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The Norwegian aquaculture industry faces several challenges. One such challenge is the prevalence of salmon lice, which adversely affect both wild and farmed salmon. At the core of the current regulatory regime are mandatory lice counts that are manually obtained from fish farms. Thus, the objective of this article was to present knowledge regarding counting practices, fish farm employees’ perceptions of the strengths and weaknesses of these practices, and possible implications for representativity. Interviews comprised the main method of data collection for this research. The results addressed 3 phases of the lice-counting process: sampling, sedation, and counting. The organizational factors that may influence counting, such as training, time, and manning, are also described. Our results show variations in the choice of equipment used for different stages of the lice-counting process, including sampling and crowding time. In the interviews, employees discussed the challenges inherent in identifying different lice species and the associated developmental stages of the lice. The findings presented in this paper demonstrate the importance of documenting actual practices at the fish farms in order to optimize lice counts and should be considered by the aquaculture industry, technology developers, and industry regulators in the future.

Aquaculture is an industry that has developed rapidly over the past decades. Despite several hazards in the operations, emergency preparedness is not at the same level as in the rest of the maritime industry. This paper highlights some possibilities to increase the aquaculture industry’s coastal emergency preparedness. This paper is the result of the innovation project “Coastal Emergency Preparedness” funded by the Norwegian Research Council and industry partners. The aquaculture industry must establish its own emergency preparedness. In this paper, the innovation of a fleet of emergency preparedness vessels along the coastline, which could fill the gaps in emergency preparedness, is presented. The vessels would be of varied sizes, with different equipment and response times, and could assist the aquaculture industry during local incidents or large‐scale ones, such as algae blooms or winter storms, that affect many sites at the same time. Each production zone would need its own dedicated fleet due to biosecurity regulations. The emergency preparedness vessel fleet would be led by an on‐scene commander. The fleet would deal with oil spills and tasks such as emergency towing, firefighting, rescue of people, recapturing of fish, silage making, algae detection, and diving missions. With such a vessel fleet, small and large aquaculture companies could increase their emergency preparedness with a common strategy and shared resources. [ABSTRACT FROM AUTHOR]

Mathematical models of cardiac electro-mechanics typically consist of three tightly coupled parts: systems of ordinary differential equations describing electro-chemical reactions and cross-bridge dynamics in the muscle cells, a system of partial differential equations modelling the propagation of the electrical activation through the tissue and a nonlinear elasticity problem describing the mechanical deformations of the heart muscle. The complexity of the mathematical model motivates numerical methods based on operator splitting, but simple explicit splitting schemes have been shown to give severe stability problems for realistic models of cardiac electro-mechanical coupling. The stability may be improved by adopting semi-implicit schemes, but these give rise to challenges in updating and linearising the active tension. In this paper we present an operator splitting framework for strongly coupled electro-mechanical simulations and discuss alternative strategies for updating and linearising the active stress component. Numerical experiments demonstrate considerable performance increases from an update method based on a generalised Rush–Larsen scheme and a consistent linearisation of active stress based on the first elasticity tensor. [ABSTRACT FROM AUTHOR]

Hemodynamic unloading by left ventricular assist devices (LVADs) in patients with advanced heart failure can result in reverse remodeling and cardiac recovery allowing pump removal. Ventriculoplasty during explantation may cause fibrosis and ventricular scars which can provide a substrate for reentry, a common cause of ventricular arrythmias. In this case report, we describe the clinical course of a patient who suffered a cardiac arrest in the following few months after undergoing LVAD explantation because of cardiac recovery. This case highlights a potential risk related to complete LVAD explantation with ventriculoplasty and patch repair of the apex., Competing Interests: Disclosure: E.N. has received speaker’s honoraria from Novartis, Astra Zeneca, Boehringer Ingelheim AB, Bristol Myers Squibb, and Bayer. T.T. has received speaker’s honoraria from Novartis, Abbot, Boehringer Ingelheim AB. The other authors have no conflicts of interest to report., (Copyright © ASAIO 2024.)

Aim: To assess cause-specific death in patients with heart failure with preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF)., Methods and Results: Data were analysed from the Swedish Heart Failure Registry (SwedeHF) and the National Patient Register of patients enrolled in SwedeHF 2000-2021. Cox proportional hazards regression models were performed and adjusted for age, sex and time period. Among 100 584 patients (23% HFpEF, 23% HFmrEF, 53% HFrEF), median age (interquartile range) was 75 (66-82) and 36% were female. Of those who died within 5 years, most deaths were ascribed to cardiovascular (CV) causes across all ejection fraction (EF) categories. Within 5 years, HFpEF had higher adjusted risk of non-CV death (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.28-1.38, p < 0.001) and lower adjusted risk of CV death (HR 0.85, 95% CI 0.82-0.88, p < 0.001) compared to HFrEF. Ischaemic heart disease (IHD) and cancer were the most common causes of CV and non-CV death regardless of EF category. The incidence rate of CV death due to IHD was highest in HFrEF while incidence rates of CV death due to pulmonary vascular disease, stroke, valvular heart disease and atrial fibrillation increased with increasing EF. The incidence rates of non-CV deaths due to cancer, respiratory disease, and infections increased with increasing EF., Conclusion: Cardiovascular death was more common than non-CV death across all EF categories although the risk of non-CV death within 5 years was higher with increasing EF. IHD and cancer were the most common causes of CV and non-CV deaths, respectively, regardless of EF category., (© 2024 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Aim: Acyl ghrelin increases cardiac output (CO) in heart failure with reduced ejection fraction (HFrEF). This could impair the right ventricular-pulmonary arterial coupling (RVPAC), both through an increased venous return and right ventricular afterload. We aim to investigate if acyl ghrelin increases CO with or without worsening the right-sided haemodynamics in HFrEF assessed by RVPAC., Methods and Results: The Karolinska Acyl ghrelin Trial was a randomized double-blind placebo-controlled trial of acyl ghrelin versus placebo (120-min intravenous infusion) in HFrEF. RVPAC was assessed echocardiographically at baseline and 120 min. ANOVA was used for difference in change between acyl ghrelin versus placebo, adjusted for baseline values. Of the 30 randomized patients, 22 had available RVPAC (acyl ghrelin n = 12, placebo n = 10). Despite a 15% increase in CO in the acyl ghrelin group (from 4.0 (3.5-4.6) to 4.6 (3.9-6.1) L/min, P = 0.003), RVPAC remained unchanged; 5.9 (5.3-7.6) to 6.3 (4.8-7.5) mm·(m/s) -1 , P = 0.372, while RVPAC was reduced in the placebo group, 5.2 (4.3-6.4) to 4.8 (4.2-5.8) mm·(m/s) -1 , P = 0.035. Comparing change between groups, CO increased in the acyl ghrelin group versus placebo (P = 0.036) while RVPAC and the right ventricular pressure gradient remained unchanged., Conclusion: Treatment with acyl ghrelin increases CO while preserving or even improving RVPAC in HFrEF, possibly due to increased contractility, reduced PVR and/or reduced left sided filling pressures. These potential effects strengthen the role of acyl ghrelin therapy in HFrEF with right ventricular failure., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Background and Aims: Ghrelin is an endogenous appetite-stimulating peptide hormone with potential cardiovascular benefits. Effects of acylated (activated) ghrelin were assessed in patients with heart failure and reduced ejection fraction (HFrEF) and in ex vivo mouse cardiomyocytes., Methods and Results: In a randomized placebo-controlled double-blind trial, 31 patients with chronic HFrEF were randomized to synthetic human acyl ghrelin (0.1 µg/kg/min) or placebo intravenously over 120 min. The primary outcome was change in cardiac output (CO). Isolated mouse cardiomyocytes were treated with acyl ghrelin and fractional shortening and calcium transients were assessed. Acyl ghrelin but not placebo increased cardiac output (acyl ghrelin: 4.08 ± 1.15 to 5.23 ± 1.98 L/min; placebo: 4.26 ± 1.23 to 4.11 ± 1.99 L/min, P < 0.001). Acyl ghrelin caused a significant increase in stroke volume and nominal increases in left ventricular ejection fraction and segmental longitudinal strain and tricuspid annular plane systolic excursion. There were no effects on blood pressure, arrhythmias, or ischaemia. Heart rate decreased nominally (acyl ghrelin: 71 ± 11 to 67 ± 11 b.p.m.; placebo 69 ± 8 to 68 ± 10 b.p.m.). In cardiomyocytes, acyl ghrelin increased fractional shortening, did not affect cellular Ca2+ transients, and reduced troponin I phosphorylation. The increase in fractional shortening and reduction in troponin I phosphorylation was blocked by the acyl ghrelin antagonist D-Lys 3., Conclusion: In patients with HFrEF, acyl ghrelin increased cardiac output without causing hypotension, tachycardia, arrhythmia, or ischaemia. In isolated cardiomyocytes, acyl ghrelin increased contractility independently of preload and afterload and without Ca2+ mobilization, which may explain the lack of clinical side effects. Ghrelin treatment should be explored in additional randomized trials., Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT05277415., Competing Interests: Conflict of interest Lars H Lund: Grants: AstraZeneca, Vifor, Boston Scientific, Boehringer Ingelheim, Novartis; consulting: Merck, Vifor, AstraZeneca, Bayer, Pharmacosmos, MedScape, Sanofi, Lexicon, Myokardia, Boehringer Ingelheim, Servier; speaker’s honoraria: Abbott, MedScape, Radcliffe, AstraZeneca, Novartis; stock ownership and founder: AnaCardio (a start-up company dedicated to developing acyl ghrelin analogues for the treatment of heart failure). Camilla Hage: consulting fees from Novartis, Roche Diagnostics, and AnaCardio, research grants from Bayer, and speaker’s honoraria from MSD and Novartis. Marcus Ståhlberg: consulting fees: AnaCardio, Impulse Dynamics, Swedish Agency for Health Technology Assessment and Assessment of Social Services; speaker’s honoraria: Medtronic, Orion Pharma, ALK-Nordic, Werfen. Ulrika Ljung-Faxen: consulting fees: AnaCardio, lecture fees: Orion Pharma. Per Hellström: consulting fees: Phamranovia, RenaPharma, Milltons. Tonje Thorvaldsen: lecture fees Orion Pharma, Boehringer Ingelheim, Abbott. All other authors report no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Background: We investigated eligibility for dapagliflozin and empagliflozin in a real-world heart failure (HF) cohort based on selection criteria of DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients with Preserved Ejection Fraction Heart Failure), and EMPEROR (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Reduced Ejection Fraction and Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with APreserved Ejection Fraction) trials., Methods and Results: Selection criteria were applied to the Swedish HF registry outpatient population according to 3 scenarios: (i) a "trial scenario" applying all selection criteria; (ii) a "pragmatic scenario" applying the most clinically relevant criteria; and (iii) a "label scenario" following the regulatory agencies labels. Of the 49,317 patients, 55% had an ejection fraction of less than 40% and were assessed for eligibility based on DAPA-HF and EMPEROR-Reduced, 45% had ejection fraction of 40% or greater and were assessed based on EMPEROR-Preserved and DELIVER. Eligibility using trial, pragmatic, and label scenarios was 35%, 61%, and 80% for DAPA-HF; 31%, 55%, and 81% for EMPEROR-Reduced; 30%, 61%, and 74% for DELIVER; and 32%, 59%, and 75% for EMPEROR-Preserved, respectively. The main selection criteria limiting eligibility were HF duration and N-terminal pro-B type natriuretic peptide levels. Eligible patients had more severe HF, more comorbidities, higher use of HF treatments and higher mortality and morbidity.Clinical Highlights: Large clinical trials for the approval of new drugs in heart failure often apply numerous selection criteria, limiting the generalizability of trial findings to real-world populations. We assessed eligibility for dapagliflozin and empagliflozin according to trial criteria, the more practical criteria usually applied in daily practice for treatment selection, and the criteria mandated by regulatory agencies, in a real-word heart failure population. Our results from the Swedish Heart Failure Registry show that a great number of patients with heart failure might be candidates for these therapies, which have been shown to significantly decrease morbidity and mortality; therefore, their use should be implemented in clinical practice., Lay Summary: When strictly applying selection criteria used in clinical trials, only one-third of a real-world heart failure population is eligible for treatment with empagliflozin and dapagliflozin. Adopting approaches that consider the most meaningful criteria, that is, those most clinically relevant or those mandated by regulatory agencies, significantly broadened eligibility. These results might contribute to future trial design taking into consideration the characteristics of real-world populations, feasibility, and potential cost benefits., Conclusions: In a real-world HF setting, eligibility for sodium glucose co-transporter-2 inhibitors was similar whether selection criteria from DAPA-HF or EMPEROR-Reduced were applied in HFrEF, or EMPEROR-Preserved or DELIVER in HFpEF. These data might help stakeholders assessing the consequences of future trial eligibility., (Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aims: In older patients, guideline-directed medical therapy (GDMT) for heart failure (HF) with reduced ejection fraction (<40%; HFrEF) is not contraindicated, but adherence to guidelines is limited. We investigated the implementation of GDMT in HFrEF across different age strata in a large nationwide cohort., Methods and Results: Patients with HFrEF and HF duration ≥3 months registered in the Swedish HF Registry between 2000-2018 were analysed according to age. Multivariable logistic and multinomial regressions were fitted to investigate factors associated with underuse/underdosing. Of 27 430 patients, 31% were <70 years old, 34% 70-79 years old, and 35% ≥80 years old. Use of treatments progressively decreased with increasing age. Use of renin-angiotensin system/angiotensin receptor-neprilysin inhibitors, beta-blockers and mineralocorticoid receptor antagonists was 80%, 88% and 35% in age ≥80 years; 90%, 93% and 47% in age 70-79 years; and 95%, 95% and 54% in age <70 years, respectively. Among patients with an indication, use of implantable cardioverter defibrillator and cardiac resynchronization therapy (CRT) was 7% and 23% in age ≥ 80 years; 22% and 42% in age 70-79 years; and 29% and 50% in age <70 years, respectively. Older patients were less likely treated with target doses or combinations of HF medications. Except for CRT, after extensive adjustments, age was inversely associated with the likelihood of GDMT use and target dose achievement., Conclusion: In HFrEF, gaps persist in the use of medications and devices. In disagreement with current recommendations, older patients remain undertreated. Improving strategies and a more individualized approach for implementing use of GDMT in HFrEF are required, particularly in older patients., (© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Fish farming is considered as a physical demanding occupation, including work operations with high workloads and awkward work positions for prolonged periods of time. Combined with potential challenging environmental conditions, these factors may negatively affect work performance, comfort and health. This study aimed to explore work strain and thermophysiological responses in Norwegian fish farming. Fourteen workers (age 35 ± 15 yrs) from four fish farms participated in the field studies, and measurements of heart rate (HR), core- and skin temperatures were registered continuously during a work shift. Questions about subjective thermal sensation and comfort were answered. This study has shown that workers at fish farms are periodically exposed to high or low levels of work strain, where the high workloads are manifested as increased core temperature and HR when working. The results are expected to give a better understanding of work strain and environmental challenges during fish farm operations.

Background: Patients with heart failure (HF) are often cared for by non-cardiologists. The implications are unknown., Methods: In a nationwide HF cohort with reduced ejection fraction (HFrEF), we compared demographics, clinical characteristics, guideline-based therapy use and outcomes in non-cardiology vs. cardiology in-patient and out-patient care., Results: Between 2000 and 2016, 36,076 patients with HFrEF were enrolled in the Swedish HF registry (19,337 [54%] in-patients overall), with 44% of in-patients and 45% of out-patients managed in non-cardiology settings. Predictors of treatment in non-cardiology were age > 75 years (adjusted odds ratio for non-cardiology 1.20; 95% confidence interval 1.14-1.27), lower education level (0.71; 0.66-0.76 for university vs. compulsory), valve disease (1.24; 1.18-1.31) and systolic blood pressure (SBP) >120 mmHg (1.05; 1.00-1.10). Non-cardiology care was significantly associated with lower use of beta-blockers (0.80; 0.74-0.86) and devices (intracardiac defibrillator [ICD] and/or cardiac resynchronization therapy [CRT]: 0.63; 0.56-0.71), and less frequent specialist follow-up (0.61; 0.57-0.65). Over 1-year follow-up the risk of all-cause mortality (adjusted hazard ratio 1.09; 1.03-1.15) was higher but the risk of first HF (re-) hospitalization was lower (0.93; 0.89-0.97) in non-cardiology vs. cardiology care., Conclusions: In HFrEF, non-cardiology care was independently associated with older ageand lower education. After covariate adjustment, non-cardiology care was associated with lower use of beta-blockers and devices, higher mortality, and lower risk of HF hospitalization. Access to cardiology care may not be equitable and this may have implications for use of guideline-based care and outcomes., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Randomized controlled trials (RCT) generalizability may be limited due to strict patient selection., Objective: In a real-world heart failure (HF) population, we assessed eligibility for sacubitril/valsartan based on PARADIGM-HF (sacubitril/valsartan effective)/PARAGON-HF [sacubitril/valsartan effective in mildly reduced ejection fraction (EF)]., Methods: Outpatients from the Swedish HF Registry (SwedeHF) were analysed. In SwedeHF, EF is recorded as <30, 30-39, 40-49 and ≥50%. In PARAGON-HF, sacubitril/valsartan was effective with EF ≤ 57% (i.e. median). We defined reduced EF/PARADIGM-HF as EF < 40%, mildly reduced EF/PARAGON-HF ≤ median as EF 40-49%, and normal EF/PARAGON-HF > median as EF ≥ 50%. We assessed 2 scenarios: (i) criteria likely to influence treatment decisions (pragmatic scenario); (ii) all criteria (literal scenario)., Results: Of 37 790 outpatients, 57% had EF < 40%, 24% EF 40-49% and 19% EF ≥ 50%. In the pragmatic scenario, 63% were eligible in EF < 50% (67% for EF < 40% and 52% for 40-49%) and 52% in EF ≥ 40% (52% for EF ≥ 50%). For the literal scenario, 32% were eligible in EF < 50% (38% of EF < 40%, 20% of EF 40-49%) and 22% in EF ≥ 40% (25% for EF ≥ 50%). Eligible vs. noneligible patients had more severe HF, more comorbidities and overall worse outcomes., Conclusion: In a real-world HF outpatient cohort, 81% of patients had EF < 50%, with 63% eligible for sacubitril/valsartan based on pragmatic criteria and 32% eligible based on literal trial criteria. Similar eligibility was observed for EF 40-49% and ≥50%, suggesting that our estimates for EF < 50% may be reproduced whether or not a higher cut-off for EF is considered., (© 2020 The Authors. Journal of Internal Medicine published by John Wiley & Sons Ltd on behalf of Association for Publication of The Journal of Internal Medicine.)

Background: Safety management is required to ensure health and safety of personnel in Norwegian fish farming. However, few studies have addressed the status and practical relevance of this risk-reducing measure., Methods: This article provides new knowledge through interviews with 35 employees at different company levels, addressing perceptions of various safety management activities according to managers and operational personnel., Results: The interviews show that managers and operational personnel at fish farms agree that the quantity of measures aimed to improve safety has increased in recent years. However, some activities are perceived to have higher practical relevance than others. In general, measures that fit well with the practical reality are well received by the employees at the fish farms., Conclusion: Suggested improvements include involving operational personnel in the design of procedures, considering all risk dimensions that may affect occupational health and safety, and challenging the value of specific safety activities based on a detailed knowledge of the distinctive characteristics of work practice in fish farming., Competing Interests: This work was supported by the 10.13039/501100005416Research Council of Norway through the “Safer operations and workplaces in fish farming” project, grant no. 254899/E40 in the HAVBRUK2 programme. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Authors.)

Hospitalisation for acute heart failure (AHF) is associated with high mortality and high rehospitalisation rates. In the absence of evidence-based therapy, treatment is aimed at stabilisation and symptom relief. The majority of AHF patients have signs and symptoms of fluid overload, and, therefore, decongestion is the number one treatment goal. Diuretics are the cornerstone of therapy in AHF, but the treatment effect is challenged by diuretic resistance and poor diuretic response throughout the spectrum of chronic to worsening to acute to post-worsening HF. Adequate dosing and monitoring and evaluation of diuretic effect are important for treatment success. Residual congestion at discharge is a strong predictor of worse outcomes. Therefore, achieving euvolaemia is crucial despite transient worsening renal function., Competing Interests: Disclosure: TT has received speaker’s fees from Orionpharma, Bayer, and Novartis. LHL has received research grants to author’s institution, speaker’s and/or consulting fees from AstraZeneca, Novartis, Bayer, Vifor Pharma, Relypsa, Abbott, Sanofi, Merck, and Pharmacosmos. IK has no conflicts of interest to declare., (Copyright © 2020, Radcliffe Cardiology.)

Background: Comorbidities may differently affect treatment response and cause-specific outcomes in heart failure (HF) with preserved (HFpEF) vs. mid-range/mildly-reduced (HFmrEF) vs. reduced (HFrEF) ejection fraction (EF), complicating trial design. In patients with HF, we performed a comprehensive analysis of type 2 diabetes (T2DM), atrial fibrillation (AF) chronic kidney disease (CKD), and cause-specific outcomes., Methods and Results: Of 42,583 patients from the Swedish HF registry (23% HFpEF, 21% HFmrEF, 56% HFrEF), 24% had T2DM, 51% CKD, 56% AF, and 8% all three comorbidities. HFpEF had higher prevalence of CKD and AF, HFmrEF had intermediate prevalence of AF, and prevalence of T2DM was similar across the EF spectrum. Patients with T2DM, AF and/or CKD were more likely to have also other comorbidities and more severe HF. Risk of cardiovascular (CV) events was highest in HFrEF vs. HFpEF and HFmrEF; non-CV risk was highest in HFpEF vs. HFmrEF vs. HFrEF. T2DM increased CV and non-CV events similarly but less so in HFpEF. CKD increased CV events somewhat more than non-CV events and less so in HFpEF. AF increased CV events considerably more than non-CV events and more so in HFpEF and HFmrEF., Conclusion: HFpEF is distinguished from HFmrEF and HFrEF by more comorbidities, non-CV events, but lower effect of T2DM and CKD on events. CV events are most frequent in HFrEF. To enrich for CV vs. non-CV events, trialists should not exclude patients with lower EF, AF and/or CKD, who report higher CV risk., Competing Interests: Declaration of competing interest GS reports grants and personal fees from Vifor, non-financial support from Boehringer Ingelheim, personal fees from Societa´ Prodotti Antibiotici, grants from MSD, grants and personal fees from AstraZeneca, personal fees from Roche, personal fees from Servier, grants from Novartis, personal fees from GENESIS, personal fees from Medtronic, personal fees from Cytokinetics, outside the submitted work. LHL reports grants and personal fees from Boehringer Ingelheim, during the conduct of the study; personal fees from Merck, personal fees from Sanofi, grants and personal fees from Vifor-Fresenius, grants and personal fees from AstraZeneca, grants and personal fees from Relypsa, personal fees from Bayer, grants from Boston Scientific, grants and personal fees from Novartis, personal fees from Pharmacosmos, personal fees from Abbott, grants and personal fees from Mundipharma, personal fees from Medscape, outside the submitted work. CS, BS, TT, IL, US, LB, FC, FA: None related with the current study. AM, SFF, MB, KGB and OV are employed by Boehringer Ingelheim., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Aims: Ramp testing in the postoperative period can be used to optimize left ventricular assist device (LVAD) speed for optimal left ventricular (LV) unloading. We tested the hypothesis that a non-invasive echocardiographic ramp test post-HeartMate 3 implantation improves LV unloading immediately after and 1-3 months after as compared with before the test. We also tested a secondary hypothesis that speed adjustments during echocardiography-guided ramp testing do not worsen right ventricular (RV) function immediately after and 1-3 months after., Methods and Results: We retrospectively reviewed data from patients who underwent an echocardiographic ramp test. A total of 14 out of 19 patients were clinically stable and were enrolled. Adequate LV unloading was defined as no more than mild mitral regurgitation, and intermittent aortic valve (AV) opening or closed AV, and reduction of left ventricular end-diastolic diameter (LVEDD); and for the follow-up measurement, decreased NT-proBNP. Median (interquartile range) time from implantation to ramp test was 27 (16; 56) days, and median time from ramp test to follow-up echocardiography was 55 (47; 102) days. Median LVAD speed achieved during ramp testing was 5550 (5375; 6025) revolutions per minute (rpm), and median final LVAD speed was 5200 (5000; 5425) rpm. Ramp testing resulted in final LVAD speed increase in 11 (79%) patients and a median net change of 200 (200; 300) rpm. Speed adjustments after ramp testing resulted in improved LVAD unloading that was achieved in additional 3 (21%) patients who were not originally optimized. RV function did not worsen significantly during ramp testing or at final LVAD speed., Conclusions: The echocardiographic ramp test allowed LVAD speed adjustment and optimization and improved LV unloading during ramp testing and at final speed with no evidence of worsening of RV function., (© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Background : All over the world, commercial fishing is known to be a hazardous occupation. Although several causal analyses of occupational accidents have been published in recent years, knowledge of the prevalence of sick leave, diagnosis and hospitalization among workers on board Norwegian fishing vessels is still sparse. Objective : The objective of this study is to provide new knowledge about the prevalence of doctor-certified sick leave among Norwegian fishers compared to an age- and gender-matched control population. A comparison of diagnoses and hospitalizations between these groups is also presented. Methods : A sample of fishers (n = 25,971) was selected by Statistics Norway (SSB), based on occupation as fishers in 2008-2013. An age- and gender-matched control population (n = 77,913) was also selected. Outpatient consultation and hospitalization data were received from the Norwegian Patient Registry (NPR). Results : Fishers have significantly lower rates of sick leave than the general working population as a whole, but a significantly higher rate sick leave than an age- and gender-matched control population. The most common cause of sick leave in both fishers and controls was musculoskeletal problems. Fishers had a higher number of hospital stays than the control group; the stays were more often unscheduled and lasted longer than those of the control group. Conclusion : The results emphasize the continued need for preventive occupational health strategies in the fishing industry.

Objectives : In Norwegian aquaculture, safer technology and better safety management systems have been developed during the last decade. Safety commitment and safe behavior are still vital to ensure a safe working environment. The objective of this paper is to explore what factors might influence the reporting of hazardous situations in aquaculture. The significance of factors on both the individual (work experience, position) and company/organizational level (company size, safety climate) was studied. It was hypothesized that reporting of hazardous situations was positively predicted by work experience, having the position as operational manager, company size, and safety climate. Methods : The study is based on a quantitative questionnaire study involving 428 fish farmers, operational managers, and service vessel employees in the Norwegian aquaculture industry, interviewed by telephone. A purposive sampling procedure was employed. Correlation and hierarchical regression analyses were applied. The data quality was considered satisfactory. Results : Individual factors had no significant relationship with the reporting of hazardous situations. Company size and safety climate factors had positive associations with reporting. Larger companies might have more resources for safety management and the development of practical reporting solutions. A positive safety climate might increase the motivation for reporting. Conclusion : Efforts by management to improve the safety climate can contribute to the reporting of hazardous events, continuous improvement of safety management and improvement of the safety level.

Despite advances in heart failure treatment, advanced heart failure affects 5-10% of people with the condition and is associated with poor prognosis. Selection for heart transplantation and left ventricular assist device implantation is a rigorous and validated process performed by specialised heart failure teams. This entails comprehensive assessment of complex diagnostic tests and risk scores, and selecting patients with the optimal benefit-risk profile. In contrast, referral for advanced heart failure evaluation is an arbitrary and poorly studied process, performed by generalists, and patients are often referred too late or not at all. The study elaborates on the differences between selection and referral and proposes some simple strategies for optimising timely referral for advanced heart failure evaluation., Competing Interests: Disclosure: TT: The author has no conflict of interest to declare. LHL: There are no conflicts of interest related to the work submitted. Outside this, there are the following potential conflicts of interest: research grants to author’s institution, speaker’s and/or consulting fees: AstraZeneca, Novartis, Bayer, Vifor Pharma, Relypsa, Abbott and Sanofi

Background: Fishers exposed to unfavourable environmental conditions may suffer negative health ef- fects. This study aimed to identify musculoskeletal symptoms in professional fishers in Norway using data from several sources; register data, telephone survey and questionnaire., Materials and Methods: Professional fishers (n = 25,971) registered in the period 2008-2013 were selected by Statistics Norway (SSB). An age- and gender-matched control population (n = 77,913) was also selected. Outpatient consultation and hospitalisation data were received from the Norwegian Patient Registry (NPR). To obtain information about self-reported symptoms, 832 registered fishers on board Norwegian fishing vessels were interviewed by telephone, and a questionnaire was distributed to the crews of 5 trawlers (n = 153)., Results: Data from NPR showed that fishers, compared to the control population, suffered significantly more acute incidents related to musculoskeletal disorders (5.4% vs. 4.8%, respectively), injuries to arms (11.3% vs. 9.8%), feet (8.4% vs. 8%), and back (0.9% vs. 0.7%). In the telephone survey, 61% and 43% reported that they performed monotonous work operations and heavy lifting often or very often, respec- tively. Thirty-three per cent had experienced pain in neck/shoulders/arms often or very often during the previous 12 months, and 93% believed this was fully or partly due to their work situation. The questionnaire among trawler crew members showed that 57% and 60% had experienced stiffness and/or pain in neck/ /shoulders and lower back/small of the back respectively during the previous 12 months., Conclusions: Data from the register study, telephone survey and questionnaire all confirmed that musculo- skeletal problems are common among fishers and related to their work situation. However, 77% of the fishers in all vessel groups and on board the 5 trawlers reported their own health as being very good or good.

Background: The use of left ventricular assist devices (LVADs) has increased in the last decade. Major complications have been well described, but there is no data on device alarms and actual or threatening malfunction which impair quality of life and may impair outcomes. This study describes the technical problems related to the use of the HVAD® left ventricular assist device in a single center., Methods: We retrospectively reviewed device malfunctions and outcomes in 22 patients with HVAD® left ventricular assist device followed at Karolinska University Hospital between 2011 and 2016. Device malfunction was defined by INTERMACS as a failure of one or more of the components of the LVAD system. The primary outcome was defined as death or hospitalization or unplanned urgent clinic visit due to device alarm of unknown significance or actual or threatening malfunction. Separate secondary outcomes were malfunction resulting in controller exchange and malfunction resulting in battery change. Exploratory outcomes were death, transplantation, or explantation because of recovery., Results: Median age was 59 years and 19% were women. Over a mean follow-up time of 1.7 years (37 patient-years), the primary outcome occurred 30 times (0.8 events per patient-year; 0 deaths, 2 hospitalizations and 28 un-planned clinic visits). Secondary outcomes were 41 device malfunctions for 14 patients requiring 45 controller exchanges in 12 patients (1.1 events per patient-year) and 128 battery changes in 12 patients (3.5 events per patient-year). Exploratory outcomes were 8 deaths (36.4%), 7 transplantations (31.8%) and 2 explants due to recovery (9.1%)., Conclusion: The use of HVAD® was associated with technical problems requiring frequent un-planned clinic visits and changes of controller and/or batteries. There were no deaths due to device malfunction. Further studies are warranted to evaluate the risk of device malfunction and associated reductions in quality of life and cost.

Background: Risk-prediction models specifically for hospitalized heart failure with preserved ejection fraction are lacking., Methods and Results: We analyzed data from the ARIC (Atherosclerosis Risk in Communities) Study Heart Failure Community Surveillance to create and validate a risk score predicting mortality in patients ≥55 years of age admitted with acute decompensated heart failure with preserved ejection fraction (ejection fraction ≥50%). A modified version of the risk-prediction model for acute heart failure developed from patients in the EFFECT (Enhanced Feedback for Effective Cardiac Treatment) study was used as a composite predictor of 28-day and 1-year mortalities and evaluated together with other potential predictors in a stepwise logistic regression. The derivation sample consisted of 1852 hospitalizations from 2005 to 2011 (mean age, 77 years; 65% women; 74% white). Risk scores were created from the identified predictors and validated in hospitalizations from 2012 to 2013 (n=821). Mortality in the derivation and validation sample was 11% and 8% at 28 days and 34% and 31% at 1 year. The modified EFFECT score, including age, systolic blood pressure, blood urea nitrogen, sodium, cerebrovascular disease, chronic obstructive pulmonary disease, and hemoglobin, was a powerful predictor of mortality. Another important predictor for both 28-day and 1-year mortalities was hypoxia. The risk scores were well calibrated and had good discrimination in the derivation sample (area under the curve: 0.76 for 28-day and 0.72 for 1-year mortalities) and validation sample (area under the curve: 0.73 and 0.71, respectively)., Conclusions: Mortality after acute decompensation in patients with heart failure with preserved ejection fraction is high, with one third of patients dying within a year. A prediction tool may allow for greater discrimination of the highest risk patients., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005131., (© 2017 American Heart Association, Inc.)

Background: Fishery is an important industry in Norway. Compared to other industries the number of occupational accidents is high. Fishers are exposed to a range of unfavourable working conditions, but there is limited research-based knowledge about the interaction between working conditions and health. The aim of the article is to study fishers' 1) work-related exposures and health complaints, 2) sickness absence, 3) subjective perception of health status and 3) level of job satisfaction., Materials and Methods: Data was gathered through a telephone survey. The survey included questions about exposure, health complaints, health status and job satisfaction. Methods for analysis were descriptive statistics and relative risk (RR)., Results: A total of 830 full-time fishers were interviewed. Coastal fishers are more exposed to factors such as climatic (RR = 1.546, 95% confidence interval [CI] 1.311-1.823), ergonomic (RR = 1.539, 95% CI 1.293-1.833) and processing (RR = 2.119, 95% CI 1.847-2.431), compared to other groups of fishers. Coastal fishers are also more likely to experience musculoskeletal problems (RR = 1.623, 95% CI 1.139-2.314), sickness absence (RR = 1.337, 95% CI 1.081-1.655) and to perceive their own health as poor (RR = 2.155, 95% CI 1.119-4.152). Purse sein fishers are less exposed to climatic (RR = 0.777, 95% CI 0.633-0.953), ergonomic (RR = 0.617, 95% CI 0.487-0.783) and processing (RR = 0.292, 95% CI 0.221-0.385) factors and are less likely to experience sickness absence (RR = 0.635, 95% CI 0.479-0.840). In terms of job satisfaction, 99% if our respondents enjoy their work., Conclusions: Norwegian fishers have a high degree of job satisfaction and overall good health. Challenges regarding health complaints and exposures in the working environment were identified. This may be helpful for the industry, showing where measures should be implemented to prevent exposure, illness and sickness absence. Findings may also serve as a basis for future intervention studies aimed at promoting healthy working environments for fishers, especially how to improve vessels and develop user-friendly technology to reduce risk of injuries and strain.

Aims: In heart failure with reduced ejection fraction, drug and device therapy improve survival. We studied contemporary trends in utilization of evidence-based therapy and associated survival., Methods and Results: We studied 5908 patients with NYHA class II-IV heart failure, EF <30%, and duration of heart failure ≥6 months registered in the Swedish Heart Failure Registry between 2003 and 2012. Regression using generalized estimation equations was used to examine temporal trends in crude and risk-adjusted rates of utilization of evidence-based heart failure therapy and 30-day, 1-year, and 3-year survival. In 2003 vs. 2012, the risk-adjusted use of therapy and P-values for trends were as follows: renin-angiotensin system antagonists, 88% vs. 86% (P = 0.091); beta-blockers, 85% vs. 93% (P = 0.008); mineralocorticoid receptor antagonists, 53% vs. 42% (P < 0.001); CRT, 2.4% vs. 8.2% (P = 0.074); and implantable cardioverter-defibrillators, 4.0% vs. 10.7% (P = 0.004). During the same period, the risk-adjusted 30-day, 1-year, and 3-year survival was 92% vs. 94% (P = 0.532), 81% vs. 77% (P = 0.260), and 58% vs. 54% (P = 0.425), respectively., Conclusions: In this large nationwide registry, over the last decade the use of evidence-based drug therapy was high and remained stable over time, but, despite an increased use of device therapy, the absolute use was poor. This was associated with an absence of improvement in survival. The improvements in therapy and prognosis over the last generation may be levelling off, and efforts should be directed at improving implementation of evidence-based therapy., (© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.)

Background/objectives: Levosimendan is used in acute heart failure (HF) and increasingly as planned repetitive infusions in stable chronic HF, but the extent of this practice is unknown. The aim was to assess the use of levosimendan vs. conventional inotropes and the use as planned repetitive vs. acute treatment, in Sweden., Methods: We performed a descriptive study with individual patient validation assessing the use of levosimendan and conventional intravenous inotropes, indications for levosimendan, clinical characteristics and survival in the Swedish Heart Failure Registry between 2000 and 2011. For repetitive levosimendan, we assessed potential indications for alternative interventions., Results: Of 53,548 total registrations, there were 655 confirmed with inotrope use (597 levosimendan, 37 conventional, 21 both) from 22 hospitals responding to validation, and 6069 in-patient controls with New York Heart Association III-IV and ejection fraction <40%. The indications for levosimendan were acute HF in 384 registrations (306 patients), and planned repetitive in 234 registrations (87 patients). Planned repetitive as a proportion of total levosimendan registrations ranged 0-65% and of total levosimendan patients ranged 0-54% in different hospitals. Of planned repetitive patients without existing cardiac resynchronization therapy, implantable cardioverter defibrillator, transplant and/or assist device, 46-98% were potential candidates for such interventions., Conclusion: In HF in cardiology and internal medicine in Sweden, levosimendan was the overwhelming inotrope of choice, and the use of planned repetitive levosimendan was extensive, highly variable between hospitals and may have pre-empted other interventions. Potential effects of and indications for planned repetitive levosimendan need to be evaluated in prospective studies., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objectives: The purpose of this study was to evaluate simple criteria for referral of patients from the general practitioner to a heart failure (HF) center., Background: In advanced HF, the criteria for heart transplantation, left ventricular assist device, and palliative care are well known among HF specialists, but criteria for referral to an advanced HF center have not been developed for generalists., Methods: We assessed observed and expected all-cause mortality in 10,062 patients with New York Heart Association (NYHA) functional class III to IV HF and ejection fraction <40% registered in the Swedish Heart Failure Registry between 2000 and 2013. Next, 5 pre-specified universally available risk factors were assessed as potential triggers for referral, using multivariable Cox regression: systolic blood pressure ≤90 mm Hg; creatinine ≥160 μmol/l; hemoglobin ≤120 g/l; no renin-angiotensin system antagonist; and no beta-blocker., Results: In NYHA functional class III to IV and age groups ≤65 years, 66 to 80 years, and >80 years, there were 2,247, 4,632, and 3,183 patients, with 1-year observed versus expected survivals of 90% versus 99%, 79% versus 97%, and 61% versus 89%, respectively. In the age ≤80 years group, the presence of 1, 2, or 3 to 5 of these risk factors conferred an independent hazard ratio for all-cause mortality of 1.40, 2.30, and 4.07, and a 1-year survival of 79%, 60%, and 39%, respectively (p < 0.001)., Conclusions: In patients ≤80 years of age with NYHA functional class III to IV HF and ejection fraction <40%, mortality is predominantly related to HF or its comorbidities. Potential heart transplantation/left ventricular assist device candidacy is suggested by ≥1 risk factor and potential palliative care by multiple universally available risk factors. These patients may benefit from referral to an advanced HF center., (Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)