022
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6. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
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Ekerstad, Niklas, primary, Javadzadeh, Dariush, additional, Alexander, Karen P, additional, Bergström, Olle, additional, Eurenius, Lars, additional, Fredrikson, Mats, additional, Gudnadottir, Gudny, additional, Held, Claes, additional, Ängerud, Karin Hellström, additional, Jahjah, Radwan, additional, Jernberg, Tomas, additional, Mattsson, Ewa, additional, Melander, Kjell, additional, Mellbin, Linda, additional, Ohlsson, Monica, additional, Ravn-Fischer, Annica, additional, Svennberg, Lars, additional, Yndigegn, Troels, additional, and Alfredsson, Joakim, additional
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- 2021
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7. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction
- Author
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Ekerstad, Niklas, Javadzadeh, Dariush, Alexander, Karen P, Bergström, Olle, Eurenius, Lars, Fredrikson, Mats, Gudnadottir, Gudny, Held, Claes, Ängerud, Karin Hellström, Jahjah, Radwan, Jernberg, Tomas, Mattsson, Ewa, Melander, Kjell, Mellbin, Linda, Ohlsson, Monica, Ravn-Fischer, Annica, Svennberg, Lars, Yndigegn, Troels, Alfredsson, Joakim, Ekerstad, Niklas, Javadzadeh, Dariush, Alexander, Karen P, Bergström, Olle, Eurenius, Lars, Fredrikson, Mats, Gudnadottir, Gudny, Held, Claes, Ängerud, Karin Hellström, Jahjah, Radwan, Jernberg, Tomas, Mattsson, Ewa, Melander, Kjell, Mellbin, Linda, Ohlsson, Monica, Ravn-Fischer, Annica, Svennberg, Lars, Yndigegn, Troels, and Alfredsson, Joakim
- Abstract
Aims: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI. Methods and Results: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1-3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5-9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30-4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI 1.41-3.02). Conclusion: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability.
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- 2021
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8. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acutemyocardial infarction.
- Author
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Ekerstad, Niklas, Javadzadeh, Dariush, Alexander, Karen P., Bergström, Olle, Eurenius, Lars, Fredrikson, Mats, Gudnadottir, Gudny, Held, Claes, Hellström Ängerud, Karin, Jahjah, Radwan, Jernberg, Tomas, Mattsson, Ewa, Melander, Kjell, Mellbin, Linda, Ohlsson, Monica, Ravn-Fischer, Annica, Svennberg, Lars, Yndigegn, Troels, and Alfredsson, Joakim
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- 2022
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9. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management
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Gudnadottir, Gudny Stella, James, Stefan, Andersen, Karl, Lagerqvist, Bo, Thrainsdottir, Inga Sigurros, Ravn-Fischer, Annica, Varenhorst, Christoph, Gudnason, Thorarinn, Gudnadottir, Gudny Stella, James, Stefan, Andersen, Karl, Lagerqvist, Bo, Thrainsdottir, Inga Sigurros, Ravn-Fischer, Annica, Varenhorst, Christoph, and Gudnason, Thorarinn
- Abstract
Background: The aim of this study was to assess one-year outcomes of invasive and non-invasive strategies in ST-elevation myocardial infarction (STEMI) among multimorbid older people with complex health needs. Methods: We included patients, registered between 2006 and 2013 in the SWEDEHEART registry, who were 70 years old or older with STEMI, had multimorbidily and complex health needs and were discharged alive. The one-year outcomes of patients who underwent invasive strategy (examined with coronary angiography <= 14 days) were compared to those who did not. The primary event was a composite of all-cause death, admission due to new acute coronary syndrome, stroke or transient ischemic attack. Results: We identified patients, and 1089 were managed invasively and 570 non-invasively. The mean age was 79 years and 83 years in the 2 groups, respectively. After multivariable adjustment for baseline differences between the groups, including propensity scores, the primary event occurred in 31% of patients in the invasive group and 55% in the non-invasive group, adjusted hazard ratio (95% confidence intervals): 0.67 (0.54-0.83). One-year mortality was 18% in the invasive group and 45% in the non-invasive group, adjusted hazard ratio 0.51 (0.39-0.65). Conclusions: Multimorbid older people with complex health needs and STEMI had high rates of new ischemic events and death. In this cohort of older, high risk STEMI patients, an invasive strategy was associated with lower event rates. Randomized studies are needed to clarify whether these high risk patients who might benefit from invasive care are being managed too conservatively.
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- 2019
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10. Beyond Randomized Clinical Trials: Multi-morbidity, Age and Gender Impact on the Treatment of Coronary Artery Disease
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Gudnadottir, Gudny Stella, Þórarinn Guðnason, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, and University of Iceland
- Subjects
Aged, 80 and over ,Revascularizations ,Aldraðir ,Kransæðasjúkdómar ,Invasive strategy ,Gender ,Kynferði ,Coronary Artery Disease ,Coronary Angiography ,Patient Readmission ,Catheterization ,Percutaneous Coronary Intervention ,Fjölveikindi ,SWEDEHEART ,Doktorsritgerðir ,Hospital Mortality ,Registries ,Acute Coronary Syndrome ,Coronary Artery Bypass ,Propensity Score ,Multi-morbid older people with complex health needs - Abstract
Aims: The purpose of this doctoral research is to investigate the treatment of coronary artery disease in groups that are underrepresented in randomized clinical trials using the SWEDEHEART registry. The more specific aims are: i) to compare the outcomes of coronary angiographies (CA) and percutaneous coronary interventions (PCI) in Iceland, with the outcomes in Sweden; ii) to compare the revascularization rate and complication rate in women and men with acute coronary syndromes (ACS); iii) to compare the outcomes of an invasive strategy to that of a non-invasive strategy in older people with multi-morbidity, complex health needs and ACS; and finally, iv) to study catheterizations in nonagenarians. Methods: Data originated from SWEDEHEART, a collection of cardiology registries used in Iceland and Sweden. i) In Paper I, all CA and PCI performed in Iceland and Sweden in 2007 were compared. ii) Paper II analyzed all consecutive CA between 2007-2011 due to ACS to explore gender differences in revascularization, in-hospital complications and 30-day mortality. iii) Paper III and unpublished data compared one-year outcome following invasive strategy in patients ≥ 70 years with multi-morbidity and complex health needs that were admitted in 2006-2013, due to ACS, to the outcome of a non-invasive strategy. iv) Paper IV enrolled all consecutive nonagenarians undergoing CA or PCI during 2006-2014 and examined indications, treatment decisions and outcomes. Results: i) More CA were performed per capita in Iceland in 2007 than in Sweden, but the overall PCI rate was similar. Stable coronary artery disease was more common as an indication for both CA and PCI in Iceland than in Sweden. The practice of PCI was largely similar in the two countries. One of the differences was the use of radial access; it was used in 1% of catheterizations in Iceland compared to 33% in Sweden. After PCI, the complication rate in the coronary care unit was 8% and 5%, in Iceland and Sweden respectively. ii) In total 34,120 CAs ±PCIs were performed in women and 72,761 in men during the study period. No significant stenosis was found in 27% of women and 12% of men. Women with one-vessel disease were less likely to undergo PCI compared to men, 94% and 97% for those with ST-elevation myocardial infarction (STEMI) and 82 and 86% respectively for those with non-ST elevation ACS (NSTE-ACS). Amongst patients with three-vessel disease or left main stem disease and NSTE-ACS, women were more likely to undergo PCI, (adjusted OR 1.12 ([1.05-1.20]) but less likely to undergo coronary artery bypass graft (adjusted OR 0.83 [0.77-0.90]). There was no gender difference in 30-day mortality (3% vs. 2%, adjusted OR 0.97 [0.84-1.05]), with similar results in those with one-vessel disease and those with three-vessel diseases and/or left main stem stenosis. iii) Multi-morbid patients with complex health needs and ACS registered in SWEDEHEART were 10,825 (2,004 with STEMI and 8,821 with NSTE-ACS). After STEMI, patients in the invasive group had a significantly lower risk of one-year primary event (death, ACS, stroke or transient ischemic attack [TIA]), compared to those who were in the non-invasive group, 31% and 55%, (risk-adjusted hazards ratio [HR] 0.73 [95% CI 0.63-0.80]). The risk of readmissions due to bleeding events was not increased. Patients with NSTE-ACS could not be matched with propensity scores. iv) A total of 1,692 nonagenarians underwent catheterizations, of whom 87% had at least one significant stenosis and 62% had multi-vessel disease. The indication for PCI vas ACS in 94%. Both in-hospital complication rate after PCI and in-hospital mortality were 8%. Conclusion: Groups that are underrepresented in randomized clinical trials can be studied using SWEDEHEART. Women are less often treated invasively compared to men, but this does not affect their mortality. Multi-morbid older people with complex health needs and STEMI have a high risk of new ischemic events and, in concordance with randomized studies in younger healthier patients, benefit from an invasive strategy. Most nonagenarians undergoing CAs have multi-vessel disease and a high level of lesion complexity, which, along with multi-morbidity and mainly acute indications, might partly explain both the in-hospital mortality and complication rate., Tilgangur: Konur og fjölveikir aldraðir með kransæðasjúkdóma bera oft skarðan hlut frá borði við framkvæmd slembirannsókna. Tilgangur þessarar doktorsrannsóknar er að rannsaka þessa hópa með gögnum úr gæðaskránni SWEDEHEART. Nánari markmið eru: i) að bera saman árangur kransæða– þræðinga (KÞ) og kransæðavíkkana (KV) á Íslandi og í Svíþjóð; ii) að bera saman líkur kvenna og karla með brátt kransæðaheilkenni (BKH) á að fara í KV og skoða hvort munur er á fylgikvillum og dánartíðni eftir kyni; iii) að bera saman afdrif fjölveikra aldraðra sem fengu ífarandi meðferð við BKH við afdrif þeirra sem fengu eingöngu lyfjameðferð og iv) að skoða árangur og fylgikvilla KÞ og KV hjá einstaklingum á tíræðisaldri. Aðferðir: Öll gögn komu úr SWEDEHEART sem er safn nokkurra gæðaskráa yfir hjartasjúkdóma. i) Í grein eitt var gerður samanburður á öllum KÞ og KV sem voru framkvæmdar á Íslandi og í Svíþjóð árið 2007. ii) Í grein tvö voru skoðaðar allar KÞ á Íslandi og í Svíþjóð framkvæmdar á árunum 2007-2011. Tilvísanir kvenna í KV og opna kransæðaaðgerð voru bornar saman við tilvísanir karla. Fylgikvillar og 30 daga dánartíðni kynjanna voru borin saman. iii) Í grein þrjú og óbirtu efni var ífarandi meðferð borin saman við lyfjameðferð hjá fjölveikum einstaklingum sem voru sjötugir eða eldri og fengu BKH á árunum 2006-2013 í Svíþjóð og voru skráðir í SWEDEHEART. iv) Í grein fjögur var metinn fjöldi, ábendingar, árangur og fylgikvillar eftir KÞ og KV hjá öllum einstaklingum á tíræðisaldri sem fóru í slíkar aðgerðir á árunum 2006-2014 í Svíþjóð. Niðurstöður: i) Fjöldi KÞ á mann var hærri á Íslandi en í Svíþjóð en fjöldi KV var sá sami. Stöðug hjartaöng var algengari sem ábending á Íslandi en í Svíþjóð. Munur var á áhættuþáttum og ábendingum sjúklinga á Íslandi og í Svíþjóð. KV voru framkvæmdar á nokkuð svipaðan hátt. Einn munur var að þrætt var í gegnum úlnliðsslagæð í 1% tilvika á Íslandi en í 33% tilvika í Svíþjóð (p, Landspitali University Hospital Science Fund, The Memorial Fund of Helga Jónsdóttir and Sigurliði Kristjánsson, The Gothenburg Medical Society and a doctoral grant from the University of Iceland Research Fund.
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- 2018
11. Outcomes after STEMI in old multimorbid patients with complex health needs and the effect of invasive management
- Author
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Gudnadottir, Gudny Stella, primary, James, Stefan Karl, additional, Andersen, Karl, additional, Lagerqvist, Bo, additional, Thrainsdottir, Inga Sigurros, additional, Ravn-Fischer, Annica, additional, Varenhorst, Christoph, additional, and Gudnason, Thorarinn, additional
- Published
- 2019
- Full Text
- View/download PDF
12. Clinical Frailty Scale classes are independently associated with 6-month mortality for patients after acute myocardial infarction.
- Author
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Ekerstad N, Javadzadeh D, Alexander KP, Bergström O, Eurenius L, Fredrikson M, Gudnadottir G, Held C, Ängerud KH, Jahjah R, Jernberg T, Mattsson E, Melander K, Mellbin L, Ohlsson M, Ravn-Fischer A, Svennberg L, Yndigegn T, and Alfredsson J
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- Aged, Frail Elderly, Humans, Prognosis, Prospective Studies, Retrospective Studies, Frailty, Myocardial Infarction
- Abstract
Aims: Data on the prognostic value of frailty to guide clinical decision-making for patients with myocardial infarction (MI) are scarce. To analyse the association between frailty classification, treatment patterns, in-hospital outcomes, and 6-month mortality in a large population of patients with MI., Methods and Results: An observational, multicentre study with a retrospective analysis of prospectively collected data using the SWEDEHEART registry. In total, 3381 MI patients with a level of frailty assessed using the Clinical Frailty Scale (CFS-9) were included. Of these patients, 2509 (74.2%) were classified as non-vulnerable non-frail (CFS 1-3), 446 (13.2%) were vulnerable non-frail (CFS 4), and 426 (12.6%) were frail (CFS 5-9). Frailty and non-frail vulnerability were associated with worse in-hospital outcomes compared with non-frailty, i.e. higher rates of mortality (13.4% vs. 4.0% vs. 1.8%), cardiogenic shock (4.7% vs. 2.5% vs. 1.9%), and major bleeding (4.5% vs. 2.7% vs. 1.1%) (all P < 0.001), and less frequent use of evidence-based therapies. In Cox regression analyses, frailty was strongly and independently associated with 6-month mortality compared with non-frailty, after adjustment for age, sex, the GRACE risk score components, and other potential risk factors [hazard ratio (HR) 3.32, 95% confidence interval (CI) 2.30-4.79]. A similar pattern was seen for vulnerable non-frail patients (fully adjusted HR 2.07, 95% CI 1.41-3.02)., Conclusion: Frailty assessed with the CFS was independently and strongly associated with all-cause 6-month mortality, also after comprehensive adjustment for baseline differences in other risk factors. Similarly, non-frail vulnerability was independently associated with higher mortality compared with those with preserved functional ability., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2022
- Full Text
- View/download PDF
13. [Evaluation of thromboprophylactic therapy at Landspítali - The National University Hospital of Iceland; a cross-sectional study on acute wards].
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Kristjansdottir HL, Gudnadottir GS, Fjalldal SB, Thorarinsdottir HR, Bjarnason A, and Einarsson O
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- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Guideline Adherence, Hospital Units, Humans, Iceland, Male, Middle Aged, Patient Safety, Practice Guidelines as Topic, Treatment Outcome, Fibrinolytic Agents administration & dosage, Hospitals, University standards, Practice Patterns, Physicians' standards, Venous Thromboembolism prevention & control
- Abstract
Objective: Venous thromboembolic disease is a serious and often fatal complication following hospital admission. Studies show that thromboprophylactic therapy for this condition is often underutilized. The aim of this study was to evaluate the performance of thromboprophylactic therapy at Landspítali - The University Hospital of Iceland in adult patients admitted to acute wards., Methods and Materials: On 2 December 2009 hospital charts of admitted patients on acute wards were reviewed and assessed for appropriate thromboprophylactic treatment according to the 2008 guidelines from The American College of Chest Physicians. The results were compared to those of other countries from the multinational Endorse study from 2008., Results: 251 patient were included of whom 47% were considered at risk for venous thromboembolic disease. Of those 57% received appropriate thromboprophylactic treatment or 78% of surgical and 26% of medical patients., Conclusions: Adherence to clinical guidelines for thromboprophylactic treatment at surgical wards of Landspítali - The National University Hospital of Iceland was good and well above the average compared to the results of the Endorse study. Performance on the medical wards was on the other hand below average. Our results show that application of thromoboprophylactic treatment at Landspítali could be improved and thereby enhance patient safety.
- Published
- 2012
- Full Text
- View/download PDF
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