Avdeling for allmennmedisin

• Nyen, J; Kristensen, A M D; Fagerland, Morten; Dammen, Toril; Zwisler, A D & Olsen, M H [Vis alle 13 forfattere av denne artikkelen] (2026). Beta-blocker therapy and sexual dysfunction after myocardial infarction: a sub-study of the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. 47(Supplement_1). doi: 10.1093/eurheartj/ehag785.4110. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Sexual dysfunction is common after myocardial infarction (MI), but the role of beta-blockers on these disturbances remains unclear. Purpose To evaluate the presence of beta-blocker induced sexual dysfunction in post-MI patients without a reduced left ventricular ejection fraction (LVEF ≥40%) enrolled in the BETAMI-DANBLOCK trial. Methods A prespecified analysis of data from BETAMI-DANBLOCK which randomly assigned patients with a recent MI and an LVEF ≥40% to open-label beta-blocker therapy (median treatment dose metoprolol 50mg/day) or no beta-blocker therapy. For patients reporting sexual activity within the past 12 months, sexual function during the past 4 weeks was assessed at baseline and follow-up (3, 12, and 21 months) with the 5-item International Index of Erectile Function (IIEF, men) and the 6-item Female Sexual Function Index (FSFI, women). Sum scores for IIEF (range 5–25) and FSFI (6–30) provides measures of sexual function increasing with higher sexual function; thresholds for dysfunction were IIEF ≤21 and FSFI ≤19. Beta-blocker effects on IIEF and FSFI scores were analysed as between-group differences in change using linear mixed models (negative estimates indicating worse sexual function with beta-blockers). Odds ratios (ORs) for sexual dysfunction were estimated with multivariable logistic regression adjusting for randomisation stratification variables LVEF and study site. Results Among 5574 patients in BETAMI-DANBLOCK, 2850 stated sexual activity within past year at baseline. Of these, 2332/2850 (82%) responded to IIEF or FSFI at least once during the trial period. Among men, baseline median IIEF score was 23 (IQR: 19-24) in the beta-blocker group and 23 (IQR: 19-25) in the no beta-blocker group, with 39% reporting scores indicating erectile dysfunction and 12% in DANBLOCK dispensing sildenafil. We found no statistically significant effect of beta-blockers on the total IIEF score during follow-up (Table). However, the odds of erectile dysfunction was slightly higher in the beta-blocker group at the first follow-up (3 months OR: 1.58, 95% CI: 1.02, 2.42), but not on the subsequent timepoints. The proportion of filled sildenafil prescriptions was similar in the beta-blocker and no beta-blocker group (18% vs 17%) during follow-up in DANBLOCK. Among women, median FSFI score at baseline was 24 (IQR: 20-27) and 24 (IQR: 18-27), with 24% and 31% of patients having a score indicating sexual dysfunction for the beta-blocker group and the no beta-blocker group, respectively. We found no effect of beta-blocker therapy on FSFI scores during follow-up, but effect estimates were uncertain. Conclusions In the BETAMI-DANBLOCK trial, beta-blocker therapy after MI was associated with a small transient increase in erectile dysfunction among men, but no long-term effects were observed.

• Johannessen, Tonje Rambøll; Atar, Dan; Halvorsen, Sigrid Groven; 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 efficacy findings from the OUT-POC Study. European Heart Journal. ISSN 0195-668X. 47(Supplement_1). doi: 10.1093/eurheartj/ehag785.1892. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background High-sensitivity troponin testing at the point-of-care (POC) level may enable faster and more accurate assessment of chest pain in low-resource, out-of-hospital settings. The ongoing prospective OUT-POC study (One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care), initiated in June 2025, aims to enrol 2,500 patients across six emergency primary care clinics in Norway. Purpose This interim analysis evaluates the triage efficacy of the study`s POC assay (TRIAGETRUE High Sensitivity Troponin I (hs-cTnI) Test) using the ESC 0/1-hour algorithm, comparing it to the standard-of-care central laboratory assay (Elecsys 5th-generation hs-cTnT) to identify discrepancies and assess potential safety concerns for patients classified as rule-out by the POC assay. Methods A prespecified interim analysis was performed on the first 300 participants enrolled at the largest study site. EDTA whole blood was collected for the POC assay, and lithium heparin samples were sent to the central laboratory via pneumatic tube for hs-cTnT analysis. The hs-cTnT results were blinded to the treating physicians. Major discrepancies were defined as cases in which the POC assay triaged a patient for direct rule-out, while the central laboratory assay classified the same patient as rule-in. Results During the first three months of inclusion, data were analysed from 308 patients with a median age of 55 years (IQR 42–69) and 47.4% (N=146) female. The POC assay triaged 65.6% (n=202) to 0-hour rule-out (<4 ng/L and ≥3 hours since symptom onset), compared with 45.5% (n=140) triaged by the hs-cTnT assay (<5 ng/L and ≥3 hours since symptom onset). The 0-hour rule-in rates were 4.2% for the POC assay (≥60 ng/L) and 2.6% for the hs-cTnT assay (≥52 ng/L). The POC assay also triaged 90 patients (29.2%) to the indeterminate observation group, requiring a repeat 1-hour sample. In comparison, the hs-cTnT assay would have required repeat sampling in 160 patients (51.9%), though 70 of these were not obtained due to blinded results. After the repeat sample, the POC 0/1-hour algorithm triaged 74.0% of the patients as rule-out, suggesting potential eligibility for discharge. No major discrepancies between the two assays were identified after a single sample. Technical error codes occurred in 3 of 308 patients (1.0%) during POC testing. Conclusions Compared with the standard-of-care central laboratory hs-cTnT assay, the TRIAGETRUE hs-cTnI POC assay provides a higher single-sample rule-out rate and a shorter turnaround time. Together, these features enable faster identification of rule-out patients and may improve patient flow and chest pain management in busy clinics. No safety concerns have been identified for the point-of-care assay, supporting continuation of the larger implementation study.Triage Efficacy after a single blood sample

• Morken, Tone; Vallersnes, Odd Martin & Lindberg, Bent Håkan (2026). Legevaktpodden #55: Usikkerhet på vakt - kunsten å stå i det grå. Fulltekst i vitenarkiv Vis sammendrag

  Usikkerhet på legevakt er ikke et tegn på utilstrekkelighet, men en iboende del av legejobben. Odd Martin Vallersnes og Bent Håkan Lindberg diskuterer hvordan vi kan flytte fokuset fra medisin som «svart-hvitt» naturvitenskap til en forståelse av det kliniske «gråfeltet».   Podkastvert: Tone Morken. Produsent: Nathalie Sandal.  

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