Marius Myrstad

• Apelland, Turid; Letnes, Jon Magne; Claessen, Guido; Janssens, Kristel; Sellevold, Andreas Berg & Willems, Rik [Show all 16 contributors for this article] (2026). Temporal Association Between Exercise and Arrhythmia Episodes in Endurance Athletes With Paroxysmal Atrial Fibrillation. Journal of the American Heart Association (JAHA). 15(19), p. e050198–e050198. doi: 10.1161/JAHA.126.050198. Full text in Research Archive
• Anjum, Mariam; Ariansen, Inger; Hjellvik, Vidar; Igland, Jannicke; Kjerpeseth, Lars Jøran & Kvalvaag, Elisabeth Myrset [Show all 12 contributors for this article] (2026). Trends in Incidence of Atrial Fibrillation-Related Stroke: The Norwegian AFNOR Study. Journal of the American Heart Association (JAHA). 15(19). doi: 10.1161/jaha.126.049696. Full text in Research Archive Show summary

  Background The increasing prevalence of atrial fibrillation (AF), along with changes in cardiovascular risk factors, AF detection and oral anticoagulant use, may have altered the epidemiology of AF‐related stroke. However, population‐based data on long‐term trends remain limited. Methods Using mandatory nationwide registry data from the Atrial Fibrillation in Norway (AFNOR) study (2001–2021), we identified incident stroke cases defined as first hospitalization or death due to stroke in individuals aged ≥15 years. Age‐standardized incidence rates were calculated using direct standardization. Sex‐ and age‐adjusted incidence rate ratios (IRR) were estimated using negative binomial regression. Results Among 227 575 incident strokes, 66 795 (29.4%) were AF‐related, and increased from 22% to 31% during 2001–2021, with 69% of all AF‐related ischemic strokes occurring in non‐anticoagulated individuals. Incidence rate of AF‐related ischemic strokes remained stable overall (67.8 per 100 000 person‐years in 2001 to 68.4 in 2021; IRR=1.01; 95% CI, 1.00–1.03) but increased among individuals aged 15 to 64 years. Non‐AF ischemic strokes declined from 204.4 to 130.8 (IRR=0.98; 95% CI, 0.97–0.99). Incidence of AF‐related intracerebral hemorrhage in individuals aged ≥75 years increased, driven by anticoagulated patients. Incidence of non‐AF intracerebral hemorrhage decreased (IRR=0.98; 95% CI, 0.97–0.99). Conclusions The favorable decline in ischemic stroke incidence from 2001 to 2021 did not include AF‐related strokes. AF‐related ischemic strokes increased in younger age groups, whereas AF‐related intracerebral hemorrhage increased in the oldest age groups driven by anticoagulated patients. These findings underscore the need for improved strategies for AF detection and stroke prevention, particularly in younger populations, and greater attention towards management of bleeding risk among older, anticoagulated individuals.

• Johansen, Kristoffer Robin; Nes, Bjarne Martens; Malmo, Vegard; Myrstad, Marius; Thelle, Dag Steinar & Heitmann, Kim Arne [Show all 11 contributors for this article] (2026). Impact of Physical Activity on Stroke and Mortality in Individuals With and Without Atrial Fibrillation: The HUNT Study and the Tromsø Study. Journal of the American Heart Association (JAHA). doi: 10.1161/jaha.126.048812. Full text in Research Archive Show summary

  Background Although physical activity (PA) is associated with a reduced risk of stroke and mortality, its impact among individuals with atrial fibrillation (AF) remains insufficiently explored. Therefore, the aim of this study was to examine the impact of PA on stroke and mortality, both overall and with respect to AF diagnosis. Methods We included 87 340 participants, of which 6539 had AF, from 2 Norwegian population‐based studies, the Tromsø Study and the HUNT (Trøndelag Health Study). Information about AF, stroke, and death were obtained from national health registries. Participants were classified as inactive (reference) or performing low, moderate, or high PA on the basis of a questionnaire. The data were analyzed using multivariable adjusted flexible parametric survival models. Results During a median follow‐up of 13.5 years, 3415 strokes and 7833 deaths occurred. The respective stroke risk reduction associated with low, moderate, and high PA was 9% (95% CI, 1%–16%), 19% (95% CI, 11%–27%) and 18% (95% CI, 8%–26%). Mortality was reduced by 11% (95% CI, 7%–14%), 18% (95% CI, 14%–22%), and 22% (95% CI, 18%–27%). Similar benefits were observed for both stroke and mortality when stratifying by presence or absence of AF. Among individuals with AF, an increased life expectancy was observed, with gains of 0.50 (95% CI, 0.22–0.78), 0.66 (95% CI, 0.31–1.01) and 1.15 (95% CI, 0.77–1.53) years, respectively. Conclusions PA was associated with a reduced risk of stroke and mortality, and similar benefits were observed irrespective of AF diagnosis. Our findings suggest that PA may complement current medical treatment strategies in individuals with AF.

• Titlestad, Irit; Watne, Leiv Otto; Blennow, Kaj; Zetterberg, Henrik; Myrstad, Marius & Dunjic, Emilija [Show all 15 contributors for this article] (2026). CSF neurofilament light chain concentration in patients with delirium following hip fracture: a multicenter prospective study. BMC Geriatrics. 26(1). doi: 10.1186/s12877-026-07630-4. Full text in Research Archive Show summary

  Background Studies suggest delirium is associated with neuronal injury, which may further raise mortality risk. Neuronal injury can be assessed by measuring neurofilament light chain (NFL) concentrations in cerebrospinal fluid (CSF). This study aimed to investigate the association of CSF-NfL with delirium and mortality in patients with hip fracture. Methods The study comprised two prospective cohorts of 548 hip fracture patients with per-operative CSF samples. CSF-NfL concentrations were measured using a commercial ELISA. Delirium was assessed daily from admission until the fifth postoperative day and survival censored at one year. The multivariable analyses (Logistic and Cox regression) were adjusted for age, sex, glomerular filtration rate, dementia status, comorbidity, and Activities of Daily Living. Additionally, Cox regression was adjusted for delirium. Results In total, 259 (52%) patients developed delirium. In univariate analysis, CSF-NfL was higher among patients with delirium (2116 pg/ml versus 1366 pg/ml, odds ratio (OR) 2.21, (95% confidence interval (CI) [1.75,2,78], P < 0.001). In adjusted analysis, CSF-NfL was not significant (OR 1.29, [0.92,1.81], P = 0.128) and only remained significantly associated with delirium in the subgroup of patients without dementia (OR 1.84, [1.17, 2.89], P = 0.007). In unadjusted analysis of mortality, CSF-NfL was significantly associated with death at one year (hazard ratio (HR) 1.60, [1.37, 1.87], P < 0.001) but not in adjusted analysis (HR 1.03 [0.84, 1.26], P = 0.736). Conclusions Our findings show that CSF-NfL concentrations were associated with delirium in patients without pre-existing dementia, suggesting possible undiagnosed dementia or, less likely, delirium-related neuronal injury. The CSF-NfL-associated mortality hazard was non-significant after adjustment, mainly for delirium. Thus, the clinical context must be considered when studying CSF-NfL and delirium.

• Janssens, Kristel; Apelland, Turid; Mitchell, Amy M.; Paepe, Jarne De; Foulkes, Stephen J. & Letnes, Jon Magne [Show all 45 contributors for this article] (2026). Exercise blood pressure response does not differentiate endurance athletes with paroxysmal atrial fibrillation. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(8), p. 1454–1464. doi: 10.1093/eurjpc/zwag136.
• Delpire, Boris; Pauwels, Rik; Peters, Benjamin; Paepe, Jarne De; Bekhuis, Youri & Hemelen, Vincent Van [Show all 19 contributors for this article] (2026). Comparative performance of wearable ECG devices for rhythm monitoring in endurance athletes. American Journal of Preventive Cardiology. doi: 10.1016/j.ajpc.2026.101629. Full text in Research Archive
• Trzpis, Monika; Melvær, Giil Lasse; Hov, Johannes Espolin Roksund; Pollmann, Christian Thomas; Idland, Ane-Victoria & Myrstad, Marius [Show all 12 contributors for this article] (2026). Assessment of the bacteria-derived metabolite TMAO as a potential factor contributing to the pathophysiology of delirium in elderly patients with hip fracture. Brain, Behavior, and Immunity. ISSN 0889-1591. 136. doi: 10.1016/j.bbi.2026.106590. Full text in Research Archive Show summary

  Background: Trimethylamine N-oxide (TMAO) concentrations are dependent on several factors including gut microbial metabolism of dietary nutrients. High TMAO levels have been implicated in the pathogenesis of age-related cognitive impairment. We hypothesized that TMAO may contribute to the pathophysiology of delirium. Methods: In this observational study, we analyzed TMAO concentration in blood and cerebrospinal fluid (CSF) samples from 487 hip fracture patients. Delirium status was set according to the DSM-5 criteria, and pre-existing cognitive impairment by the IQCODE. We performed a logistic regression analysis to examine the association between TMAO and delirium, adjusting for age, pre-existing dementia, and renal function. Results: The median TMAO concentration was significantly higher in patients with delirium (3.9 µM, IQR 2.6–6.6 in blood; 2.5 µM, IQR 1.3–4.9 in CSF) than without delirium (3.0 µM, IQR 2.1–5.1 in blood; P = 0.02, and 1.6 µM, IQR 0.9–3.0 in CSF, P < 0.001). After adjusting for confounders, the association between TMAO and delirium remained significant in CSF (OR = 1.5, 95%CI 1.09–2.05, P = 0.01). Analysis stratified by dementia showed the association was significant only for CSF TMAO among patients without pre-existing dementia (OR = 1.6, 95% CI 1.09–2.30, P = 0.02). Conclusions: The increased concentration of TMAO in CSF is positively associated with delirium among patients without pre-existing dementia. Our finding supports previous observations that the gut derived metabolites may be relevant in delirium, but the pathophysiology may differ in patients with and without pre-existing dementia.

• Henjum, Kristi; Neerland, Bjørn Erik; Blennow, Kaj; Zetterberg, Henrik; Pollmann, Christian Thomas & Olsen, Roy Bjørkholt [Show all 13 contributors for this article] (2026). Biomarkers of Alzheimer's disease pathophysiology and delirium. EBioMedicine. 127. doi: 10.1016/j.ebiom.2026.106252. Full text in Research Archive
• Berntsen, Thea; Blennow, Kaj; Zetterberg, Henrik; Brekke, Ingrid Fæhn; Hella, Mathias Nikolai Petersen & Lian, Tom [Show all 16 contributors for this article] (2026). Increased cerebrospinal fluid YKL-40 concentration in hip fracture patients with delirium. Brain Communications. 8(1). doi: 10.1093/braincomms/fcag005. Full text in Research Archive Show summary

  The underlying mechanisms of the neuropsychiatric syndrome delirium are still unknown, but neuroinflammation is a central hypothesis. Chitinase-3-like-protein-1 (YKL-40/CHI3L1) is considered a marker of neuroinflammation when measured in cerebrospinal fluid (CSF). The aim of this study was to examine concentrations of CSF YKL-40 in patients with and without delirium, to enhance the understanding of delirium pathophysiology. A total of 545 hip fracture patients were included from two similar cohorts. CSF samples were collected in conjunction with spinal anaesthesia for hip fracture surgery. The patients were screened for delirium both pre- and postoperatively. Those with delirium were further divided into subgroups based on whether they developed it before surgery (prevalent delirium) or after surgery (incident delirium). Among patients without delirium, those who met some, but not all diagnostic criteria, were classified as having subsyndromal delirium. Prefracture cognitive function was assessed, and American Society of Anaesthesiologists physical status score was included as a marker of comorbidity. In total, 257 (47%) of the patients developed delirium. These patients were older and had a higher prevalence of dementia and severe systemic diseases. Among the patients without dementia, those with delirium had higher median concentration of CSF YKL-40 compared with those without delirium (first cohort: 175 versus 132 ng/mL, P = 0.01, second cohort: 243 versus 174 ng/mL, P < 0.001). No association was found among the patients with dementia. The results remained consistent when adjusting for age and comorbidity. No difference in median CSF YKL-40 concentration was found between patients who had delirium at the time of surgery (prevalent delirium) and those who developed it afterwards (incident delirium). Our findings support the hypothesis of neuroinflammation as a mechanism for delirium in patients without dementia.

• Myrstad, Marius (2026). A broken heart: 100 years since the first diagnosis of atrial fibrillation in an athlete. European Heart Journal. ISSN 0195-668X. 47(12), p. 1385–1386. doi: 10.1093/eurheartj/ehaf859. Full text in Research Archive
• Landgraff, Ida Kalstad; Myrstad, Marius; Ranhoff, Anette Hylen; Talsnes, Ove; Holvik, Kristin & Meyer, Haakon E. (2026). Midlife physical activity, BMI, and hip fracture risk five decades later in men: a NOREPOS study. Archives of Osteoporosis. ISSN 1862-3522. 21(1), p. 1–9. doi: 10.1007/s11657-026-01657-1. Full text in Research Archive Show summary

  Summary: Research on hip fracture prevention in men is limited. In men, physical activity and body mass index were independently and jointly associated with hip fracture risk, with the highest risk among inactive and thin men. Promoting exercise and healthy weight in midlife may reduce fracture burden and support healthy ageing. Purpose: Hip fractures predominantly affect older people with frailty. The incidence increases with age, and the number is expected to increase substantially due to population aging. Physical inactivity and low body mass index (BMI) are key modifiable risk factors for hip fractures. This study aimed to explore the associations of physical activity and BMI with long-term hip fracture risk in men. Method: This prospective cohort study included 12,900 men aged 40 – 49 years from the Oslo study 1972 – 1973. A questionnaire assessed physical activity, whereas height and weight were measured. Hip fractures were identified through linkage to a national database. Cox regression calculated adjusted hazard ratios (HR) with 95% confidence intervals (CI) for hip fracture according to physical activity level. A secondary analysis examined a composite variable combining activity level (inactive/active) and BMI (< 22/22–24.9/ ≥ 25 kg/m 2 ). Results: During 195,384 person-years of follow-up, 1542 men (12%) sustained a hip fracture at a median age of 82 years. Inactive men had a 38% higher risk (HR 1.38 [95% CI 1.16 – 1.63]) than active men. Active men had a lower hip fracture risk across all categories of BMI, while the greatest risk was found in inactive men with a BMI < 22 kg/m 2 , HR 1.79 [95% CI 1.36 – 2.35] compared to active men with a BMI ≥ 25. Conclusions: Physical inactivity and low BMI in midlife were independently associated with increased long-term hip fracture risk. Inactive and thin men had the greatest risk, suggesting that maintaining physical activity in mid-life is important for healthy ageing and independence.

• Flannery, M. Darragh; Canovas, Rodrigo; Janssens, Kristel; Mitchell, Amy M.; D’Ambrosio, Paolo & Spencer, Luke W. [Show all 26 contributors for this article] (2025). Atrial fibrillation in former world-class rowers: role of environmental and genetic factors. European Heart Journal. ISSN 0195-668X. 46(47), p. 5114–5125. doi: 10.1093/eurheartj/ehaf369. Full text in Research Archive
• Anjum, Mariam; Ariansen, Inger; Myrstad, Marius; Kjerpeseth, Lars Jøran; Hjellvik, Vidar & Skovlund, Eva [Show all 9 contributors for this article] (2025). Timing of stroke risk reassessment in atrial fibrillation patients with a CHA2DS2-VA score of 0 or 1: the Norwegian AFNOR study. Europace. ISSN 1099-5129. 27(10). doi: 10.1093/europace/euaf145. Full text in Research Archive Show summary

  Aims: Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals. Methods and results: Using Norwegian national registries (2011–18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18–44 years (8%) and 45–54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively. Conclusion: New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.

• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Show all 14 contributors for this article] (2025). Blood pressure at age 40 and key features of cerebral small vessel disease at age 70: data from the ACE 1950 Study. BMC Cardiovascular Disorders. 25(1). doi: 10.1186/s12872-025-05140-6. Full text in Research Archive Show summary

  Background The separate effects of systolic (SBP) and diastolic blood pressure (DBP) on cerebral small vessel disease (cSVD) development needs elucidation. We investigated the association between SBP and DBP at age 40 and two selected brain magnetic resonance imaging (MRI) features of cSVD (lacunes and white matter hyperintensities [WMHs]) at age 70 in a general Norwegian population cohort. Methods We included individuals from the Akershus Cardiac Examination (ACE) 1950 Study (2012–2015) who had previously participated in the Age 40 Program (1990–1993). A random subset of participants with SBP in the categories of non-elevated (< 120 mmHg), high elevated (130–139 mmHg) or hypertension (≥ 140 mmHg) at age 40 were invited to perform brain MRI for assessment of cSVD (lacunes and WMHs) at age 70 (2016–2024). DBP was categorized as non-elevated (< 70 mmHg), low elevated (70–79 mmHg), high elevated (80–89 mmHg) and hypertension (≥ 90 mmHg). Logistic and ordinal regressions assessed the association between SBP and DBP and lacunes and severity of WMHs (measured with Fazekas scale), adjusting for sex, total cholesterol, smoking, physical activity, diabetes, education, and age at MRI, with non-elevated BP as the reference category. Results A total of 414 participants (167 [40%] women) were included. Participants were 70.2 ± 2.3 years when undergoing brain MRI. Mean Fazekas scale was 1.3 ± 0.8, and 54 (13%) had lacunes. SBP and DPB were not associated with lacunes. DPB of 80–89 mmHg (adjusted OR [95% CI], 1.91 [1.01–3.62]) and ≥ 90 mmHg (2.11 [1.06–4.19]) at age 40 were associated with WMHs. Conclusions Elevated DBP (80–89 mmHg) and diastolic hypertension (> 90 mmHg) at age 40 were associated with WMH burden at age 70, suggesting a long-term association between midlife DBP and cerebrovascular health.

• Hella, Mathias Nikolai Petersen; Halaas, Nathalie Bodd; Sønnesyn, Hogne; Bergland, Anne Katrine; Hetland, Hanne Brit & Blennow, Kaj [Show all 14 contributors for this article] (2025). Neurogranin in cerebrospinal fluid as a marker of synaptic dysfunction in hip fracture patients with delirium: a multicentre cross-sectional study. BMJ Open. 15(11). doi: 10.1136/bmjopen-2024-097579. Full text in Research Archive Show summary

  Objectives: Neurogranin (Ng) has a role in synaptic plasticity and is considered a biomarker of synaptic dysfunction, a process hypothesised to be important in delirium. Few studies examining Ng in delirium exist, with mixed findings. This study aimed to investigate associations between cerebrospinal fluid (CSF) Ng concentrations and delirium in acutely admitted hip fracture patients. Design: Cross-sectional study. Setting: Acutely admitted orthopaedic patients with hip fracture recruited from four participating hospitals in eastern Norway, representing secondary and tertiary care settings. Participants: This study included 392 hip fracture patients. All admitted hip fracture patients operated in spinal anaesthesia were, regardless of age, considered for inclusion. Methods: An in-house ELISA was used to measure CSF Ng concentration in patients acutely admitted with a hip fracture (n=392). Delirium status was evaluated daily according to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Editions criteria independently by two experienced geriatricians. A value > 3.44 on The Informant Questionnaire on Cognitive Decline in the Elderly was used as a surrogate marker of probable dementia. Results: 180 patients (46 %) developed delirium and 70% of these had dementia. CSF Ng concentration did not differ significantly between those with and without delirium (176 pg/mL vs 164 pg/mL), with an estimated difference in medians of 12 (95% CI −5.8 to 29.8), p=0.185. Analyses adjusted for age, gender and dementia status did not show a statistically significant difference in Ng concentrations between the patients. Conclusions: We did not find an association between delirium and CSF concentrations of Ng. This could imply that synaptic dysfunction and degeneration, involving Ng, are not key processes in the development of delirium. Further studies on other synaptic proteins are warranted to better explore synaptic dysfunction’s potential role in the pathophysiology of delirium.

• Letnes, Jon Magne; Sellevold, Andreas Berg; Apelland, Turid; Brown, Fedelix Phetogo; Byrkjeland, Rune & Flasnes, Marius [Show all 9 contributors for this article] (2025). Atrial fibrillation detection in endurance athletes vs. non-athletes: positive predictive value and burden estimation using insertable cardiac monitors. Heart Rhythm O2. doi: 10.1016/j.hroo.2025.12.002. Full text in Research Archive
• Apelland, Turid; Letnes, Jon Magne; Janssens, Kristel; Claessen, Guido; Tveit, Arnljot & Sellevold, Andreas Berg [Show all 16 contributors for this article] (2025). Arrhythmia burden, symptoms and quality of life in female and male endurance athletes with paroxysmal atrial fibrillation: a multicentre cohort study in Norway, Australia and Belgium. BMJ Open. 15(8). doi: 10.1136/bmjopen-2025-100496. Full text in Research Archive Show summary

  Objectives To assess atrial fibrillation (AF) burden, symptoms and quality of life (QoL) in endurance athletes with paroxysmal AF. Design Prospective cohort study. Setting and participants Otherwise healthy endurance athletes with paroxysmal AF in Norway, Australia and Belgium. The current study presents baseline measurements collected before the intervention of a randomised controlled trial on effects of individually tailored training adaptation. Methods AF burden (percentage time in AF) was measured by insertable cardiac monitors (Confirm Rx, Abbott). AF-related symptoms and QoL were assessed using the Atrial Fibrillation Effect on QualiTy-of-Life Questionnaire (AFEQT) with any score <80 defined as clinically relevant. Results 43 athletes (age 57±10 (mean±SD), range 33–75 years, 3 women) were included. The athletes were monitored for 50±18 days. Median AF burden was 0.18% (IQR 0%–2.6%). Out of 29 athletes with at least one AF episode, 21 (72%) had AF episodes >60 min. 13 athletes (30%) had AFEQT overall score <80, indicating reduced QoL, and 23 athletes (53%) had significant symptoms. AF burden above median, and episodes >60 min were associated with reduced QoL (mean AFEQT score 78 vs 90, p=0.001 and 78 vs 90, p=0.001, respectively). There were large individual variations between the athletes concerning AF burden, symptoms and QoL. Conclusions Although most athletes were still competing, more than half had troublesome symptoms. One-third had reduced QoL, which was associated with higher AF burden and longer duration of AF episodes. Variations between the athletes highlight the need for individually tailored AF management in athletes with paroxysmal AF.

• Apelland, Turid; Sellevold, Andreas Berg; Letnes, Jon Magne; Onarheim, Sophia; Enger, Steve & Tveit, Arnljot [Show all 12 contributors for this article] (2025). Cardiac arrhythmia assessment with patch electrocardiogram versus insertable cardiac monitor: a cohort study in endurance athletes with atrial fibrillation. BMJ Open. 15. doi: 10.1136/bmjopen-2024-093250. Full text in Research Archive Show summary

  Objectives The objective of this study was to assess the quality of ECG recordings and the concordance between the automatic detection of cardiac arrhythmia episodes by a patch ECG and an insertable cardiac monitor. Design Prospective cohort study. Setting and participants Endurance athletes diagnosed with paroxysmal atrial fibrillation (AF) and no other relevant comorbidities participating in a randomised controlled trial on the effects of training adaption. Methods A patch ECG (ECG247 Smart Heart Sensor) was sent to 29 non-elite endurance athletes with clinical paroxysmal AF. ECG247 continuously monitors, detects and categorises cardiac arrhythmias. The participants were simultaneously monitored with an insertable cardiac monitor (Confirm Rx, Abbott). ECG recording quality was assessed by an experienced physician. Training sessions were monitored using sports watches. Results Out of 29 invited athletes, 14 athletes (mean age 60.4 years, 2 women) made use of the patch ECG and were monitored for a total of 2987 hours and a median of 14 (range 1–17) days. During this period, the athletes performed a total of 112 training sessions. ECG quality varied between athletes and by type of exercise, with poor quality in 16% and 40% of recordings during cross-country skiing and running, respectively. In two athletes, the patch ECG detected AF episodes that were confirmed with insertable cardiac monitor recordings. One technical artefact was falsely classified as ventricular tachycardia by the ECG247 Smart Heart Sensor system. Conclusion Monitoring with patch ECG was feasible in endurance athletes, but ECG recording quality varied between athletes and by type of exercise.

• Myrstad, Marius & Elliott, Adrian (2025). The fitter the better? The relationship between high cardiorespiratory fitness and the risk of atrial fibrillation and stroke. Expert Review of Cardiovascular Therapy. ISSN 1477-9072. doi: 10.1080/14779072.2025.2476123. Full text in Research Archive
• Lausund, Hilde; Jøranson, Nina; Breievne, Grete; Myrstad, Marius; Heiberg, Kristi Elisabeth & Walle-Hansen, Marte [Show all 7 contributors for this article] (2024). Older people's experiences of vulnerability in a trust-based welfare society affected by the COVID-19 pandemic. Nursing Inquiry (NI). ISSN 1320-7881. 31(3), p. 1–10. doi: 10.1111/nin.12643. Full text in Research Archive Show summary

  The early coronavirus disease 2019 (COVID-19) outbreak inflicted vulnerability on individuals and societies on a completely different scale than we have seen previously. The pandemic developed rapidly from 1 day to the next, and both society and individuals were put to the test. Older people's experiences of the early outbreak were no exception. Using an abductive analytical approach, the study explores the individual experiences of vulnerability as described by older people hospitalised with COVID–19 in the early outbreak. In these older people, we found that the societal context and the individual experiences of vulnerability were inextricable linked. The study demonstrates that despite significant individual stress, informants displayed an interesting ability to also view their situation to reorient their perspective. The experience of vulnerability is both conditional and individual, which imposes a degree of unpredictability that neither they nor others were able to negotiate. The article discusses the phenomenon of unpredictability in light of a modern society with regard to how individuals and society may encounter unexpected events in the future where the potential to reorient will be vital.

• Vaage, Anders Myhre; Meyer, Haakon Eduard; Landgraff, Ida Kalstad; Myrstad, Marius; Holmøy, Trygve & Nakken, Ola (2024). Physical Activity, Fitness, and Long-Term Risk of Amyotrophic Lateral Sclerosis: A Prospective Cohort Study. Neurology. ISSN 0028-3878. 103(2). doi: 10.1212/WNL.0000000000209575. Full text in Research Archive Show summary

  Background and Objectives Observational studies have demonstrated an increased amyotrophic lateral sclerosis (ALS) risk among professional athletes in various sports. For moderately increased levels of physical activity and fitness, the results are diverging. Through a cohort study, we aimed to assess the relationship between indicators of physical activity and fitness (self-reported physical activity and resting heart rate) and long-term ALS risk. Methods From a large Norwegian cardiovascular health survey (1985–1999), we collected information on self-reported physical activity in leisure time, resting heart rate, and other cardiovascular risk factors. Patients with ALS were identified through health registries covering the whole population. We fitted Cox proportional hazard models to assess the risk of ALS according to levels of self-reported physical activity in 3 categories (1: sedentary; 2: minimum 4 hours per week of walking or cycling; 3: minimum 4 hours per week of recreational sports or hard training), and resting heart rate modeled both on the continuous scale and as quartiles of distribution. Results Out of 373,696 study participants (mean 40.9 [SD 1.1] years at inclusion), 504 (41.2% women) developed ALS during a mean follow-up time of 27.2 (SD 5.0) years. Compared with participants with the lowest level of physical activity, the hazard ratio was 0.71 (95% CI 0.53–0.95) for those with the highest level. There were no clear associations between resting heart rate and ALS in the total sample. In men, the hazard ratio of ALS was 0.71 (95% CI 0.53–0.95) for those reporting moderate levels of physical activity and 0.59 (95% CI 0.42–0.84) for those reporting high levels, compared with those reporting low levels. Men with resting heart rate in the lowest quartile had 32% reduced risk of ALS (hazard ratio 0.68, 95% CI 0.49–0.94) compared with those in the second highest quartile. In women, no association was detected between neither self-reported levels of physical activity nor resting heart rate and ALS risk. Discussion Indicators of high levels of physical activity and fitness are associated with a reduced risk of ALS more than 30 years later in men, but not in women.

• Aksnes, Mari; Schibstad, Mari Haavig; Chaudhry, Farrukh Abbas; Neerland, Bjørn Erik; Caplan, Gideon A. & Saltvedt, Ingvild Tina [Show all 17 contributors for this article] (2024). Differences in metalloproteinases and their tissue inhibitors in the cerebrospinal fluid are associated with delirium. Communications Medicine. 4(1). doi: 10.1038/s43856-024-00558-z. Full text in Research Archive Show summary

  Background The aetiology of delirium is not known, but pre-existing cognitive impairment is a predisposing factor. Here we explore the associations between delirium and cerebrospinal fluid (CSF) levels of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs), proteins with important roles in both acute injury and chronic neurodegeneration. Methods Using a 13-plex Discovery Assay®, we quantified CSF levels of 9 MMPs and 4 TIMPs in 280 hip fracture patients (140 with delirium), 107 cognitively unimpaired individuals, and 111 patients with Alzheimer’s disease dementia. The two delirium-free control groups without acute trauma were included to unravel the effects of acute trauma (hip fracture), dementia, and delirium. Results Here we show that delirium is associated with higher levels of MMP-2, MMP-3, MMP-10, TIMP-1, and TIMP-2; a trend suggests lower levels of TIMP-4 are also associated with delirium. Most delirium patients had pre-existing dementia and low TIMP-4 is the only marker associated with delirium in adjusted analyses. MMP-2, MMP-12, and TIMP-1 levels are clearly higher in the hip fracture patients than in both control groups and several other MMP/TIMPs are impacted by acute trauma or dementia status. Conclusions Several CSF MMP/TIMPs are significantly associated with delirium in hip fracture patients, but alterations in most of these MMP/TIMPs could likely be explained by acute trauma and/or pre-fracture dementia. Low levels of TIMP-4 appear to be directly associated with delirium, and the role of this marker in delirium pathophysiology should be further explored.

• Deutekom, Colinda van; Hendriks, Jeroen M L; Myrstad, Marius; Gelder, Isabelle C Van & Rienstra, Michiel (2024). Managing elderly patients with atrial fibrillation and multimorbidity: call for a systematic approach. Expert Review of Cardiovascular Therapy. ISSN 1477-9072. doi: 10.1080/14779072.2024.2416666. Full text in Research Archive
• Walle-Hansen, Marte; Hagberg, Guri; Myrstad, Marius; Berge, Trygve; Vigen, Thea & Ihle-Hansen, Hege Beate [Show all 13 contributors for this article] (2024). Systolic blood pressure at age 40 and 30-year stroke risk in men and women. Open heart. 11(2). doi: 10.1136/openhrt-2024-002805. Full text in Research Archive Show summary

  Background American and European guidelines define hypertension differently and are sex agnostic. Our aim was to assess the impact of different hypertension thresholds at the age of 40 on 30-year stroke risk and to examine sex differences. Methods We included 2608 stroke-free individuals from the Akershus Cardiac Examination 1950 Study, a Norwegian regional study conducted in 2012–2015 of the 1950 birth cohort, who had previously participated in the Age 40 Program, a nationwide health examination study conducted in 1990–1993. We categorised participants by systolic blood pressure (SBP) at age 40 (<120 mm Hg (reference), 120–129 mm Hg, 130–139 mm Hg and ≥140 mm Hg) and compared stroke risk using Cox proportional hazard regressions adjusted for age, sex, smoking, cholesterol, physical activity, obesity and education. Fatal and non-fatal strokes were obtained from the Norwegian Cardiovascular Disease Registry from 1 January 2012 to 31 December 2020, in addition to self-reported strokes. Results The mean age was 40.1±0.3 years (50.4% women) and mean SBP was 128.3±13.5 mm Hg (mean±SD). Stroke occurred in 115 (4.4%) individuals (32 (28%) women and 83 (72%) men) during 29.4±2.9 years of follow-up. SBP between 130 and 139 mm Hg was not associated with stroke (adjusted HR 1.71, 95% CI 0.87 to 3.36) while SBP ≥140 mm Hg was associated with increased stroke risk (adjusted HR 3.11, 95% CI 1.62 to 6.00). The adjusted HR of stroke was 4.32 (95% CI 1.66 to 11.26) for women and 2.66 (95% CI 1.03 to 6.89) for men, with non-significant sex interactions. Conclusions SBP ≥140 mm Hg was significantly associated with 30-year stroke risk in both sexes. A small subgroup of women had SBP ≥140 mm Hg and systolic hypertension was a strong risk factor for stroke in these women.

• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne Martens; Sandbakk, Silvana Bucher & Wilsgaard, Tom [Show all 9 contributors for this article] (2023). Ten-year mortality among older male recreational endurance athletes in the Birkebeiner Aging Study in comparison with older men from the Tromsø Study - PubMed. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 33(8), p. 1541–1551. doi: 10.1111/sms.14385. Full text in Research Archive Show summary

  Endurance sport practice was associated with reduced 10-year mortality, beyond the effect of PA in older men. This study suggests that long-term endurance sport practice maintained into older adulthood promotes longevity.

• Myrstad, Marius (2023). Er NEWS2 gode nyheter for tidlig påvisning av sepsis? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(2). doi: 10.4045/tidsskr.22.0761. Full text in Research Archive
• Ihle-Hansen, Håkon; Johnsen, Nina T.; Jankowiak, Tatiana; Hagberg, Guri; Walle-Hansen, Marte & Landgraff, Ida Kalstad [Show all 9 contributors for this article] (2023). Delirium screening in a stroke unit by nurses using 4AT: Results from a quality improvement project. Nursing Open. 10(11), p. 7431–7436. doi: 10.1002/nop2.1856. Full text in Research Archive
• Rønningen, Peter Selmer; Walle-Hansen, Marte; Ihle-Hansen, Håkon; Andersen, Elizabeth Lyster; Tveit, Arnljot & Myrstad, Marius (2023). Impact of frailty on the performance of the National Early Warning Score 2 to predict poor outcome in patients hospitalised due to COVID-19. BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-03842-0. Full text in Research Archive Show summary

  Background The National Early Warning Score 2 (NEWS2) is a scoring tool predictive of poor outcome in hospitalised patients. Older patients with COVID-19 have increased risk of poor outcome, but it is not known if frailty may impact the predictive performance of NEWS2. We aimed to investigate the impact of frailty on the performance of NEWS2 to predict in-hospital mortality in patients hospitalised due to COVID-19. Methods We included all patients admitted to a non-university Norwegian hospital due to COVID-19 from 9 March 2020 until 31 December 2021. NEWS2 was scored based on the first vital signs recorded upon hospital admission. Frailty was defined as a Clinical Frailty Scale score ≥ 4. The performance of a NEWS2 score ≥ 5 to predict in-hospital mortality was assessed with sensitivity, specificity and area under the receiver operating characteristic curve (AUROC) according to frailty status. Results Out of 412 patients, 70 were aged ≥ 65 years and with frailty. They presented less frequently with respiratory symptoms, and more often with acute functional decline or new-onset confusion. In-hospital mortality was 6% in patients without frailty, and 26% in patients with frailty. NEWS2 predicted in-hospital mortality with a sensitivity of 86%, 95% confidence interval (CI) 64%-97% and AUROC 0.73, 95% CI 0.65–0.81 in patients without frailty. In older patients with frailty, sensitivity was 61%, 95% CI 36%-83% and AUROC 0.61, 95% CI 0.48–0.75. Conclusion A single NEWS2 score at hospital admission performed poorly to predict in-hospital mortality in patients with frailty and COVID-19 and should be used with caution in this patient group. Graphical Abstract Graphical abstract summing up study design, results and conclusion

• Anjum, Mariam; Ariansen, Inger; Hjellvik, Vidar; Selmer, Randi Marie; Kjerpeseth, Lars Jøran & Skovlund, Eva [Show all 11 contributors for this article] (2023). Stroke and bleeding risk in atrial fibrillation with CHA2DS2-VASC risk score of one: the Norwegian AFNOR study. European Heart Journal. ISSN 0195-668X. 45(1), p. 57–66. doi: 10.1093/eurheartj/ehad659. Full text in Research Archive Show summary

  Background and Aims The benefit of oral anticoagulant (OAC) therapy in atrial fibrillation (AF) and intermediate stroke risk is debated. In a nationwide Norwegian cohort with a non-sex CHA2DS2-VASc risk score of one, this study aimed to investigate (i) stroke and bleeding risk in AF patients with and without OAC treatment, and (ii) the risk of stroke in non-anticoagulated individuals with and without AF. Methods A total of 1 118 762 individuals including 34 460 AF patients were followed during 2011–18 until ischaemic stroke, intracranial haemorrhage, increased CHA2DS2-VASc score, or study end. One-year incidence rates (IRs) were calculated as events per 100 person-years (%/py). Cox regression models provided adjusted hazard ratios (aHRs [95% confidence intervals]). Results Among AF patients, the ischaemic stroke IR was 0.51%/py in OAC users and 1.05%/py in non-users (aHR 0.47 [0.37–0.59]). Intracranial haemorrhage IR was 0.28%/py in OAC users and 0.19%/py in non-users (aHR 1.23 [0.88–1.72]). Oral anticoagulant use was associated with an increased risk of major bleeding (aHR 1.37 [1.16–1.63]) but lower risk of the combined outcome of ischaemic stroke, major bleeding, and mortality (aHR 0.57 [0.51–0.63]). Non-anticoagulated individuals with AF had higher risk of ischaemic stroke compared to non-AF individuals with the same risk profile (aHR 2.47 [2.17–2.81]). Conclusions In AF patients at intermediate risk of stroke, OAC use was associated with overall favourable clinical outcomes. Non-anticoagulated AF patients had higher risk of ischaemic stroke compared to the general population without AF with the same risk profile.

• Myrstad, Marius; Johansen, Kristoffer Robin; Sørensen, Eivind; Løchen, Maja-Lisa; Ranhoff, Anette Hylen & Morseth, Bente (2023). Atrial fibrillation in female endurance athletes. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(5). doi: 10.1093/eurjpc/zwad218. Full text in Research Archive
• Jøranson, Nina; Synnes, Oddgeir; Heggestad, Anne Kari Tolo; Breievne, Grete; Myrstad, Marius & Heiberg, Kristi Elisabeth [Show all 8 contributors for this article] (2023). ‘A Story of Being Invisible’: A Single Case Study on the Significance of Being Recognised When Needing Acute Healthcare in the Early COVID-19 Pandemic. Qualitative Health Research. ISSN 1049-7323. 33(12). doi: 10.1177/10497323231197375. Full text in Research Archive Show summary

  Severe illness is often an existential threat that triggers emotions like fear, stress, and anxiousness. Such emotions can affect ill patients’ encounters with healthcare personnel. We present a single case study of an older woman who contracted COVID-19 and her challenge to be recognised by healthcare personnel in the early pandemic. Storytelling is vital to understand how patients can create meaning in illness as it gives them the opportunity to reshape and restore their past and to project a future. We used Arthur Frank’s dialogical narrative analysis to explore how one patient experienced her encounters with healthcare personnel. Although she felt very ill from COVID-19, she experienced being almost invisible and not being believed by healthcare personnel in a system marked by high stress levels and uncertainty. Despite rejections and illness, she managed to mobilise her resources, even though she depended on significant others. Her story brings forward altered self-understanding and growth. The importance of facilitating dialogical settings for healthcare professionals through patient storytelling also contributes to a broader societal understanding of illness beyond a biological perspective.

• Aksnes, Mari; Edwin, Trine Holt; Saltvedt, Ingvild Tina; Eldholm, Rannveig Sakshaug; Chaudhry, Farrukh Abbas & Halaas, Nathalie Bodd [Show all 9 contributors for this article] (2023). Sex-specific associations of matrix metalloproteinases in Alzheimer’s disease. Biology of Sex Differences. 14(1). doi: 10.1186/s13293-023-00514-x. Full text in Research Archive Show summary

  Introduction Alzheimer’s disease (AD) can be characterised in vivo by biomarkers reflecting amyloid-β (Aβ) and tau pathology. However, there is a need for biomarkers reflecting additional pathological pathways. Matrix metalloproteinases (MMPs) have recently been highlighted as candidate biomarkers for sex-specific mechanisms and progression in AD. Methods In this cross-sectional study, we investigated nine MMPs and four tissue inhibitors of metalloproteinases (TIMPs) in the cerebrospinal fluid of 256 memory clinic patients with mild cognitive impairment or dementia due to AD and 100 cognitively unimpaired age-matched controls. We studied group differences in MMP/TIMP levels and examined the associations with established markers of Aβ and tau pathology as well as disease progression. Further, we studied sex-specific interactions. Results MMP-10 and TIMP-2 levels differed significantly between the memory clinic patients and the cognitively unimpaired controls. Furthermore, MMP- and TIMP-levels were generally strongly associated with tau biomarkers, whereas only MMP-3 and TIMP-4 were associated with Aβ biomarkers; these associations were sex-specific. In terms of progression, we found a trend towards higher MMP-10 at baseline predicting more cognitive and functional decline over time exclusively in women. Conclusion Our results support the use of MMPs/TIMPs as markers of sex differences and progression in AD. Our findings show sex-specific effects of MMP-3 and TIMP-4 on amyloid pathology. Further, this study highlights that the sex-specific effects of MMP-10 on cognitive and functional decline should be studied further if MMP-10 is to be used as a prognostic biomarker for AD.

• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne Martens; Sandbakk, Silvana Bucher & Wilsgaard, Tom [Show all 10 contributors for this article] (2023). Ten-year mortality among older male recreational endurance athletes in the Birkebeiner Aging Study in comparison with older men from the Tromsø Study. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 33(8), p. 1541–1551. doi: 10.1111/sms.14385. Full text in Research Archive Show summary

  Background Physical activity (PA) is associated with reduced mortality. However, whether there is an added benefit of long-term endurance training is unclear. Thus, we aimed to examine 10-year mortality in older male endurance athletes compared with an older male general population. Method Male athletes (n = 503) participating in an annual long-distance ski race (median years of participation: 14, range: 1–53) from the Norwegian Birkebeiner Aging study (BiAS), and non-athletic men (n = 1867) attending the sixth Tromsø Study (Tromsø6) aged ≥65 years were included. Associations with endurance sport practice and joint exposures of endurance sport practice and self-reported leisure-time PA with all-cause mortality were examined. We analyzed the data with Cox proportional hazard models and regression standardization. Results After 10 years (median: 10.4, range: 0.5–11.1) the mortality rate was lower in athletes (hazard ratio (HR) 0.34, 95% confidence interval (CI): 0.24–0.49) compared with non-athletes, corresponding to a 15% (95% CI: 12–19%) absolute risk reduction associated with endurance sport practice. In joint analyses categorized according to PA and endurance sport practice, we observed an inverse dose–response relationship with mortality (p < 0.001). Compared to inactive non-athletes, PA was associated with lower mortality in both active non-athletes and athletes. However, the observed benefit among participants reporting moderate-to-vigorous PA was larger in athletes (HR: 0.21, 95% CI: 0.14–0.32) than non-athletes (HR: 0.43, 95% CI: 0.31–0.59) (p < 0.01). Conclusion Endurance sport practice was associated with reduced 10-year mortality, beyond the effect of PA in older men. This study suggests that long-term endurance sport practice maintained into older adulthood promotes longevity.

• Titlestad, Irit; Watne, Leiv; Caplan, Gideon A.; McCann, Adrian; Ueland, Per Magne & Neerland, Bjørn Erik [Show all 15 contributors for this article] (2023). Impaired glucose utilization in the brain of patients with delirium following hip fracture. Brain. ISSN 0006-8950. 147(1), p. 215–223. doi: 10.1093/brain/awad296. Full text in Research Archive Show summary

  Alterations in brain energy metabolism have long been proposed as one of several neurobiological processes contributing to delirium. This is supported by previous findings of altered CSF lactate and neuron-specific enolase concentrations and decreased glucose uptake on brain-PET in patients with delirium. Despite this, there are limited data on metabolic alterations found in CSF samples, and targeted metabolic profiling of CSF metabolites involved in energy metabolism has not been performed. The aim of the study was to investigate whether metabolites related to energy metabolism in the serum and CSF of patients with hip fracture are associated with delirium. The study cohort included 406 patients with a mean age of 81 years (standard deviation 10 years), acutely admitted to hospital for surgical repair of a hip fracture. Delirium was assessed daily until the fifth postoperative day. CSF was collected from all 406 participants at the onset of spinal anaesthesia, and serum samples were drawn concurrently from 213 participants. Glucose and lactate in CSF were measured using amperometry, whereas plasma glucose was measured in the clinical laboratory using enzymatic photometry. Serum and CSF concentrations of the branched-chain amino acids, 3-hydroxyisobutyric acid, acetoacetate and β-hydroxybutyrate were measured using gas chromatography-tandem mass spectrometry (GC-MS/MS). In total, 224 (55%) patients developed delirium pre- or postoperatively. Ketone body concentrations (acetoacetate, β-hydroxybutyrate) and branched-chain amino acids were significantly elevated in the CSF but not in serum among patients with delirium, despite no group differences in glucose concentrations. The level of 3-hydroxyisobutyric acid was significantly elevated in both CSF and serum. An elevation of CSF lactate during delirium was explained by age and comorbidity. Our data suggest that altered glucose utilization and a shift to ketone body metabolism occurs in the brain during delirium.

• Aksnes, Mari; Capogna, Elettra; Vidal-Piñeiro, Didac; Chaudhry, Farrukh Abbas; Myrstad, Marius & Idland, Ane-Victoria [Show all 13 contributors for this article] (2023). Matrix metalloproteinases are associated with brain atrophy in cognitively unimpaired individuals. Neurobiology of Aging. ISSN 0197-4580. 131, p. 11–23. doi: 10.1016/j.neurobiolaging.2023.05.012. Full text in Research Archive Show summary

  Matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) have been linked to age-related neurodegeneration and Alzheimer’s disease (AD), but their role in normal aging is poorly understood. We used linear mixed models to determine if baseline or rate of yearly change in cerebrospinal fluid (CSF) levels of MMP-2; MMP-3; MMP-10; TIMP-123 (composite of TIMP-1, TIMP-2, and TIMP-3); or TIMP-4 predicted changes in bilateral entorhinal cortex thickness, hippocampal volume, or lateral ventricle volume in cognitively unimpaired individuals. We also assessed effects on the CSF AD biomarkers amyloid-β42 and phosphorylated tau181. Low baseline levels of MMP-3 predicted larger ventricle volumes and more entorhinal cortex thinning. Increased CSF MMP-2 levels over time predicted more entorhinal thinning, hippocampal atrophy, and ventricular expansion, while increased TIMP-123 over time predicted ventricular expansion. No MMP/TIMPs predicted changes in CSF AD biomarkers. Notably, we show for the first time that longitudinal increases in MMP-2 and TIMP-123 levels may predict age-associated brain atrophy. In conclusion, MMPs and TIMPs may play a role in brain atrophy in cognitively unimpaired aging.

• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Platonov, Pyotr G. & Carlson, Jonas [Show all 8 contributors for this article] (2023). Left atrial dyssynchrony in veteran endurance athletes with and without paroxysmal atrial fibrillation. Echocardiography. ISSN 0742-2822. doi: 10.1111/echo.15634. Full text in Research Archive Show summary

  Background Prolonged endurance exercise increase the risk of atrial fibrillation (AF) in men. Functional parameters may help separate physiological from pathological atrial remodeling in athletes. LA mechanical dispersion (LA MD) is associated with AF in the general population, but the associations between prolonged exercise, LA MD and AF are not known. Purpose To describe LA MD in veteran athletes with and without paroxysmal AF (pAF) and to investigate LA MD's ability to identify veteran athletes with pAF. Methods Two hundred and ninety-three men, skiers with (n = 57) and without (n = 87) pAF, and controls with (n = 61) and without pAF (n = 88) underwent an echocardiographic exam in sinus rhythm. LA reservoir strain (LASr) was measured, and LA MD defined as the standard deviation of time-to-peak strain (SD-TPS). Results Skiers (mean age 70.7 ± 6.7 years) reported an average of 40–50 years of endurance exercise. LA volumes were associated with pAF and athletic status (p < .001). SD-TPS was associated with pAF (p < .001) but not athletic status (p = .173). We found no significant trend between years of exercise and SD-TPS in individuals without AF (p = .893). SD-TPS did not add incremental value in identifying athletes with pAF in addition to clinical markers, QRS width, LA volume, and LASr (p = .056). Conclusion LA MD was associated with pAF regardless of athletic status but not related to years of endurance exercise, suggesting LA MD could be a promising marker of pathological atrial remodeling in athletes. However, we found no incremental value of LA MD identifying athletes with pAF when LASr was included in the model.

• Myrstad, Marius; Johansen, Kristoffer Robin; Sørensen, Eivind & Ranhoff, Anette Hylen (2023). Rationale and design of the Birkebeiner Ageing Study – a prospective cohort study of older endurance athletes. BMC Geriatrics. 23(1). doi: 10.1186/s12877-023-04099-3. Full text in Research Archive Show summary

  Background While regular physical activity is associated with reduced mortality and morbidity in general populations, health outcomes and functional capacity related to upholding strenuous endurance exercise beyond the age of 65 years are only sparsely studied. The aim of this study is to assess associations of prolonged strenuous endurance sport practice with ageing, functional decline, morbidity and longevity among older recreational endurance athletes, during long-term follow-up. Methods Prospective cohort study of older recreational endurance athletes in Norway. All skiers aged 65 years and older who participated in a long-distance endurance competition, the annual 54-km Birkebeiner cross-country ski race in 2009 or 2010, were invited. The participants answered an extensive baseline questionnaire about lifestyle habits, including leisure-time physical activity and endurance sport participation, diseases, medication use and physical and mental health, with follow-up questionnaires planned every fifth year until 2029. New participants may be invited with the aim to increase the study size. Endpoints such as all-cause and disease-specific mortality, incidence and cumulative prevalence of diseases, use of medication, physical and mental health and functional decline will be assessed subsequently. Out of 658 invited skiers (51 women), 551(84%) completed the baseline questionnaire and were included in the study. The mean age was 68.8 years (median 68, range 65- 90). At baseline, the participants had completed the Birkebeiner race for an average of 16.6 years and reported an average of 33.4 years of regular endurance exercise, with one out of five reporting at least 50 years of exercise. In all, 479 (90%) reported that they were still practicing leisure-time physical activity of moderate or vigorous intensity at least twice weekly. The prevalence of cardiovascular risk factors and diseases was low. Discussion This prospective study of a cohort of recreational athletes exposed to prolonged and strenuous endurance exercise, could complement population-based studies by providing data on associations between life-long endurance sport participation, aging, functional decline and health outcomes during long-term follow-up.

• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Tveit, Arnljot & Aarønæs, Marit (2022). Right Heart Structure and Function in Lifelong Recreational Endurance Athletes with and without Paroxysmal Atrial Fibrillation. Journal of the American Society of Echocardiography. ISSN 0894-7317. doi: 10.1016/j.echo.2022.06.008. Full text in Research Archive
• Watne, Leiv Otto; Pollmann, Christian Thomas; Neerland, Bjørn Erik; Paulsen, Else Quist; Halaas, Nathalie Bodd & Idland, Ane-Victoria [Show all 20 contributors for this article] (2022). Cerebrospinal fluid quinolinic acid is strongly associated with delirium and mortality in hip-fracture patients. Journal of Clinical Investigation. ISSN 0021-9738. 133(2). doi: 10.1172/JCI163472. Full text in Research Archive Show summary

  Background: The kynurenine pathway (KP) has been identified as a potential mediator linking acute illness to cognitive dysfunction by generating neuroactive metabolites in response to inflammation. Delirium (acute confusion) is a common complication of acute illness and is associated with increased risk of dementia and mortality. However, the molecular mechanism underlying delirium, particularly in relation to the KP, remain elusive. Methods: We undertook a multi-center observational study with 586 hospitalized patients (248 with delirium) and investigated associations between delirium and KP metabolites measured in cerebrospinal fluid (CSF) and serum by targeted metabolomics. We also explored associations between KP metabolites and markers of neuronal damage and one-year mortality. Results: In delirium, we found concentrations of the neurotoxic metabolite quinolinic acid in CSF (CSF-QA, OR 2.26 [1.78, 2.87], p

• Walle-Hansen, Marte; Berge, Trygve; Vigen, Thea; Myrstad, Marius; Hagberg, Guri & Ihle-Hansen, Hege Beathe [Show all 14 contributors for this article] (2022). Systolic blood pressure at age 40 and cognitive function 25 years later: The Akershus Cardiac Examination (ACE) 1950 Study. Journal of Hypertension. ISSN 0263-6352. 41(1), p. 132–139. doi: 10.1097/HJH.0000000000003312. Full text in Research Archive
• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne; Heitmann, Kim Arne & Apelland, Turid [Show all 12 contributors for this article] (2022). Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice: a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study. Open heart. 9(2). doi: 10.1136/openhrt-2022-002154. Full text in Research Archive Show summary

  Aims Endurance sport practice is associated with a high prevalence of atrial fibrillation (AF), which increases the risk of stroke in the general population. However, stroke risk in endurance athletes with AF is sparsely investigated. Most studies have been limited by design and are largely restricted to younger and middle-aged populations. Thus, we aimed to investigate AF and stroke risk in older athletes exposed to prolonged endurance training. Method During a 10-year period, 505 male athletes aged ≥65 years frequently participating in a long-distance ski race were compared with 1867 men of the same age from the general population. The main exposure was endurance sport practice with self-reported AF and stroke as outcomes. Stroke risk was further examined by joint modelling of AF and endurance practice. Statistical analysis was conducted with a modified Poisson model. Results Athletes (median age: 68, range: 65–90) participated in a long-distance ski race over a median of 14 years (range: 1–53). Prevalence (28.5% vs 17.8%) and adjusted risk of AF (risk ratio (RR): 1.88, 95% CI: 1.49 to 2.37) were higher in athletes compared with non-athletes, whereas the prevalence (5.4% vs 9.7%) and risk of stroke were lower (RR: 0.60, 95% CI: 0.37 to 0.95). Compared with athletes without AF, risk of stroke was twofold in athletes (RR: 2.38, 95% CI: 1.08 to 5.24) and nearly fourfold in non-athletes (RR: 3.87, 95% CI: 1.98 to 7.57) with AF. Conclusion Although older male endurance athletes experienced an increased risk of AF, the long-term risk of stroke was substantially reduced compared with non-athletes.

• Heiberg, Kristi Elisabeth; Heggestad, Anne Kari Tolo; Jøranson, Nina; Lausund, Hilde; Breievne, Grete & Myrstad, Marius [Show all 9 contributors for this article] (2022). ‘Brain fog’, guilt, and gratitude: experiences of symptoms and life changes in older survivors 6 months after hospitalisation for COVID-19. European Geriatric Medicine. ISSN 1878-7649. 13(13), p. 695–703. doi: 10.1007/s41999-022-00630-8. Full text in Research Archive Show summary

  Aim The aim of the study is to explore older participants’ experiences of symptoms and life changes approximately 6 months after hospitalisation for COVID-19. Findings The participants experienced various persistent physical and cognitive symptoms. At the same time, they experi- enced gratitude for having survived and for having achieved new life perspectives. Message Despite suffering from the post-COVID-19 condition the older adults’ coping resources helped them achieve new life perspectives

• Heiberg, Kristi Elisabeth; Jøranson, Nina; Heggestad, Anne Kari Tolo; Breievne, Grete; Lausund, Hilde & Myrstad, Marius [Show all 9 contributors for this article] (2022). “This path I must walk alone”. Challenges experienced by older patients while recovering from severe COVID-19 – a qualitative study. BMC Geriatrics. 22(1), p. 1–8. doi: 10.1186/s12877-022-02959-y. Full text in Research Archive Show summary

  In March 2020, the COVID-19 pandemic challenged both the Norwegian population and healthcare system. In this study we explored how older men and women experienced rehabilitation and recovery after hospitalisation due to severe COVID-19. Methods: Semi-structured interviews with 17 participants aged 60–96 years were performed 6 months after discharge from hospital. A thematic descriptive analysis was conducted. Results The results revealed that the participants experienced a challenging span between loneliness and companionship in recovering from severe COVID-19. The four subthemes highlighted experiences of being discharged to home and left to themselves, the importance of exercise and companionship at rehabilitation stay, requirement of self-effort and time to recover, and the challenging span between loneliness and companionship when being with family. Conclusion: Among participants, the experiences of loneliness throughout the recovery period were striking. An individualised approach including psychological support should be emphasized in primary healthcare to promote recovery in older survivors after severe COVID-19 and their next-of-kin.

• Myrstad, Marius; Sørensen, Eivind; Janssens, Kristel; Mitchell, Amy; Apelland, Turid & Claessen, Guido [Show all 7 contributors for this article] (2022). Exercixe-Induced Cardiac Remodeling and Atrial Fibrillation in Female Endurance Athletes. Journal of the American Society of Echocardiography. ISSN 0894-7317. 36(3), p. 344–345. doi: 10.1016/j.echo.2022.12.006. Full text in Research Archive
• Landgraff, Ida Kalstad; Meyer, Haakon Eduard; Ranhoff, Anette Hylen; Holvik, Kristin; Talsnes, Ove & Myrstad, Marius (2022). Resting heart rate, self-reported physical activity in middle age, and long-term risk of hip fracture. A NOREPOS cohort study of 367,386 men and women. Bone. ISSN 8756-3282. 167. doi: 10.1016/j.bone.2022.116620. Full text in Research Archive Show summary

  Enhanced knowledge regarding modifiable risk factors for hip fractures are warranted. We aimed to study the associations between two indicators of physical fitness (resting heart rate and level of physical activity) in middle-aged individuals, and the risk of hip fractures during the subsequent three decades. Data on objectively measured resting heart rate and self-reported leisure time physical activity from a national health survey (1985–1999) was linked to a database including all hip fractures treated in Norwegian hospitals from 1994 through 2018. We calculated hazard ratios (HR) with 95 % confidence intervals (95 % CI) for hip fractures according to categories of resting heart rate (mean of two repeated measures), and leisure time physical activity level in adjusted Cox proportional hazard models. In total, 367,386 persons (52 % women) aged 40 to 45 years were included, of whom 5482 persons sustained a hip fracture during a mean follow-up of 24.8 years. Higher resting heart rate was associated with higher hip fracture risk. Men with a resting heart rate above 80 bpm, who also reported low levels of physical activity, had a HR of 1.82 (95 % CI 1.49–2.22) for hip fracture compared to men with a resting heart rate below 70 bpm who reported high levels of physical activity. The same measure of association fo women was 1.62 (95 % CI 1.28–2.06). Physical fitness measured by low resting heart rate in middle age, and a high physical activity level were associated with a lower long-term risk of hip fractures in both men and women.

• Jøranson, Nina; Heggestad, Anne Kari Tolo; Breievne, Grete; Bruun-Olsen, Vigdis; Heiberg, Kristi Elisabeth & Myrstad, Marius [Show all 8 contributors for this article] (2022). Older patients’ perspectives on illness and healthcare during the early phase of the COVID-19 pandemic. Nursing Ethics. ISSN 0969-7330. 29(4), p. 872–884. doi: 10.1177/09697330211072362. Full text in Research Archive Show summary

  Background: Equal access to healthcare is a core principle in Norway’s public healthcare system. The COVID-19 pandemic challenged healthcare systems in the early phase – in particular, related to testing and hospital capacity. There is little knowledge on how older people experienced being infected with an unfamiliar and severe disease, and how they experienced the need for healthcare early in the pandemic Aim: To explore the experiences of older people infected by COVID-19 and their need for testing and hospitalisation. Research design: An explorative and descriptive approach, with qualitative interviews conducted in October 2020. Participants and research context: Seventeen participants above 60 years of age hospitalised due to COVID-19 during spring 2020 were recruited 6 months after discharge. Ethical considerations: Ethical approval was granted by the Regional Committee for Medical and Health Research Ethics in South-Eastern Norway (155425). Findings: The main finding was that the informants experienced vulnerability and arbitrariness. This finding was supported by three sub-themes: experiences with a severe and unfamiliar disease, the strict criteria and the importance of someone advocating needs. Discussion: Participants described varying access to healthcare. Those who did not meet the national criteria to be tested or hospitalised struggled against the system. Findings reveal arbitrary access to healthcare, in contrast to Norway’s ethical principle of fair and just access to health services. Moreover, to access and receive necessary healthcare, informants were dependent on their next-of-kin’s advocacy. Conclusion: Even when dealing with an unfamiliar disease, health professionals’ assessments of symptoms must be performed with an ethical obligation to applicate competent appraisal and the exercise of dis- cernment; this is in line with care ethics and ethical standards for nurses. These perspectives are a significant part of caring and the intension of doing good.

• Sørensen, Eivind; Myrstad, Marius; Solberg, Magnar Gangås; Øie, Erik; Tveit, Arnljot & Aarønæs, Marit (2022). Left atrial function in male veteran endurance athletes with paroxysmal atrial fibrillation. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 23(1), p. 137–146. doi: 10.1093/ehjci/jeab248. Full text in Research Archive Show summary

  Abstract Aims To assess left atrial (LA) function in sinus rhythm in veteran athletes with a history of paroxysmal atrial fibrillation (AF) exposed to prolonged endurance exercise compared with veteran athletes without AF and controls with and without paroxysmal AF from a non-athletic population. Methods and results Three hundred and two male participants from four groups, veteran recreational skiers with paroxysmal AF (n = 62), veteran skiers without AF (n = 89), and controls from a non-athletic population with (n = 62) and without paroxysmal AF (n = 89) underwent an echocardiographic examination in sinus rhythm to evaluate LA anatomy and function. The skiers (mean age 70.8±6.7 years) reported an average exposure to regular endurance exercise for 40–50 years. LA maximum and minimum volumes were larger in skiers (P &lt; 0.001). LA volumes differed within the athletic and non-athletic groups with larger volumes in the AF groups ( P &lt; 0.001). We observed a considerable overlap in LA volumes among non-athletes with AF and athletes without AF. LA reservoir strain (33.6% ± 4.8% vs. 28.3% ± 6.7% P &lt; 0.001) and contractile strain (18.3% ± 4.0% vs. 15.0% ± 5.2% P &lt; 0.001) were lower in both AF groups regardless of athletic status. LA reservoir strain was superior to volumetric measurements at identifying participants with AF (area under the curve 0.740 ±0.041). Conclusion Male veteran athletes had significantly larger LA volumes than non-athletes. In contrast, LA strain values were similar in athletes and non-athletes with paroxysmal AF, and significantly lower than in subjects without AF.

• Ihle-Hansen, Håkon; Hagberg, Guri; Sandset, Else Charlotte; Ihle-Hansen, Hege; Amundsen, Erik Koldberg & Sandset, Per Morten [Show all 7 contributors for this article] (2021). Reversering av antikoagulerende legemidler ved hjerneblødning. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(14), p. 1–6. doi: 10.4045/tidsskr.21.0063. Full text in Research Archive Show summary

  Antikoagulerende legemidler kan effektivt forebygge og behandle blodpropper, men gir samtidig økt risiko for hjerneblødning. Ved hjerneblødning anbefales rask reversering av den antikoagulerende effekten. Reverserende behandling må imidlertid velges ut ifra antikoagulasjonsmidlenes ulike virkningsmekanismer, og spesifikk antidot foretrekkes hvis tilgjengelig.

• Wyller, Torgeir Bruun; Kittang, Bård Reiakvam; Ranhoff, Anette Hylen; Harg, Pernille & Myrstad, Marius (2021). Dødsfall i sykehjem etter covid-19-vaksine. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(10), p. 1–8. doi: 10.4045/tidsskr.21.0383. Full text in Research Archive Show summary

  Bakgrunn: I perioden 27.12.2020–15.2.2021 ble om lag 29 400 av Norges ca. 35 000 sykehjemspasienter vaksinert med mRNA-vaksinen BNT162b2. I samme tidsrom mottok Statens legemiddelverk 100 meldinger om mistenkte fatale bivirkninger av vaksinen. En ekspertgruppe har gransket meldingene og vurdert grad av årsakssammenheng mellom vaksinering og dødsfallene. Materiale og metode: Ekspertgruppen arbeidet i to par som gransket 50 anonymiserte meldinger hver. Hvert medlem gransket først meldingene alene og klassifiserte sammenhengen som usannsynlig, mulig, sannsynlig, sikker eller ikke-klassifiserbar. Deretter drøftet hvert ekspertpar seg frem til konsensus. Alle de fire ekspertene vurderte et tilfeldig utvalg på 20 meldinger. Graden av enighet ble vurdert med vektet kappa og McNemars symmetritest. Resultater: Pasientenes gjennomsnittsalder var 87,7 år (spredning 61–103 år). Blant 100 meldte dødsfall ble en sammenheng med vaksinen vurdert som sannsynlig i 10 tilfeller, som mulig i 26 og som usannsynlig i 59 tilfeller. Fem var ikke-klassifiserbare. Vektet kappa var henholdsvis 0,40 og 0,38 i de to ekspertparene. Fortolkning: De fleste sykehjemspasienter har kort forventet gjenstående levetid, men vaksineringen kan i noen få tilfeller ha bidratt til å akselerere en pågående dødsprosess. Sykehjemspasienter bør fortsatt prioriteres for vaksine, men hos de mest skrøpelige bør nytte versus risiko avveies grundig. Hovedfunn: For flertallet av sykehjemspasienter var det ingen åpenbar sammenheng mellom vaksinasjon og død. Noen få pasienter med høy grad av skrøpelighet fikk vaksinebivirkninger som sannsynligvis akselererte en allerede pågående dødsprosess.

• Myrstad, Marius; Kuwelker, Kanika; Haakonsen, Sigurd; Valebjørg, Therese; Langeland, Nina & Kittang, Bård Reiakvam [Show all 9 contributors for this article] (2021). Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study. European Geriatric Medicine. ISSN 1878-7649. 13, p. 1–8. doi: 10.1007/s41999-021-00558-5. Full text in Research Archive Show summary

  Purpose We aimed to study the use of The 4 ‘A’s test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). Out of the 100 patients with sepsis, 68 (68%) had delirium during the hospital stay, as compared to 34 out of 96 patients (35%) without sepsis (p < 0.05). Conclusion Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis.

• Myrstad, Marius; Rønningen, Peter Selmer; Tveita, Anders Aune; Rønning, Else Johanne; Ernø, Per Erik & Andersen, Elizabeth Lyster [Show all 13 contributors for this article] (2021). Tre bølger med covid-19 på et norsk lokalsykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(2), p. 1–11. doi: 10.4045/tidsskr.21.0750. Full text in Research Archive Show summary

  BAKGRUNN Formålet med artikkelen er å oppsummere sykdomsforløp og behandling for pasienter med covid-19 innlagt på Bærum sykehus siden starten av pandemien. MATERIALE OG METODE Vi presenterer data fra en prospektiv observasjonsstudie med mål om å systematisere kunnskap om pasienter innlagt på grunn av covid-19. Alle pasienter innlagt på Bærum sykehus til og med 28.6.2021 ble inkludert. Resultatene presenteres for tre bølger av sykehusinnleggelser: 9.3.–23.6.2020, 21.9.2020–28.2.2021 og 1.3.–28.6.2021. RESULTATER I alt 300 pasienter, fordelt på hhv. 77, 101 og 122 i de tre bølgene, var innlagt på grunn av covid-19. Antallet som døde under sykehusoppholdet i de tre bølgene, var hhv. 14 (18 %), 11 (11 %) og 5 (4 %). Gjennomsnittsalderen for innlagte var 67,6 år i første bølge og 53,3 år i tredje bølge. Totalt 204 pasienter (68 %) fikk oksygenbehandling eller ventilasjonsstøtte, og 31 av disse (10 % av alle pasientene) fikk invasiv ventilasjonsstøtte. Ikke-invasiv ventilasjonsstøtte ble brukt som høyeste nivå av behandling hos hhv. 4 (8 %), 9 (13 %) og 17 (20 %) pasienter med respirasjonssvikt i de tre bølgene. I andre og tredje bølge fikk 125 av 152 pasienter med respirasjonssvikt (82 %) behandling med deksametason. FORTOLKNING Forskjeller i pasientkarakteristika og endringer i behandling, som i bruk av deksametason og ikke-invasiv ventilasjonsstøtte, kan ha bidratt til at dødeligheten tilsynelatende sank fra første til tredje bølge. Forhold som ikke er registrert i studien, slik som vaksinasjonsstatus, kan også ha påvirket dødeligheten.

• Walle-Hansen, Marte; Ranhoff, Anette Hylen; Mellingsæter, Marte; Wang-Hansen, Marte Sofie & Myrstad, Marius (2021). Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatrics. 21(1). doi: 10.1186/s12877-021-02140-x. Full text in Research Archive Show summary

  Background Older people are particularly vulnerable to severe COVID-19. Little is known about long-term consequences of COVID-19 on health-related quality of life (HR-QoL) and functional status in older people, and the impact of age in this context. We aimed to study age-related change in health-related quality of life, functional decline and mortality among older patients 6 months following hospitalisation due to COVID-19. Methods This was a cohort study including patients aged 60 years and older admitted to four general hospitals in South-Eastern Norway due to COVID-19, from March 1 up until July 1, 2020. Patients who were still alive were invited to attend a six-month follow-up. Change in HR-QoL and functional status compared to before the COVID-19 hospitalisation were assessed using the EuroQol 5-dimensional-5 levels questionnaire (EQ. 5D-5L). A change in visual analogue scale (VAS) score of 7 or more was considered clinically relevant. Results Out of 216 patients aged 60 years and older that were admitted to hospital due to COVID-19 during the study period, 171 were still alive 180 days after hospital admission, and 106 patients (62%) attended the six-month follow-up. Mean age was 74.3 years, 27 patients (26%) had experienced severe COVID-19. Fifty-seven participants (54%) reported a decrease in the EQ. 5D-5L VAS score after 6 months, with no significant difference between persons aged 75 years and older compared to younger. Seventy participants (66%) reported a negative change in any of the dimensions of the EQ. 5D-5L, with impaired ability to perform activities of daily life (35%), reduced mobility (33%) and having more pain or discomfort (33%) being the most commonly reported changes. Forty-six participants (43%) reported a negative change in cognitive function compared to before the COVID-19 hospitalisation. Six-month mortality was 21%, and increased with increasing age.

• Ihle-Hansen, Håkon; Berge, Trygve; Ernø, Per Erik; Rønning, Else Johanne; Svendsen, Jan & Wien, Tale Norbye [Show all 11 contributors for this article] (2020). Komplikasjoner og dødelighet blant pasienter innlagt med covid-19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(11), p. 1–12. doi: 10.4045/tidsskr.20.0432. Full text in Research Archive Show summary

  BAKGRUNN Sykdomsforløp, komplikasjoner og sykehusdødelighet blant pasienter med covid-19 innlagt ved norske sykehus er lite beskrevet. Formålet med denne studien var å kartlegge pasienter med covid-19 innlagt ved et lokalsykehus. MATERIALE OG METODE Dataene er hentet fra en prospektiv observasjonell kvalitetsstudie av alle pasienter innlagt med covid-19 på Bærum sykehus siden starten av koronavirusutbruddet. RESULTATER I alt 73 pasienter med covid-19 innlagt i perioden 9.3.2020–7.5.2020 ble inkludert. Gjennomsnittsalderen var 67,9 år, og 43 pasienter (59 %) var menn. Gjennomsnittlig antall liggedøgn på sykehus var 10,1. I alt hadde 19 pasienter (26 %) et svært alvorlig forløp, og 14 (19 %) døde under sykehusoppholdet. Gjennomsnittsalderen blant pasientene som døde, var 79,5 år. Totalt 49 pasienter (67 %) hadde hypoksemi og behov for oksygenbehandling i gjennomsnittlig 10,1 dager. Av disse fikk 9 pasienter invasiv respirasjonsstøtte i median 18 dager. Symptomer på delirium forekom hos 26 pasienter (36 %) og var den hyppigste ikke-respiratoriske komplikasjonen. FORTOLKNING De fleste pasientene innlagt på sykehus med covid-19 hadde behov for langvarig oksygenbehandling, og det var høy forekomst av alvorlige komplikasjoner.

• Myrstad, Marius; Ihle-Hansen, Håkon; Tveita, Anders Aune; Andersen, Elizabeth Lyster; Nygård, Ståle & Tveit, Arnljot [Show all 7 contributors for this article] (2020). National Early Warning Score 2 (NEWS2) on admission predicts severe disease and in-hospital mortality from Covid-19 - a prospective cohort study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 28(1). doi: 10.1186/s13049-020-00764-3. Full text in Research Archive Show summary

  Background There is a need for validated clinical risk scores to identify patients at risk of severe disease and to guide decision-making during the covid-19 pandemic. The National Early Warning Score 2 (NEWS2) is widely used in emergency medicine, but so far, no studies have evaluated its use in patients with covid-19. We aimed to study the performance of NEWS2 and compare commonly used clinical risk stratification tools at admission to predict risk of severe disease and in-hospital mortality in patients with covid-19. Methods This was a prospective cohort study in a public non-university general hospital in the Oslo area, Norway, including a cohort of all 66 patients hospitalised with confirmed SARS-CoV-2 infection from the start of the pandemic; 13 who died during hospital stay and 53 who were discharged alive. Data were collected consecutively from March 9th to April 27th 2020. The main outcome was the ability of the NEWS2 score and other clinical risk scores at emergency department admission to predict severe disease and in-hospital mortality in covid-19 patients. We calculated sensitivity and specificity with 95% confidence intervals (CIs) for NEWS2 scores ≥5 and ≥ 6, quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2, ≥2 Systemic Inflammatory Response Syndrome (SIRS) criteria, and CRB-65 score ≥ 2. Areas under the curve (AUCs) for the clinical risk scores were compared using DeLong’s test. Results In total, 66 patients (mean age 67.9 years) were included. Of these, 23% developed severe disease. In-hospital mortality was 20%. Tachypnoea, hypoxemia and confusion at admission were more common in patients developing severe disease. A NEWS2 score ≥ 6 at admission predicted severe disease with 80.0% sensitivity and 84.3% specificity (Area Under the Curve (AUC) 0.822, 95% CI 0.690–0.953). NEWS2 was superior to qSOFA score ≥ 2 (AUC 0.624, 95% CI 0.446–0.810, p < 0.05) and other clinical risk scores for this purpose. Conclusion NEWS2 score at hospital admission predicted severe disease and in-hospital mortality, and was superior to other widely used clinical risk scores in patients with covid-19.

• Myrstad, Marius; Kittang, Bård Reiakvam; Ranhoff, Anette Hylen; Neerland, Bjørn Erik & Wyller, Torgeir Bruun (2020). Kortikosteroider til sykehjemspasienter med covid-19? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. Full text in Research Archive
• Ihle-Hansen, Håkon; Berge, Trygve; Tveita, Anders Aune; Rønning, Else Johanne; Ernø, Per Erik & Andersen, Elizabeth Lyster [Show all 9 contributors for this article] (2020). Covid-19: Symptomer, forløp og bruk av kliniske skåringsverktøy hos de 42 første pasientene innlagt på et norsk lokalsykehus. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(7), p. 1–10. doi: 10.4045/TIDSSKR.20.0301. Full text in Research Archive Show summary

  BAKGRUNN Covid-19-utbruddet medfører nye utfordringer for helsevesenet, og det er et stort behov for kunnskap om symptomer, kliniske funn og sykdomsforløp hos pasienter som legges inn med covid-19 på norske sykehus. MATERIALE OG METODE I denne observasjonelle kvalitetsstudien ble alle pasienter innlagt på et norsk lokalsykehus (Bærum sykehus) med påvist covid-19-infeksjon inkludert fortløpende fra utbruddets start. Vi presenterer her pasientkarakteristika, symptomer, kliniske funn, erfaringer med bruk av kliniske skåringsverktøy og sykdomsforløp basert på journalopplysninger. RESULTATER I perioden 9.–31. mars 2020 ble 42 pasienter, hvorav 28 menn (67 %), innlagt på sykehuset med covid-19-infeksjon. Median alder var 72,5 år (spredning 30–95 år). Feber (79 %), redusert allmenntilstand (79 %), dyspné (69 %) og hoste (67 %) var de vanligste symptomene. I alt ni pasienter (21 %) hadde et svært alvorlig sykdomsforløp med behandling på intensivavdeling og/eller død under sykehusoppholdet. Pasienter med svært alvorlig forløp hadde høyere gjennomsnittlig skår på National Early Warning Score 2 (NEWS2) ved innkomst (7,6 vs. 3,3). Kun én av de mest alvorlig syke pasientene skåret ≥ 2 på quick Sepsis-related Organ Failure Assessment (qSOFA) ved innkomst. FORTOLKNING De fleste pasienter innlagt på vårt sykehus med covid-19 hadde feber og luftveissymptomer. En høy andel pasienter hadde svært alvorlig sykdomsforløp. NEWS2-skår ≥ 5 ved innkomst kan være et nyttig hjelpemiddel for å identifisere pasienter med risiko for svært alvorlig sykdomsforløp, mens CRB-65- og qSOFA- skår ≥ 2 var lite egnet til dette formålet i vårt materiale.

• Kjerpeseth, Lars Jøran; Igland, Jannicke; Selmer, Randi Marie; Ellekjær, Hanne; Tveit, Arnljot & Berge, Trygve [Show all 13 contributors for this article] (2020). Prevalence and incidence rates of atrial fibrillation in Norway 2004-2014. Heart. ISSN 1355-6037. 107, p. 201–207. doi: 10.1136/heartjnl-2020-316624. Full text in Research Archive Show summary

  ABSTRACT Objective To study time trends in incidence of atrial fibrillation (AF) in the entire Norwegian population from 2004 to 2014, by age and sex, and to estimate the prevalence of AF at the end of the study period. Methods A national cohort of patients with AF (≥18 years) was identified from inpatient admissions with AF and deaths with AF as underlying cause (1994– 2014), and AF outpatient visits (2008–2014) in the Cardiovascular Disease in Norway (CVDNOR) project. AF admissions or out-of-hospital death from AF, with no AF admission the previous 10 years defined incident AF. Age-standardised incidence rates (IR) and incidence rate ratios (IRR) were calculated. All AF cases identified through inpatient admissions and outpatient visits and alive as of 31 December 2014 defined AF prevalence. Results We identified 175 979 incident AF cases (30% primary diagnosis, 69% secondary diagnosis, 0.6% outof-hospital deaths). AF IRs (95% confidence intervals) per 100 000 person years were stable from 2004 (433 (426–440)) to 2014 (440 (433–447)). IRs were stable or declining across strata of sex and age with the exception of an average yearly increase of 2.4% in 18–44 yearolds: IRR 1.024 (1.014–1.034). In 2014, the prevalence of AF in the adult population was 3.4%. Conclusions We found overall stable IRs of AF for the adult Norwegian population from 2004 to 2014. The prevalence of AF was 3.4% at the end of 2014, which is higher than reported in previous studies. Signs of an increasing incidence of early-onset AF (<45 years) are worrying and need further investigation.

• Myrstad, Marius; Watne, Leiv; Johnsen, Nina T.; Børs-Lind, Emma & Neerland, Bjørn Erik (2019). Delirium screening in an acute geriatric ward by nurses using 4AT: results from a quality improvement project. European Geriatric Medicine. ISSN 1878-7649. 10(4), p. 667–671. doi: 10.1007/s41999-019-00215-y. Full text in Research Archive
• Evensen, Sigurd; Saltvedt, Ingvild; Ranhoff, Anette Hylen; Myrstad, Marius; Myrstad, Christian & Mellingsæter, Marte [Show all 8 contributors for this article] (2019). Delirium og kognitiv svikt blant eldre i norske akuttmottak. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(6), p. 517–520. doi: 10.4045/tidsskr.18.0578. Full text in Research Archive Show summary

  BAKGRUNN Delirium er vanlig og underdiagnostisert blant pasienter på sykehus og er assosiert med komplikasjoner, økt dødelighet, demensutvikling og behov for sykehjemsplass. Kognitiv svikt av andre årsaker er også vanlig blant sykehusinnlagte eldre og er en viktig risikofaktor for delirium. Da det ikke er gjort kartlegging av tilstandene i norske sykehus, undersøkte vi forekomsten av delirium og kognitiv svikt blant eldre pasienter i norske akuttmottak på World Delirium Awareness Day 14.3.2018. MATERIALE OG METODE Vi inkluderte pasienter ≥ 75 år som ankom ti norske akuttmottak mellom kl 8 og 22 denne dagen. Vi undersøkte delirium og kognitiv svikt ved hjelp av screeningverktøyet «4AT» og registrerte alder, kjønn, innleggelsessykehus og innleggelsesavdeling (indremedisin, kirurgi, ortopedi, «andre»). RESULTATER Av 118 inkluderte pasienter hadde 20 (17 %) tegn til delirium og 36 (30 %) tegn til annen kognitiv svikt. Alle sykehus og alle kategorier avdelinger mottok pasienter med slike tegn. FORTOLKNING Både delirium og andre former for kognitiv svikt er vanlig blant eldre pasienter i norske akuttmottak. Våre tall tyder på at alle sykehusavdelinger som behandler eldre pasienter regelmessig ser disse problemstillingene. Alle avdelinger bør derfor ha rutiner for å identifisere og håndtere pasienter med delirium og kognitiv svikt.

• Figved, Wender; Myrstad, Marius; Saltvedt, Ingvild; Finjarn, Merete; Odland, Liv Marie Flaten & Frihagen, Frede Jon (2019). Team approach: Multidisciplinary treatment of hip fractures in elderly patients: Orthogeriatric care. Journal of bone and joint surgery reviews (JBJS Reviews). 7(6), p. 1–9. doi: 10.2106/JBJS.RVW.18.00136. Full text in Research Archive Show summary

  Patients with hip fractures are best managed by a multidisciplinary team. The multidisciplinary team consists of an orthogeriatrician, orthopaedic surgeon, aanesthesiologist, orthopaedic and/or geriatric nurse, occupational therapist, physical therapist, and clinical pharmacologist and may also include other professions, such as endocrinologist, nutritional therapist, and social worker. Key factors include perioperative assessment and minimal delay to surgery; comprehensive geriatric assessment; multidisciplinary in-ward assessment including discharge planning, treatment, and rehabilitation; and secondary fracture prevention. Current evidence shows that older people receiving multidisciplinary treatment for a hip fracture, comprehensive geriatric assessment, and systematic secondary fracture prevention have reduced morbidity and mortality and a lower risk of subsequent fractures and are more likely to return to the same location in which they lived before hospital admission.

• Myrstad, Marius; Berge, Trygve; Ihle-Hansen, Håkon; Sørensen, Eivind; Nystad, Wenche & Ranhoff, Anette Hylen [Show all 7 contributors for this article] (2019). Stroke in endurance athletes with atrial fibrillation. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1177/2047487319866273. Full text in Research Archive
• Myrstad, Marius; Malmo, Vegard; Ulimoen, Sara Reinvik; Tveit, Arnljot & Loennechen, Jan Pål (2019). Exercise in individuals with atrial fibrillation. Clinical Research in Cardiology. ISSN 1861-0684. 108(4), p. 347–354. doi: 10.1007/s00392-018-1361-9. Full text in Research Archive Show summary

  Background Despite the high prevalence of atrial fibrillation (AF), there is a lack of recommendations for physical activity and exercise in individuals with AF, including athletes with AF. Methods With the aim to review studies that have investigated effects and safety of exercise in individuals with AF, we conducted a literature search in Pubmed using the key words atrial fibrillation AND exercise OR physical activity OR exercise/adverse effects OR adverse outcome. Results Observational data from one registry suggest that regular exercise is associated with reduced mortality in AF patients. Three randomized controlled trials (RCTs) have demonstrated that 12-week exercise interventions might reduce the burden of AF and improve exercise capacity by 10–16% in patients with paroxysmal or persistent AF. Three small RCTs suggest that exercise might improve exercise capacity with 15–41% in patients with permanent AF. Exercise might improve quality of life in patients with AF. Data on safety of exercise are sparse. No studies have evaluated the effect of exercise in athletes with AF. Conclusions Despite weak evidence, we suggest that individuals with AF should exercise regularly after evaluation of underlying conditions. Recommendations should be individualized. There is a lack of data to support exercise recommendations in athletes with AF.

• Gulsvik, Anne Kristine; Myrstad, Marius; Landgraff, Ida Wilson; Emaus, Nina & Ranhoff, Anette Hylen (2018). Lower bone mineral density in older female endurance skiers – a cross-sectional, observational study. European Review of Aging and Physical Activity. ISSN 1813-7253. 15. doi: 10.1186/s11556-018-0202-1. Full text in Research Archive Show summary

  <p><i>Background</i>: Physical activity (PA) is generally beneficial for bone health, but the effect of high levels of PA over many years, in older women, is unknown.</p> <p><i>Methods</i>: T-score from Dual-energy X-ray absorptiometry (DXA), and self-reported baseline characteristics were recorded for 24 female, cross-country-skiing-competitors, aged 68–76 years, from the Birkebeiner Ageing Study. Data from 647 women in the same age range from the Tromso-6 population study, with recorded DXA findings, were used for comparison.</p> <p><i>Results</i>: The athletes reported a median(range) of 9(1–34) participations in the 54 km, yearly ski-race, indicating long-term PA. They also reported more moderate and high levels of PA than women in the general population (52% vs. 12 and 30% vs. 0%, respectively). The athletes had lower body mass index (BMI) than the controls (mean BMI 21.7 vs 26.9 kg/m2, p < 0.001). As many as 22/24(92%) of the athletes and 477/647(74%) of the controls had a low bone mineral density (BMD) (T-score < − 1), p 0.048, Pearson chi square test. Odds ratio (OR) of low BMD was 3.9 in athletes vs. controls (p 0.048, logistic regression), but adjusting for BMI largely diminished the effect estimate, which was no longer statistically significant (aOR 1.81, p 0.432). The proportion of self-reported fractures was the same in the two groups.</p> <p><i>Conclusions</i>: This pilot study suggests that long-term, high levels of PA are associated with low bone mineral density in older women, and the finding might be due to differences in BMI. Despite the lower bone mineral density the athletes did not report more fractures.

• Morseth, Bente; Løchen, Maja-Lisa; Ariansen, Inger Kristine Holtermann; Myrstad, Marius & Thelle, Dag Steinar (2018). The ambiguity of physical activity, exercise and atrial fibrillation. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 25(6), p. 624–636. doi: 10.1177/2047487318754930. Full text in Research Archive Show summary

  Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.

• Berge, Trygve; Brynildsen, Jon; Larssen, Hege Kristin Netmangen; Onarheim, Sophia; Jenssen, Gaute Reier & Ihle-Hansen, Håkon [Show all 11 contributors for this article] (2017). Systematic screening for atrial fibrillation in a 65-year-old population with risk factors for stroke: data from the Akershus Cardiac Examination 1950 study. Europace. ISSN 1099-5129. 20(3), p. f299–f305. doi: 10.1093/europace/eux293. Full text in Research Archive Show summary

  Aims To investigate the yield of screening for atrial fibrillation (AF) in a cohort of 65-year-old individuals from the general population with additional risk factors for stroke. Methods and results We invited participants with additional risk factors for stroke (CHA2DS2-VASc score ≥2 for men or ≥ 3 for women) without previously known AF from a population-based study in Norway to participate in a 2-week screening for AF. Screening was performed by one-lead ‘thumb electrocardiography (ECG)’ recordings of 30 s twice daily or when the participants experienced symptoms. In total, 1742 (47.0%) participants of the Akershus Cardiac Examination (ACE) 1950 study had at least one additional risk factor for stroke. Of these, 123 cases reported a history of AF and 101 (5.8%) cases were ECG validated. Eight [0.5%, 95% confidence interval (CI) 0.2–0.9] new AF cases were diagnosed by 12-lead ECG at baseline, and 10 additional participants were diagnosed with AF before screening commenced. We invited all 1601 participants who met the inclusion criteria for screening, of which 1510 (94.3%) participants were included (44% women and 56% men). The screening revealed AF in 13 (0.9%, 95% CI 0.5–1.5) participants. The total prevalence of ECG-validated AF after screening among the 65-year-olds with risk factors for stroke was 7.6% (95% CI 6.4–8.9), in men 10.0% (95% CI 8.2–12.0), and in women 4.3% (95% CI 3.0–6.1) (P < 0.001). Conclusion In a group of 1510 well-characterized 65-year-olds with risk factors for stroke, 2-week intermittent ECG screening identified undiagnosed AF in 0.9%. The total prevalence of AF was 7.6%

• Myrstad, Marius (2017). Trening ved koronar hjertesykdom og ved atrieflimmer. Hjerteforum. ISSN 0802-1465. 30(1), p. 31–35. Full text in Research Archive
• Myrstad, Marius; Aarønæs, Marit; Graff-Iversen, Sidsel; Ariansen, Inger; Nystad, Wenche & Ranhoff, Anette Hylen (2016). Physical activity, symptoms, medication and subjective health among veteran endurance athletes with atrial fibrillation. Clinical Research in Cardiology. ISSN 1861-0684. 105(2), p. 154–161. doi: 10.1007/s00392-015-0898-0. Full text in Research Archive
• Corvol, Aline; Gulsvik, Anne Kristine; Kuper*, I.M.J.A; Phylaktou, P.; Myrstad, Marius & Somme, D. [Show all 7 contributors for this article] (2014). Use of anticoagulants for atrial fibrillation in older subjects across different countries: Cyprus, France, Netherlands, Norway. European Geriatric Medicine. ISSN 1878-7649. 5(1), p. 60–65. doi: 10.1016/j.eurger.2013.10.013. Full text in Research Archive
• Myrstad, Marius; Nystad, Wenche; Graff-Iversen, Sidsel; Thelle, Dag Steinar; Stigum, Hein & Aarønæs, Marit [Show all 7 contributors for this article] (2014). Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. American Journal of Cardiology. ISSN 0002-9149. 114(8), p. 1229–1233. doi: 10.1016/j.amjcard.2014.07.047. Full text in Research Archive
• Myrstad, Marius; Løchen, Maja-Lisa; Graff-Iversen, Sidsel; Gulsvik, Anne Kristine; Thelle, Dag Steinar & Stigum, Hein [Show all 7 contributors for this article] (2014). Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 24(4), p. e238–e244. doi: 10.1111/sms.12150. Full text in Research Archive Show summary

  Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65–90 years who participated in a long-distance cross-country ski race with 1768 men aged 65–87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8–11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.

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• Kvalvaag, Elisabeth Myrset; Hjellvik, Vidar; Maltzahn, Niklas Nyboe; Karlstad, Øystein; Anjum, Mariam & Wisløff, Torbjørn [Show all 15 contributors for this article] (2026). Sex differences in OAC initiation for patients with incident atrial fibrillation: The Norwegian AFNOR study. Full text in Research Archive
• Maltzahn, Niklas Nyboe; Kvalvaag, Elisabeth Myrset; Hjellvik, Vidar; Anjum, Mariam; Skovlund, Eva & Wisløff, Torbjørn [Show all 14 contributors for this article] (2026). Causal effects of modifying CHA2DS2Va guidelines on incidence of ischemic stroke. Full text in Research Archive
• Kvalvaag, Elisabeth Myrset; Maltzahn, Niklas Nyboe; Hjellvik, Vidar; Anjum, Mariam; Skovlund, Eva & Wisløff, Torbjørn [Show all 17 contributors for this article] (2026). Factors associated with initiation of oral anticoagulants in atrial fibrillation. Full text in Research Archive
• Myrstad, Marius; Skaar, Elisabeth & Myhre, Peder Langeland (2026). Addressing the gaps in heart failure treatment for frail older adults: challenges, evidence, and future directions. ESC Heart Failure. 13(2). doi: 10.1093/eschf/xvag084. Full text in Research Archive Show summary

  This viewpoint examines gaps in evidence and practical challenges in treating heart failure (HF) among people living with frailty. Our aim is not to argue that guideline-directed medical therapy (GDMT) should be universally applied or withheld. Rather, we (i) highlight limitations in current randomized trial evidence for frail and multimorbid patients, (ii) offer person-centred approaches for decision-making when trial data are incomplete, and (iii) propose realistic research and implementation priorities to improve safety and outcomes for this vulnerable population. Frailty is highly prevalent in older patients with HF, yet individuals living with frailty—especially those living with severe frailty, cognitive impairment, or substantial multimorbidity—are underrepresented in HF trials. While recent pharmacological advances [e.g. neprilysin inhibition and sodium–glucose cotransporter-2 (SGLT2) inhibition) have reduced HF-related events and improved symptoms, the balance between benefits and harms remains uncertain when extrapolated to patients living with severe frailty. Frailty magnifies vulnerability to adverse effects, polypharmacy harms, and functional decline, and conversely, many patients with frailty derive large symptom and function benefits from appropriate HF therapy. Moreover, treatment goals for frail patients may place relatively greater emphasis on symptom control and quality of life than on mortality benefits.

• Kleve, Guro; Santa, Chiara Dalla; Kristiansen, Felicia Iselin Svensson; Tegnander, Marita; Buch, Victoria & Hagemann, Cecilie Steen [Show all 29 contributors for this article] (2025). Digital home-based multimodal prehabilitation of colorectal cancer patients prior to surgery (the dHOPE study): a non-inferiority clinical trial protocol. doi: 10.3389/fdgth.2025.1609678. Full text in Research Archive Show summary

  Cancer surgery is associated with risk of complications and loss of function. Vulnerability factors, such as advanced age, malnutrition, smoking, comorbidity, frailty, and low socioeconomic status increase the risk. Lifestyle intervention prior to surgery, known as prehabilitation, often include physical activity, nutritional support, psychological coaching, and smoking cessation, increase functional reserves and reduce postoperative complications. Most importantly, it prevents loss of functional capacity and dependence. Methods The dHOPE study is a three-armed, open-labelled, parallel-group randomized controlled trial (RCT) with non-inferiority design to compare a digital home-based prehabilitation program with a hospital-based program or no organized prehabilitation. In addition, the dHOPE study aims to identify measurable parameters reflecting the effect of prehabilitation, thus preparing for future personalization of the prehabilitation programs. Discussion The feasibility of multimodal prehabilitation is threatened by low compliance to hospital-based programs due to burdensome commuting, even in central and metropolitan areas. In sparsely populated countries, this challenge is even more pronounced. To ensure equal healthcare to all citizens regardless of address or economic situation, there is a need to transfer the prehabilitation program to the patients’ homes. Thus, the primary hypothesis of dHOPE is that a digital home-based program is not inferior to a hospital-based program. Moreover, given the patient diversity, prehabilitation must be personalized to meet individual profiles or needs. An exploratory subtask of dHOPE is to confirm the utility of clinical, genetic, and molecular factors in evaluating prehabilitation response ultimately to identify new biomarkers and develop medical software for individual risk stratification and development of personalized prehabilitation programs. Clinical Trial registration https://clinicaltrials.gov/ , identifier (NCT06231576).

• Nes, Bjarne Martens; Letnes, Jon Magne; Johnson, Kristin Espolin; Sellevold, Andreas Berg; Byrkjeland, Rune & Brown, Fedelix Phetogo [Show all 14 contributors for this article] (2025). Effects of 1-year exercise in patients with atrial fibrillation: Study protocol for the Norwegian Exercise in Atrial Fibrillation (NEXAF) randomised controlled trial. doi: 10.1136/openhrt-2024-003077. Full text in Research Archive
• Myrstad, Marius (2025). Damenes pokal og medaljens bakside. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(4). doi: 10.4045/tidsskr.25.0080. Full text in Research Archive
• Sørensen, Eivind; Berge, Trygve & Myrstad, Marius (2024). Atrial fibrillation is the most prevalent cardiac condition in master athletes. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 31(4), p. E7–E7. doi: 10.1093/eurjpc/zwad188. Full text in Research Archive
• Landgraff, Ida Kalstad; Myrstad, Marius; Holvik, Kristin; Ranhoff, Anette Hylen & Meyer, Haakon Eduard (2024). Fysisk aktivitet, kroppsmasseindeks og langtidsrisiko for hoftebrudd blant menn. En NOREPOS kohortstudie med 47 års oppfølging. Full text in Research Archive
• Myrstad, Marius; Sørensen, Eivind; Janssens, Kristel; Mitchell, Amy; Apelland, Turid & Claessen, Guido [Show all 7 contributors for this article] (2023). Exercise-Induced Cardiac Remodeling and Atrial Fibrillation in Female Endurance Athletes. Journal of the American Society of Echocardiography. ISSN 0894-7317. 36(3), p. 344–345. doi: 10.1016/j.echo.2022.12.006. Full text in Research Archive
• Landgraff, Ida Kalstad; Myrstad, Marius; Holvik, Kristin; Ranhoff, Anette Hylen & Meyer, Haakon Eduard (2023). Leisure time physical activity and long-term hip fracture risk in men. Full text in Research Archive
• Myrstad, Marius; Apelland, Turid; Letnes, Jon Magne; Enger, Steve; Onarheim, Sophia & Sellevold, Andreas Berg [Show all 13 contributors for this article] (2023). Temporal relationship between training and episodes of atrial fibrillation in endurance athletes. European Heart Journal, Supplement. ISSN 1520-765X. doi: 10.1093/eurheartj/ehad655.2608. Full text in Research Archive
• Apelland, Turid; Janssens, Kristel; Loennechen, Jan Pål; Claessen, Guido; Sørensen, Eivind & Mitchell, Amy [Show all 14 contributors for this article] (2023). Effects of training adaption in endurance athletes with atrial fibrillation: Protocol for a multicentre randomised controlled trial. BMJ Open sport & exercise medicine. 9(2). doi: 10.1136/bmjsem-2023-001541. Full text in Research Archive Show summary

  Endurance athletes have a high prevalence of atrial fibrillation (AF), probably caused by exercise-induced cardiac remodelling. Athletes diagnosed with AF are often advised to reduce the intensity and amount of training but the efficacy of this intervention has not been investigated in endurance athletes with AF. Effects of detraining in endurance athletes with atrial fibrillation is a two-arm international multicentre randomised (1:1) controlled trial on the effects of a period of training adaption on AF burden in endurance athletes with paroxysmal AF. One-hundred-and-twenty endurance athletes diagnosed with paroxysmal AF are randomised to a 16-week period of intervention (training adaption) or a control group. We define training adaption as training with a heart rate (HR) not exceeding 75% of the individual maximum HR (HRmax), and total duration of weekly training not exceeding 80% of the self-reported average before the study. The control group is instructed to uphold training intensity including sessions with HR ≥85% of HRmax. AF burden is monitored with insertable cardiac monitors, and training intensity with HR chest-straps and connected sports watches. The primary endpoint, AF burden, will be calculated as the cumulative duration of all AF episodes lasting ≥30sec divided by total duration of monitoring. Secondary endpoints include number of AF episodes, adherence to training adaption, exercise capacity, AF symptoms and health-related quality of life, echocardiographic signs of cardiac remodelling and risk of cardiac arrhythmias related to upholding training intensity.

• Johansen, Kristoffer Robin; Sørensen, Eivind; Ranhoff, Anette Hylen & Myrstad, Marius (2023). Exercise and prevalence of cardiovascular disease in older female endurance athletes during 10 years follow-up. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 30. doi: 10.1093/eurjpc/zwad125.181. Full text in Research Archive
• Rønningen, Peter Selmer; Walle-Hansen, Marte; Ihle-Hansen, Håkon; Heide, Jens Bendiks Bremnes; Rønning, Else Johanne & Andersen, Elizabeth Lyster [Show all 9 contributors for this article] (2023). Sykdomsforløp blant pasienter innlagt på Bærum sykehus med deltaog omikronvariantene av SARS-CoV-2-viruset. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(10). doi: 10.4045/tidsskr.22.0808. Full text in Research Archive Show summary

  BAKGRUNN Covid-19-pandemien har hatt form av smittebølger. En smittebølge dominert av deltavarianten av SARS-CoV-2-viruset høsten 2021 ble i løpet av få uker rundt jul avløst av en ny smittebølge med omikronvarianten. Vi beskriver hvordan overgangen påvirket pasientpopulasjonen innlagt med covid-19 på et norsk lokalsykehus. MATERIALE OG METODE Alle pasienter innlagt ved Bærum sykehus med påvist SARS-CoV-2-virus ble inkludert i en kvalitetsstudie med mål om å beskrive pasientkarakteristika og sykdomsforløp. Vi presenterer pasienter innlagt i periodene 28.6.2021–31.12.2021 og 1.1.2022–12.6.2022, her omtalt som henholdsvis deltabølgen og omikronbølgen. RESULTATER I alt 144 innlagte pasienter fikk påvist SARS-CoV-2-viruset under deltabølgen og 261 under omikronbølgen. Henholdsvis 14/144 (10 %) og 89/261 (34 %) var innlagt av annen årsak enn covid-19. Pasienter med covid-19 under deltabølgen var i gjennomsnitt yngre (59 år vs. 69 år) samt hadde lavere skår på Charlsons komorbiditetsindeks (2,6 vs. 4,9) og på klinisk skrøpelighetsskala (2,8 vs. 3,7) enn dem i omikronbølgen. Blant 302/405 pasienter innlagt med covid-19 som hoveddiagnose var det 88/130 (68 %) med respirasjonssvikt under deltabølgen og 59/172 (34 %) under omikronbølgen, med median antall sykehusdøgn på henholdsvis 8 (interkvartilbredde 5–15) og 5 (interkvartilbredde 3–8). FORTOLKNING Overgangen fra smittebølgen dominert av deltavarianten til smittebølgen dominert av omikronvarianten påvirket i stor grad karakteristika og sykdomsforløp hos pasienter innlagt på sykehuset med SARS-CoV-2-infeksjon.

• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne; Sandbakk, Silvana Bucher & Wilsgaard, Tom [Show all 10 contributors for this article] (2022). Ten-year mortality among older male recreational endurance athletes in the Birkebeiner Ageing Study in comparison with older men from the Tromsø Study. Full text in Research Archive
• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne; Heitmann, Kim Arne & Apelland, Turid [Show all 12 contributors for this article] (2022). Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice – a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study. Full text in Research Archive
• Johansen, Kristoffer Robin; Ranhoff, Anette Hylen; Sørensen, Eivind; Nes, Bjarne; Heitmann, Kim Arne & Apelland, Turid [Show all 12 contributors for this article] (2022). Risk of atrial fibrillation and stroke among older men exposed to prolonged endurance sport practice - a 10-year follow-up. The Birkebeiner Ageing Study and the Tromsø Study. Full text in Research Archive
• Myrstad, Marius; Nes, Bjarne & Morseth, Bente (2021). NEXAF-studiene . et norsk initiativ for økt kunnskap om atrieflimmer og trening. Hjerteforum. ISSN 0802-1465. 34(4), p. 46–51. Full text in Research Archive
• Ranhoff, Anette Hylen; Myrstad, Marius; Kittang, Bård Reiakvam & Wyller, Torgeir Bruun (2021). Bør alle sykehjemsbeboere vaksineres? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 141(3), p. 210–210. doi: 10.4045/tidsskr.21.0072. Full text in Research Archive
• Hagberg, Guri; Berg, Anne-Cathrine; Skar, Tommy; Myrstad, Marius & Ihle-Hansen, Håkon (2019). God slagbehandling er mer enn akuttmedisin. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(17). doi: 10.4045/tidsskr.19.0574. Full text in Research Archive
• Sørensen, Eivind; Myrstad, Marius; Ihle-Hansen, Håkon & Berge, Trygve (2018). Atrieflimmer hos idrettsutøvere. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(13), p. 1214–1214. doi: 10.4045/tidsskr.18.0627. Full text in Research Archive
• Myrstad, Marius (2018). Perioperativ nulling av nye antikoagulasjonsmidler. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(15), p. 1400–1401. doi: 10.4045/tidsskr.18.0697. Full text in Research Archive
• Ihle-Hansen, Håkon; Hagberg, Guri; Molden, Espen & Myrstad, Marius (2018). Hvem bør få klopidogrel etter hjerneslag? Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 138(9). doi: 10.4045/tidsskr.18.0277. Full text in Research Archive
• Myrstad, Marius; Neerland, Bjørn Erik; Hagberg, Guri & Watne, Leiv Otto (2017). Vurdering av mental status hos akutt syke gamle. 137(12), p. 1–2. doi: 10.4045/tidsskr.17.0480. Full text in Research Archive
• Myrstad, Marius; Vandvik, Inger Helene; Engebretsen, Erik Hauge & Tveit, Arnljot (2017). Hjerneslag etter seponering av nye antikoagulasjonsmidler før kirurgi. 137(23/24), p. 1878–1880. doi: 10.4045/tidsskr.17.0532. Full text in Research Archive
• Myrstad, Marius; Aarønæs, Marit; Graff-Iversen, Sidsel; Nystad, Wenche & Ranhoff, Anette Hylen (2015). Does endurance exercise cause atrial fibrillation in women? International Journal of Cardiology. ISSN 0167-5273. 184, p. 431–432. doi: 10.1016/j.ijcard.2015.03.018. Full text in Research Archive
• Gulsvik, Anne Kristine; Myrstad, Marius & Thelle, Dag Steinar (2014). Re: Fysisk aktivitet, røyking og dødelighet hos menn som deltok i Oslo-undersøkelsene i 1972 og 2000. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(22), p. 2126–2126. doi: 10.4045/tidsskr.14.1357. Full text in Research Archive
• Ranhoff, Anette Hylen; Bakken, Marit Stordal; Bogen, Bård Erik; Bruvik, Frøydis Kristine; Flote, Vidar Gordon & Furberg, Anne-Sofie [Show all 17 contributors for this article] (2014). Nyttig informasjon for god helse. In Ranhoff, Anette Hylen (Eds.), God helse. Hva du selv kan gjøre. Kom forlag. ISSN 9788293191070. Full text in Research Archive
• Mo, Lars; Myrstad, Marius; Sangnes, Ida; Henriksen, Andreas & Ranhoff, Anette Hylen (2013). Maintaince of physical capacity in elderly cross-country skiers. Longitudinal observations from the Birkebeiner Ageing Study. Full text in Research Archive

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