Dan Atar

Sisteforfatter på publikasjonen 'The myth of 'stable' coronary artery disease publisert i Nature Reviews Cardiology i 2019: 10.1038/s41569-019-0233-y

• Asher, Elad; Taha, Louay; Karmi, Mohammad; Sabouret, Pierre; Mamas, Mamas A. & Atar, Dan [Vis alle 9 forfattere av denne artikkelen] (2026). Association of Admission Immature Platelet Fraction with Long-Term Mortality Following Primary Percutaneous Coronary Intervention for STEMI. Thrombosis and Haemostasis. ISSN 0340-6245. doi: 10.1055/a-2945-5355.
• Boskovic, Miroslav; Haraldsen, Marius Blørstad; Berge, Trygve; Grenne, Bjørnar Leangen; Skretteberg, Torger & Engdahl, Johan [Vis alle 14 forfattere av denne artikkelen] (2026). Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial. Europace. ISSN 1099-5129. 28(8). doi: 10.1093/europace/euag140. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Conventional screening modalities for atrial fibrillation (AF) are often constrained by considerable resource and logistical demands. The randomized controlled NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial employs a fully digital approach to recruitment and implementation. The aim of this pre-specified analysis was to evaluate the effectiveness of the fully digital recruitment and screening strategy, determine the prevalence of screen-detected AF, and assess initial adherence to therapeutic recommendations. Methods and results: Individuals aged ≥65 years with ≥1 additional risk factor for stroke were digitally recruited from the general Norwegian population and randomized 1:1 to screening or usual care. Exclusion criteria included prior AF, anticoagulation, implantable cardiac electronic devices, or lack of smartphone access. Participants allocated to screening were mailed a patch-based electrocardiogram sensor for site-less continuous monitoring over 7 days. Those with diagnosed AF were advised to contact their general practitioner to initiate appropriate therapy. A total of 551 555 Norwegian residents were digitally invited; of these, 139 596 (25.3%) completed the digital eligibility assessment, 74 956 (53.7%) were eligible, and 50 549 (67.4%) were randomized to screening or usual care. The median age was 75 years (inter-quartile range: 69–78), 23 445 (46.4%) were female, and the mean CHA2DS2-VA risk score was 2.6 ± 0.9. In the screening group, 19 723 (78.1%) completed the study procedures. Previously undiagnosed AF was identified in 382 (1.9%) screened participants, of whom 366 (95.8%) initiated anticoagulation therapy. Conclusion: The NORSCREEN trial demonstrates that fully digital, large-scale, site-less AF screening is feasible and effective in an at-risk population, identifying previously undiagnosed AF in 1.9% of screened individuals and showing high adherence to therapeutic recommendations.

• Caglar, Harun; Holmager, Therese; Kristensen, Anna Meta Dyrvig; Bakken, Arnhild; Rykind-Eriksen, Frida & Deeg, Peter Stefan [Vis alle 12 forfattere av denne artikkelen] (2026). Risk-Score Guided Estimation of Absolute Benefit From Beta-blockers after Myocardial Infarction in Patients Without Heart Failure. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. doi: 10.1093/ehjqcco/qcag142. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims To assess whether a modified clinical risk-score can stratify baseline risk and estimate expected absolute benefit from beta-blocker therapy in post-MI (myocardial infarction) patients with LVEF (left ventricular ejection fraction) ≥40%. Methods This substudy of the BETAMI-DANBLOCK trial included patients with a recent MI and LVEF ≥40% who were randomized to beta-blocker or no beta-blocker therapy. A modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) was constructed, and patients were categorized as low-, intermediate-, or high-risk. The primary outcome was a composite of all-cause mortality, new-MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia. Treatment effects across TRS-2P strata were estimated using Cox proportional hazards and Fine-Gray subdistribution hazard models. Three-year absolute risk reduction (ARR) and number needed to treat (NNT) were calculated for each risk stratum. Results Among 5558 patients, 38.4% were classified as low-risk, 52.8% as intermediate-risk, and 8.8% as high-risk. Event rates increased stepwise with higher modified TRS-2P, with no evidence of heterogeneity in the relative treatment effects across risk-strata (hazard ratios: 0.88, 0.81 and 0.88, respectively). However, the score translated the modest relative effects into clinically distinct absolute benefits: Three-year ARR was 1.4% (NNT=72 [95% CI: 41 to 361]) in low-risk, 2.1% (NNT=47 [95% CI: 27 to 239]) in intermediate-risk, and 3.6% (NNT=28 [95% CI: 16 to 140]) in high-risk patients. Conclusions The modified TRS-2P stratified baseline risk and provided estimates of absolute beta-blocker benefit, supporting further evaluation of individualized, risk-guided treatment after MI in patients with LVEF ≥40%.

• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2026). Authors’ Response Letter – 30-day Outcome Data from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. s. 5–5. doi: 10.1159/000553527. Fulltekst i vitenarkiv
• Madssen, Erik; Sverre, Elise Christine Bjørkholen; Nyen, Johanne E; Holmager, Therese L F; Kristensen, Anna M D & Bakken, Arnhild [Vis alle 13 forfattere av denne artikkelen] (2026). Beta-blocker therapy and physical activity after myocardial infarction: a preplanned sub-study of the BETAMI trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1093/eurjpc/zwag412. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims To investigate the effect of long-term beta-blocker therapy on physical activity (PA) level after myocardial infarction (MI) in patients without heart failure. Method The BETAMI trial, randomised patients hospitalised with a MI without heart failure (LVEF ≥40%) to beta-blocker or no beta-blocker. In this pre-planned sub-study PA level was assessed by guideline-recommended PA level (≥30 minutes moderate activity ≥5 days/week) or not and self-reported hours/week with light to moderate and vigorous PA. Between-group differences in PA from baseline before randomisation to 18-months were estimated by linear mixed models. Exploratory analysis assessed treatment effects on a composite of all-cause mortality and major adverse cardiovascular events using Cox proportional hazards model. Results Of the 2867 randomised patients, 2185 (76%) responded to the PA questions and were included in this analysis. Mean age was 62.5 (SD 10.1) years, 20.6% were women. No differences in guideline-recommended PA level or mean hours of light to moderate and vigorous PA were reported between the beta-blocker and non-beta-blocker group at baseline or during 18-months follow-up. At 12-month follow-up, 37.0% in the beta-blocker group and 36.7% in the no beta-blocker group reported guideline-recommended PA level (OR 0.97, 95% CI 0.69-1.37). Exploratory, hypothesis-generating analyses did not demonstrate a statistically significant interaction (p for interaction = 0.06) between treatment assignment and baseline PA level for recurrent clinical events. Conclusions Beta-blocker therapy did not result in a change in PA level in post-MI patients without heart failure during the 18 months follow-up.

• Pope, Marita Knudsen; Chugh, Harpriya; Truyen, Thien Tan Tri Tai; Mathias, Marco; Uy-Evanado, Audrey & Lin, Honghuang [Vis alle 11 forfattere av denne artikkelen] (2026). Dynamic Risk Trajectories for Sudden Cardiac Arrest: The Role of Recurrent Cardiovascular Events. Journal of the American Heart Association (JAHA). 15(13). doi: 10.1161/JAHA.125.049853. Fulltekst i vitenarkiv
• Maamoen, Anniken; Bondjers, Kristina; Langerud, Anne Kathrine; Dyb, Grete Anita; Stensland, Synne Øien Blixt & Zwart, John Anker Henrik [Vis alle 12 forfattere av denne artikkelen] (2026). Turnover Intentions Among Intensive Care Healthcare Workers: Key Factors Influencing Decisions to Stay or Leave. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 70(7). doi: 10.1111/aas.70296. Fulltekst i vitenarkiv Vis sammendrag

  Background: Turnover among healthcare workers (HCWs) is highly prevalent in intensive care units (ICUs). Due to demanding workloads, stressful conditions, and increasing pressure to work more efficiently, this problem is likely to persist. Consequently, implementing proactive strategies to support HCWs retention is needed. This study aimed to examine associations between work environment factors and ICU HCWs’ intentions to quit. Methods: Based on data from a prospective, open‐cohort, multicenter study of hospital frontline workers conducted during the four main waves of the COVID‑19 pandemic in Norway, we analyzed self‐reported data from HCWs who completed the final survey, which included two outcomes relevant to turnover: (1) frequent thoughts of quitting and (2) intention to look for a new job. A work‐environment ‐factor tool assessing occupational risk and characteristics in emergencies (FORCE‐index). Hierarchical linear regression was used to examine associations between work environment factors and the two turnover outcomes. Results: Among 977 frontline HCWs (median age 45 years, 75% women, median 16 years of work experience), several work environment factors showed protective association with turnover intention. Across both outcomes, familiarity with colleagues and surroundings and social support from colleagues and immediate superiors were the most important protective factors, linked to fewer thoughts of quitting and a lower intention to seek a new job. For frequent thoughts of quitting, additional protective factors included better stress management, workload manageability, infection safety, and social safety. Younger age was a consistent risk factor for both outcomes, while working in the ICU and experiencing morally distressing situations were specifically associated with thoughts of quitting. Pandemic exposure variables were not significantly associated with either outcome. Conclusion: Turnover intention among ICU HCWs at four Norwegian university hospitals during the fourth time point of the COVID‑19 pandemic was associated with work environment factors. Work in the ICU, younger age, and morally distressing experiences were associated with frequent thoughts of quitting, whereas several work environment factors were protective. Familiarity and social support were also protective against actively looking for a new job, suggesting that strengthening these factors may be particularly important for reducing turnover intention and retaining HCWs in the ICU.

• Kristensen, Anna Meta Dyrvig; Jortveit, Jarle; Holmager, Therese; Atar, Dan; Olsen, Michael Hecht & Bakken, Arnhild [Vis alle 14 forfattere av denne artikkelen] (2026). Outcomes in the BETAMI-DANBLOCK trial compared with a Norwegian nationwide myocardial infarction population. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehag348. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background and Aims In patients with myocardial infarction (MI), no heart failure, and left ventricular ejection fraction (LVEF) ≥ 40%, the combined BETAMI-DANBLOCK trial showed that beta-blockers reduced the risk of all-cause mortality or major adverse cardiovascular events. This study evaluated the representativeness of the trial. Methods Participants in BETAMI (n = 2867) and DANBLOCK (n = 2707) were compared with a cohort of revascularized MI patients with LVEF ≥40%, and no heart failure from the Norwegian Myocardial Infarction Registry (the NORMI cohort)(n = 20 804). Baseline characteristics were evaluated, and absolute risks of all-cause mortality and/or MI were estimated. A transportability analysis was conducted by weighting the BETAMI-DANBLOCK population according to the NORMI cohort. Results Median age was 66 years (interquartile range [IQR]: 57–74) in the NORMI cohort and 63 years (IQR: 55–70) in BETAMI and DANBLOCK. Patients in the NORMI cohort had a higher prevalence of diabetes, previous coronary artery disease, and LVEF 40–49%, compared with trial participants. At 3-year follow-up, the absolute risk of all-cause mortality or MI was 12.0% in the NORMI cohort, 7.7% in BETAMI, and 7.8% in DANBLOCK. Corresponding risks of MI were 6.3%, 5.6%, and 4.3%, respectively. The treatment effects of beta-blockers were similar when the trial population was weighted according to the characteristics of the NORMI cohort. Conclusions Compared with the NORMI cohort, participants in BETAMI and DANBLOCK were younger, had a lower proportion of certain comorbidities, and experienced a lower risk of all-cause mortality and MI. Despite these differences, the effect of beta-blockers remained consistent when the trial population was weighted according to the NORMI cohort.

• Monguillon, Victorien; Kelly, Peter J.; O’Donoghue, Michelle L.; Park, Jeong-Gun; Bohula, Erin A. & Saver, Jeffrey L. [Vis alle 13 forfattere av denne artikkelen] (2026). Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke. Circulation. ISSN 0009-7322. 153(2), s. 93–93. doi: 10.1161/circulationaha.125.077549. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Patients with previous ischemic stroke are at high risk for recurrent stroke and other major adverse cardiovascular events. The benefits of achieving very low levels of low-density lipoprotein cholesterol (LDL-C) in such patients is unclear. METHODS: We analyzed patients with previous ischemic stroke enrolled in FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), a randomized placebo-controlled trial studying evolocumab in patients with stable atherosclerotic cardiovascular disease (median follow-up, 2.2 years), and through the open-label extension (FOURIER-OLE) period (additional median follow-up, 5 years), to examine the relationship between achieved LDL-C and the long-term incidence of the primary end point (cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization) and stroke-related end points. RESULTS: The analysis included 5291 patients with previous ischemic stroke (>4 weeks). Of these, 666 (12.6%), 1410 (26.6%), 586 (11.1%), 508 (9.6%), and 2121 (40.1%) patients achieved LDL-C values of <20, 20 to <40, 40 to <55, 55 to <70, and ≥70 mg/dL, respectively. The incidence of the primary end point, all stroke, and ischemic stroke each decreased in a monotonic fashion with lower achieved LDL-C levels on a continuous scale ( P trend <0.001, 0.002, and 0.002, respectively). Compared with patients with LDL-C ≥70 mg/dL, those who achieved levels <40 mg/dL had incidence rate ratios of 0.69 (95% CI, 0.57–0.84), 0.73 (95% CI, 0.53–0.99), and 0.75 (95% CI, 0.54–1.05) for the outcomes of the primary end point, all stroke, and ischemic stroke, respectively. Hemorrhagic strokes were infrequent and unrelated to achieved LDL-C ( P trend =0.85). CONCLUSIONS: In patients with previous ischemic stroke, it appeared that the lower the LDL-C, down to levels <40 mg/dL, the lower the risk of major adverse cardiovascular events, including recurrent stroke, without a clear increase in risk of hemorrhagic stroke. These findings support the concept that more intensive LDL-C lowering in patients with previous ischemic stroke may be warranted. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01764633/NCT01764633.

• Nyen, Johanne E; Kristensen, Anna Meta D; Dammen, Toril; Zwisler, Ann-Dorthe; Olsen, Michael Hecht & Maeng, Michael [Vis alle 14 forfattere av denne artikkelen] (2026). Beta-blockers, depression, and anxiety after myocardial infarction: the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehag200. Fulltekst i vitenarkiv
• Holmager, Therese Lucia Friis; Kristensen, Anna Meta Dyrvig; Fagerland, Morten; Atar, Dan; Olsen, Michael Hecht & Bakken, Arnhild [Vis alle 8 forfattere av denne artikkelen] (2026). Validating National Registry Data for Randomised Trials: Comparison of registry-derived cardiovascular events with and without adjudication in the BETAMI-DANBLOCK trial. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. doi: 10.1093/ehjqcco/qcag055. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Registry-based randomised clinical trials are increasingly applied in clinical research, providing advantages in feasibility and data capture. However, registry-based data may introduce bias through misclassification or missing information. Methods In the BETAMI-DANBLOCK trial, 5,574 patients with myocardial infarction (MI) and no heart failure were randomised to beta-blocker or no beta-blocker therapy. The primary endpoint events (all-cause mortality, MI, ischemic stroke, heart failure, unplanned coronary revascularisation, and malignant ventricular arrhythmias) were identified from the Danish/Norwegian national patient registries, self-reported questionnaires, and medical records. All registry-identified events, except all-cause mortality, underwent blinded adjudication. We compared non-adjudicated and adjudicated events by calculating incidence rates and hazard ratios (HRs) for beta-blocker therapy versus controls. Results National registries captured 99.7% of primary endpoint events registered by self-report and medical records. Of the primary endpoint events identified through the registries, 75% were confirmed by adjudication (incidence rate 6.23 versus 4.43/100 person-years). The confirmation rate was lower during the first six months and varied by event type (from 92% for ischemic stroke to 45% for unplanned coronary revascularisations and heart failure). Estimated treatment effects were consistent for the primary endpoint with non-adjudicated and adjudicated events (HR 0.88, 95% confidence interval (CI): 0.78-0.98 and HR 0.85, 95% CI: 0.75-0.98, respectively), with no apparent differences across event types except for heart failure and revascularisation. Conclusion Registry data provided effect estimates of beta-blockers comparable to adjudicated data. However, adjudication substantially reduced the number of cardiovascular endpoint events and event-specific misclassification appeared, particularly during the first months after the index-event.

• Lamy, Andre; Sandhu, Roopinder K.; Tong, Wesley; McIntyre, William F.; Lopes, Renato D. & Granger, Christopher B. [Vis alle 22 forfattere av denne artikkelen] (2025). Cost-effectiveness of apixaban vs. aspirin for the reduction of thrombo-embolism in high-risk patients with device-detected atrial fibrillation: insights from the ARTESiA trial. Europace. ISSN 1099-5129. 27(9). doi: 10.1093/europace/euaf195. Fulltekst i vitenarkiv Vis sammendrag

  Aims Apixaban was superior to aspirin for the prevention of stroke or systemic embolism in participants with subclinical atrial fibrillation (SCAF) in the Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation trial. This was especially true for those with CHA2DS2-VASc score > 4. Understanding the cost-effectiveness of treating SCAF is important for decision-makers. Methods and results Canadian, UK, German, and US direct healthcare costs [in 2023 US dollars (USD)] were applied to hospitalized events (including strokes and bleeds) and study drugs for all participants with a CHA2DS2-VASc score > 4 to determine the mean cost per participant during the trial (mean follow-up 3.5 years). A daily cost of $0.63, $0.11, $2.26, and $6.06 for apixaban in Canada, the UK, Germany, and the USA was used. If in-trial results were not cost-saving (below $0), the prospective plan was to perform a lifetime cost-effectiveness analysis using a Markov model and a willingness-to-pay of 50 000 USD per quality-adjusted life year (QALY). After considering the cost of study medication and clinical events over 3.5 years, apixaban was dominant (cost-saving and more effective) in Canada (−$2301) and the UK (−$902) but cost more in Germany and the USA ($600 and $1990, respectively). Over a lifetime, treatment with apixaban produced a net gain of 0.107 QALYs, but with costs in both Germany ($2623 more) and the USA ($9110 more), yielding an incremental cost-effectiveness ratio of $24 514 per QALY for Germany and $85 140 for the USA. Conclusion In patients with SCAF and a CHA2DS2-VASc score > 4, apixaban is cost saving in Canada and the UK and cost-effective in Germany. Apixaban was not cost-effective in the USA under the base cost assumption but would be cost-effective at a daily cost of $4.35 and cost saving at $3.59.

• Alrahimi, Jamilah S.; Ahmed, Fatima A.; Haneef, Ali A. & Atar, Dan (2025). Integrative Perspectives on Atherosclerosis: From Molecular Mechanisms to Therapeutic Approaches. Saudi Journal of Medicine & Medical Sciences (SJMMS). ISSN 1658-631X. 13(4), s. 239–252. doi: 10.4103/sjmms.sjmms_18_25. Fulltekst i vitenarkiv
• Atar, Dan & Linde, Cecilia (2025). Subclinical atrial fibrillation: Who benefits from oral anticoagulation? Kardiologia Polska. ISSN 0022-9032. 83(7-8), s. 808–813. doi: 10.33963/v.phj.106733. Fulltekst i vitenarkiv
• Ni, Wenli; Stafoggia, Massimo; Zhang, Siqi; Ljungman, Petter; Breitner, Susanne & Bont, Jeroen de [Vis alle 10 forfattere av denne artikkelen] (2025). Short-term exposure to ambient temperature variability and myocardial infarction hospital admissions: A nationwide case-crossover study in Sweden. PLoS Medicine. ISSN 1549-1277. 22(5). doi: 10.1371/journal.pmed.1004607. Fulltekst i vitenarkiv Vis sammendrag

  Background Climate change threatens human health and general welfare via multiple dimensions. However, the associations of short-term exposure to temperature variability, a crucial aspect of climate change, with myocardial infarction (MI) hospital admissions remains unclear. Methods and findings This population-based nationwide study employed a time-stratified, case-crossover design to investigate the association between ambient temperature variability and MI hospital admissions among 233,617 patients recorded in the SWEDEHEART registry in Sweden between 2005 and 2019. High-resolution (1 × 1 km) daily mean ambient temperature was assigned to patients’ residential areas. Temperature variability was calculated as the difference between the same-day (as the MI event) ambient temperature and the average temperature over the preceding 7 days. An upward temperature shift represents a rise in the current day’s temperature relative to the 7-day average, while a downward temperature shift indicates a corresponding decrease. A conditional logistic regression model with distributed lag non-linear model was applied to estimate the association between ambient temperature variability and total MI (encompassing all MI types), ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) hospital admissions at lag 0–6 days. Potential effect modifiers, such as sex, history of diseases, and season, were also examined. The patients had an average age of 70.6 years, and 34.5% of them were female. Our study found that an upward temperature shift was associated with increased risks of total MI (encompassing all MI types), STEMI, and NSTEMI hospital admissions at lag 0 day, with odds ratios (OR, 95% confidence intervals [CIs]) of 1.009 (1.005, 1.013; p < 0.001), 1.014 (1.006, 1.022; p < 0.001), and 1.007 (1.001, 1.012; p = 0.014) per 1 °C increase, respectively. These associations attenuated and became non-significant over lags 1–6 days. Furthermore, a downward temperature shift was associated with increased risks of hospital admissions for total MI (encompassing all MI types) at a lag of 2 days with an OR (95% CI): 1.003 (1.001, 1.005; p = 0.014), and for STEMI at lags 2 and 3 days with ORs (95% CI): 1.006 (1.002, 1.010; p = 0.001) and 1.005 (1.001, 1.008; p = 0.011), per 1 °C decrease, respectively. Conversely, higher downward temperature shifts were associated with decreased risks of total MI (encompassing all MI types) and NSTEMI at lag 0 day. No significant associations were observed at other lag days for downward temperature shifts. Males and patients with diabetes had higher MI hospitalization risks from upward temperature shift exposure, while downward temperature shift exposure in cold seasons posed greater MI hospitalization risks. A methodological limitation was the use of ambient temperature variability as a proxy for personal exposure, which, while practical for large-scale studies, may not precisely reflect individual temperature exposure. Conclusions This nationwide study contributes insights that short-term exposures to higher temperature variability—greater upward or downward temperature shifts—are associated with an increased risk of MI hospitalization. Our finding highlights the cardiovascular health threats posed by higher temperature variability, which are anticipated to increase in frequency and intensity due to climate change.

• Kristensen, Anna Meta Dyrvig; Rossello, Xavier; Atar, Dan; Yndigegn, Troels; Kimura, Takeshi & Latini, Roberto [Vis alle 30 forfattere av denne artikkelen] (2025). Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction. New England Journal of Medicine. ISSN 0028-4793. 394(6), s. 540–550. doi: 10.1056/nejmoa2512686. Fulltekst i vitenarkiv
• Fyksen, Tea Sætereng; Gravning, Jørgen; Rossebø, Anne Bjørhovde; Vanberg, Paul; Grøtta, Ole Jørgen & Atar, Dan [Vis alle 7 forfattere av denne artikkelen] (2025). Cardiac structure and function in anabolic-androgenic steroid users: a 16-year follow-up study. Open heart. 12(2). doi: 10.1136/openhrt-2025-003376. Fulltekst i vitenarkiv Vis sammendrag

  Background and aim Long-term data on cardiac changes in anabolic-androgenic steroid (AAS) users are lacking. The aim of this study was to explore the effects of AAS on cardiac structure and function during long-term follow-up. Methods In this prospective cohort study, AAS users and strength-trained non-users were included and examined at two time points with echocardiography and coronary CT angiography. AAS use and non-use were verified by blood and urine analyses. Results A cohort of 32 AAS users (median age 33 years) and 13 non-users (median age 34 years) were followed for a median of 16 (IQR, 15–17) and 13 (7–15) years, respectively. At baseline, AAS users had been taking AAS for a median of 5–10 years. At follow-up, 15 had discontinued AAS, while 17 remained continued users. At baseline, AAS users presented with larger left ventricular mass (LVM) (266 g (213–319) vs 215 g (196–217), p<0.01), and lower left ventricular ejection fraction (LVEF) (49% (44–53) vs 53% (51–56), p=0.05), compared with non-users. At follow-up, LVM in discontinued users was reduced and similar to the non-users, while continued users still had larger LVM. LVEF remained significantly impaired in continued users versus non-users (p<0.01). In discontinued users, LVEF seemed to improve over time. The median change in LVEF over time differed significantly between continued and discontinued AAS users (−2 (−6 to 2) vs 3 (1 to 8), p<0.01). Despite higher cardiac troponin T levels in AAS users, coronary artery disease prevalence did not differ between groups. Conclusion Long-term AAS use was associated with myocardial remodelling and left ventricular dysfunction. In AAS users who discontinued use during follow-up, left ventricular remodelling and systolic function seemed to improve, even after more than a decade of AAS use.

• Zimerman, André; O'Donoghue, Michelle L.; Ran, Xinhui; Im, Kyung Ah; Ott, Brian R. & Mach, François [Vis alle 14 forfattere av denne artikkelen] (2025). Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab. NEJM Evidence. 4(1). doi: 10.1056/EVIDoa2400112. Fulltekst i vitenarkiv
• Rossello, Xavier; Prescott, Eva Irene Bossano; Kristensen, Anna Meta Dyrvig; Latini, Roberto; Fuster, Valentin & Fagerland, Morten [Vis alle 22 forfattere av denne artikkelen] (2025). β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. The Lancet. ISSN 0140-6736. 406(10508), s. 1128–1137. doi: 10.1016/s0140-6736(25)01592-2. Fulltekst i vitenarkiv Vis sammendrag

  Background The effects of β-blocker therapy on clinical outcomes in patients with myocardial infarction and mildly reduced (40–49%) left ventricular ejection fraction (LVEF) are largely unknown. Four recently conducted randomised trials tested the efficacy of β blockers after a recent myocardial infarction in patients without reduced LVEF (LVEF ≥40%). However, none were individually powered to assess these effects in the subgroup of patients with mildly reduced LVEF. We aimed to assess the efficacy of β blockers in patients with myocardial infarction and mildly reduced LVEF during the index hospitalisation. Methods We conducted an individual patient-level meta-analysis of patients with mildly reduced LVEF and no history or signs of heart failure from four recent clinical trials. These studies were included because they were randomised controlled trials testing long-term effects (median follow-up >1 year) of oral β-blocker therapy in patients who recently had a myocardial infarction (randomisation within 14 days) and had mildly reduced LVEF. No further studies were found in a systematic review (Jan 1, 2020 to June 26, 2025). A one-stage, fixed-effects, Cox proportional hazards regression model was used to assess the treatment effect of β blockers on the predefined primary composite endpoint of all-cause death, new myocardial infarction, or heart failure. All endpoints were independently adjudicated. This meta-analysis was registered with PROSPERO (CRD420251023480). Findings 1885 patients with myocardial infarction and mildly reduced LVEF were included in the meta-analysis: 979 from the REBOOT trial, 422 from the BETAMI trial, 430 from the DANBLOCK trial, and 54 from the CAPITAL-RCT trial. Overall, 991 patients were assigned to β blockers and 894 to control (no β blockers). The primary composite endpoint occurred in 106 patients (32·6 events per 1000 patient-years) in the β-blocker group and 129 patients (43·0 per 1000 patient-years) in the no β-blocker group (hazard ratio 0·75 [95% CI 0·58–0·97]; p=0·031). No heterogeneity between the trials (trial-by-treatment pinteraction=0·95) or between countries of enrolment was observed (pinteraction=0·98). Interpretation In patients with acute myocardial infarction with mildly reduced LVEF without history or clinical signs of heart failure, β-blocker therapy was associated with a reduction in the composite of all-cause death, new myocardial infarction, or heart failure. These results extend the known benefits of these agents in patients with myocardial infarction with reduced LVEF to the subgroup with mildly reduced LVEF.

• Johannessen, Tonje Rambøll; Melessen, Indra M B; Vallersnes, Odd Martin; Manten, Amy; Halvorsen, Sigrun & Atar, Dan [Vis alle 7 forfattere av denne artikkelen] (2025). Adequately identifying low-risk chest pain in emergency primary care: evaluating the performance of preHEAR(T) based on two European cohorts. Open heart. 12(2). doi: 10.1136/openhrt-2025-003362. Fulltekst i vitenarkiv Vis sammendrag

  Background Differentiating cardiac from non-cardiac acute chest pain poses a diagnostic challenge, especially in primary care. The History, ECG, Age, Risk factors and Troponin level (HEART) score aid in risk stratification in hospitals, while the prehospital HEART (preHEART) score was refined for paramedics’ use. However, its accuracy in emergency primary care has not been studied. This study evaluates the preHEAR(T) score, with and without high-sensitivity cardiac troponin (hs-cTn), as a tool to rule out acute myocardial infarction (MI) in emergency primary care. Methods Retrospective data from two European cohorts were analysed, namely the One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome (OUT-ACS) study (1711 patients) at a Norwegian emergency primary care centre (2016–2018) and the TRiage of Acute Chest pain Evaluated in urgent primary care (TRACE) study (664 patients) at a Dutch emergency primary care centre (2017). The preHEAR (without hs-cTn) score was evaluated in both cohorts. The preHEART score was assessed in OUT-ACS only, as the TRACE study did not measure troponins. The threshold of ≤3 points has previously been determined as low risk for acute MI (AMI) and optimal for rule-out purposes. The primary outcome was diagnostic performance for ruling out MI, and the secondary outcome was the composite of 90-day AMI or all-cause death. Results In OUT-ACS, 3.6% of patients had an AMI (median age 56 years (45–68); 47.7% female), and 3% in TRACE (median age 48 years (32–67); 56.9% female). PreHEAR identified 49.3% (OUT-ACS) and 82.7% (TRACE) as low risk, while preHEART identified 33.6% (OUT-ACS) as low risk. Sensitivity/specificity for AMI were 63.9% (95% CI 50.6 to 75.8)/49.8% (95% CI 47.3 to 52.7) (OUT-ACS) and 65% (95% CI 40.8 to 84.6)/84.2% (95% CI 81.1 to 86.9) (TRACE) for preHEAR and 93.4% (95% CI 84.1 to 98.2)/34.6% (95% CI 32.2 to 37) for preHEART. For the secondary outcome, similar diagnostic performance metrics were found. There were four missed AMI cases in the low-risk preHEART group, who were all female. Conclusion Neither the preHEAR nor preHEART scores provide sufficient rule out safety in emergency primary care and may particularly underestimate AMI risk in females. Trial registration number OUT-ACS: clinicaltrials.gov NCT02983123 . TRACE: Netherlands Trial Registry (NL-OMON20102); https://onderzoekmetmensen.nl/nl/trial/20102 .

• Munkhaugen, John; Kristensen, Anna Meta D.; Halvorsen, Sigrun; Holmager, Therese; Olsen, Michael Hecht & Bakken, Arnhild [Vis alle 64 forfattere av denne artikkelen] (2025). Beta-Blockers after Myocardial Infarction in Patients without Heart Failure. New England Journal of Medicine. ISSN 0028-4793. 393(19), s. 1901–1911. doi: 10.1056/nejmoa2505985. Fulltekst i vitenarkiv Vis sammendrag

  Background: The evidence supporting beta-blocker therapy after myocardial infarction was established before the introduction of modern coronary reperfusion therapy and secondary prevention strategies. Methods: In an open-label, randomized trial with blinded end-point evaluation, conducted in Denmark and Norway, we assigned patients who had had a myocardial infarction and who had a left ventricular ejection fraction of at least 40%, in a 1:1 ratio, to receive long-term beta-blocker therapy within 14 days after the event or no beta-blocker therapy. The primary end point was a composite of death from any cause or major adverse cardiovascular events (new myocardial infarction, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmias). Results: A total of 5574 patients underwent randomization and were included in the main analyses - 2783 in the beta-blocker group and 2791 in the no-beta-blocker group. After a median follow-up of 3.5 years (interquartile range, 2.2 to 4.6), a primary end-point event had occurred in 394 patients (14.2%) in the beta-blocker group and in 454 patients (16.3%) in the no-beta-blocker group (hazard ratio, 0.85; 95% confidence interval [CI], 0.75 to 0.98; P = 0.03). Death from any cause occurred in 4.2% of the patients in the beta-blocker group and in 4.4% of those in the no-beta-blocker group; myocardial infarction occurred in 5.0% and 6.7%, respectively (hazard ratio, 0.73; 95% CI, 0.59 to 0.92), unplanned coronary revascularization in 3.9% and 3.9%, ischemic stroke in 1.6% and 1.3%, heart failure in 1.5% and 1.9%, and malignant ventricular arrhythmias in 0.5% and 0.6%. No apparent differences in safety outcomes were observed between the groups. Conclusions: Among patients with a myocardial infarction and a left ventricular ejection fraction of at least 40%, beta-blocker therapy led to a lower risk of death or major adverse cardiovascular events than no beta-blocker therapy

• Stensland, Synne Øien Blixt; Bondjers, Kristina; Zwart, John Anker Henrik; Rosseland, Leiv Arne; Atar, Dan & Christensen, Jan Olav [Vis alle 11 forfattere av denne artikkelen] (2025). Development and psychometric validation of the frontline health workers’ occupational risk and characteristics in emergencies index (FORCE-index) – The covid Hospital cohort study. Public Health in Practice. 9. doi: 10.1016/j.puhip.2025.100582. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: A lack of tools for the systematic identification of frontline health workers' changing occupational risks, characteristics, and needs, poses a major barrier to supporting vital personnel to stay in practice through health emergencies and beyond. The current study reports on the development and psychometric evaluation of the Frontline health workers’ Occupational Risk and Characteristics in Emergencies index (FORCE-index). Study design: The Covid hospital study is a large, multisite, four-wave, open cohort study of frontline health workers responding to the first four waves of the COVID-19 pandemic (2020–2022). Methods: 2496 frontline health workers responded to questionnaires assessing various aspects of their work environment. Using exploratory factor analysis, we estimated the latent structure of the FORCE-index at the first and second waves. This structure was evaluated using confirmatory factor analysis at the third and fourth waves. The internal consistency of the instrument's subscales (e.g., factors) was evaluated using omega reliability, Cronbach's alpha coefficient, and mean inter-item correlation. Results: A nine-factor solution provided best fit to the data. These factors mapped onto the following aspects of the work environment; competency, stress management, familiarity, workload manageability, work performance, infection safety, personal protective equipment, social safety, and social support. Internal consistency for the full FORCE-index and the nine factors was satisfactory. Conclusions: The initial psychometric validation indicates that the FORCE-index is a valid measure which can be used by health authorities, services, and institutions to adequately and systematically assess central aspects of frontline health workers’ work environment that are commonly challenged in health emergencies.

• Bondjers, Kristina; Hyland, Philip; Atar, Dan; Christensen, Jan Olav; Nilsen, Kristian Bernhard & Reitan, Solveig Klæbo [Vis alle 12 forfattere av denne artikkelen] (2025). Burnout trajectories among healthcare workers during a pandemic, and predictors of change. BMC Health Services Research. 25(1). doi: 10.1186/s12913-025-12802-w. Fulltekst i vitenarkiv Vis sammendrag

  Background: While several cross-sectional studies have suggested high burnout levels among health-care workers (HCW) during the Covid-19 pandemic, fewer studies have examined longitudinal trajectories of burnout. Objectives: To examine (1) trajectories of change in levels of burnout among Norwegian HCW during a one-year period in the mid-phase of the Covid-19 pandemic (second, third, and fourth incidence rate peaks), and (2) how demographic and occupational variables, and pandemic-related experiences (e.g., own infection, severe infection in family, friend, or colleague, caring for deceased patient with Covid-19) were associated with such change. Methods: Burnout was measured by the Copenhagen Burnout Inventory. Latent growth curve modeling was used to estimate trajectories of burnout symptoms, and predictors of starting point and rate of change in burnout levels. Results: Starting points of burnout scores were, on average, low-to-moderate. Women, younger HCW, those living alone, and nurses had higher initial scores. Overall, burnout scores remained mostly unchanged across the study period. However, lower burnout scores at the initial assessment were associated with increasing scores over time. Being exposed to patients with Covid-19 and having a Covid-19 infection were associated with increased burnout over time. Conclusions: While burnout symptoms among frontline health workers remained stable across the peaks of the Covid-19 pandemic overall, the study identified higher risk of worsening symptoms over time among certain demographic (younger personnel, females, and nurses) and highly exposed individuals and groups. These findings may be helpful for identifying frontline workers at particular risk of burnout during future public health emergencies.

• Haukeland-Parker, Stacey Marie; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Gleditsch, Jostein [Vis alle 13 forfattere av denne artikkelen] (2025). Exercise capacity, dyspnea, and quality of life 6 months after exercise-based rehabilitation in patients with persistent dyspnea following pulmonary embolism. Research and Practice in Thrombosis and Haemostasis (RPTH). 9(2). doi: 10.1016/j.rpth.2025.102736. Fulltekst i vitenarkiv Vis sammendrag

  Background Exercise is safe and effective in the short-term following pulmonary embolism. To date, little is known about the long-term effects. Objectives The aim of the study was to investigate whether the effects of exercise-based rehabilitation are maintained 6 months after completion in patients with persistent dyspnea following pulmonary embolism when compared with usual care. Methods A 2-center, randomized controlled trial compared 8 weeks of exercise-based rehabilitation with usual care. Patients were reassessed postintervention and 6 months later. Exercise capacity was measured with the incremental shuttle walk test (ISWT). Dyspnea was assessed with the Shortness of Breath Questionnaire, and health-related quality of life was assessed with disease-specific (Pulmonary Embolism Quality of Life Questionnaire) and generic questionnaires. Results In total, 159 of 211 randomized patients attended follow-up 6 months postintervention. The significant improvement on the ISWT in the rehabilitation group was maintained at the 6-month follow-up (96 m; SE: 15 m; 95% CI: 66, 127). There were no changes on the ISWT in the control group at either time point. From postintervention to 6×-month follow-up, the rehabilitation group had further improvements in dyspnea compared with the control group (−3 points; SE: 1.4; 95% CI: −6, −1; P = .02). Health-related quality of life improved in both groups although superior improvements were seen in the rehabilitation group. Conclusion The improvement in exercise capacity after 8 weeks of exercise-based rehabilitation in patients with pulmonary embolism and persistent dyspnea was maintained at the 6-month follow-up, while no improvement was observed in the control group, highlighting the relevance of offering rehabilitation to these patients.

• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. doi: 10.1159/000545127. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Novel point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) tests could enhance acute myocardial infarction (MI) assessment outside hospital. This pilot study evaluates the efficacy, feasibility, and precision of the QuidelOrtho TriageTrue hs-cTnI POC assay when used by non-laboratory personnel in emergency primary care. Methods: A prospective pilot study was conducted from April to June 2024 at the main emergency primary care clinic in Oslo, Norway. Patients ≥18 years with acute nontraumatic chest pain were eligible. The 0/1-h diagnostic algorithms for the POC TriageTrue hs-cTnI and the Roche Elecsys hs-cTnT central laboratory assay (routine protocol) were compared to assess the efficacy and potential safety issues for patients triaged to MI rule-out. Results: Over 2 months, 199 patients (median age 54 years [interquartile range 45–70]; 52.8% female) were included. Five (2.5%) patients were hospitalised with acute MI. After a single hs-cTnI measurement, the POC algorithm categorised more patients to direct rule-out than the hs-cTnT assay (65% vs. 32%). The rule-out efficacy was similar for both assays after adding the 1-hour measurement (hs-cTnT 74%; POC hs-cTnI 73%). Device-related error rates were low (0.5%), with high reproducibility and repeatability (coefficients of variation < 10%) when performed by non-laboratory personnel. Conclusion: The 0/1-h algorithm for the TriageTrue hs-cTnI POC assay appears efficient, feasible, and robust when applied by personnel without laboratory expertise in an emergency primary care setting. Further research is warranted, but given the high proportion of single-sample rule-out cases, 1-h measurements could likely be avoided, improving patient management.

• Johannessen, Tonje Rambøll; Ruud, Sven Eirik; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan; Halvorsen, Sigrun & Nilsen, Beate [Vis alle 7 forfattere av denne artikkelen] (2025). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care: the OUT-ACS implementation study. BMC Primary Care. 26(1). doi: 10.1186/s12875-025-02723-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Acute chest pain has a high hospital referral rate due to the limited ability to exclude acute myocardial infarction (MI) in primary care. We aimed to evaluate the effectiveness of implementing the European Society of Cardiology (ESC) 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) testing in emergency primary care. Methods In a prospective study (April-October 2023), the ESC 0/1-hour algorithm for hs-cTnT was implemented at the main emergency primary care clinic in Oslo, Norway. All consecutive patients ≥ 18 years with acute non-traumatic chest pain having hs-cTnT measurements done were registered. The patients were assigned to MI rule-out, rule-in, or further observation using the algorithm. Patients in the observation group had a 4-hour hs-cTnT measurement done. The outcome measures were the proportion of patients conclusively assessed by the protocol, personnel adherence, reduction in length of stay (LOS) compared to the previous 0/4-hour protocol (historical cohort), and disposition. Results During six months, hs-cTnT measurements were conducted in 32.6% (995/3053) of chest pain patients (median age 58 years (IQR 45–68); 50.6% female). A single hs-cTnT measurement assigned 24.1% (n = 240/995) towards MI rule-out, suitable for early discharge, increasing to 63.8% after adding a 1-hour measurement. The observation group (319/995, 32.1%) was reduced to 23.0% (229/995) after a 4-hour measurement. A total of 77.0% of the patients were conclusively assigned to either rule-out or rule-in group. The personnel adhered well to the new protocol, with a median 1-hour sampling interval of 63 min (IQR 60–66) and 4.6 h (IQR 4.1–5.5) for the 4-hour sample. The protocol was misinterpreted or overruled in 8.6% of the cases. Compared to the previous 0/4-hour protocol, LOS was reduced by -2.2 h (95% confidence intervals − 2.6 to -1.7). After completed assessment at the clinic, 14.8% were transferred to hospital, where 20 patients were diagnosed with an MI. The remaining patients were sent home or managed in the outpatient setting; any occurrence of MIs in this group is unknown. Conclusions The ESC 0/1-hour algorithm effectively assesses low-risk acute chest pain in emergency primary care, reinforcing its gatekeeper role by managing these patients at a lower level of care.

• Said, Samer Al; O'Donoghue, Michelle L.; Ran, Xinhui; Murphy, Sabina A.; Atar, Dan & Keech, Anthony [Vis alle 10 forfattere av denne artikkelen] (2025). Long-Term Lipid Lowering With Evolocumab in Older Individuals. Journal of the American College of Cardiology. ISSN 0735-1097. 85(5), s. 504–512. doi: 10.1016/j.jacc.2024.11.019. Fulltekst i vitenarkiv
• Atar, Dan; Vandenbriele, Christophe; Agewall, Stefan; Gigante, Bruna; Goette, Andreas & Gorog, Diana A. [Vis alle 13 forfattere av denne artikkelen] (2025). Management of patients with congenital bleeding disorders and cardiac indications for antithrombotic therapy. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 11(3), s. 275–289. doi: 10.1093/ehjcvp/pvaf006. Fulltekst i vitenarkiv Vis sammendrag

  Aims Cardiologists have only had rare exposure to haemophilia patients and patients with other congenital bleeding disorders during the last decades, as these patients had a reduced life expectancy and were partly protected against thrombosis due to the bleeding disorder. With the availability of effective and safe replacement therapies of clotting factors, the average life expectancy in these populations of patients has significantly increased, and thrombotic complications may occur. Methods and results The European Society of Cardiology Working Group on Thrombosis has taken the initiative to broaden the spectrum of these haematological conditions to include patients with a larger variety of congenital bleeding disorders with concomitant cardiac conditions as compared to a recent position paper by the European Haematology Association in collaboration with other societies (ISTH, European Association for Haemophilia and Allied Disorders, and ESO). Management of antithrombotic therapy or thromboprophylaxis in these individuals is challenging due to the wide phenotypes encompassed by congenital bleeding disorders. These include abnormalities in both primary haemostasis (involving von Willebrand factor and platelet function) and secondary haemostasis (related to coagulation factors and fibrinogen). Bleeding disorders range from mild to very severe. Based on existing literature, we provide clinical consensus statements on optimizing antithrombotic treatment strategies for patients with congenital bleeding disorders and highlight the current gaps in knowledge in these complex clinical settings. Conclusion Of importance, an individualized approach to antithrombotic therapy is warranted to properly balance the two risks of thrombosis and bleeding. Adoption of the safest interventional techniques, reduction of the intensity and/or duration of antithrombotic therapies, and attention to the safe levels of clotting factors is generally advised.

• Schnabel, Renate B.; Benezet-Mazuecos, Juan; Becher, Nina; McIntyre, William F.; Fierenz, Alexander & Lee, Shun Fu [Vis alle 33 forfattere av denne artikkelen] (2024). Anticoagulation in device-detected atrial fibrillation with or without vascular disease: a combined analysis of the NOAH-AFNET 6 and ARTESiA trials. European Heart Journal. ISSN 0195-668X. 45(46), s. 4902–4916. doi: 10.1093/eurheartj/ehae596. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims The optimal antithrombotic therapy in patients with device-detected atrial fibrillation (DDAF) is unknown. Concomitant vascular disease can modify the benefits and risks of anticoagulation. Methods These pre-specified analyses of the NOAH-AFNET 6 (n = 2534 patients) and ARTESiA (n = 4012 patients) trials compared anticoagulation with no anticoagulation in patients with DDAF with or without vascular disease, defined as prior stroke/transient ischaemic attack, coronary or peripheral artery disease. Efficacy outcomes were the primary outcomes of both trials, a composite of stroke, systemic arterial embolism (SE), myocardial infarction, pulmonary embolism or cardiovascular death, and stroke or SE. Safety outcomes were major bleeding or major bleeding and death. Results In patients with vascular disease (NOAH-AFNET 6, 56%; ARTESiA, 46%), stroke, myocardial infarction, systemic or pulmonary embolism, or cardiovascular death occurred at 3.9%/patient-year with and 5.0%/patient-year without anticoagulation (NOAH-AFNET 6), and 3.2%/patient-year with and 4.4%/patient-year without anticoagulation (ARTESiA). Without vascular disease, outcomes were equal with and without anticoagulation (NOAH-AFNET 6, 2.7%/patient-year; ARTESiA, 2.3%/patient-year in both randomized groups). Meta-analysis found consistent results across both trials (I2heterogeneity = 6%) with a trend for interaction with randomized therapy (pinteraction = .08). Stroke/SE behaved similarly. Anticoagulation equally increased major bleeding in vascular disease patients [edoxaban, 2.1%/patient-year; no anticoagulation, 1.3%/patient-year; apixaban, 1.7%/patient-years; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.55 (1.10–2.20)] and without vascular disease [edoxaban, 2.2%/patient-year; no anticoagulation, 0.6%/patient-year; apixaban, 1.4%/patient-year; no anticoagulation, 1.1%/patient-year; incidence rate ratio 1.93 (0.72–5.20)]. Conclusions Patients with DDAF and vascular disease are at higher risk of stroke and cardiovascular events and may derive a greater benefit from anticoagulation than patients with DDAF without vascular disease.

• Sandberg, Edvard Liljedahl; Halvorsen, Sigrun; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Grenne, Bjørnar Leangen [Vis alle 7 forfattere av denne artikkelen] (2024). Digital recruitment and compliance to treatment recommendations in the Norwegian Atrial Fibrillation self-screening pilot study. The European Heart Journal – Digital Health (EHJ-DH). 5(3), s. 371–378. doi: 10.1093/ehjdh/ztae026. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Atrial fibrillation (AF) is prevalent, undiagnosed in approximately one-third of cases, and is associated with severe complications. Guidelines recommend screening individuals at increased risk of stroke. This report evaluated the digital recruitment procedure and compliance with the follow-up recommendations in participants with screen-detected AF in the Norwegian Atrial Fibrillation self-screening pilot study. Methods and results: Norwegians ≥65 years were invited through Facebooks posts, web pages, and newspapers to participate in the study. Targeted Facebook posts promoted over 11 days reached 84 208 users and 10 582 visitors to the study homepage. This accounted for 51% of the total homepage visitors (n = 20 704). A total of 2118 (10%) of the homepage visitors provided digital consent to participate after they met the inclusion criteria. The mean (standard deviation) age of the participants was 70 (4) years, and the majority [n = 1569 (74%)] were women. A total of 1849 (87%) participants completed the electrocardiogram self-screening test, identifying AF in 41 (2.2%) individuals. Of these, 39 (95%) participants consulted a general practitioner, and 34 (83%) participants initiated anticoagulation therapy. Conclusion: Digital recruitment and inclusion in digital AF screening with a high rate of initiation of anticoagulation therapy in AF positive screening cases are feasible. However, digital recruitment and inclusion may introduce selection bias with regard to age and gender. Larger studies are needed to determine the efficacy and cost-effectiveness of a fully digital AF screening. Trial registration: Clinical trials: NCT04700865

• McClintick, Daniel J.; O'Donoghue, Michelle L.; Ferrari, Gaetano M. De; Ferreira, Jorge; Ran, Xinhui & Im, KyungAh [Vis alle 14 forfattere av denne artikkelen] (2024). Long-Term Efficacy of Evolocumab in Patients With or Without Multivessel Coronary Disease. Journal of the American College of Cardiology. ISSN 0735-1097. 83(6), s. 652–664. doi: 10.1016/j.jacc.2023.11.029. Fulltekst i vitenarkiv
• Glad, Kristin Alve; Wøien, Hilde; Stensland, Synne; Reitan, Solveig Klæbo; Zwart, John Anker Henrik & Atar, Dan [Vis alle 8 forfattere av denne artikkelen] (2024). Health care workers’ qualitative descriptions of ethically challenging situations evoking moral distress during Covid-19. Nursing Ethics. ISSN 0969-7330. 31(8), s. 1709–1721. doi: 10.1177/09697330241257567. Fulltekst i vitenarkiv Vis sammendrag

  Background: The high public demand for healthcare services during the COVID-19 pandemic and strict infection control measures, coupled with threat of severe illness and death, and limited resources, led to many healthcare workers (HCWs) experiencing ethically challenging situations (ECSs). Objective: To systematically explore first-hand accounts of ECS-evoking moral distress among HCWs during this public health emergency. Research design: This was an open cohort study. All participants were asked whether they had been in ECS-evoking moral distress during the pandemic. Those who had were asked to describe these situations. Answers were systematically analyzed according to three levels of root causes for ECSs, using thematic analysis. Participants and research context: In January 2022, 977 HCWs from four Norwegian university hospitals participated. Ethical considerations: The study received ethical approval from the Norwegian Ethical Review Authority (No. 130944). Results: In total, 508 participants (52%) reported that they had experienced ECS-evoking moral distress during the pandemic, whereof 323 provided a qualitative description. We found that while a few reported ECSs caused at the patient level, and some described situations at the unit/team level, the vast majority reported situations caused at the system level, predominantly related to resource scarcity, particularly poor staffing. Conclusion: Our findings strongly indicate that efforts to mitigate moral distress among HCWs should be targeted at the system level. More specifically, the study findings highlight resource limitations, particularly poor staffing, as a major cause of moral distress during the pandemic.

• Bondjers, Kristina; Glad, Kristin Alve; Wøien, Hilde; Wentzel-Larsen, Tore; Atar, Dan & Reitan, Solveig Klæbo [Vis alle 10 forfattere av denne artikkelen] (2024). Moral distress and protective work environment for healthcare workers during public health emergencies. BMC Medical Ethics. 25(1). doi: 10.1186/s12910-024-01098-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Public health emergencies, such as the Covid-19 pandemic, put great pressure on healthcare workers (HCW) across the world, possibly increasing the risk of experiencing ethically challenging situations (ECS). Whereas experiencing ECS as a HCW in such situations is likely unavoidable, mitigation of their adverse effects (e.g., moral distress) is necessary to reduce the risk of long-term negative consequences. One possible route of mitigation of these effects is via work environmental factors. Objectives The current study aimed to examine: [1] risk factors associated with ECS among HCW [2], intensity of moral distress associated with ECS across various occupational factors (i.e., profession, degree of exposure to patients with Covid-19), and [3] the impact of work environmental factors on this association, in a sample of HCW during the pandemic. Methods We employed multiple logistic and linear regression to self-report data from 977 HCWs at four Norwegian hospitals responding to a survey at the fourth wave of the pandemic. Results About half of HCW in this study had experienced ECS during the pandemic, and levels of moral distress associated with such were higher than in previous studies using similar assessment methods. Younger age, female sex, geographical work area (mid-north of Norway), and profession (nurse) were all associated with higher odds (range of OR: 1.30–2.59) of experiencing ECS, as were direct contact with patients with Covid-19. Among those participants who reported that they had experienced ECS during the pandemic, moral distress levels when recalling those situations were moderate (Mean 5.7 on a 0–10 scale). Men reported somewhat lower intensity of moral distress (partial eta squared; ηp2 = 0.02). Reporting a manageable workload (ηp2 = 0.02), and greater opportunity to work according to best practice (ηp2 = 0.02), were associated with lower levels of moral distress. Conclusions Our findings suggest that moral distress could potentially be mitigated on an organizational level, particularly by focusing on ensuring a manageable workload, and an ability to work according to best practice. To build sustainable healthcare systems robust enough to withstand future public health emergencies, healthcare organizations should implement measures to facilitate these aspects of HCWs’ work environment.

• Ni, Wenli; Stafoggia, Massimo; Zhang, Siqi; Ljungman, Petter; Breitner, Susanne & Bont, Jeroen de [Vis alle 10 forfattere av denne artikkelen] (2024). Short-Term Effects of Lower Air Temperature and Cold Spells on Myocardial Infarction Hospitalizations in Sweden. Journal of the American College of Cardiology. ISSN 0735-1097. 84(13), s. 1149–1159. doi: 10.1016/j.jacc.2024.07.006. Fulltekst i vitenarkiv
• Nordlund, David; Lav, Theodor; Jablonowski, Robert; Khoshnood, Ardavan; Ekelund, Ulf & Atar, Dan [Vis alle 9 forfattere av denne artikkelen] (2024). Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data. Clinical Cardiology. ISSN 0160-9289. 47(1). doi: 10.1002/clc.24216. Fulltekst i vitenarkiv Vis sammendrag

  Background Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). Methods A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2−6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax) reflecting contractility, Ea, ventriculoarterial coupling (Ea/Emax), SW, potential energy, external power, energy per ejected volume, and efficiency. Results All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax: 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea/Emax: 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax: r2 = 0.25 and r2 = 0.29; Ea/Emax: r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). Conclusions Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.

• Andel, Peter Michael; Aamodt, Anne Hege; Gleditsch, Jostein; Melin, Erik; Rootwelt-Revheim, Mona-Elisabeth & Steine, Kjetil [Vis alle 7 forfattere av denne artikkelen] (2024). Elective Direct Current Cardioversion of Atrial Fibrillation: Silent Brain Infarction and Health-Related Quality of Life. Cardiology. ISSN 0008-6312. 149(6), s. 571–579. doi: 10.1159/000540007. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Atrial fibrillation (AF) increases the risk for stroke, dementia, and impaired health-related quality of life (HRQL). Elective direct current cardioversion (ECV) is often used to restore sinus rhythm but is associated with thromboembolism. While larger strokes usually produce symptoms, subclinical ones may go unrecognized and may cause cognitive and functional decline over time. In the current study, we sought to evaluate the effects of ECV on silent brain infarctions and HRQL in patients with AF. Methods: Patients with AF (n = 46) underwent brain magnetic resonance imaging (MRI) and HRQL assessment using the EuroQL-5D5L questionnaire before and after ECV. Implantable loop recorders (ILRs) were used to observe the rate of early AF recurrences within the first 30 days. All patients were treated with anticoagulants according to guidelines. The primary endpoint was silent brain infarction assessed by brain MRI within the first 2 weeks after ECV. Secondary endpoints were the change in HRQL and its association with AF recurrence at follow-up and by ILR recordings. Results: New silent brain infarction after ECV was detected in 1 patient. At follow-up visit after 19.1 days AF recurrence was detected by 12-lead ECG in 13 patients (28.3%), whereas 27 patients (58.7%) had AF recurrence recorded by ILR within the first 30 days after ECV. European Heart Rhythm Association (EHRA) symptom score and the EuroQL-5d5L score were improved after ECV. Conclusion: Silent brain infarctions may occur after ECV despite anticoagulation treatment. Early AF recurrence is frequent. ECV positively affects HRQL mainly in those patients with sustained sinus rhythm at follow-up.

• Fyksen, Tea Sætereng; Seljeflot, Ingebjørg; Vanberg, Paul; Atar, Dan & Halvorsen, Sigrun (2024). Platelet activity, coagulation, and fibrinolysis in long-term users of anabolic-androgenic steroids compared to strength-trained athletes. Thrombosis Research. ISSN 0049-3848. 238, s. 60–66. doi: 10.1016/j.thromres.2024.04.027. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Use of anabolic-androgenic steroids (AAS) is associated with adverse cardiovascular (CV) effects, including potential prothrombotic effects. This study aimed to assess platelet activation and aggregation, coagulation, and fibrinolysis, in long-term AAS users compared to non-using strength-trained athletes. Materials and methods Thirty-seven strength-trained men using AAS were compared to seventeen non-using professional strength-trained athletes at similar age (median 33 years). AAS use was verified by blood and urine analyses. Platelet Function Analyzer 100 (PFA-100) and whole blood impedance aggregometry with thrombin, arachidonic acid, and ADP as agonists, were performed to evaluate platelet aggregation. ELISA methods were used for markers of platelet activation. Fibrinogen, D-dimer, the coagulation inhibitors protein S and C activity, and antithrombin were measured by routine. Fibrinolysis was evaluated by Plasminogen Activator Inhibitor-1 (PAI-1) activity. Results There were no significant differences in platelet aggregation between the two groups. Von Willebrand factor was lower among the AAS users (p < 0.01), and P-Selectin was slightly higher (p = 0.05), whereas CD40 Ligand, β-thromboglobulin, and thrombospondin did not differ significantly. No differences were found in the assessed coagulation inhibitors. Higher D-dimer levels (p < 0.01) and lower PAI-1 activity (p < 0.01) were found among the AAS users. Conclusions The investigated long-term users of AAS did not exhibit elevated platelet activity compared to strength-trained non-using athletes. However, AAS use was associated with higher D-dimer levels and lower PAI-1 activity. These findings suggest that any prothrombotic effect of long-term AAS use may predominantly involve other aspects of the hemostatic system than blood platelets.

• AlRahimi, Jamilah; Ahmed, Fatima Ali & Atar, Dan (2024). The Interplay of Atherothrombotic Factors and the Evolving Landscape of Atherosclerotic Cardiovascular Disease: Comprehensive Insights from Recent Studies. The Anatolian Journal of Cardiology. ISSN 2149-2263. 28(8), s. 375–380. doi: 10.14744/AnatolJCardiol.2024.4632. Fulltekst i vitenarkiv Vis sammendrag

  The aim of the current work is to present a thorough recapitulation of the emerging understanding of atherosclerotic cardiovascular disease and recommending avenues for future studies. Cardiovascular diseases (CVDs) remain a leading cause of global morbidity and mortality, influenced by a complex interplay of genetic, environmental, and atherothrombotic factors. Atherosclerosis, a multifaceted and dynamic process, is at the core of many CVDs. Recent studies have shed light on the multilayered nature of atherosclerosis and cardiovascular risk, emphasizing the need for a nuanced understanding of these diseases across different populations and disease mechanisms. This review synthesizes findings from 6 pivotal studies, shedding light on the intricate mechanisms underlying atherosclerotic cardiovascular events, the evolving understanding of atherosclerosis, and the potential pathways to attempt implementation in clinical practice. Insights into atherothrombotic factors, the role of macrophages, and the implications of aortic enlargement and coronary artery calcification underscore the complexity of CVD pathogenesis and highlight the need for comprehensive strategies in diagnosis, treatment, and prevention.

• Lopes, Renato D.; Granger, Christopher B.; Wojdyla, Daniel M.; McIntyre, William F.; Alings, Marco & Mani, Thenmozhi [Vis alle 28 forfattere av denne artikkelen] (2024). Apixaban vs Aspirin According to CHA<inf>2</inf>DS<inf>2</inf>-VASc Score in Subclinical Atrial Fibrillation: Insights From ARTESiA. Journal of the American College of Cardiology. ISSN 0735-1097. 84(4), s. 354–364. doi: 10.1016/j.jacc.2024.05.002. Fulltekst i vitenarkiv
• Lambert, Anna Tancin; Sætre, Dag Ottar; Ratajczak-Tretel, Barbara; Gleditsch, Jostein; Høie, Gudrun & Al-Ani, Riadh Ibrahim Mahmud [Vis alle 9 forfattere av denne artikkelen] (2024). Imaging features for the identification of atrial fibrillation in cryptogenic stroke patients. Journal of Neurology. ISSN 0340-5354. doi: 10.1007/s00415-024-12397-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Whether specific imaging aspects can be used to identify cryptogenic stroke (CS) patients with high risk of underlying atrial fibrillation (AF) remains unclear. The purpose of this study was to evaluate brain-imaging features in CS patients and their utility as AF predictors. Methods The Nordic Atrial Fibrillation and Stroke study was a prospective observational study of CS and transient ischemic attack patients undergoing 12-month cardiac-rhythm monitoring, biomarker and clinical assessments. In this imaging sub-study, brain magnetic resonance imaging and computed tomography scans from 106 patients were assessed for acute and chronic ischemic lesions in relation to AF occurrence and included in a score to predict AF. Receiver operating characteristics (ROC) curve was used to evaluate the discriminative ability of the score and for its dichotomization for predictive model. Results Age, periventricular white-matter hyperintensities (PVWMH), acute lesion size, and vessel occlusion were significantly associated with AF. Acute and chronic cortical infarcts as well as chronic cerebellar infarcts were numerically more frequent in the AF group than the non-AF group. A score consisting of six features (0–6 points) was proposed (age ≥ 65 years, chronic cortical or cerebellar lesions, acute cortical lesions, PVWMH ≥ 2 in Fazekas scale, vessel occlusion, and acute lesion size ≥ 10 mm). Area under ROC curve was 0.735 and a score of ≥ 3 points was a predictor of AF. Conclusions The suggested score was shown to identify CS patients with an increased risk of underlying AF.

• Rubboli, Andrea; Atar, Dan & Sibbing, Dirk (2024). De-escalation of antithrombotic treatment after acute coronary syndrome, a new paradigm. Internal and Emergency Medicine. ISSN 1828-0447. doi: 10.1007/s11739-024-03590-y. Fulltekst i vitenarkiv
• Gigante, Bruna; Tamargo, Juan; Agewall, Stefan; Atar, Dan; Berg, Jurrien ten & Campo, Gianluca [Vis alle 18 forfattere av denne artikkelen] (2024). Update on antithrombotic therapy and body mass: a clinical consensus statement of the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy and the European Society of Cardiology Working Group on Thrombosis. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 10(7), s. 614–645. doi: 10.1093/ehjcvp/pvae064. Fulltekst i vitenarkiv
• Sandberg, Edvard Liljedahl; Halvorsen, Sigrun; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Grenne, Bjørnar Leangen [Vis alle 7 forfattere av denne artikkelen] (2024). Screening for Atrial Fibrillation by Digital Health Technology in Older People in Homecare Settings: A Feasibility Trial. International Journal of Telemedicine and Applications. ISSN 1687-6415. 2024(1). doi: 10.1155/2024/4080415. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Users of homecare services are often excluded from clinical trials due to advanced age, multimorbidity, and frailty. Atrial fibrillation (AF) is a common and frequently undiagnosed arrhythmia in the elderly and is associated with severe mortality, morbidity, and healthcare costs. Timely identification prevents associated complications through evidence-based treatment. This study is aimed at assessing the feasibility of AF screening using new digital health technology in older people in a homecare setting. Methods: Users of homecare services ≥ 65 years old with at least one additional risk factor for stroke in two Norwegian municipalities were assessed for study participation by nurses. Participants performed a continuous prolonged ECG recording using a patch ECG device (ECG247 Smart Heart Sensor). Results: A total of 144 individuals were assessed for study participation, but only 18 (13%) were included. The main reasons for noninclusion were known AF and/or anticoagulation therapy (25%), severe cognitive impairment (26%), and lack of willingness to participate (36%). The mean age of participants performing the ECG test was 81 (SD ± 7) years, and 9 (50%) were women. All ECG tests were interpretable; the mean ECG monitoring time was 104 hours (IQR 34-338 hours). AF was detected in one individual (6%). Conclusion: This feasibility study highlights the challenges of enrolling older people receiving homecare services in clinical trials. However, all included participants performed an interpretable and prolonged continuous ECG recording with a digital ECG patch device. This trial is registered with NCT04700865.

• Gaba, Prakriti; O'Donoghue, Michelle L.; Park, Jeong-Gun; Wiviott, Stephen D.; Atar, Dan & Kuder, Julia F. [Vis alle 23 forfattere av denne artikkelen] (2023). Association between Achieved Low-Density Lipoprotein Cholesterol Levels and Long-Term Cardiovascular and Safety Outcomes: An Analysis of FOURIER-OLE. Circulation. ISSN 0009-7322. 147(16), s. 1192–1203. doi: 10.1161/CIRCULATIONAHA.122.063399. Fulltekst i vitenarkiv
• Jervan, Øyvind; Haukeland-Parker, Stacey Marie; Gleditsch, Jostein; Tavoly, Mazdak; Klok, Frederikus A. & Steine, Kjetil [Vis alle 14 forfattere av denne artikkelen] (2023). The Effects of Exercise Training in Patients With Persistent Dyspnea Following Pulmonary Embolism: A Randomized Controlled Trial. Chest. ISSN 0012-3692. 164(4), s. 981–991. doi: 10.1016/j.chest.2023.04.042. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Vedvarende dyspné, funksjonelle begrensninger og redusert livskvalitet (QoL) er vanlig etter lungeemboli (PE). Rehabilitering er et potensielt behandlingsalternativ , men den vitenskapelige dokumentasjonen er begrenset. Forskningsspørsmål Forbedrer et treningsbasert rehabiliteringsprogram treningskapasiteten hos PE-overlevere med vedvarende dyspné? Studiedesign og metoder Denne randomiserte kontrollerte studien ble utført ved to sykehus. Pasienter med vedvarende dyspné etter PE diagnostisert 6 til 72 måneder tidligere, uten kardiopulmonale komorbiditeter, ble randomisert 1:1 til enten rehabiliterings- eller kontrollgruppen. Rehabiliteringsprogrammet besto av to ukentlige økter med fysisk trening i 8 uker og en pedagogisk økt. Kontrollgruppen fikk vanlig pleie. Det primære endepunktet var forskjellen i Incremental Shuttle Walk Test mellom grupper ved oppfølging. Sekundære endepunkter inkluderte forskjeller i Endurance Shuttle Walk Test (ESWT), QoL (EQ-5D og lungeemboli-QoL spørreskjemaer) og dyspné (Shortness of Breath spørreskjema). Resultater Totalt 211 forsøkspersoner ble inkludert: 108 (51 %) ble randomisert til rehabiliteringsgruppen og 103 (49 %) til kontrollgruppen. Ved oppfølging presterte deltakerne fordelt på rehabiliteringsgruppen bedre på ISWT sammenlignet med kontrollgruppen (gjennomsnittlig forskjell, 53,0 m; 95 % KI, 17,7-88,3; P = 0,0035). Rehabiliteringsgruppen rapporterte bedre skårer på spørreskjemaet lungeemboli-kvalitet (gjennomsnittlig forskjell, –4 %; 95 % KI, –0,09 til 0,00; P = 0,041) ved oppfølging, men det var ingen forskjeller i generisk livskvalitet, dyspné. score, eller ESWT. Ingen uønskede hendelser oppsto under intervensjonen. Tolkning Hos pasienter med vedvarende dyspné etter PE hadde de som gjennomgikk rehabilitering bedre treningskapasitet ved oppfølging enn de som fikk vanlig behandling. Rehabilitering bør vurderes hos pasienter med vedvarende dyspné etter PE. Ytterligere forskning er imidlertid nødvendig for å vurdere optimal pasientvalg, tidspunkt, modus og varighet av rehabilitering.

• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, Riadh Ibrahim Mahmud; Arntzen, Kathrine Grønning; Bakkejord, Grete & Bekkeseth, Hanna Marie Otterholt [Vis alle 32 forfattere av denne artikkelen] (2023). Prediction of underlying atrial fibrillation in patients with a cryptogenic stroke: results from the NOR-FIB Study. Journal of Neurology. ISSN 0340-5354. 270, s. 4049–4059. doi: 10.1007/s00415-023-11680-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Atrial fibrillation (AF) detection and treatment are key elements to reduce recurrence risk in cryptogenic stroke (CS) with underlying arrhythmia. The purpose of the present study was to assess the predictors of AF in CS and the utility of existing AF-predicting scores in The Nordic Atrial Fibrillation and Stroke (NOR-FIB) Study. Method The NOR-FIB study was an international prospective observational multicenter study designed to detect and quantify AF in CS and cryptogenic transient ischaemic attack (TIA) patients monitored by the insertable cardiac monitor (ICM), and to identify AF-predicting biomarkers. The utility of the following AF-predicting scores was tested: AS5F, Brown ESUS-AF, CHA2DS2-VASc, CHASE-LESS, HATCH, HAVOC, STAF and SURF. Results In univariate analyses increasing age, hypertension, left ventricle hypertrophy, dyslipidaemia, antiarrhythmic drugs usage, valvular heart disease, and neuroimaging findings of stroke due to intracranial vessel occlusions and previous ischemic lesions were associated with a higher likelihood of detected AF. In multivariate analysis, age was the only independent predictor of AF. All the AF-predicting scores showed significantly higher score levels for AF than non-AF patients. The STAF and the SURF scores provided the highest sensitivity and negative predictive values, while the AS5F and SURF reached an area under the receiver operating curve (AUC) > 0.7. Conclusion Clinical risk scores may guide a personalized evaluation approach in CS patients. Increasing awareness of the usage of available AF-predicting scores may optimize the arrhythmia detection pathway in stroke units.

• Navarese, Eliano Pio; Landi, Antonio; Oliva, Angelo; Piccolo, Raffaele; Aboyans, Victor & Angiolillo, Dominick [Vis alle 23 forfattere av denne artikkelen] (2023). Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC). European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 9(3), s. 271–290. doi: 10.1093/ehjcvp/pvad016. Fulltekst i vitenarkiv
• Serebruany, Victor L.; Tanguay, Jean-Francois; Gurvich, Milana L.; Marciniak, Thomas A. & Atar, Dan (2023). Strokes and Transient Ischemic Attacks Occurrence during Annual Dual Antiplatelet Therapy. American Journal of Therapeutics. ISSN 1075-2765. 30(5), s. E411–E415. doi: 10.1097/MJT.0000000000001622. Fulltekst i vitenarkiv
• Lambert, Anna Tancin; Ratajczak-Tretel, Barbara; Al-Ani, Riadh Ibrahim Mahmud; Arntzen, Kathrine Grønning; Bakkejord, Grete & Bekkeseth, Hanna Marie Otterholt [Vis alle 35 forfattere av denne artikkelen] (2023). Biomarkers predictive of atrial fibrillation in patients with cryptogenic stroke. Insights from the Nordic Atrial Fibrillation and Stroke (NOR-FIB) study. European Journal of Neurology. ISSN 1351-5101. 30(5), s. 1352–1363. doi: 10.1111/ene.15746. Fulltekst i vitenarkiv Vis sammendrag

  Background There are currently no biomarkers used to select cryptogenic stroke (CS) patients for monitoring with insertable cardiac monitors (ICMs), the most effective tool for diagnosing atrial fibrillation (AF) in CS. The purpose of this study was to assess clinically available biomarkers as predictors of AF. Methods Eligible CS and cryptogenic transient ischemic attack (TIA) patients underwent 12-month monitoring with ICMs, clinical follow-up, and biomarker sampling. Levels of cardiac and thromboembolic biomarkers, taken within 14 days from symptom onset, were compared between patients diagnosed with AF (n=74) during monitoring and those without AF (n=185). Receiver operating characteristic (ROC) curves were created. Biomarkers reaching area under ROC curve (AUC) ≥ 0.7 were dichotomized by finding optimal cut-off values and used in logistic regression establishing their predictive value for increased risk of AF in unadjusted and adjusted models. Results B-type natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-proBNP), creatine kinase, D-dimer, high-sensitivity cardiac Troponin I and T were significantly higher in the AF than non-AF group. BNP and NT-proBNP reached predefined AUC level, 0.755 and 0.725 respectively. Optimal cut-off values were 33.5 ng/L for BNP, and 87 ng/L for NT-proBNP. Regression analysis showed that NT-proBNP was a predictor of AF in both unadjusted, odds ratio (OR) 7.72 (95% confidence interval [CI] 3.16–18.87), and age and sex adjusted models, OR 4.82 (95% CI 1.79–12.96). Conclusion Several clinically established biomarkers were associated with AF. NT-proBNP performed best as AF predictor and could be used for selecting patients for long-term monitoring with ICMs.

• Atar, Dan; Auricchio, Angelo & Blomström-Lundqvist, Carina (2023). Cardiac device infection: removing barriers to timely and adequate treatment. European Heart Journal. ISSN 0195-668X. 44(35), s. 3323–3326. doi: 10.1093/eurheartj/ehad490. Fulltekst i vitenarkiv
• Valgimigli, Marco; Aboyans, Victor; Angiolillo, Dominick; Atar, Dan; Capodanno, Davide & Halvorsen, Sigrun [Vis alle 23 forfattere av denne artikkelen] (2023). Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 9(5), s. 462–496. doi: 10.1093/ehjcvp/pvad032. Fulltekst i vitenarkiv
• Kristensen, Anna Meta Dyrvig; Munkhaugen, John; Halvorsen, Sigrun; Olsen, Michael Hecht; Bakken, Arnhild & Sehested, Thomas Steen Gyldenstierne [Vis alle 12 forfattere av denne artikkelen] (2023). The Danish-Norwegian randomized trial on beta-blocker therapy after myocardial infarction: Design, rationale, and baseline characteristics. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 10(3), s. 175–183. doi: 10.1093/ehjcvp/pvad093. Fulltekst i vitenarkiv
• Serebruany, Victor L.; Tanguay, Jean-Francois; Gurvich, Milana L.; Marciniak, Thomas A. & Atar, Dan (2023). Time Course of Death After Acute Coronary Syndrome Treated With Dual Antiplatelet Therapy for 1 Year. American Journal of Medicine. ISSN 0002-9343. doi: 10.1016/j.amjmed.2023.01.029. Fulltekst i vitenarkiv
• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Al-Ani, Riadh Ibrahim Mahmud; Bekkeseth, Hanna Marie Otterholt; Bakkejord, Grete & Bjerkeli, Vigdis [Vis alle 31 forfattere av denne artikkelen] (2023). Underlying causes of cryptogenic stroke and TIA in the nordic atrial fibrillation and stroke (NOR-FIB) study – the importance of comprehensive clinical evaluation. BMC Neurology. 23(1), s. 1–10. doi: 10.1186/s12883-023-03155-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Cryptogenic stroke is a heterogeneous condition, with a wide spectrum of possible underlying causes for which the optimal secondary prevention may differ substantially. Attempting a correct etiological diagnosis to reduce the stroke recurrence should be the fundamental goal of modern stroke management. Methods Prospective observational international multicenter study of cryptogenic stroke and cryptogenic transient ischemic attack (TIA) patients clinically monitored for 12 months to assign the underlying etiology. For atrial fibrillation (AF) detection continuous cardiac rhythm monitoring with insertable cardiac monitor (Reveal LINQ, Medtronic) was performed. The 12-month follow-up data for 250 of 259 initially included NOR-FIB patients were available for analysis. Results After 12 months follow-up probable stroke causes were revealed in 43% patients, while 57% still remained cryptogenic. AF and atrial flutter was most prevalent (29%). In 14% patients other possible causes were revealed (small vessel disease, large-artery atherosclerosis, hypercoagulable states, other cardioembolism). Patients remaining cryptogenic were younger (p<0.001), had lower CHA2DS2-VASc score (p<0.001) on admission, and lower NIHSS score (p=0.031) and mRS (p=0.016) at discharge. Smoking was more prevalent in patients that were still cryptogenic (p=0.014), while dyslipidaemia was less prevalent (p=0.044). Stroke recurrence rate was higher in the cryptogenic group compared to the group where the etiology was revealed, 7.7% vs. 2.8%, (p=0.091). Conclusion Cryptogenic stroke often indicates the inability to identify the cause in the acute phase and should be considered as a working diagnosis until efforts of diagnostic work up succeed in identifying a specific underlying etiology. Timeframe of 6-12-month follow-up may be considered as optimal. Trial registration ClinicalTrials.gov Identifier NCT02937077, EudraCT 2018-002298-23

• Pope, Marita Knudsen; Hall, Trygve Sørdahl; Virdone, Saverio; Atar, Dan; Camm, Camm John & Pieper, Karen S [Vis alle 13 forfattere av denne artikkelen] (2023). Rhythm versus rate control in patients with newly diagnosed atrial fibrillation – Observations from the GARFIELD-AF registry. International journal of cardiology: Heart and Vasculature (IJCHA). 49. doi: 10.1016/j.ijcha.2023.101302. Fulltekst i vitenarkiv Vis sammendrag

  Background Investigate real-world outcomes of early rhythm versus rate control in patients with recent onset atrial fibrillation. Methods The Global Anticoagulant Registry in the FIELD-AF (GARFIELD-AF) is an international multi-centre, non-interventional prospective registry of newly diagnosed (≤6 weeks’ duration) atrial fibrillation patients at risk for stroke. Patients were stratified according to treatment initiated at baseline (≤48 days post enrolment), and outcome risks evaluated by overlap propensity weighted Cox proportional-hazards models. Results Of 45,382 non-permanent atrial fibrillation patients, 23,858 (52.6 %) received rhythm control and 21,524 (47.4 %) rate control. Rhythm-controlled patients had lower median age (68.0 [Q1;Q3: 60.0;76.0] versus 73.0 [65.0;79.0]), fewer histories of stroke/transient ischemic attack/systemic embolism (9.4 % versus 13.0 %), and lower expected probabilities of death (median GARFIELD-AF death score 4.0 [2.3;7.5] versus 5.1 [2.8;9.2]). The two groups had the same median CHA2DS2-VASc scores (3.0 [2.0;4.0]) and similar proportions of anticoagulated patients (rhythm control: 66.0 %, rate control: 65.5 %). The propensity-score-weighted hazard ratios of rhythm vs rate control (reference) were 0.85 (95 % CI: 0.79–0.92, p-value < 0.0001) for all-cause mortality, 0.84 (0.72–0.97, p-value 0.020) for non-haemorrhagic stroke/systemic embolism and 0.90 (0.78–1.04, p-value 0.164) for major bleeding. Conclusion Rhythm control strategy was initiated in about half of the patients with newly diagnosed non-valvular non-permanent atrial fibrillation. After balancing confounders, significantly lower risks of all-cause mortality and non-haemorrhagic stroke were observed in patients who received early rhythm control.

• Fröhlich, Hanna; Bossmeyer, Anna; Kazmi, Syed; Goode, Kevin M.; Agewall, Stefan & Atar, Dan [Vis alle 12 forfattere av denne artikkelen] (2023). Glycaemic control and insulin therapy are significant confounders of the obesity paradox in patients with heart failure and diabetes mellitus. Clinical Research in Cardiology. ISSN 1861-0684. doi: 10.1007/s00392-023-02268-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: A high body mass index (BMI) confers a paradoxical survival benefit in patients with heart failure (HF) or diabetes mellitus (DM). There is, however, controversy whether an obesity paradox is also present in patients with HF and concomitant DM. In addition, the influence of glycaemic control and diabetes treatment on the presence or absence of the obesity paradox in patients with HF and DM is unknown. Methods: We identified 2936 patients with HF with reduced ejection fraction (HFrEF) in the HF registries of the universities of Heidelberg, Germany, and Hull, UK (general sample). Of these, 598 (20%) were treated for concomitant DM (DM subgroup). The relationship between BMI and all-cause mortality was analysed in both the general sample and the DM subgroup. Patients with concomitant DM were stratified according to HbA1c levels or type of diabetes treatment and analyses were repeated. Results: We found an inverse BMI-mortality relationship in both the general sample and the DM subgroup. However, the obesity paradox was less pronounced in patients with diabetes treated with insulin and it disappeared in those with poor glycaemic control as defined by HbA1c levels > 7.5%. Conclusion: In patients with HFrEF, a higher BMI is associated with better survival irrespective of concomitant DM. However, insulin treatment and poor glycaemic control make the relationship much weaker. Keywords: Diabetes mellitus; Heart failure; Mortality; Obesity paradox; Reverse epidemiology. © 2023. The Author(s).

• Lundin, Magnus; Heiberg, Einar; Nordlund, David; Gyllenhammar, Tom; Steding-Ehrenborg, Katarina & Engblom, Henrik [Vis alle 26 forfattere av denne artikkelen] (2023). Prognostic utility and characterization of left ventricular hypertrophy using global thickness. Scientific Reports. 13(1). doi: 10.1038/s41598-023-48173-7. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12–1.20], p &lt; 0.001), followed by GTI (HR 1.14[1.09–1.19], p &lt; 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35–1.94], p &lt; 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p &lt; 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).

• Healey, Jeff S.; Lopes, Renato D.; Granger, Christopher B.; Alings, Marco; Rivard, Lena & McIntyre, William F. [Vis alle 37 forfattere av denne artikkelen] (2023). Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation. New England Journal of Medicine. ISSN 0028-4793. 390(2), s. 107–117. doi: 10.1056/NEJMoa2310234. Fulltekst i vitenarkiv Vis sammendrag

  Background Subclinical atrial fibrillation is short-lasting and asymptomatic and can usually be detected only by long-term continuous monitoring with pacemakers or defibrillators. Subclinical atrial fibrillation is associated with an increased risk of stroke by a factor of 2.5; however, treatment with oral anticoagulation is of uncertain benefit. Methods We conducted a trial involving patients with subclinical atrial fibrillation lasting 6 minutes to 24 hours. Patients were randomly assigned in a double-blind, double-dummy design to receive apixaban at a dose of 5 mg twice daily (2.5 mg twice daily when indicated) or aspirin at a dose of 81 mg daily. The trial medication was discontinued and anticoagulation started if subclinical atrial fibrillation lasting more than 24 hours or clinical atrial fibrillation developed. The primary efficacy outcome, stroke or systemic embolism, was assessed in the intention-to-treat population (all the patients who had undergone randomization); the primary safety outcome, major bleeding, was assessed in the on-treatment population (all the patients who had undergone randomization and received at least one dose of the assigned trial drug, with follow-up censored 5 days after permanent discontinuation of trial medication for any reason). Results We included 4012 patients with a mean (±SD) age of 76.8±7.6 years and a mean CHA2DS2-VASc score of 3.9±1.1 (scores range from 0 to 9, with higher scores indicating a higher risk of stroke); 36.1% of the patients were women. After a mean follow-up of 3.5±1.8 years, stroke or systemic embolism occurred in 55 patients in the apixaban group (0.78% per patient-year) and in 86 patients in the aspirin group (1.24% per patient-year) (hazard ratio, 0.63; 95% confidence interval [CI], 0.45 to 0.88; P=0.007). In the on-treatment population, the rate of major bleeding was 1.71% per patient-year in the apixaban group and 0.94% per patient-year in the aspirin group (hazard ratio, 1.80; 95% CI, 1.26 to 2.57; P=0.001). Fatal bleeding occurred in 5 patients in the apixaban group and 8 patients in the aspirin group. Conclusions Among patients with subclinical atrial fibrillation, apixaban resulted in a lower risk of stroke or systemic embolism than aspirin but a higher risk of major bleeding. (Funded by the Canadian Institutes of Health Research and others; ARTESIA ClinicalTrials.gov number, NCT01938248.)

• Sandberg, Edvard Liljedahl; Halvorsen, Sigrun; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Fensli, Rune Werner [Vis alle 8 forfattere av denne artikkelen] (2023). Fully digital self-screening for atrial fibrillation with patch electrocardiogram. Europace. ISSN 1099-5129. 25(5). doi: 10.1093/europace/euad075. Fulltekst i vitenarkiv Vis sammendrag

  Aims Atrial fibrillation (AF) is the most common arrhythmia worldwide. The AF is associated with severe mortality, morbidity, and healthcare costs, and guidelines recommend screening people at risk. However, screening methods and organization still need to be clarified. The current study aimed to assess the feasibility of a fully digital self-screening procedure and to assess the prevalence of undetected AF using a continuous patch electrocardiogram (ECG) monitoring system. Methods and results Individuals ≥65 years old with at least one additional risk factor for stroke from the general population of Norway were invited to a fully digital continuous self-screening for AF using a patch ECG device (ECG247 Smart Heart Sensor). Participants self-reported clinical characteristics and usability online, and all participants received digital feedback of their results. A total of 2118 individuals with a mean CHA2DS2-VASc risk score of 2.6 (0.9) were enrolled in the study [74% women; mean age 70.1 years (4.2)]. Of these, 1849 (87.3%) participants completed the ECG self-screening test, while 215 (10.2%) did not try to start the test and 54 (2.5%) failed to start the test. The system usability score was 84.5. The mean ECG monitoring time was 153 h (87). Atrial fibrillation was detected in 41 (2.2%) individuals. Conclusion This fully digitalized self-screening procedure for AF demonstrated excellent feasibility. The number needed to screen was 45 to detect one unrecognized case of AF in subjects at risk for stroke. Randomized studies with long-term follow-up are needed to assess whether self-screening for AF can reduce the incidence of AF-related complications

• Bondjers, Kristina; Lingaas, Ingebjørg; Stensland, Synne; Atar, Dan; Zwart, John Anker Henrik & Wøien, Hilde [Vis alle 7 forfattere av denne artikkelen] (2023). “I’ve kept going” – a multisite repeated cross-sectional study of healthcare workers’ pride in personal performance during the COVID-19 pandemic. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09246-5. Fulltekst i vitenarkiv Vis sammendrag

  Background For healthcare workers, working through a pandemic may include both challenges, such as coping with increased demands and a lack of control, and rewards, such as experiencing a sense of achievement and meaningfulness. In this study, we explore the accomplishments healthcare workers themselves are proud of achieving at work, in order to elucidate the positive aspects of working through a pandemic. Methods In June 2020 (T1), December 2020 (T2), and May 2021 (T3), healthcare workers (n = 1,996) at four Norwegian hospitals participated in a web-based survey assessing job strain, psychological health, and support during the pandemic. The survey included the open-ended question “During the past two weeks, what have you been feeling proud of achieving at work?”. Responses (1,046) to this item were analyzed using conventional content analysis, which resulted in 13 subthemes under 6 themes. Results For some, pride was found in their professional identity and dedication to their work. Others took pride in specific achievements, such as juggling their own needs (e.g., health, private life) with those of the workplace, contributing to cohesion and collaboration, their ability to learn and adjust, in being a useful resource at work, and in their efforts towards developing the organization and workplace. Implications The current findings shed light on what healthcare workers feel proud of achieving in their day-to-day work. Assessment of these factors provides insight on both positive and negative aspects of working clinically during a pandemic, and highlights specific targets for building sustainable and rewarding work environments for healthcare workers.

• Butt, Jawad H.; Dewan, Pooja; Jhund, Pardeep S.; Anand, Inder S.; Atar, Dan & Ge, Junbo [Vis alle 24 forfattere av denne artikkelen] (2022). Sacubitril/Valsartan and Frailty in Patients With Heart Failure and Preserved Ejection Fraction. Journal of the American College of Cardiology. ISSN 0735-1097. 80(12), s. 1130–1143. doi: 10.1016/j.jacc.2022.06.037. Fulltekst i vitenarkiv Vis sammendrag

  Background Frailty is an increasingly common problem, and frail patients are less likely to receive new pharmacologic therapies because the risk–benefit profile is perceived to be less favorable than in nonfrail patients. Objectives This study investigated the efficacy of sacubitril/valsartan according to frailty status in 4,796 patients with heart failure with preserved ejection fraction randomized in the PARAGON-HF (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. Methods Frailty was measured by using the Rockwood cumulative deficit approach. The primary endpoint was total heart failure hospitalizations or cardiovascular death. Results A frailty index (FI) was calculable in 4,795 patients. In total, 45.2% had class 1 frailty (FI ≤0.210, not frail), 43.5% had class 2 frailty (FI 0.211-0.310, more frail), and 11.4% had class 3 frailty (FI ≥0.311, most frail). There was a graded relationship between FI class and the primary endpoint, with a significantly higher risk associated with greater frailty (class 1: reference; class 2 rate ratio: 2.19 [95% CI: 1.85-2.60]; class 3 rate ratio: 3.29 [95% CI: 2.65-4.09]). The effect of sacubitril/valsartan vs valsartan on the primary endpoint from lowest to highest FI class (as a rate ratio) was: 0.98 [95% CI: 0.76-1.27], 0.92 [95% CI: 0.76-1.12], and 0.69 [95% CI: 0.51-0.95]), respectively (Pinteraction = 0.23). When FI was examined as a continuous variable, the interaction with treatment was significant for the primary outcome (Pinteraction = 0.002) and total heart failure hospitalizations (Pinteraction < 0.001), with those most frail deriving greater benefit. Conclusions Frailty was common in heart failure with preserved ejection fraction and associated with worse outcomes. Compared with valsartan, sacubitril/valsartan seemed to show a greater reduction in the primary endpoint with increasing frailty, although this was not significant when FI was examined as a categorical variable. (Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).

• Fyksen, Tea Sætereng; Vanberg, Paul; Gjesdal, Knut Tjøl; Lueder, Thomas Gero von; Bjørnerheim, Reidar & Steine, Kjetil [Vis alle 8 forfattere av denne artikkelen] (2022). Cardiovascular phenotype of long-term anabolic-androgenic steroid abusers compared with strength-trained athletes. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 32(8), s. 1170–1181. doi: 10.1111/sms.14172. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Abuse of anabolic-androgenic steroids (AAS) has been linked to a variety of different cardiovascular (CV) side effects, but still the clinical effects of AAS abuse on CV risk are not clear. The aim of this study was to assess the CV phenotype of a large cohort of men with long-term AAS use compared with strength-trained athletes without AAS use. Methods Fifty one strength-trained men with ≥3 years of AAS use was compared with twenty one strength-trained competing athletes. We verified substance abuse and non-abuse by blood and urine analyses. The participants underwent comprehensive CV evaluation including laboratory analyses, 12-lead ECG with measurement of QT dispersion, exercise ECG, 24 h ECG with analyses of heart rate variability, signal averaged ECG, basic transthoracic echocardiography, and coronary computed tomography angiography (CCTA). Results Hemoglobin levels and hematocrit were higher among the AAS users compared with non-users (16.8 vs. 15.0 g/dl, and 0.50% vs. 0.44%, respectively, both p < 0.01) and HDL cholesterol significantly lower (0.69 vs. 1.25 mmol/L, p < 0.01). Maximal exercise capacity was 270 and 280 W in the AAS and the non-user group, respectively (p = 0.04). Echocardiography showed thicker intraventricular septum and left ventricular (LV) posterior wall among AAS users (p < 0.01 for both), while LV ejection fraction was lower (50 vs. 54%, p = 0.02). Seven AAS users (17%) had evidence of coronary artery disease on CCTA. There were no differences in ECG measures between the groups. Conclusions A divergent CV phenotype dominated by increased CV risk, accelerated coronary artery disease, and concentric myocardial hypertrophy was revealed among the AAS users.

• Atar, Dan; Langslet, Gisle & Tonstad, Serena (2022). Do we need new lipid-lowering agents in the era of PCSK9 inhibitors? Recent advances. Kardiologia Polska. ISSN 0022-9032. 80(7-8), s. 741–749. doi: 10.33963/KP.a2022.0117. Fulltekst i vitenarkiv Vis sammendrag

  Atherosclerotic disease remains the leading cause of death worldwide. Much of atherosclerotic disease initiation and progression is driven by dyslipidemia. With the advent of statins, ezetimibe, and more recently the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, physicians across all specialties have access to an armamentarium to address this major pathophysiological driver. Nevertheless, there is still a large unmet need in terms of optimizing pharmacotherapeutic lipid lowering strategies. This article will review the evidence pertaining to the major lipid-lowering agents that have been introduced lately, or still are under development, after the advent of statins, ezetimibe and PCSK9 inhibitors. There is cumulating evidence suggesting that there soon will be a broad specter of differential therapies across a variety of mechanistic pathways that will enter clinical medicine. Knowledge about these potential recent advances and various upcoming therapeutic options will make choice easier for physicians, and will lead to more personalized selections of available treatments.

• Kotecha, Dipak; Asselbergs, Folkert W; Achenbach, Stephan; Anker, Stefan D; Atar, Dan & Baigent, Colin [Vis alle 44 forfattere av denne artikkelen] (2022). CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. The BMJ. s. 1–9. doi: 10.1136/bmj-2021-069048. Fulltekst i vitenarkiv Vis sammendrag

  Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.

• Ratajczak-Tretel, Barbara; Lambert, Anna Tancin; Atar, Dan & Aamodt, Anne Hege (2022). Cryptogenic stroke and TIA: Suggested diagnostic approach while waiting for evaluation and treatment guidelines. Acta Neurologica Scandinavica. ISSN 0001-6314. 145(5), s. 641–646. doi: 10.1111/ane.13590. Fulltekst i vitenarkiv Vis sammendrag

  Background Empiric strategies for secondary prevention in cryptogenic stroke and cryptogenic TIA are lacking. The best therapy to prevent recurrence depends on the cause of stroke. Attempting a correct diagnosis is therefore the fundamental goal of stroke treatment. Further investigation into the source of embolism if suspected, and determination of the etiology, even if demanding, is the needed prerequisite for optimal secondary prevention and risk reduction. Aims This paper discusses evaluation and treatment of cryptogenic stroke in light of recent years’ clinical trials results and developments in cardiology and neuroradiology. No ethical approval was needed for this work. Results Cardioembolism due to paroxysmal atrial fibrillation, patent foramen ovale, or cardiomyopathy; occult atherosclerosis from unstable plaques and hypercoagulable conditions seem to be the most common underlying causes to be revealed by further investigations. Treatment of these conditions can reduce the stroke recurrence significantly. Conclusions An individual approach and targeted diagnostics using advanced medical technologies in selected patients, who may benefit from a tailored treatment regimen, can help reveal a probable cause in the majority of strokes and TIAs previously classified as cryptogenic.

• Kotecha, Dipak; Asselbergs, Folkert W; Achenbach, Stephan; Anker, Stefan D; Atar, Dan & Baigent, Colin [Vis alle 44 forfattere av denne artikkelen] (2022). CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research. The Lancet Digital Health. 4(10), s. e757–e764. doi: 10.1016/S2589-7500(22)00151-0. Fulltekst i vitenarkiv Vis sammendrag

  Big data is important to new developments in global clinical science that aim to improve the lives of patients. Technological advances have led to the regular use of structured electronic health-care records with the potential to address key deficits in clinical evidence that could improve patient care. The COVID-19 pandemic has shown this potential in big data and related analytics but has also revealed important limitations. Data verification, data validation, data privacy, and a mandate from the public to conduct research are important challenges to effective use of routine health-care data. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including representation from patients, clinicians, scientists, regulators, journal editors, and industry members. In this Review, we propose the CODE-EHR minimum standards framework to be used by researchers and clinicians to improve the design of studies and enhance transparency of study methods. The CODE-EHR framework aims to develop robust and effective utilisation of health-care data for research purposes.

• O'Donoghue, Michelle L.; Giugliano, Robert P.; Wiviott, Stephen D.; Atar, Dan; Keech, Anthony & Kuder, Julia F. [Vis alle 15 forfattere av denne artikkelen] (2022). Long-Term Evolocumab in Patients with Established Atherosclerotic Cardiovascular Disease. Circulation. ISSN 0009-7322. 146(15), s. 1109–1119. doi: 10.1161/CIRCULATIONAHA.122.061620. Fulltekst i vitenarkiv
• Kotecha, Dipak; Asselbergs, Folkert W.; Achenbach, Stephan; Anker, Stefan D.; Atar, Dan & Baigent, Colin [Vis alle 44 forfattere av denne artikkelen] (2022). CODE-EHR best practice framework for the use of structured electronic healthcare records in clinical research. European Heart Journal. ISSN 0195-668X. 43(37), s. 3578–3588. doi: 10.1093/eurheartj/ehac426. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Big data is central to new developments in global clinical science aiming to improve the lives of patients. Technological advances have led to the routine use of structured electronic healthcare records with the potential to address key gaps in clinical evidence. The covid-19 pandemic has demonstrated the potential of big data and related analytics, but also important pitfalls. Verification, validation, and data privacy, as well as the social mandate to undertake research are key challenges. The European Society of Cardiology and the BigData@Heart consortium have brought together a range of international stakeholders, including patient representatives, clinicians, scientists, regulators, journal editors and industry. We propose the CODE-EHR Minimum Standards Framework as a means to improve the design of studies, enhance transparency and develop a roadmap towards more robust and effective utilisation of healthcare data for research purposes.

• Moschetti, Karine; Kwong, Raymond Y.; Petersen, Steffen E.; Lombardi, Massimo; Garot, Jerome & Atar, Dan [Vis alle 19 forfattere av denne artikkelen] (2022). Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries. JACC Cardiovascular Imaging. ISSN 1936-878X. 15(4), s. 607–625. doi: 10.1016/j.jcmg.2021.11.008. Fulltekst i vitenarkiv
• Birnbaum, Yochai; Rankinen, Jani; Jneid, Hani; Atar, Dan & Nikus, Kjell (2022). The Role of ECG in the Diagnosis and Risk Stratification of Acute Coronary Syndromes: an Old but Indispensable Tool. Current Cardiology Reports. ISSN 1523-3782. 24(2), s. 109–118. doi: 10.1007/s11886-021-01628-7. Fulltekst i vitenarkiv Vis sammendrag

  Purpose of Review Since its inception in 1902 by Willem Einthoven, the electrocardiogram (ECG) has fundamentally undergone minimal technological advances. Nevertheless, its clinical utility is critical, and it remains an essential tool to diagnose, risk stratify, and guide reperfusion and invasive strategies in patients with suspected acute coronary syndromes. ECG reading can be demanding, with many healthcare professionals lacking the necessary expertise to accurately interpret them. This is exacerbated by the need to constantly revisit old dogmas pertinent to the interpretation of ECGs. Recent Findings Notably, ECG leads record the global electrical activity of the heart toward and away from each electrode rather than local events. The long-held central paradigm that the various ECG leads record local events underneath specific electrodes should therefore be reassessed. For example, ST segment elevation in leads V1 and V2 usually denote antero-apical rather than septal infarction, often a misnomer utilized by the majority of clinicians. The ECG diagnosis of ST-elevation myocardial infarction (STEMI) is sometimes challenging and discerning it from non-ST-elevation myocardial infarction (NSTEMI) is of paramount importance to implement timely acute reperfusion therapy. In fact, when qualifications for emergency reperfusion therapy are based on STEMI ECG criteria, nearly one-third of cases with acute coronary occlusion are missed. Diagnostic ST elevation in the absence of left ventricular (LV) hypertrophy or left bundle-branch block (LBBB) is defined by a specific set of sex-specific criteria for new ST elevation at the J point in contiguous precordial or limb leads. However, other ECG criteria need to be kept in mind. These include, but are not limited to, new or presumably new left bundle branch block (LBBB), which is often considered as an STEMI-equivalent; ST depression in two or more precordial leads (V1–V4), denoting a true inferolateral transmural myocardial infarction; and the infrequent presentation with hyperacute T-wave changes. Summary As our understanding of the pathology of ischemic reperfusion injury has evolved and following the introduction of new imaging modalities such as cardiac magnetic resonance imaging, we need to re-assess the old dogmas pertinent to the interpretation of ECGs and update the terms and classifications.

• Atar, Dan; Sarkar, Sougat; Kolev, Emil; Mura, Carla; Brosstad, Frank Roger & Theodorsen, Lotte [Vis alle 8 forfattere av denne artikkelen] (2022). Randomized, open-label, crossover trial comparing the pharmacokinetic profile of a novel oral aspirin solution and a chewed aspirin tablet. International Journal of Clinical Pharmacology and Therapeutics. ISSN 0946-1965. 60(10), s. 430–438. doi: 10.5414/CP204271. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Johannessen, Tonje Rambøll; Atar, Dan; Halvorsen, Sigrun; Munkhaugen, John; Vallersnes, Odd Martin & Bakken, Arnhild [Vis alle 7 forfattere av denne artikkelen] (2026). Point-of-Care High-Sensitivity Troponin Testing for Rapid Chest Pain Triage in Emergency Primary Care: Preliminary Single-Sample Efficacy Findings from the OUT-POC Study. Fulltekst i vitenarkiv
• Otterstad, Jan Erik; Atar, Dan & Munkhaugen, John (2026). Betablokkerbehandling etter hjerteinfarkt? Oppdatert kunnskapsgrunnlag etter nyere studier. Indremedisineren. ISSN 1891-1617. s. 32–35. Fulltekst i vitenarkiv
• Kristensen, A M D; Holmager, T L F; Halvorsen, Sigrun; Olsen, M H; Bakken, Arnhild & Atar, Dan [Vis alle 8 forfattere av denne artikkelen] (2026). Beta-blocker therapy and angina pectoris after myocardial infarction: a BETAMI-DANBLOCK substudy. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.435. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Angina pectoris after myocardial infarction (MI) remains prevalent despite contemporary treatment strategies and affects quality of life and healthcare use. The evidence for the effects of beta-blocker therapy on angina pectoris in MI patients treated according to contemporary standards is limited. Purpose We aimed to evaluate the effects of beta-blockers on diagnostic procedures and hospitalizations for angina pectoris, as well as redeemed anti-anginal prescriptions and self-reported symptoms of angina among MI patients with LVEF ≥40% enrolled in the BETAMI-DANBLOCK trial. Methods Participants in the BETAMI-DANBLOCK trial were randomized to open-label long-term beta-blocker therapy or no such therapy within 14 days from MI. In this pre-specified substudy, we analyzed the effect of beta-blocker therapy on time to first diagnostic procedure (coronary angiogram, coronary CT angiography, PET-CT, myocardial perfusion scintigraphy, or stress echocardiography), hospitalization for angina, and ≥2 redeemed prescriptions for anti-anginal medications (calcium-antagonists, short-/long-acting nitrates) using Fine-Gray subdistribution hazards models with death as a competing risk. Self-reported angina symptoms were measured using the Canadian Cardiovascular Society angina grading and the New York Heart Association functional classification. Differences in self-reported symptoms (symptoms vs. no symptoms) at 1 year were compared between treatment groups using the chi-square test. Results In the DANBLOCK trial, 1352 patients were randomized to beta-blockers and 1355 to no beta-blockers. After a median follow-up of 3.5 years, 329 patients (24.3%) in the beta-blocker group and 395 patients (29.2%) in the no beta-blocker group underwent at least one diagnostic procedure for angina pectoris (subdistribution hazard ratio [sHR] 0.85; 95% confidence interval [CI] 0.74-0.99) (Table 1). Hospitalization for angina pectoris occurred in 59 patients (4.4%) in the beta-blocker group and 60 patients (4.4%) in the no beta-blocker group (sHR 0.99; 95% CI 0.69-1.42). A higher proportion of patients in the no-beta-blocker group redeemed ≥2 prescriptions for calcium-antagonists, whereas no difference was seen for nitrates (Table 1). Self-reported angina symptoms at 1 year did not differ significantly between treatment groups (Table 2). If accepted for presentation at the ESC Preventive Cardiology 2026 the results from BETAMI will also be included. Conclusion Among MI patients with LVEF ≥40%, beta-blocker therapy was associated with a lower risk of undergoing a diagnostic procedure for angina pectoris, and of redeeming ≥2 prescriptions for calcium antagonists, but not with a lower risk of hospitalization for angina pectoris. Self-reported angina symptoms appeared similar between treatment groups.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.

• Sverre, Elise Christine Bjørkholen; Madssen, Erik; Kristensen, A M D; Nyen, J E; Bakken, Arnhild & Holmager, T [Vis alle 12 forfattere av denne artikkelen] (2026). Effect of long-term beta-blocker therapy on physical activity after myocardial infarction: a post hoc analysis of the BETAMI trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.065. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Introduction The BETAMI-DANBLOCK trial recently found that beta-blockers reduced the risk of all-cause death or major adverse cardiovascular events in patients with a recent myocardial infarction (MI) without heart failure symptoms and left ventricular ejection fraction ≥40%. Some observational data and small intervention studies indicate a possible negative relationship between beta-blocker therapy and physical activity (PA) levels. However, it is still unclear how beta-blocker treatment influences PA after an acute MI. Purpose To investigate the effect of long-term beta-blocker therapy on PA level after MI in patients without heart failure. Method In this post-hoc analysis of the multicentre, randomized, open-label BETAMI trial with blinded endpoint evaluation, patients hospitalized with a MI and without heart failure were assigned to beta-blocker therapy within seven days after the event or no beta-blocker therapy. PA levels were assessed prior to randomization and at 1-, 6-, 12- and 18-months follow-up by self-reported questionnaires. The main endpoints were between-group changes in hours/week of light- (e.g., walking, dancing, cycling) and vigorous PA (e.g., brisk uphill walking, running) from baseline to 18 months, estimated by linear mixed models. Additionally, we assessed between-group differences in the proportion with guideline-recommended PA level (≥30 minutes of moderate activity on ≥5 days/week) and the participation rates in cardiac rehabilitation or organized PA programs. Results Of the 2867 patients, 2148 (75%) responded to the questions regarding PA in the follow-up period. Median age was 62 (IQR 55-70) years, and 19.6% were women. The median beta-blocker dose in the intervention arm was equivalent to metoprolol depot 50 mg/day. No differences in mean hours of light and vigorous physical activity were reported between the beta-blocker and non-beta-blocker groups at baseline, and these remained comparable throughout the 18 months follow-up (Figure 1). At baseline 31.2% met the guideline-recommended level of PA. This proportion increased to 39.2% at 6 months, with no significant differences between treatment arms at any time point (Figure 2). We found no effect of beta-blocker dose on the PA level. Participation in cardiac rehabilitation or organized PA at 12 months follow-up was 43.6% in the beta-blocker group and 42.3% in the non-beta-blocker group. Conclusions Beta-blocker therapy did not affect the PA level in post-MI patients without heart failure during 18 months follow-up.For image description, please refer to the figure legend and surrounding text.  For image description, please refer to the figure legend and surrounding text.

• Caglar, H; Holmager, T; Kristensen, A; Atar, Dan; Munkhaugen, John & Prescott, E (2026). Risk stratified effect of beta-blockers after myocardial infarction in patients without heart failure: A substudy of the BETAMI-DANBLOCK trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.076. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Recent meta-analyses show that beta-blockers benefit patients with mildly reduced left ventricular ejection fraction (LVEF) after myocardial infarction (MI), but not those with preserved LVEF. Whether simple clinical risk factors can identify patients who derive greater absolute benefit remains unknown. Purpose To assess whether the clinical effect of long-term beta-blocker therapy after MI differs across baseline risk strata defined by a modified Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention (TRS-2P) Methods This was a substudy of the BETAMI-DANBLOCK trial, which randomized patients with recent MI and LVEF &gt;40% to long-term beta-blocker or no beta-blocker therapy. A modified TRS-2P score (0–8 points) was constructed by excluding current smoking and incorporating mildly reduced LVEF (41–49%). Patients were categorized as low- (0 points), intermediate- (1–2 points), or high-risk (≥3 points). The primary endpoint was a composite of all-cause mortality, MI, unplanned coronary revascularization, ischemic stroke, heart failure, or malignant ventricular arrhythmia. The secondary endpoint was recurrent MI. Within each TRS-2P strata the effect of beta-blocker was estimated using Cox proportional hazard model and Fine-Gray subdistribution hazard model. Three-year absolute risk reduction (ARR) and number needed to treat (NNT) were estimated for each TRS-2P stratum using the total trial hazard ratio (HR) applied to stratum-specific cumulative incidences derived from Kaplan–Meier estimates Results Among the 5,558 patients included in the analysis, 38.4% were low-, 52.8% intermediate-, and 8.8% high-risk. Event rates increased stepwise across risk strata (2.96, 4.58, and 11.05 per 100 person-years, respectively). Relative treatment effects were consistent in low-risk (HR 0.88, 95% CI 0.67-1.13), intermediate-risk (HR 0.81, 95% CI 0.67-0.97), and high-risk patients (HR 0.88, 95% CI 0.63-1.20). Absolute benefit increased with risk strata: 3-year ARR was 1.4% (NNT 72) in low-risk-, 2.1% (NNT 47) in intermediate-risk-, and 3.6% (NNT 28) in high-risk patients. Recurrent MI demonstrated the same pattern, with greater absolute benefit in the higher-risk strata. Conclusions The modified TRS-2P score showed clear prognostic ability, and the absolute benefit of beta-blockers increased with baseline risk despite similar relative effects. These findings support the use of simple clinical risk stratification to guide long-term beta-blocker therapy after MI.Treatment effect of beta-blockersFor image description, please refer to the figure legend and surrounding text.  Cumulative incidence of primary endpointFor image description, please refer to the figure legend and surrounding text.

• Nyen, J; Kristensen, A M D; Fagerland, Morten; Dammen, Toril; Zwisler, A D & Olsen, M H [Vis alle 14 forfattere av denne artikkelen] (2026). Beta-blocker therapy and sleep disturbances after myocardial infarction: a prespecified sub-study of the BETAMI-DANBLOCK trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Issue Supplement_2). doi: 10.1093/eurjpc/zwag249.074. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Introduction Sleep disturbances have been proposed as a side effect of beta-blocker therapy, but evidence from large, randomised controlled trials are lacking. Purpose To evaluate the effects of beta-blockers on insomnia and nightmare frequency in patients with myocardial infarction (MI) and preserved or mildly reduced left ventricular ejection fraction (LVEF≥40%) enrolled in the BETAMI-DANBLOCK trial. Methods BETAMI-DANBLOCK was an open-label trial in Norway and Denmark in which MI-patients were randomised to receive long-term beta-blocker therapy or no such therapy. For this prespecified analysis, patients completed the Bergen Insomnia Scale (BIS) (all patients) and the Nightmare Frequency Questionnaire (NFQ) (Norwegian patients only) at baseline, 1-6, 12 and 18-24-months follow-up. BIS provides a continuous score (0-42) increasing with symptoms severity. BIS can also be used as a diagnostic tool (insomnia vs. no insomnia) based on self-reported diagnostic criteria scores. NFQ measures the number of nights with nightmares per week/month/year. The main endpoint was the incidence of insomnia during the first 12 months of follow-up in the two groups, estimated with logistic regression. Additional endpoints included between-group changes in BIS scores and nightmare frequency from baseline to 12 months, estimated by linear mixed models. Results Of 5574 randomised patients, 4728 (85% of all patients) completed BIS and 2031 (71% of the Norwegian patients) completed NFQ during the trial period. Median age was 62 (IQR: 55-70) years, 21% were women, and median metoprolol dose was 50 mg/day. At baseline, median self-reported sleep duration was 7 hours/night (IQR: 6-7.5) in both groups, median BIS score was 10 (IQR: 4-19) in both groups, and 40% fulfilled diagnostic criteria for insomnia. Beta-blocker therapy was associated with a negligible increase of 0.63 (95% CI: 0.03 to 1.24) in continuous BIS score. We found no statistically significant effect of beta-blockers on the incidence of insomnia during follow-up (Table 1). At baseline, the proportion of patients reporting nightmares at least monthly was 16% in the beta-blocker group and 15% in the no-beta-blocker group. A higher proportion of patients on beta-blockers reported at least monthly nightmares at 6 (25% vs 18%) and 12 (23% vs. 18%) months follow-up (6 months OR 2.12, 95% CI 1.02 to 4.40; 12 months OR 1.08, 95% CI 0.51 to 2.25). No significant change in the number of monthly nightmares was observed at 12 months (0.21, 95% CI: -0.15 to 0.57). Conclusions We found no clear and substantial effects of beta-blocker therapy on the incidence of insomnia or nightmare frequency among post-MI patients with LVEF ≥40%; however, a small effect cannot be ruled out.For image description, please refer to the figure legend and surrounding text.

• Holmager, T; Kristensen, A; Fagerland, Morten; Atar, Dan; Olsen, M & Bakken, Arnhild [Vis alle 8 forfattere av denne artikkelen] (2026). Validating national registry data for randomised trials: comparison of adjudicated and registry-derived cardiovascular outcomes in the BETAMI-DANBLOCK trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.475. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Registry-based randomised clinical trials are increasingly dependent on registry-derived outcomes, providing advantages in feasibility and data capture. However, registry data may introduce bias through misclassification or incomplete information. In the BETAMI-DANBLOCK trial, we compared registry-based cardiovascular events with and without adjudication, using information from national registries, electronic health records, and patient reports. Purpose To investigate whether registry-based endpoints can substitute adjudicated endpoints without materially altering trial results. Methods BETAMI-DANBLOCK enrolled 5,574 patients with myocardial infarction (MI) and a left ventricular ejection fraction ≥40% from 2018 through 2024. Patients were randomised to beta-blocker therapy or no beta-blocker therapy. The primary endpoint events (death, MI, ischemic stroke, heart failure, unplanned coronary revascularisation, and ventricular arrhythmias) were identified from the Danish and Norwegian national patient registries, self-reported questionnaires, and medical records. All registry-identified events, except death, underwent blinded adjudication. We compared events with and without adjudication by calculating incidence rates and hazard ratios (HRs) for beta-blocker treatment versus controls. Results National registries had almost complete capture of events when compared to site-reporting. In total, 75% of the primary endpoint events identified through the registries were confirmed by adjudication. The confirmation rate was lower during the first six months and varied by event type (from 92% for ischemic stroke to 45% for unplanned coronary revascularisations). The incidence rate of the primary endpoint was 6.23 per 100 person-years using registry data without adjudication and 4.43 with adjudication. Estimated treatment effects were consistent for the primary endpoint (0.88, 95% confidence interval (CI): 0.78-0.98 without adjudication and 0.85, 95% CI: 0.75-0.98 with adjudication), with no apparent differences across event types. Conclusion Registry data provide treatment effect estimates comparable to those obtained from adjudicated data in BETAMI-DANBLOCK. However, adjudication substantially reduced the total number of endpoint events and event-specific misclassification was a limitation, particularly during the first months after the index event.Cumulative incidence of primary endpointFor image description, please refer to the figure legend and surrounding text.  Forest plot of hazard ratiosFor image description, please refer to the figure legend and surrounding text.

• Haukeland-Parker, Stacey; Jervan, Øyvind; Ghanima, Waleed; Spruit, Martijn A.; Holst, Rene & Gleditsch, Jostein [Vis alle 13 forfattere av denne artikkelen] (2026). Exercise capacity, dyspnoea and health-related quality of life six months after exercise- based rehabilitation in patients with persistent dyspnea following pulmonary embolism. Fulltekst i vitenarkiv
• Sverre, Elise Christine Bjørkholen; Madssen, Erik; Nyen, Johanne; Bakken, Arnhild; Holmager, Therese & Jortveit, Jarle [Vis alle 11 forfattere av denne artikkelen] (2026). Effect of long-term beta-blocker therapy on physical activity after myocardial infarction: a post hoc analysis of the BETAMI trial. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18492-behaviour-and-awareness-in-risk-development-and-successful-risk-management. Fulltekst i vitenarkiv
• Nyen, Johanne; Kristensen, Anna Meta; Fagerland, Morten; Dammen, Toril; Zwisler, Ann-Dorthe & Olsen, Michael Hecht [Vis alle 14 forfattere av denne artikkelen] (2026). Beta-blocker therapy and sleep disturbances after myocardial infarction: a prespecified sub-study of the BETAMI-DANBLOCK trial. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18499-risk-management-in-acute-coronary-syndrome. Fulltekst i vitenarkiv
• Kristensen, Anna Meta Dyrvik; Rosello, Xavier; Atar, Dan; Yndigegn, Troels; Kimura, Takeshi & Latini, Roberto [Vis alle 25 forfattere av denne artikkelen] (2026). Bata-Blocker therapy after myocardial infraction in patients with preserved left ventricular ejection fraction: An individual patient data meta-analysis of randomized controlled trials. Hjerteforum. ISSN 0802-1465. 39(1), s. 120–121. Fulltekst i vitenarkiv
• Munkhaugen, John; Atar, Dan & Prescott, Eva (2026). Beta-Blockers after Myocardial Infarction. Reply. New England Journal of Medicine. ISSN 0028-4793. 394(8), s. 825–825. doi: 10.1056/nejmc2518019. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Atar, Dan; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Vallersnes, Odd Martin (2025). One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care: OUT-POC-pilotstudien. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). Authors' Response Letter - Expanding the Use of Point-of-Care hs-cTnI in Emergency Primary Care: Insights from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. s. 3–3. doi: 10.1159/000546344. Fulltekst i vitenarkiv
• Atar, Dan & Roffi, Marco (2025). Fellow of the European Society of Cardiology: recognizing excellence in cardiology. European Heart Journal. ISSN 0195-668X. 46(24), s. 2253–2255. doi: 10.1093/eurheartj/ehaf246. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-POC Pilot Study. Fulltekst i vitenarkiv
• Boskovic, Miroslav; Jortveit, Jarle; Haraldsen, Marius Blørstad; Berge, Trygve; Engdahl, Johan & Løchen, Maja-Lisa [Vis alle 14 forfattere av denne artikkelen] (2024). The NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial: rationale and design of a randomized controlled trial. Europace. ISSN 1099-5129. 26(10). doi: 10.1093/europace/euae228. Fulltekst i vitenarkiv Vis sammendrag

  Aims Atrial fibrillation (AF) is a common arrhythmia, and many cases of AF may be undiagnosed. Whether screening for AF and subsequent treatment if AF is detected can improve long-term outcome remains an unsettled question. The primary aim of the NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial is to assess whether self-screening for AF with continuous electrocardiogram (ECG) for 3–7 days in individuals aged 65 years or older with at least one additional risk factor for stroke, and initiation of guideline-recommended therapy in patients with detected AF, will reduce the occurrence of stroke. Methods and results This study is a nationwide open, siteless, randomized, controlled trial. Individuals ≥65 years of age are randomly identified from the National Population Register of Norway and are invited to take a digital inclusion/exclusion test. Individuals passing the inclusion/exclusion test are randomized to either the intervention group or the control group. A total of 35 000 participants will be enrolled. In the intervention group, self-screening is performed continuously over 3–7 days at home with a patch ECG device (ECG247) at inclusion and after 12–18 months. If AF is detected, guideline-recommended therapy will be initiated. Patients will be followed up for 5 years through national health registries. The primary outcome is time to a first stroke (ischaemic or haemorrhagic stroke). The first participant in the NORSCREEN trial was enrolled on 1 September 2023. Conclusion The results from the NORSCREEN trial will provide new insights regarding the efficacy of digital siteless self-screening for AF with respect to stroke prevention in individuals at an increased risk of stroke.

• Atar, Dan; Munkhaugen, John & Sverre, Elise Christine Bjørkholen (2024). Statin discontinuation: How can we improve on the multiple pathways that contribute to suboptimal statin adherence? Kardiologia Polska. ISSN 0022-9032. 82(9), s. 828–830. doi: 10.33963/v.phj.102335. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Nilsen, Beate [Vis alle 7 forfattere av denne artikkelen] (2024). Rapid rule-out of acute myocardial infarction using troponins in emergency primary care: the OUT-ACS implementation study. Fulltekst i vitenarkiv
• Landi, Antonio; Aboyans, Victor; Angiolillo, Dominick J.; Atar, Dan; Capodanno, Davide & Fox, Keith A.A. [Vis alle 22 forfattere av denne artikkelen] (2024). Antithrombotic therapy in patients with acute coronary syndrome: similarities and differences between a European expert consensus document and the 2023 European Society of Cardiology guidelines. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 13(1), s. 173–180. doi: 10.1093/ehjacc/zuad158. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Ruud, Sven Eirik [Vis alle 7 forfattere av denne artikkelen] (2024). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care. The OUT-ACS implementation study. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Melessen, Indra & Manten, Amy [Vis alle 7 forfattere av denne artikkelen] (2024). Identifying low-risk chest pain in out-of-hours primary care: the diagnostic performance of preHEAR and preHEART scores based on two European cohorts. Fulltekst i vitenarkiv
• Melessen, Indra; Vallersnes, Odd Martin; Harskamp, Ralf E.; Atar, Dan; Halvorsen, Sigrun & Manten, Amy [Vis alle 7 forfattere av denne artikkelen] (2024). Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts. Fulltekst i vitenarkiv
• Atar, Dan; Bakken, Arnhild & Munkhaugen, John (2023). Achieving the unachievable: How to optimize lipid-lowering therapy in survivors of acute myocardial infarction. Kardiologia Polska. ISSN 0022-9032. 81(4), s. 327–329. doi: 10.33963/KP.a2023.0087. Fulltekst i vitenarkiv
• Aunan, Kristin; Atar, Dan & Agewall, Stefan (2023). Klima - en hjertesak. Hjerteforum. ISSN 0802-1465. 1, s. 54–61. Fulltekst i vitenarkiv
• Semb, Anne Grete; Vesterbekk, Elisabeth Kleivhaug; Retterstøl, Kjetil; Atar, Dan; Solberg, Erik E. & Schirmer, Henrik [Vis alle 11 forfattere av denne artikkelen] (2023). PCSK9-hemmere på blå resept for hvem? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(8). doi: 10.4045/tidsskr.23.0191. Fulltekst i vitenarkiv
• Bakken, Arnhild; Atar, Dan; Ruddox, Vidar; Halvorsen, Sigrun & Munkhaugen, John (2023). BETABLOKKERE ETTER HJERTEINFARKT– SKAL DEN FORTSATT GIS? Hjerteposten : fagtidsskrift for NSFs landsgruppe av kardiologiske sykepleiere. ISSN 1891-2532. s. 28–32. Fulltekst i vitenarkiv Vis sammendrag

  Betablokkere har vært standard sekundærforebyggende behandling etter akutt hjerteinfarkt siden 1980-tallet. Siden den gang har diagnostikken og behandlingen av hjerteinfarkt forandret seg betydelig. Om betablokkere fortsatt er nyttig, skal BETAMI-studien gi svar på. Studien startet opp i oktober 2018 og er en av de største ikke-industrisponsede hjertestudiene som er gjennomført i Norge.

• Andel, Peter Michael; Aukrust, Pål; Gleditsch, Jostein; Gude, Einar; Haugeberg, Glenn & Høie, Sverre [Vis alle 9 forfattere av denne artikkelen] (2023). Residiverende perikarditt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(8), s. 708–711. doi: 10.4045/tidsskr.22.0580. Fulltekst i vitenarkiv Vis sammendrag

  Perikarditt er en viktig differensialdiagnose ved brystsmerter. I den vestlige verden er idiopatisk perikarditt og inflammasjon etter hjerteinngrep eller infarkt de to viktigste årsakene. Opptil 30 % av perikardittpasientene får tilbakefall, halvparten av disse får flere anfall, og ca. 10 % utvikler et steroidavhengig og kolkisinresistent forløp. Residiv skyldes autoinflammatoriske prosesser i perikard. Avansert bildediagnostikk og behandling med kolkisin og interleukin-1-hemmere har de siste årene bidratt til betydelig redusert sykelighet. I denne kliniske oversikten oppsummerer vi oppdatert kunnskap om diagnostikk og behandling av pasienter med residiverende primær perikarditt.

• Jervan, Øyvind; Haukeland-Parker, Stacey Marie; Gleditsch, Jostein; Tavoly, Mazdak; Klok, Frederikus A. & Steine, Kjetil [Vis alle 14 forfattere av denne artikkelen] (2023). Rehabilitation to improve exercise capacity and quality of life after pulmonary embolism. Fulltekst i vitenarkiv

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