Kristian Berge

• Bonnevie-Svendsen, Martin; Edvardsson, Erle Viktoria; Oppen, Kjersti; Melau, Jørgen; Nyborg, Christoffer & Sæter, Frode Wirum [Show all 9 contributors for this article] (2026). Cardiac troponin patterns in athletes completing Norseman Xtreme Triathlon. BMJ Open sport & exercise medicine. 12(2). doi: 10.1136/bmjsem-2025-002810. Full text in Research Archive
• Janssen, Sylvan L.J.E.; Everdingen, Wouter M. van; Saalmink, Wouter B.J.; Lamers, Sacha K.; Vroemen, Wim H.M. & Denessen, Ellen J.S. [Show all 46 contributors for this article] (2025). Relationship Between Exercise-Induced Cardiac Troponin Elevations and Occult Coronary Atherosclerosis in Middle-Aged Athletes. Journal of the American College of Cardiology. ISSN 0735-1097. 85(24), p. 2370–2382. doi: 10.1016/j.jacc.2025.04.047. Full text in Research Archive
• Berge, Kristian; Wisløff, Torbjørn; Lippestad, Kristine; Jakobsen, Rune Bruhn; Gjestland, Johanna & Lenvik, Olav [Show all 10 contributors for this article] (2025). Pragmatic, quasi-experimental, pseudo-randomized clinical trial to assess the impact of patient safety monitors on clinical and patient safety outcomes: The Akershus Clinical Trial (ACT) 1. PLOS ONE. 20(10). doi: 10.1371/journal.pone.0335052. Full text in Research Archive Show summary

  Background The Norwegian National Action Plan for Patient Safety and Quality Improvement recommends implementing electronic patient safety monitors (PSM) in Norwegian hospitals. We hypothesized that PSM implementation would reduce hospital length of stay, with secondary endpoints related to clinical and patient safety outcomes. Methods We performed a retrospective single-center, pragmatic, quasi-experimental, pseudo-randomized controlled trial assessing differences in endpoints for patients admitted before (control group: years 2019–2020) and after PSM implementation (intervention group: years 2021–2022) in two orthopedic bays in a Norwegian teaching hospital. To account for temporal changes unrelated to PSM, we assessed the same endpoints for 2019–2020 vs. 2021–2022 in two orthopedic bays that did not implement PSM. Data extraction from the local data warehouse was controlled according to internal standards, and we predefined all statistical analyses. Results The intervention group (n = 2786) and the control group (n = 2610) were evenly distributed for baseline characteristics, including age (median 73 [quartile 1–3 55–83] vs. 72 [55–83] years, p = 0.29), female sex (76.2% vs. 76.4%, p = 0.96), and Charlson Comorbidity Index (p = 0.24). Median hospital length of stay was 4.4 (2.1–7.7) days after implementation of PSM compared to 4.3 (2.0–7.2) days in the control group (p = 0.046 for difference between the groups). Nutritional screening and fall screening within 24 hours were lower in the intervention group compared to the control group, while medical reconciliation during the hospital stay was higher in the intervention group. We found no differences between the groups in 30-day or 1-year readmission or mortality rates. Hospital length of stay was similar in 2021–2022 vs. 2019–2020 for the bays that did not implement PSM. Conclusion The implementation of PSMs in this study did not improve clinical or patient safety outcomes. Hospital length of stay was statistically longer after PSM implementation, although the difference was not clinically relevant.

• Berge, Kristian; Janssen, Sylvan L.J.E.; Velthuis, Birgitta K.; Myhre, Peder Langeland; Mosterd, Arend & Omland, Torbjørn [Show all 8 contributors for this article] (2025). Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 26(3), p. 461–470. doi: 10.1093/ehjci/jeae317. Full text in Research Archive Show summary

  Aims Exercise improves cardiovascular health, but high-volume high-intensity exercise is associated with increased coronary artery calcification (CAC). We aimed to identify predictors of CAC in athletes. Methods and results We assessed the association of traditional and non-traditional cardiovascular risk factors with CAC using linear and logistic regression. A total of 289 male athletes from the MARC-2 study were included, with a median age of 60 (Q1–3 56–66) years, lifelong weekly training load of 26 (17–35) metabolic equivalent of task hours, body mass index of 24.5 (22.9–26.6) kg/m2, systolic blood pressure of 139 ± 18 mmHg, and reported 0.0 (0.0–8.0) smoking pack years. Thirty-one per cent had a CAC score > 100 and 13% > 400. Among traditional cardiovascular risk factors, higher age, systolic blood pressure, smoking pack years, and family history of coronary artery disease independently predicted greater CAC scores, while body mass index, low-density lipoprotein cholesterol, and diabetes mellitus did not. Among non-traditional risk factors, higher training loads, serum phosphate, and lower adjusted energy intake and fat percentage of energy intake independently predicted greater CAC scores. The full model with all traditional and non-traditional risk factors had higher accuracy in predicting CAC > 100 [receiver operating characteristic area under the curve 0.76, 95% confidence interval (0.70–0.82)] and CAC > 400 [0.85 (0.77–0.92)] than traditional cardiovascular risk factors alone [0.72 (0.65–0.78), P = 0.012, and 0.81 (0.74–0.90), P = 0.038, respectively]. Conclusion Non-traditional risk factors, including training load, dietary patterns, and serum phosphate, were independently associated with CAC in aging male athletes. Prediction accuracy for CAC increased when including these variables in a prediction model with traditional risk factors.

• Øvrebotten, Tarjei; Tholin, Birgitte; Berge, Kristian; Myhre, Peder Langeland & Stavem, Knut (2025). Cardiac events and procedures following COVID-19 compared with other pneumonias: a national register study. Open heart. 12(1). doi: 10.1136/openhrt-2024-002914. Full text in Research Archive Show summary

  Background Studies have shown an increased risk of cardiac disease following COVID-19, but how it compares to pneumonia of other etiologies is unclear. Aims To determine the incidence and HRs of cardiac disease in patients hospitalised with COVID-19 compared with other viral or bacterial pneumonias. Methods Using nationwide registry data, we estimated the incidence of cardiac events after hospitalisation with COVID-19 (n=2082) in February to November 2020 vs hospitalisation with viral (n=9018) or bacterial (n=29 339) pneumonia in 2018–2019. We defined outcomes using ICD-10 codes for incident myocarditis, acute myocardial infarction, atrial fibrillation/flutter, heart failure, ischaemic heart disease, other cardiac disease and total cardiac disease (any heart condition). We used Cox regression and logistic regression for analysis. Results Patients with COVID-19 had a mean (SD) age of 60 (18) years, compared with 69 (19) years for viral and 72 (17) years for bacterial pneumonia. Those with COVID-19 were more often male and had fewer comorbidities and fewer prior hospitalisations. Patients with COVID-19 had a lower hazard of new-onset cardiac disease compared with viral (HR 0.79 [95%CI 0.66 to 0.93]) and bacterial pneumonia (HR 0.66 [95%CI 0.57 to 0.78]), adjusted for age, sex, comorbidity, hospital admission prior year and respiratory support. Results were similar when including recurrent events. Conclusion Patients hospitalised with COVID-19 had a lower hazard of new-onset cardiac disease during the first 9 months after hospitalisation compared with patients with other viral or bacterial pneumonias after adjusting for multiple possible confounders. However, there may still be residual confounding from other or unknown factors.

• Berge, Kristian; Schirmer, Henrik; Øvrebotten, Tarjei; Nahoui, Hamza; Gullestad, Lars & Ingul, Charlotte Ingeborg Björk [Show all 13 contributors for this article] (2025). Improvements in medical therapy and prognosis for patients with HFrEF following the 2021 ESC HF guidelines. ESC Heart Failure. 12(5), p. 3343–3352. doi: 10.1002/ehf2.15337. Full text in Research Archive Show summary

  Aims The guideline-directed medical therapy (GDMT) sequencing strategy for patients with heart failure (HF) and reduced ejection fraction (HFrEF) underwent a paradigm shift with the 2021 ESC HF guidelines, from stepwise escalation to rapid simultaneous initiation of quadruple therapy. We aimed to assess the temporal trends in the use of GDMT and prognosis for patients with HFrEF. Methods and results Through the Norwegian HF Registry, we obtained data on patients treated at HF outpatient clinics with left ventricular ejection fraction ≤40% from 2016 through 2023 (n = 13 992), including GDMT, HF hospitalisations and mortality. Since 2016, >90% of patients have been treated with beta-blockers and renin-angiotensin-system-inhibitors, with angiotensin receptor-neprilysin inhibitors (ARNI) utilisation increasing from 4% in 2016 to 54% in 2023. Mineralocorticoid-receptor-antagonists (MRA) utilisation was at 36% in 2016, increased by 3% per year to 54% in 2021, and thereafter increased by 12% per year to 78% in 2023. Sodium-glucose cotransporter-2-inhibitors (SGLT2i) utilisation increased rapidly from 3% in 2020 to 85% in 2023. The utilisation of ≥50% of target dose followed similar trends. From 2016 to 2021, the crude 6-month mortality rate remained at 2.7%, followed by a decline of approximately 0.5% per year to 1.8% in 2023. HF hospitalisations declined steadily from 12.9% in 2016 to 8.2% in 2021, with a further decline to 6.8% in 2023. Conclusions The utilisation of GDMT in Norwegian HF clinics has increased markedly since 2016, with a fourfold acceleration in MRA and a substantial increase in SGLT2i use following the 2021 ESC HF guidelines. HF hospitalisations have consistently declined, while mortality rates first declined after 2021.

• Jortveit, Jarle; Myhre, Peder Langeland; Berge, Kristian & Halvorsen, Sigrun (2025). Survival after myocardial infarction according to left ventricular function and heart failure symptoms. ESC Heart Failure. 12(4), p. 2528–2539. doi: 10.1002/ehf2.15265. Full text in Research Archive
• Janssen, Sylvan L.J.E.; Lamers, Sacha K.; Vroemen, Wim H.M.; Denessen, Ellen J.S.; Berge, Kristian & Bekers, Otto [Show all 14 contributors for this article] (2024). Cardiac troponin concentrations following exercise and the association with cardiovascular disease and outcomes: rationale and design of the prospective TREAT cohort study. BMJ Open sport & exercise medicine. 10(2). doi: 10.1136/bmjsem-2024-002070. Full text in Research Archive
• Bhatnagar, Rahul; Berge, Kristian; Høiseth, Arne Didrik; Omland, Torbjørn; Lyngbakken, Magnus Nakrem & Røsjø, Helge Rørvik (2024). Associations between Chest Pain, Diagnosis, and Clinical Outcome in Patients Hospitalized with Acute Dyspnea: Data from the ACE 2 Study. Cardiology. ISSN 0008-6312. doi: 10.1159/000541897. Full text in Research Archive Show summary

  Introduction: Patients hospitalized due to dyspnea sometimes also report concomitant chest pain. Whether co-existing chest pain in patients with acute dyspnea associates with specific diagnosis and clinical outcome is not known. Method: We included 313 patients admitted to Akershus University Hospital with acute dyspnea and asked the patients directly on hospital admission whether they had experienced chest pain during the last 24 h. We examined the associations between chest pain and (1) diagnosis of the index hospitalization and (2) clinical outcome during follow-up. The diagnosis for the index hospitalization was adjudicated as acute heart failure (HF) or non-HF etiology of acute dyspnea by two experts working independently. Non-HF patients were further sub-grouped into chronic obstructive pulmonary disease (COPD) or non-COPD etiology. Results: In total, 143 patients were admitted with acute HF (46% of the population), 83 patients with COPD (26% of the population), and 87 patients with non-HF, non-COPD-related dyspnea (28% of the population). Ninety-six patients (31%) with acute dyspnea reported chest pain during the last 24 h prior to hospital admission. The prevalence of chest pain was not statistically different for patients who were hospitalized with acute HF (n = 42, 44%), acute exacerbation of COPD (n = 22, 23%), or non-HF, non-COPD-related dyspnea (n = 32, 33%), p > 0.05 for all comparisons between groups. During median of 823 days follow-up, 114 patients died (36%). Patients with dyspnea and concomitant chest pain did not have different outcome compared to patients with dyspnea and no chest pain (log-rank test: p = 0.09). Chest pain prior to admission was neither associated with all-cause mortality in any of the adjudicated diagnosis groups. Conclusions: Chest pain was reported in 31% of patients hospitalized with acute dyspnea but the prevalence did not differ according to adjudicated diagnosis. Patients with dyspnea and chest pain did not have worse outcome compared to patients with dyspnea and no chest pain.

• Myhre, Peder Langeland; Kleiven, Øyunn; Berge, Kristian; Grundtvig, Morten; Gullestad, Lars & Ørn, Stein (2024). Changes in 6-min walk test is an independent predictor of death in chronic heart failure with reduced ejection fraction. European Journal of Heart Failure. ISSN 1388-9842. 26(12), p. 2608–2615. doi: 10.1002/ejhf.3391. Full text in Research Archive Show summary

  Aims Functional capacity provides important clinical information in patients with heart failure (HF) and reduced ejection fraction (HFrEF). The 6-min walk test (6MWT) is a simple and inexpensive tool for assessing functional capacity and risk. Although change in 6MWT is frequently used as a surrogate outcome in HF trials, the association with mortality is unclear. We aimed to assess the prognostic importance of changes in 6MWT. Methods and results Patients with chronic HFrEF referred to HF outpatient clinics in Norway completed a 6MWT at the first visit (baseline) and at a stable follow-up visit after treatment optimization (follow-up). Absolute and relative changes in 6MWT were analysed in association with mortality risk using Cox regression models and flexible cubic splines. The study included 3636 HFrEF patients aged 67.3 ± 11.6 years, 23% women, with left ventricular ejection fraction 30 ± 7%. At baseline, mean 6MWT was 438 ± 125 m, median N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1574 (732–3093) ng/L, and 27% had New York Heart Association (NYHA) class III/IV. After optimization of guideline-directed medical therapy (median 147 [86–240] days), 6MWT increased by mean 40 ± 74 m, NT-proBNP decreased by median 425 (14–1322) ng/L, and NYHA class improved in 38% of patients. Patients with greater improvements in 6MWT were younger, with greater improvements in NYHA class (r = 0.27, p < 0.001) and larger reductions in NT-proBNP concentrations (r = 0.19, p < 0.001). After mean 845 ± 595 days, 419 (11.5%) patients were dead. Both absolute and relative changes in 6MWT were non-linearly associated with survival, attenuating as 6MWT increased. A 50 m increase in 6MWT was associated with a 17% lower mortality risk (hazard ratio 0.84, 95% confidence interval 0.77–0.90, p < 0.001) in the fully adjusted model, including changes in NYHA class, NT-proBNP concentrations, and other established risk factors. The associations were more pronounced in patients with lower baseline 6MWT and higher age. Conclusion Improvement in 6MWT in patients with HFrEF is associated with increased survival, independent of changes in NT-proBNP and NYHA class. These findings support 6MWT change as a surrogate outcome in HF trials.

• Janssen, Sylvan LJE; Berge, Kristian; Luiken, Tom; Aengevaeren, Vincent L & Eijsvogels, Thijs MH (2023). Cardiac troponin release in athletes: what do we know and where should we go? Current Opinion in Physiology. ISSN 2468-8681. 31. doi: 10.1016/j.cophys.2022.100629. Full text in Research Archive Show summary

  Cardiac troponins (cTn) are proteins that regulate cardiomyocyte contraction. A rise and fall of cTn above the upper reference limit is diagnostic of myocardial injury. Therefore, cTn measurements are part of the routine workup when suspecting acute coronary syndromes. Exercise can also produce cTn elevations. Many studies in the last three decades have advanced our understanding of exercise-induced cTn release. Beyond technical improvements in cTn assays, various predictors of cTn release have been identified, whereas insight into exercise-induced cTn release patterns and its clinical implications have been improved. Whether cTn release in athletes represents a physiological or pathological response remains a topic of debate. This review summarizes our current understanding of exercise-induced cTn release and provides directions for future studies. We address how to 1) discriminate physiological versus pathological cTn release, 2) unravel the underlying mechanisms of exercise-induced cTn release, and 3) determine whether exercise-induced cTn elevation is a novel cardiovascular risk factor.

• Bhatnagar, Rahul; Berge, Kristian; Røysland, Ragnhild; Høiseth, Arne Didrik; Brynildsen, Jon & Christensen, Geir [Show all 9 contributors for this article] (2023). Cardiac Troponin T and NT-proBNP for Prediction of 30-Day Readmission or Death in Patients with Acute Dyspnea: Data from the Akershus Cardiac Examination 2 Study. Cardiology. ISSN 0008-6312. 148(6), p. 506–516. doi: 10.1159/000533266. Full text in Research Archive Show summary

  Introduction: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) measurements are recommended in patients with acute dyspnea. We aimed to assess the prognostic merit of cTnT compared to NT-proBNP for 30-day readmission or death in patients hospitalized with acute dyspnea. Methods: We measured cTnT and NT-proBNP within 24 h in 314 patients hospitalized with acute dyspnea and adjudicated the cause of the index admission. Time to first event of readmission or death ≤30 days after hospital discharge was recorded, and cTnT and NT-proBNP measurements were compared head-to-head. Results: Patients who died (12/314) or were readmitted (71/314) within 30 days had higher cTnT concentrations (median: 32.6, Q1–Q3: 18.4–74.2 ng/L vs. median: 19.4, Q1–Q3: 8.4–36.1 ng/L; p for comparison &amp;lt;0.001) and NT-proBNP concentrations (median: 1,753.6, Q1–Q3: 464.2–6,862.0 ng/L vs. median 984, Q1–Q3 201–3,600 ng/L; for comparison p = 0.027) compared to patients who survived and were not readmitted. cTnT concentrations were associated with readmission or death within 30 days after discharge both in the total cohort (adjusted hazard ratio [aHR]: 1.64, 95% confidence interval [CI]: 1.30–2.05) and in patients with heart failure (HF) (aHR: 1.58, 95% CI: 1.14–2.18). In contrast, NT-proBNP concentrations were not associated with short-term events, neither in the total cohort (aHR: 1.10, 95% CI: 0.94–1.30) nor in patients with adjudicated HF (aHR: 1.06, 95% CI: 0.80–1.40). Conclusion: cTnT concentrations are associated with 30-day readmission or death in patients hospitalized with acute dyspnea, as well as in patients adjudicated HF.

• Berge, Kristian; Aengevaeren, Vincent L.; Mosterd, Arend; Velthuis, Birgitta K.; Lyngbakken, Magnus Nakrem & Omland, Torbjørn [Show all 8 contributors for this article] (2023). Plasma Advanced Glycation End Products and Dicarbonyl Compounds Are Not Associated with Coronary Atherosclerosis in Athletes. Medicine & Science in Sports & Exercise. ISSN 0195-9131. 55(7), p. 1143–1150. doi: 10.1249/MSS.0000000000003152. Full text in Research Archive Show summary

  Purpose Coronary atherosclerosis is the leading cause of sudden death among athletes >35 yr old, but current cardiovascular risk prediction algorithms have not been validated for athletes. Advanced glycation end products (AGE) and dicarbonyl compounds have been associated with atherosclerosis and rupture-prone plaques in patients and ex vivo studies. The detection of AGE and dicarbonyl compounds might be a novel screening tool for high-risk coronary atherosclerosis in older athletes. Methods Concentrations of three different AGE and the dicarbonyl compounds methylglyoxal, glyoxal, and 3-deoxyglucosone were measured in plasma with ultraperformance liquid chromatography tandem mass spectrometry in athletes from the Measuring Athletes’ Risk of Cardiovascular Events 2 study cohort. Coronary plaques, plaque characteristics (calcified, noncalcified or mixed), and coronary artery calcium (CAC) scores were assessed with coronary computed tomography, and potential associations with AGE and dicarbonyl compounds were analyzed using linear and logistic regression. Results A total of 289 men were included (60 [quartiles 1–3 = 56–66] yr old, body mass index = 24.5 [22.9–26.6] kg·m−2), with a weekly exercise volume of 41 (25–57) MET-hours. Coronary plaques were detected in 241 participants (83%), with a dominant plaque type of calcified plaques in 42%, noncalcified plaques in 12% and mixed plaques in 21%. No AGE or dicarbonyl compounds were associated with total number of plaques or any of the plaque characteristics in adjusted analyses. Similarly, AGE and dicarbonyl compounds were not associated with CAC score. Conclusions Concentrations of plasma AGE and dicarbonyl compounds do not predict the presence of coronary plaques, plaque characteristics or CAC scores, in middle-age and older athletes.

• Berge, Kristian; Brynildsen, Jon; Røysland, Ragnhild; Strand, Heidi; Christensen, Geir & Høiseth, Arne Didrik [Show all 9 contributors for this article] (2022). Prognostic value of cardiac biomarkers and National Early Warning Score 2 in acute dyspnoea. Open heart. 9(1). doi: 10.1136/openhrt-2021-001938. Full text in Research Archive Show summary

  Objective Patients hospitalised with acute dyspnoea due to acute heart failure (AHF) have a grave prognosis, but the European Society of Cardiology guidelines recommend no system to risk stratify these patients. The prognostic value of combining National Early Warning Score (NEWS) 2 and established cardiac biomarkers is not known. Methods We measured high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and calculated NEWS2 in 314 patients with acute dyspnoea within 24 hours of hospitalisation. Their prognostic merits were assessed in the total cohort and for the subgroup with AHF separately. Results The median age was 73 (quartile (Q) 1–3, 63–81) years, 48% were women and 143 patients (46%) were hospitalised with AHF. The 114 patients (36%) who died during follow-up (median 823 days, Q1–3, 471–998) had higher concentrations of hs-cTnT (62 vs 33 ng/L, p&lt;0.001) and NT-proBNP (6995 vs 2605 ng/L, p&lt;0.001), and higher NEWS2 (6.1 vs 4.5 points, p&lt;0.001), compared with survivors. Patients with increased vs low NEWS2 clinical risk had higher mortality rates in adjusted analyses in the total cohort (HR 2.11, 95% CI 1.28 to 3.48) and in patients with AHF (HR 2.00, 95% CI 1.54 to 2.60). NEWS2 provided incremental prognostic information compared with biomarkers alone for the total cohort: area under the curve 0.72 vs 0.70, p=0.042, and for the subpopulation with AHF: 0.70 vs 0.67, p=0.014. Conclusion NEWS2 predicts long-term mortality in patients hospitalised due to acute dyspnoea and the subgroup with AHF and provide incremental prognostic information to hs-cTnT and NT-proBNP.

• Jerjes, Waseem K.; Hamdoon, Zaid; Berge, Kristian; Høgset, Anders & Hopper, Colin (2021). Squamous cell carcinoma of the ear treated by photochemical internalization. Photodiagnosis and Photodynamic Therapy. ISSN 1572-1000. 36. doi: 10.1016/j.pdpdt.2021.102528. Full text in Research Archive
• Berge, Kristian; Lyngbakken, Magnus Nakrem; Omland, Torbjørn; Juliebø, Vibeke; Schirmer, Henrik & Røsjø, Helge Rørvik (2021). Ytterligere læringsmomenter fra et kardiologisk perspektiv. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(1). doi: 10.4045/tidsskr.20.1025. Full text in Research Archive
• Berge, Kristian; Lyngbakken, Magnus; Myhre, Peder Langeland; Brynildsen, Jon; Røysland, Ragnhild & Strand, Heidi [Show all 10 contributors for this article] (2020). High-sensitivity cardiac troponin T and N-terminal pro-B-type natriuretic peptide in acute heart failure: Data from the ACE 2 study. Clinical Biochemistry. ISSN 0009-9120. p. 1–7. doi: 10.1016/j.clinbiochem.2020.11.009. Full text in Research Archive Show summary

  Background To assess if cardiac troponins can improve diagnostics of acute heart failure (AHF) and provide prognostic information in patients with acute dyspnea. Methods We measured cardiac troponin T with a high-sensitivity assay (hs-cTnT) in 314 patients hospitalized with acute dyspnea. The index diagnosis was adjudicated and AHF patients were stratified into AHF with reduced or preserved ejection fraction (HFrEF/HFpEF). The prognostic and diagnostic merit of hs-cTnT was compared to the merit of N-terminal pro-B-type natriuretic peptide (NT-proBNP). Results In the total population, median age was 73 (quartile [Q] 1–3 63–81) years and 48% were women. One-hundred-forty-three patients were categorized as AHF (46%) and these patients had higher hs-cTnT concentrations than patients with non-AHF-related dyspnea: median 38 (Q1-3 22–75) vs. 13 (4–25) ng/L; p < 0.001. hs-cTnT concentrations were similar between patients with HFrEF and HFpEF (p = 0.80), in contrast to NT-proBNP, which was higher in HFrEF (p < 0.001). C-statistics for discriminating HFpEF from non-AHF-related dyspnea was 0.80 (95% CI 0.73–0.86) for hs-cTnT, 0.79 (0.73–0.86) for NT–proBNP, and 0.83 (0.76–0.89) for hs-cTnT and NT-proBNP in combination. Elevated hs-cTnT remained associated with HFpEF in logistic regression analysis after adjusting for demographics, comorbidities and renal function. During median 27 months of follow-up, 114 (36%) patients died in the total population. Higher hs-cTnT concentrations were associated with increased risk of all-cause mortality after adjustment for clinical variables and NT-proBNP: hazard ratio 1.30 (95% CI 1.07–1.58), p = 0.009. Conclusion hs-cTnT measurements improve diagnostic accuracy for HFpEF and provide independent prognostic information in unselected patients with acute dyspnea.

• Berge, Kristian; Lyngbakken, Magnus; Einvik, Gunnar; Winther, Jacob Andreas; Brynildsen, Jon & Røysland, Ragnhild [Show all 11 contributors for this article] (2018). Diagnostic and prognostic properties of procalcitonin in patients with acute dyspnea: Data from the ACE 2 Study. Clinical Biochemistry. ISSN 0009-9120. 59, p. 62–68. doi: 10.1016/j.clinbiochem.2018.07.006. Full text in Research Archive

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• Rolland, J; Ovrebotten, T; Berge, Kristian; Nahoui, Hamza; Bjorkelund, O A & Broch, Kaspar [Show all 15 contributors for this article] (2026). Contemporary post-discharge management in heart failure at home (STRONG@HOME). European Journal of Heart Failure. ISSN 1388-9842. 28(Supplement_2). doi: 10.1093/ejhf/xuag193.1424. Full text in Research Archive Show summary

  Abstract Background The post-discharge period after heart failure (HF) hospitalisation is associated with high-risk, and the uptake of guideline-directed medical therapy (GDMT) remains suboptimal. In the STRONG-HF trial, an intensive strategy of rapid GDMT up-titration and close follow-up after an acute HF admission reduced the risk of all-cause mortality and HF readmissions compared to usual care. Based on the STRONG-HF results, this strategy received a Class IB recommendation in the 2023 Focused Update of the ESC HF Guidelines, but requires substantial resources and may offer logistical challenges. Whether follow-up visits can safely be performed virtually at home and still achieve the same degree of GDMT without excess adverse events remains unknown. Objectives This abstract describes the design and methodological framework of STRONG@HOME. This trial evaluates whether patients discharged after hospitalisation for acute HF can safely achieve the same level of GDMT via digital follow-up at home as compared to hospital visits, according to the STRONG-HF strategy. Methods STRONG@HOME is a randomised, multicentre, open-label, parallel group trial. In total, 462 patients hospitalised for acute HF will be randomised in a 1:1 ratio to receive digital (experimental arm) or in-person (control arm) follow-up at 1-, 2-, 3- and 6-weeks post-discharge (See Figure). Patients in the control arm are followed at outpatient HF clinics, while patients in the experimental arm are followed up via video consultations and telemonitoring. The dual primary outcomes (Bonferroni corrected with 0.025 as significance level) are assessed for non-inferiority after 90 days at the final follow-up visit. Efficacy is measured by the GDMT-score (0-9), based on four drug classes. Safety is assessed as treatment-emergent adverse events, including eGFR &lt;30 mL/min/1.73 m², systolic BP &lt;95 mm Hg, heart rate &lt;50 bpm, and serum potassium &gt;5.5 mmol/L. The expected median GDMT-score in the control arm is 7 (SD 2.5). With a 10% non-inferiority margin, a sample size of 404 is needed for 80% power and a significance level of 0.025. For safety, a 51% expected adverse events rate requires a sample size of 416. At an expected 10% dropout rate, the final overall target sample size is 462. Per January 1, 2026, 83 patients have been enrolled, and all sites are activated. Conclusion STRONG@HOME is the first study to assess if patients with acute HF can safely achieve the same level of GDMT through digital home follow-up as through hospital visits, using the STRONG-HF strategy. This approach could enable broader implementation of guideline-recommended post-discharge management at reduced cost, improve accessibility for patients in rural or underserved areas, and alleviate capacity constraints at specialised HF clinics. Digital follow-up may also enhance patient convenience and adherence while maintaining clinical outcomes, potentially transforming post-discharge HF care delivery at scale.Strong@Home flow chartFor image description, please refer to the figure legend and surrounding text.

• Myhre, Peder Langeland; Berge, Kristian & Ørn, Stein (2024). Reply to the letter regarding the article ‘Changes in 6-min walk test is an independent predictor of death in chronic heart failure with reduced ejection fraction’. European Journal of Heart Failure. ISSN 1388-9842. doi: 10.1002/ejhf.3448. Full text in Research Archive

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