Sigrun Halvorsen

• Boskovic, Miroslav; Haraldsen, Marius Blørstad; Berge, Trygve; Grenne, Bjørnar Leangen; Skretteberg, Torger & Engdahl, Johan [Vis alle 14 forfattere av denne artikkelen] (2026). Digital recruitment and prevalence of screen-detected atrial fibrillation in nationwide patch-based ECG screening: the NORSCREEN randomized clinical trial. Europace. ISSN 1099-5129. 28(8). doi: 10.1093/europace/euag140. Fulltekst i vitenarkiv Vis sammendrag

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

• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2026). Authors’ Response Letter – 30-day Outcome Data from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. s. 5–5. doi: 10.1159/000553527. Fulltekst i vitenarkiv
• Singstad, Bjørn-Jostein; Turan, Bangin; Ravn, Jesper; Sovershaev, Timofey; Eek, Christian & Aksnes, Tonje Amb [Vis alle 12 forfattere av denne artikkelen] (2026). Artificial intelligence-enabled electrocardiographic detection of acute occlusive myocardial infarction. Research Square. ISSN 2693-5015. doi: 10.21203/rs.3.rs-10574825/v1. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Occluded myocardial infarction (OMI) remains under-recognized in patients without ST-elevation, delaying revascularization despite a high risk of adverse outcomes. We fine-tuned and validated a foundation model for detecting OMI from standard 12-lead electrocardiograms (ECGs), recorded between 2016 and 2022. The study included 17 165 ECGs from 11 338 patients. Among these, 4 038 encounters proceeded to acute invasive coronary angiography, identified from the Norwegian Registry of Invasive Cardiology (NORIC), and 1 338 of these were diagnosed with OMI. OMI was defined as an acute culprit lesion with Thrombolysis In Myocardial Infarction (TIMI) flow grade 0–2 treated with percutaneous coronary intervention. A pretrained ECG foundation model was fine-tuned and evaluated on a held-out test set. The model achieved an area under the receiver operating characteristic (AUROC) curve of 0.93 and an area under the precision-recall curve (AUPRC) of 0.72 for detecting OMI cases. Performance was high for OMI with ST-elevation (AUROC 0.98) and moderate for OMI without ST-elevation (AUROC 0.84, AUPRC 0.20), reflecting the inherent difficulty of detecting non-ST-elevation occlusions. Among OMI cases with available door-to-procedure timestamps, the model identified 59 (53%) of those with delayed door-to-procedure time (>30 minutes), of which 32 (54%) were NSTEMIs. These findings highlight the potential of AI-enabled ECG interpretation to improve early recognition and timely management of high-risk OMIs.

• Madssen, Erik; Sverre, Elise Christine Bjørkholen; Nyen, Johanne E; Holmager, Therese L F; Kristensen, Anna M D & Bakken, Arnhild [Vis alle 13 forfattere av denne artikkelen] (2026). Beta-blocker therapy and physical activity after myocardial infarction: a preplanned sub-study of the BETAMI trial. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1093/eurjpc/zwag412. Fulltekst i vitenarkiv Vis sammendrag

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

• Haraldsen, Marius Blørstad; Boskovic, Miroslav; Berge, Trygve; Grenne, Bjørnar Leangen; Skretteberg, Torger & Jortveit, Jarle [Vis alle 7 forfattere av denne artikkelen] (2026). Interrater agreement in atrial fibrillation diagnosis using one-week single-lead patch ECG monitoring: findings from the NORSCREEN trial. Europace. ISSN 1099-5129. 28(7). doi: 10.1093/europace/euag162. Fulltekst i vitenarkiv
• Aaseth, Eirik; Halvorsen, Sigrun; Kjeldsen, Sverre Erik & Gravning, Jørgen (2026). Blood pressure and cardiovascular risk in a contemporary cohort of young adults. American Journal of Hypertension. ISSN 0895-7061. 39(8), s. 1005–1012. doi: 10.1093/ajh/hpag025. Fulltekst i vitenarkiv
• Bruun, Lina Dorthea; Andersen, Geir Øystein; Myhre, Peder Langeland; Halvorsen, Sigrun; Kringen, Marianne Kristiansen & Hansen, Charlotte Holst [Vis alle 8 forfattere av denne artikkelen] (2026). Prognostic relevance of β1-adrenergic receptor polymorphisms on cardiovascular outcome in patients treated with metoprolol after acute myocardial infarction - an observational study. European Journal of Clinical Pharmacology. ISSN 0031-6970. 82(7). doi: 10.1007/s00228-026-04091-x. Fulltekst i vitenarkiv
• Kristensen, Anna Meta Dyrvig; Jortveit, Jarle; Holmager, Therese; Atar, Dan; Olsen, Michael Hecht & Bakken, Arnhild [Vis alle 14 forfattere av denne artikkelen] (2026). Outcomes in the BETAMI-DANBLOCK trial compared with a Norwegian nationwide myocardial infarction population. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehag348. Fulltekst i vitenarkiv Vis sammendrag

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

• Gorog, Diana A.; Berg, Jurrien M. ten; Campo, Gianluca; Geisler, Tobias; Gigante, Bruna & Grove, Erik L. [Vis alle 19 forfattere av denne artikkelen] (2026). Antithrombotic therapy for secondary prevention in patients with acute coronary syndromes treated with percutaneous coronary intervention: options for personalization to reduce bleeding or ischaemic risks: A Clinical Consensus Statement of the ESC Working Group on Thrombosis, the Association for Acute CardioVascular Care of the ESC, the European Association of Percutaneous Cardiovascular Interventions of the ESC, and the ESC Working Group on Cardiovascular Pharmacology. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 15(4), s. 337–363. doi: 10.1093/ehjacc/zuag021. Fulltekst i vitenarkiv
• Nyen, Johanne E; Kristensen, Anna Meta D; Dammen, Toril; Zwisler, Ann-Dorthe; Olsen, Michael Hecht & Maeng, Michael [Vis alle 14 forfattere av denne artikkelen] (2026). Beta-blockers, depression, and anxiety after myocardial infarction: the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehag200. Fulltekst i vitenarkiv
• Jortveit, Jarle; Boskovic, Miroslav; Haraldsen, Marius Blørstad; Berge, Trygve; Grenne, Bjørnar L & Munkhaugen, John [Vis alle 7 forfattere av denne artikkelen] (2026). Cardiac-related symptoms in individuals ≥65 years without diagnosed cardiac disease: insights from the NORSCREEN-trial. European Heart Journal Open (EHJ Open). doi: 10.1093/ehjopen/oeag032. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims Population-based data on cardiac-related symptoms in individuals without diagnosed cardiac disease remain limited, despite important implications for early detection and management. We aimed to assess the prevalence of self-reported symptoms and the association with quality of life (QoL) among adults ≥65 years with ≥1 additional stroke risk factor, but without diagnosed cardiac disease. Methods Cross-sectional study of the NORSCREEN trial population at baseline. NORSCREEN is an ongoing, nationwide, randomised atrial fibrillation screening study in adults aged ≥65 years at increased risk of stroke (CHA2DS2-VA ≥2). All participants completed a baseline questionnaire capturing clinical information, symptoms, and QoL. Results Of 50,549 participants enrolled from 2023 to 2025, 39,281 (78%) reported no diagnosed cardiac disease. Among those, 17,069 (43%) reported cardiac-related symptoms compared to 7,551 (67%) of 11,268 individuals with known cardiac disease. Most common symptoms were fatigue, exertional dyspnoea and tachycardia. Female sex (adjusted odds ratio 1.66, [95% CI 1.58–1.75], physical inactivity (1.43 [1.32–1.55]), current smoking (1.24 [1.12–1.37]), age <75 years (1.14 [1.08-1.20]), living alone (1.13 [1.07–1.20]), and comorbidities including chronic obstructive pulmonary disease (6.51 [5.63-7.54]) and anxiety (3.99 [3.64-4.38]) were associated with cardiac-related symptoms. Symptomatic individuals reported significantly lower RAND-36 QoL scores across all domains compared to those without symptoms. Conclusion In this cohort of individuals ≥65 years at increased risk of stroke, but without diagnosed cardiac disease, nearly half reported cardiac-related symptoms, which were associated with substantially reduced QoL. These findings suggest there might be unmet needs in identifying and managing cardiovascular disease.

• Alexander, John H.; Lydon, Elizabeth J.; Piccini, Jonathan P.; Viethen, Thomas; Oldgren, Jonas & Goodman, Shaun G. [Vis alle 26 forfattere av denne artikkelen] (2025). Asundexian or Apixaban in Patients with Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial. JAMA cardiology. ISSN 2380-6583. 10(6), s. 555–563. doi: 10.1001/jamacardio.2025.0277. Fulltekst i vitenarkiv
• Gualandro, Danielle M.; Masip, Josep; Halvorsen, Sigrun; Price, Susanna; Rosselló, Xavier & Chioncel, Ovidiu [Vis alle 22 forfattere av denne artikkelen] (2025). Acute heart failure in non-cardiac surgery. European Heart Journal. ISSN 0195-668X. 46(40), s. 4042–4059. doi: 10.1093/eurheartj/ehaf559. Fulltekst i vitenarkiv Vis sammendrag

  More than 64 million people worldwide have heart failure (HF), and these numbers are expected to rise. Acute HF (AHF) is the leading cause of hospitalization in patients over 65 years old and is linked to high mortality and readmission rates. AHF may also be a frequent complication in patients hospitalized for other medical reasons as well as after cardiac or non-cardiac surgery. These three entities are summarized as secondary AHF. As secondary AHF has been largely overlooked by medical research and education, little is known about its pathophysiology, phenotypes, diagnosis, management, and prognosis. Secondary AHF occurring after non-cardiac surgery warrants particular attention due to its very high mortality rates of up to 44% within 1 year and is therefore the focus of this review. The scope of this document is to summarize the available evidence regarding the pathophysiology, prevention, diagnosis, treatment, and prognosis of AHF after non-cardiac surgery. Key to prevention is understanding and addressing the pathophysiology of AHF after non-cardiac surgery, which involves close monitoring of fluid status to avoid volume overload and/or hypovolemia, avoiding hypo- and/or hypertension, treating pain and anaemia to prevent tachycardia, and avoiding electrolyte disturbances to prevent arrhythmias. Cardiac biomarkers, such as cardiac troponins and natriuretic peptides, serve as important diagnostic tools and enhance risk stratification in the perioperative setting. A low threshold to perform echocardiography in this population is suggested. Vigilant post-operative care is essential for the early recognition and treatment of AHF after non-cardiac surgery, which could help improve outcomes for patients.

• Jortveit, Jarle; Myhre, Peder L; Andersen, Geir Øystein & Halvorsen, Sigrun (2025). Cardiogenic shock as a complication of acute myocardial infarction: a nationwide cohort study. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. s. 1–11. doi: 10.1093/ehjacc/zuaf118. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI). This study aimed to assess real-world incidence, characteristics, and outcomes in relation to age among patients with AMI complicated by CS (AMI-CS) compared with those without CS in a nationwide cohort. Methods and results Cohort study of all patients <85 years with AMI registered in the Norwegian Myocardial Infarction Registry 2013–2022. Outcomes were short- and long-term all-cause mortality. Mortality was assessed by Kaplan-Meier survival curves, Life Tables, and multivariable Cox regression models. Among 86 730 AMI patients (40% women), 1645 (2.7%) patients <75 years and 969 (3.9%) patients 75–84 years developed CS. Regardless of age, patients with AMI-CS were more likely to have previous heart failure, diabetes, renal failure, and ST-elevation AMI compared with patients without CS. In-hospital mortality was 47.5% in AMI-CS patients <75 years and 71.4% in patients 75–84 years, and the estimated one year cumulative mortality rates were 54.7% (95% CI: 52.3–57.1%) and 79.8% (95% CI: 77.2–82.3), respectively. Patients with AMI-CS who survived to hospital discharge remained at a higher long-term mortality risk compared with patients without CS (<75 years: adjusted HR 1.91 (95% CI 1.67–2.18), 75–84 years: adjusted HR 1.65 (95% CI: 1.41–1.93)). Conclusion The in-hospital mortality rates for AMI-related CS remain high, especially in patients ≥75 years. However, long-term mortality in CS patients surviving to hospital discharge was only moderately higher compared with AMI patients without CS.

• Kristensen, Anna Meta Dyrvig; Rossello, Xavier; Atar, Dan; Yndigegn, Troels; Kimura, Takeshi & Latini, Roberto [Vis alle 30 forfattere av denne artikkelen] (2025). Beta-Blockers after Myocardial Infarction with Normal Ejection Fraction. New England Journal of Medicine. ISSN 0028-4793. 394(6), s. 540–550. doi: 10.1056/nejmoa2512686. Fulltekst i vitenarkiv
• Kluge, Karsten Engseth; Halvorsen, Sigrun; Andersen, Geir Øystein; Hansen, Charlotte Holst; Seljeflot, Ingebjørg & Tønnessen, Theis [Vis alle 8 forfattere av denne artikkelen] (2025). Combined complement and coagulation activation in ST-elevation myocardial infarction: associations with myocardial injury and dysfunction. Frontiers in Immunology. 16. doi: 10.3389/fimmu.2025.1613603. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Preclinical data indicates reciprocal activation of the complement system and the coagulation cascade. The magnitude of this interaction in patients with acute myocardial infarction is unknown. We aimed to determine associations between circulating markers of complement and coagulation activation in patients with acute ST-elevation myocardial infarction (STEMI), and explore a possible link to myocardial injury and left ventricular dysfunction. Materials and methods: We included 864 patients with STEMI. Blood was drawn at a median of 18 hours after percutaneous coronary intervention. Complement activation was assessed by the terminal complement complex (TCC), and coagulation activation by prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). Myocardial injury was estimated by peak troponin T (TnT), and left ventricular function was quantified on echocardiography by left ventricular ejection fraction (LVEF). Results: TCC was weakly correlated to F1 + 2 (r=0.086, p=0.012), D-dimer (r=0.176, p<0.001) and ETP (r=0.144, p<0.001). In multivariate binary logistic regression, there was no significant interaction between TCC and the coagulation markers on the risk of having high peak TnT or low LVEF. Conclusion: In this STEMI cohort, complement activation as measured by TCC was weakly associated with markers of coagulation activation, but the measured markers had no combined relation with the risk of high peak TnT or low LVEF. These findings suggest that while simultaneous activation of complement and coagulation cannot be ruled out, combined high levels of TCC and coagulation markers do not mirror the extent of myocardial injury or dysfunction in STEMI.

• Araiza-Garaygordobil, Diego; Alexander, Thomas; Huber, Kurt; Halvorsen, Sigrun; Ahrens, Ingo & Alviar, Carlos [Vis alle 19 forfattere av denne artikkelen] (2025). Reperfusion therapy for ST elevation myocardial infarction in low- to middle-income countries: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Preventive Cardiology (EAPC), the ESC Working Group on Thrombosis, and the Stent-Save a Life! Initiative. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 14(11), s. 690–697. doi: 10.1093/ehjacc/zuaf114. Fulltekst i vitenarkiv
• Aaseth, Eirik; Halvorsen, Sigrun; Helseth, Ragnhild & Gravning, Jørgen (2025). Remnant cholesterol, plasma triglycerides, and risk of cardiovascular disease events in young adults: a prospective cohort study. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 32(13), s. 1181–1189. doi: 10.1093/eurjpc/zwaf104. Fulltekst i vitenarkiv Vis sammendrag

  Aims This study aims to investigate if elevated levels of cholesterol carried in triglyceride-rich lipoproteins, marked by remnant cholesterol or plasma triglycerides, are associated with increased risk of premature cardiovascular disease (CVD) events in young adults. Methods and results This study is a prospective cohort study. In the year 2000, all 30-year-old inhabitants living in Oslo, Norway, were invited to the ‘Oslo Health Study’ including a clinical examination and routine blood tests. Follow-up with respect to CVD events (cardiovascular death, non-fatal myocardial infarction, non-fatal ischaemic stroke, coronary revascularization, or hospitalization for unstable angina) was obtained by linkage with national mandatory registries through 2022. We estimated the risk of CVD events in relation to levels of remnant cholesterol and plasma triglycerides at inclusion using Cox regression analysis. The risk of CVD events in relation to LDL cholesterol (LDL-C) levels was estimated as comparison. A total of 5939 participants were included (median age 31 years, 56% women). During a median follow-up time of 22 years, a CVD event occurred in 107 (1.8%) participants. The adjusted hazard ratio (aHR) for CVD events per 0.5 mmol/L increase in remnant cholesterol concentrations was 1.3 [95% confidence interval (CI): 1.1–1.5]. Per 1 mmol increase in plasma triglycerides and LDL-C concentrations, the aHR for CVD events was 1.2 (95% CI: 1.1–1.4) and 1.3 (95% CI: 1.1–1.6), respectively. Conclusion Already at 31 years of age, higher concentrations of remnant cholesterol and plasma triglycerides were associated with increased risk of premature CVD events. We suggest that remnant cholesterol or plasma triglycerides are included in the risk assessment of young adults.

• Fyksen, Tea Sætereng; Gravning, Jørgen; Rossebø, Anne Bjørhovde; Vanberg, Paul; Grøtta, Ole Jørgen & Atar, Dan [Vis alle 7 forfattere av denne artikkelen] (2025). Cardiac structure and function in anabolic-androgenic steroid users: a 16-year follow-up study. Open heart. 12(2). doi: 10.1136/openhrt-2025-003376. Fulltekst i vitenarkiv Vis sammendrag

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

• Engebretsen, Ingrid; Oteiza, Francisco; Birkelund, Elisabeth Floberghagen; Brandal, Signe Marie; Bugge, Christoffer & Halvorsen, Sigrun (2025). Cardiovascular disease in breast cancer patients: a nationwide real-world evidence study 2013–20. European Heart Journal Open (EHJ Open). 5(3). doi: 10.1093/ehjopen/oeaf043. Fulltekst i vitenarkiv Vis sammendrag

  Aims Various measures have been implemented in clinical practice to reduce the risk of cardiovascular complications during breast cancer (BC) treatment. The aim of this study was to investigate whether women diagnosed with BC exhibit a higher incidence of cardiovascular disease (CVD). Methods and results Matched cohort study. Using data from the Cancer Registry of Norway and the Norwegian Patient Registry, we created a nationwide cohort of women diagnosed with BC between 2013 and 2020 and age-matched controls (matching ratio 1:10). For BC patients, the index date was the date of their BC diagnosis. For controls, the index date was a random date within the index year of the matched BC patient. For eight selected CVDs, we compared the prevalence before BC diagnosis between cases and controls, as well as the overall incidence, hazard ratios (HRs), and cumulative incidences post BC diagnosis. Follow-up was through 2021. Our study population consisted of 27 526 BC patients and 269 904 matched controls. Among the subset of patients without CVD prior to index, BC patients had significantly increased overall and cumulative risk of pulmonary embolism (HR = 3.00, 95% CI: [2.51–3.59]), atrial fibrillation (1.53 [1.38–1.70]), other cardiac arrhythmias (1.43 [1.27–1.61]), heart failure (1.93 [1.33–2.80]), hypertensive heart disease (1.79 [1.67–1.91]), and heart valve disease (2.02 [1.79–2.27]). Conclusion In this contemporary cohort, BC patients still had an increased risk of several CVDs compared to age-matched controls. Further research is needed to determine the causes of this increased risk, but clinicians should be aware and optimize therapy accordingly.

• Jortveit, Jarle; Munkhaugen, John; Kaldal, Anete & Halvorsen, Sigrun (2025). Sekundærforebygging hos hjerteinfarktpasienter med kjent koronarsykdom. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(15). doi: 10.4045/tidsskr.25.0186. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Sekundærforebyggende behandling for pasienter med kjent koronarsykdom reduserer risikoen for nye kardiovaskulære hendelser. Vi har undersøkt i hvilken grad pasienter med kjent koronarsykdom, innlagt med akutt hjerteinfarkt, hadde oppnådd behandlingsmålene for sekundærforebygging. Materiale og metode Studien benyttet data fra Norsk hjerteinfarktregister og inkluderte pasienter yngre enn 85 år med kjent koronarsykdom, som ble innlagt med akutt type 1-hjerteinfarkt i norske sykehus i tidsrommet 1.1.2013–31.12.2022. Resultater Av 74 993 pasienter yngre enn 85 år som var innlagt med akutt type 1-hjerteinfarkt, hadde 22 825 (30,4 %) kjent koronarsykdom. Av disse var 24,4 % kvinner, og medianalderen var 72 år (interkvartilbredde 64–78). Andelen med kjent koronarsykdom var stabil i studieperioden. Andelen ikke-røykere økte fra 71 % til 75 % (+0,7 % per år), andelen normalvektige ble redusert fra 33 % til 29 % (−1,8 % per år), og andelen som brukte blodplatehemmer og/eller antikoagulasjon økte fra 88 % til 91 % (+0,3 % per år). Andelen som brukte lipidsenkende behandling (77,0 %) og andelen som hadde LDL-kolesterol < 1,8 mmol/L (21 %) var stabile. Andelen med blodtrykk < 140/90 mmHg ble redusert fra 43 % til 30 % (−4,6 % per år frem til 2020, og uendret etter det). Fortolkning Studien viser behov for tiltak for å bedre den sekundærforebyggende behandlingen hos pasienter med koronarsykdom i Norge.

• Rossello, Xavier; Prescott, Eva Irene Bossano; Kristensen, Anna Meta Dyrvig; Latini, Roberto; Fuster, Valentin & Fagerland, Morten [Vis alle 22 forfattere av denne artikkelen] (2025). β blockers after myocardial infarction with mildly reduced ejection fraction: an individual patient data meta-analysis of randomised controlled trials. The Lancet. ISSN 0140-6736. 406(10508), s. 1128–1137. doi: 10.1016/s0140-6736(25)01592-2. Fulltekst i vitenarkiv Vis sammendrag

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

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

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

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

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

• Jüni, Peter; Antoniou, Sotiris; Arbelo, Elena; Buccheri, Sergio; Cikes, Maja & Costa, Bruno R. da [Vis alle 20 forfattere av denne artikkelen] (2025). 2024 Revision of the level of evidence grading system for ESC clinical practice guideline recommendations I: therapy and prevention. European Heart Journal. ISSN 0195-668X. 46(20), s. 1885–1894. doi: 10.1093/eurheartj/ehaf009. Fulltekst i vitenarkiv
• Baron, Suzanne J.; Chou, Josephine C.; Shah, Tayyab; Vest, Amanda R.; Abbott, J. Dawn & Alasnag, Mirvat [Vis alle 20 forfattere av denne artikkelen] (2025). SCAI/EAPCI/ACVC Expert Consensus Statement on Cardiogenic Shock in Women: This statement was endorsed by the Heart Failure Society of America (HFSA). Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI). 4(6), s. 1–13. doi: 10.1016/j.jscai.2024.102150. Fulltekst i vitenarkiv Vis sammendrag

  Cardiovascular disease is the leading cause of death for women worldwide, with mortality rates due to cardiogenic shock (CS) remaining exceedingly high. Sex-based disparities in the timely delivery of optimal CS treatment contribute to poor outcomes; addressing these disparities is a major priority to improve women’s cardiovascular health. This consensus statement provides a comprehensive summary of the current state of treatment of CS in women across the spectrum of cardiovascular disease states and identifies important gaps in evidence. As sex-based data are limited in contemporary literature, clinicians may use this document as a resource to guide practice. Further investigations are necessary to inform best practices for the diagnosis and treatment of women with CS.

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

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

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

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

• Askeland-Gjerde, Daniel E.; Westlye, Lars Tjelta; Andersson, Patrik; Korbmacher, Max; Lange, Ann-Marie Glasø de & Meer, Dennis van der [Vis alle 10 forfattere av denne artikkelen] (2025). Mediation Analyses Link Cardiometabolic Factors and Liver Fat With White Matter Hyperintensities and Cognitive Performance: A UK Biobank Study. Biological Psychiatry: Global Open Science. 5(4). doi: 10.1016/j.bpsgos.2025.100488. Fulltekst i vitenarkiv Vis sammendrag

  Background Liver fat is associated with cardiometabolic disease, cerebrovascular disease, and dementia. Cerebrovascular disease, most often cerebral small vessel disease, identified by magnetic resonance imaging as white matter hyperintensities (WMHs) often contributes to dementia. However, liver fat’s role in the relationship between cardiometabolic risk, WMHs, and cognitive performance is unclear. Methods In the UK Biobank cohort (N = 32,461, 52.6% female; mean age 64.2 ± 7.7 years; n = 23,354 in the cognitive performance subsample), we used linear regression to investigate associations between cardiometabolic factors measured at baseline and liver fat, WMHs, and cognitive performance measured at follow-up, which was 9.3 ± 2.0 years later on average. We used structural equation modeling to investigate whether liver fat mediated associations between cardiometabolic factors and WMHs and whether WMHs mediated associations between liver fat and cognitive performance. Results Nearly all cardiometabolic factors were significantly associated with liver fat (|r| range = 0.03–0.41, p = 3.4 × 10−8 to 0) and WMHs (|r| = 0.04–0.15, p = 5.8 × 10−13 to 7.0 × 10−159) in regression models. Liver fat was associated with WMHs (r = 0.11, p = 4.3 × 10−82) and cognitive performance (r = −0.03, p = 1.6 × 10−7). Liver fat mediated the associations between cardiometabolic factors and WMHs (|βmediation| = 0.003–0.027, pmediation = 1.9 × 10−8 to 0), and WMHs mediated the associations between liver fat and cognitive performance (βmediation = −0.01, pmediation = 0). Conclusions Our findings indicate that liver fat mediates associations between cardiometabolic factors and WMHs and that WMHs mediate the association between liver fat and cognitive performance. This suggests that liver fat may be important for understanding the effects of cardiometabolic factors on cerebrovascular disease and cognitive function. Experimental studies are warranted to determine relevant targets for preventing vascular-driven cognitive impairment.

• Jortveit, Jarle; Myhre, Peder Langeland; Berge, Kristian & Halvorsen, Sigrun (2025). Survival after myocardial infarction according to left ventricular function and heart failure symptoms. ESC Heart Failure. 12(4), s. 2528–2539. doi: 10.1002/ehf2.15265. Fulltekst i vitenarkiv
• Bruun, Lina Dorthea; Andersen, Geir Øystein; Kringen, Marianne K.; Myhre, Peder Langeland; Halvorsen, Sigrun & Hansen, Charlotte Holst [Vis alle 8 forfattere av denne artikkelen] (2025). Effect of metoprolol exposure following myocardial infarction on future cardiovascular events: a Mendelian randomization study. European Journal of Clinical Pharmacology. ISSN 0031-6970. 81(4), s. 551–560. doi: 10.1007/s00228-025-03806-w. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The clinical benefit of up-titration of metoprolol to a guideline-recommended target dose after myocardial infarction (MI) is unknown. Our aim was to investigate whether variation in metoprolol exposure determined by cytochrome p450 enzyme 2D6 (CYP2D6) influences the occurrence of major adverse cardiovascular events (MACE) and cardiovascular death (CV death) among patients treated with metoprolol after MI. Method This Mendelian randomization study was performed using individual-level data from 1554 patients treated with metoprolol after an acute MI. CYPD26 genotype was applied as a binary genetic instrument assigning patients into two metoprolol exposure groups: CYP2D6 normal metabolizers (NM) (low exposure) and CYP2D6 intermediate and poor metabolizers (IM + PM) (high exposure). The null hypothesis of no association between the CYP2D6 metabolizer subgroup and MACE or CV death was tested using the Cox proportional hazards model. All-cause mortality and individual components of MACE were included as secondary outcomes. Results In total, 879 (56.6%) patients were classified as NM and 675 (43.4%) as IM + PM. During the 3-year follow-up, 56 patients (6.4%) in the NM group had an outcome of MACE, and 24 (2.7%) patients died from CV disease. Corresponding frequency in the IM + PM group was 47 (7.0%) and 22 (3.3%), respectively. There was no association between genotype and MACE [unadjusted HR 1.12 (CI 0.76, 1.65)] or CV death [unadjusted HR 1.20 (CI 0.67, 2.14)], or between the CYP2D6 group and any of the secondary outcomes. Conclusion In patients treated with metoprolol after MI, variation in metoprolol exposure determined by CYP2D6 did not impact the occurrence of cardiovascular events.

• Schlotter, Florian; Huber, Kurt; Hassager, Christian; Halvorsen, Sigrun; Vranckx, Pascal & Pöss, Janine [Vis alle 12 forfattere av denne artikkelen] (2024). Ventricular septal defect complicating acute myocardial infarction: diagnosis and management. A Clinical Consensus Statement of the Association for Acute CardioVascular Care (ACVC) of the ESC, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the ESC Working Group on Cardiovascular Surgery. European Heart Journal. ISSN 0195-668X. 45(28), s. 2478–2492. doi: 10.1093/eurheartj/ehae363. Fulltekst i vitenarkiv
• Andrup, Simon Johan Mattias; Andersen, Geir Øystein; Hoffmann, Pavel; Eritsland, Jan; Seljeflot, Ingebjørg & Halvorsen, Sigrun [Vis alle 7 forfattere av denne artikkelen] (2024). Novel cardiac extracellular matrix biomarkers in STEMI: Associations with ischemic injury and long-term mortality. PLOS ONE. 19(5), s. e0302732–e0302732. doi: 10.1371/journal.pone.0302732. Fulltekst i vitenarkiv Vis sammendrag

  Background We aimed to determine whether serum levels of proteins related to changes in cardiac extracellular matrix (ECM) were associated with ischemic injury assessed by cardiac magnetic resonance (CMR) and mortality in patients with ST-elevation myocardial infarction (STEMI). Methods The concentrations of six ECM-related proteins (periostin, osteopontin, syndecan-1, syndecan-4, bone morphogenetic protein 7, and growth differentiation factor (GDF)-15) were measured in serum samples from patients on Day 1 and Month 4 after STEMI (n = 239). Ischemic injury was assessed by myocardial salvage index, microvascular obstruction, infarct size, and left ventricular function measured by CMR conducted during the initial admission (median 2 days after admission) and after 4 months. All-cause mortality was recorded after a median follow-up time of 70 months. Results Levels of periostin increased from Day 1 to Month 4 after hospitalization, while the levels of GDF-15, osteopontin, syndecan-1, and syndecan-4 declined. At both time points, high levels of syndecan-1 were associated with microvascular obstruction, large infarct size, and reduced left ventricular ejection fraction, whereas high levels of syndecan-4 at Month 4 were associated with a higher myocardial salvage index and less dilatation of the left ventricle. Higher mortality rates were associated with periostin levels at both time points, low syndecan-4 levels at Month 4, or high GDF-15 levels at Month 4. Conclusions In patients with STEMI, we found an association between serum levels of ECM biomarkers and ischemic injury and mortality. The results provide new insight into the role ECM components play in ischemic injury following STEMI and suggests a potential for these biomarkers in prognostication after STEMI.

• Langslet, Gisle; Nyström, Thomas; Vistisen, Dorte; Carstensen, Bendix; Grip, Emilie Toresson & Casajust, Paula [Vis alle 18 forfattere av denne artikkelen] (2024). Empagliflozin Use Is Associated With Lower Risk of All-Cause Mortality, Hospitalization for Heart Failure, and End-Stage Renal Disease Compared to DPP-4i in Nordic Type 2 Diabetes Patients: Results From the EMPRISE (Empagliflozin Comparative Effectiveness and Safety) Study. Journal of Diabetes Research. ISSN 2314-6745. 2024. doi: 10.1155/2024/6142211. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To evaluate the effectiveness of empagliflozin in reducing all-cause mortality (ACM), hospitalization for heart failure (HHF), myocardial infarction (MI), stroke, cardiovascular mortality (CVM), and end-stage renal disease (ESRD) in routine clinical practice in the Nordic countries of the Empagliflozin Comparative Effectiveness and Safety (EMPRISE) study. Methods: This noninterventional, multicountry cohort study used secondary data from four Nordic countries (Denmark, Sweden, Finland, and Norway). Propensity score (PS) matched (1:1) adults with type 2 diabetes (T2D) initiating empagliflozin (a sodium-glucose cotransporter-2 inhibitor) during 2014–2018 who were compared to those initiating a dipeptidyl peptidase-4 inhibitor (DPP-4i). Cox proportional hazards regression modelling was used to assess the risk for ACM, HHF, MI, stroke, CVM, and ESRD. Meta-analyses were conducted and hazard ratios (HRs) with 95% confidence intervals (CIs) from random-effects models were calculated. Results: A total of 43,695 pairs of PS-matched patients were identified. Patients initiating empagliflozin exhibited a 49% significantly lower risk of ACM (HR: 0.51, 95% CI 0.40–0.64) compared to DPP-4i. Additionally, empagliflozin was associated with a 36% significantly lower risk of HHF (HR: 0.64, 95% CI 0.46–0.89), a 52% significantly lower risk of CVM (HR: 0.48, 95% CI 0.37–0.63), and a 66% significantly lower risk of ESRD (HR: 0.34, 95% CI 0.15–0.77) compared to DPP-4i. No significant differences were observed in the risk of stroke and MI between patients initiating empagliflozin compared with those initiating a DPP-4i. Results were generally consistent for subgroups (with/without pre-existing CV disease or congestive heart failure) and in sensitivity analyses. Conclusion: Empagliflozin initiation was associated with a significantly reduced risk of ACM, HHF, CVM, and ESRD compared with initiation of DPP-4i in patients with T2D when examining routine clinical practice data from Nordic countries.

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

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

• Engebretsen, Ingrid; Ødegaard, Kristina Malene; Halvorsen, Sigrun; Bugge, Christoffer; Kristiansen, Ivar Sønbø & Støvring, Henrik [Vis alle 7 forfattere av denne artikkelen] (2024). Treatment with PCSK9 monoclonal antibodies is associated with discontinuation of oral lipid lowering therapy. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. doi: 10.1093/ehjqcco/qcae099. Fulltekst i vitenarkiv Vis sammendrag

  Aims Proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9 mAbs) are recommended for high-risk patients if the low-density lipoprotein cholesterol targets are not achieved with statins and ezetimibe. We studied persistence and adherence to (i) PCSK9 mAbs and (ii) statins and ezetimibe in a nationwide cohort of incident PCSK9 mAb users. Methods and results Information on all PCSK9 mAb users ≤80 years from 2015 through 2023 were extracted from the Norwegian Drug Registry. Discontinuation was defined as a gap in treatment ≥180 days and ≥90 days. Adherence was measured as the proportion of days covered during the initial year of PCSK9 mAb therapy. We analysed adherence of statins and ezetimibe before and after PCSK9 mAb initiation. Of 4784 patients initiating PCSK9 mAbs, the median age was 63 years, 41% were female, 61% had atherosclerotic disease, and 34% had familial hypercholesterolaemia. Within 3 years after initiation, 17% experienced a PCSK9 mAb treatment gap exceeding 180 days. In the 12-month period preceding PCSK9 mAb initiation, 74% dispensed statins whereas 67% dispensed ezetimibe. These numbers were reduced to 35% for statins and 42% for ezetimibe during the 12-month period after PCSK9 mAb initiation. Atherosclerotic disease, using ≥3 statins previously, and older age were significantly associated with discontinuation of statins and ezetimibe. Conclusion In this high-risk cohort of incident PCSK9 mAb users, more than 1 out of 2 stopped taking statin treatment whereas 40% discontinued ezetimibe. There is a major potential for improving adherence to oral LLD treatment following initiation of PCSK9 mAb.

• Skjøth, Flemming; Larsen, Torben Bjerregaard; Dun, Alexander Rieem; Lilja, Mathias; Rahman, Iffat & Abdelgawwad, Khaled [Vis alle 9 forfattere av denne artikkelen] (2024). Comparative Safety and Effectiveness of Reduced Doses of Direct Acting Oral Anticoagulants for Stroke Prevention in Atrial Fibrillation. American Journal of Medicine. ISSN 0002-9343. doi: 10.1016/j.amjmed.2024.02.005. Fulltekst i vitenarkiv
• Sambola, Antonia; Halvorsen, Sigrun; Adlam, David; Hassager, Christian; Price, Susanna & Rosano, Giuseppe [Vis alle 12 forfattere av denne artikkelen] (2024). Management of cardiac emergencies in women: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the Heart Failure Association (HFA), and the European Heart Rhythm Association (EHRA) of the ESC, and the ESC Working Group on Cardiovascular Pharmacotherapy. European Heart Journal Open (EHJ Open). 4(2). doi: 10.1093/ehjopen/oeae011. Fulltekst i vitenarkiv Vis sammendrag

  Cardiac emergencies in women, such as acute coronary syndromes, acute heart failure, and cardiac arrest, are associated with a high risk of adverse outcomes and mortality. Although women historically have been significantly underrepresented in clinical studies of these diseases, the guideline-recommended treatment for these emergencies is generally the same for both sexes. Still, women are less likely to receive evidence-based treatment compared to men. Furthermore, specific diseases affecting predominantly or exclusively women, such as spontaneous coronary dissection, myocardial infarction with non-obstructive coronary arteries, takotsubo cardiomyopathy, and peripartum cardiomyopathy, require specialized attention in terms of both diagnosis and management. In this clinical consensus statement, we summarize current knowledge on therapeutic management of these emergencies in women. Key statements and specific quality indicators are suggested to achieve equal and specific care for both sexes. Finally, we discuss several gaps in evidence and encourage further studies designed and powered with adequate attention for sex-specific analysis.

• Tsaban, Gal; Perez, Rafael Vidal; Krychtiuk, Konstantin A.; Ahrens, Ingo; Halvorsen, Sigrun & Hassager, Christian [Vis alle 10 forfattere av denne artikkelen] (2024). Lipid-lowering therapy after acute coronary syndromes: a multinational European survey. Coronary Artery Disease. ISSN 0954-6928. doi: 10.1097/MCA.0000000000001420. Fulltekst i vitenarkiv
• Fyksen, Tea Sætereng; Seljeflot, Ingebjørg; Vanberg, Paul; Atar, Dan & Halvorsen, Sigrun (2024). Platelet activity, coagulation, and fibrinolysis in long-term users of anabolic-androgenic steroids compared to strength-trained athletes. Thrombosis Research. ISSN 0049-3848. 238, s. 60–66. doi: 10.1016/j.thromres.2024.04.027. Fulltekst i vitenarkiv Vis sammendrag

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

• Engebretsen, Ingrid; Bugge, Christoffer; Støvring, Henrik; Husebye, Einar; Sverre, Elise Christine Bjørkholen & Dammen, Toril [Vis alle 8 forfattere av denne artikkelen] (2024). Treatment patterns and adherence to lipid-lowering drugs during eight-year follow-up after a coronary heart disease event. Atherosclerosis. ISSN 0021-9150. 393. doi: 10.1016/j.atherosclerosis.2024.117550. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims Proper prescription and high adherence to intensive lipid lowering drugs (LLD) in patients with coronary heart disease (CHD) is crucial and strongly recommended. The aim of this study is to investigate long-term treatment patterns and adherence to LLD following hospitalization for a CHD event. Methods Patients admitted to two Norwegian hospitals with a CHD event from 2011-2014 (N=1094) attended clinical examination and completed a questionnaire, median 16 months later. Clinical data were linked to pharmacy dispensing data from 2010-2020. The proportions using high-intensity statin therapy (atorvastatin 40/80 mg or rosuvastatin 20/40 mg) and non-statin LLD after the CHD event were assessed. Adherence was evaluated by proportion of days covered (PDC) and gaps in treatment. Results Median age at hospitalization was 63 (IQR 12) years, 21% were female. Altogether, 1054 patients (96%) were discharged with a statin prescription, while treatment was dispensed in 85% within the following 90 days. During median 8 (SD 2.5) years follow-up, the proportion using high-intensity statin therapy ranged 62-68%, whereas the use of ezetimibe increased from 4-26 %. PDC <0.8 was found in 22% of statin users and 26% of ezetimibe users. The proportions with a treatment gap exceeding 180 days were 22% for statins and 28% for ezetimibe. Smoking at hospitalization and negative affectivity were significantly associated with reduced statin adherence, regardless of adherence measure. Conclusions In this long-term follow-up of patients with CHD, less than 70% used high-intensity statin therapy with only small changes over time, and only 25% used additional treatment with ezetimibe. We identified factors associated with reduced statin adherence that may be target for interventions.

• Halvorsen, Sigrun; Vranckx, Pascal & Diepen, Sean Van (2024). Should renin-Angiotensin system inhibitors be stopped or not before non-cardiac surgery? European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 13(9), s. 670–671. doi: 10.1093/ehjacc/zuae101. Fulltekst i vitenarkiv
• Halvorsen, Sigrun & Hassager, Christian (2024). Cardiogenic shock in women: From risk factors to therapy. Kardiologia Polska. ISSN 0022-9032. 82(11), s. 1071–1075. doi: 10.33963/v.phj.103739. Fulltekst i vitenarkiv Vis sammendrag

  Cardiogenic shock (CS) in women is a serious cardiovascular (CV) event associated with a high mortality rate. Non-ischemic etiologies are the most common etiologies in women, such as stress-induced cardiomyopathy, peripartum/postpartum cardiomyopathy, heart failure-related CS, or CS due to myocarditis or valvular heart disease. Although not being the most common etiology in women, acute myocardial infarction is still an important one. Guidelines recommend similar treatment of CS in both sexes, but women have consistently been underrepresented in randomized trials regarding treatment of CS, and more robust data on the optimal management of CS in women is needed. Particularly, the role of mechanical circulatory support in women with CS is still unsettled. Several registries have shown that women with CS are less likely to receive evidence-based therapy compared to men. There is therefore a need for increased awareness about CS in women, in order to increase timely diagnosis and management. In this paper we give a short overview over the etiology, risk factors, diagnosis and treatment of CS in women.

• Jortveit, Jarle; Boskovic, Miroslav; Sandberg, Edvard Liljedahl; Vegsundvåg, Jonas Kvale & Halvorsen, Sigrun (2024). High Diagnostic Accuracy of Long-Term Electrocardiogram Interpretation by General Practitioners. International Journal of Telemedicine and Applications. ISSN 1687-6415. 2024. doi: 10.1155/2024/6624344. Fulltekst i vitenarkiv Vis sammendrag

  Aims. Traditional long-term ECG monitoring systems have primarily been used by cardiologist. New remote and wearable easy-to-use devices have led to increased use of ECG recordings also outside cardiology clinics. The aims of this study were to assess the feasibility and diagnostic accuracy of interpretation of the one-lead ECG recordings from a patch ECG device (ECG247 Smart Heart Sensor system) by general practitioners (GP). Methods. Norwegian GPs were invited to digitally assess 10 long-term ECG recordings with different arrhythmias performed by the ECG247 Smart Heart Sensor system. For all ECG examinations, the presence/absence of different arrhythmias was registered. Results. A total of 40 GPs accepted the invitation and assessed all the 10 long-term ECG recordings. All the tests were assessed as interpretable by all the GPs. Arrhythmias (atrial fibrillation/flutter, supraventricular tachycardia, and ventricular tachycardia) were correctly identified in most cases, with sensitivity of 98% (95% CI 95-99%), specificity of 75% (95% CI 68-82%), and diagnostic accuracy of 89% (85-92%). Incorrect automatic system algorithm interpretations were rarely corrected by the GPs. Conclusion. GPs interpreted one-lead recordings by the ECG247 Smart Heart Sensor system with high diagnostic accuracy for common arrhythmias. However, in cases with rare arrhythmias, we recommend consulting a cardiologist to confirm the diagnosis before treatment is initiated. This trial is registered with NCT04700865.

• Jortveit, Jarle; Andersen, Geir Øystein & Halvorsen, Sigrun (2024). Short- and long-term outcomes of patients with acute myocardial infarction complicated by cardiac arrest: a nationwide cohort study 2013–22. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 13(12), s. 828–837. doi: 10.1093/ehjacc/zuae121. Fulltekst i vitenarkiv Vis sammendrag

  Aims To assess short- and long-term outcomes of acute myocardial infarction (AMI) complicated by out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) in a nationwide cohort. Methods and results Cohort study of AMI patients admitted to hospitals in Norway 2013–22 registered in the Norwegian Myocardial Infarction Registry. Outcomes were in-hospital and long-term mortality. Cumulative mortality was assessed with the Kaplan–Meier and the life-table methods. Cox regression was used for risk comparisons. Among 105 439 AMI patients (35% women), we identified 3638 (3.5%) patients with OHCA and 2559 (2.4%) with IHCA. The mean age was 65.7 (13.2), 70.9 (12.6), and 70.7 (13.6) years for OHCA, IHCA, and AMI without cardiac arrest (CA), respectively. The median follow-up time was 3.3 (25th, 75th percentile: 1.1, 6.3) years. In-hospital mortality was 28, 49, and 5%, in OHCA, IHCA, and AMI without CA, and the estimated 5-year cumulative mortality was 48% [95% confidence interval (CI) 46–50%], 69% (95% CI 67–71%), and 35% (95% CI 34–35%), respectively. Among patients surviving to hospital discharge, no significant difference in mortality during follow-up was found between OHCA and AMI without CA [adjusted hazard ratio (HR) 1.04, 95% CI 0.96–1.13], while the long-term mortality of AMI patients with IHCA was higher (age-adjusted HR 1.31, 95% CI 1.19–1.45). Conclusion In this large, contemporary cohort of AMI patients, in-hospital mortality of patients with OHCA or IHCA was still high. Among patients surviving to hospital discharge, long-term mortality was comparable between OHCA and AMI without CA, while the outcome of patients with IHCA was significantly worse.

• Guimarães, Patricia O.; Lopes, Renato D.; Wojdyla, Daniel M.; Alexander, John H.; Goodman, Shaun G. & Aronson, Ronald [Vis alle 15 forfattere av denne artikkelen] (2024). Antithrombotic Strategies According to Age: Insights from the AUGUSTUS Trial. American Journal of Medicine. ISSN 0002-9343. doi: 10.1016/j.amjmed.2024.06.001. Fulltekst i vitenarkiv
• Gurholt, Tiril Pedersen; Elvsåshagen, Torbjørn; Bahrami, Shahram; Rahman, Mohammad Zillur; Shadrin, Alexey & Askeland-Gjerde, Daniel E. [Vis alle 13 forfattere av denne artikkelen] (2024). Large-scale brainstem neuroimaging and genetic analyses provide new insights into the neuronal mechanisms of hypertension. Human Genetics and Genomics Advances (HGG Advances). 6(1). doi: 10.1016/j.xhgg.2024.100392. Fulltekst i vitenarkiv Vis sammendrag

  While brainstem regions are central regulators of blood pressure, the neuronal mechanisms underlying their role in hypertension remain poorly understood. Here, we investigated the structural and genetic relationships between global and regional brainstem volumes and blood pressure. We used magnetic resonance imaging data from n = 32,666 UK Biobank participants, and assessed the association of volumes of the whole brainstem and its main regions with blood pressure. We applied powerful statistical genetic tools, including bivariate causal mixture modeling (MiXeR) and conjunctional false discovery rate (conjFDR), to non-overlapping genome-wide association studies of brainstem volumes (n = 27,034) and blood pressure (n = 321,843) in the UK Biobank cohort. We observed negative associations between the whole brainstem and medulla oblongata volumes and systolic blood and pulse pressure, and positive relationships between midbrain and pons volumes and blood pressure traits when adjusting for the whole brainstem volume (all partial correlation coefficients ∣r∣ effects between 0.03 and 0.05, p ≤ 0.0042). We observed the largest genetic overlap for the whole brainstem, sharing 77% of its trait-influencing variants with blood pressure. We identified 65 shared loci between brainstem volumes and blood pressure traits and mapped these to 71 genes, implicating molecular pathways linked to sympathetic nervous system development, metal ion transport, and vascular homeostasis. The present findings support a link between brainstem structures and blood pressure and provide insights into their shared genetic underpinnings. The overlapping genetic architectures and mapped genes offer mechanistic information about the roles of brainstem regions in hypertension.

• Sandberg, Edvard Liljedahl; Halvorsen, Sigrun; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Grenne, Bjørnar Leangen [Vis alle 7 forfattere av denne artikkelen] (2024). Screening for Atrial Fibrillation by Digital Health Technology in Older People in Homecare Settings: A Feasibility Trial. International Journal of Telemedicine and Applications. ISSN 1687-6415. 2024(1). doi: 10.1155/2024/4080415. Fulltekst i vitenarkiv Vis sammendrag

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

• Navarese, Eliano Pio; Landi, Antonio; Oliva, Angelo; Piccolo, Raffaele; Aboyans, Victor & Angiolillo, Dominick [Vis alle 23 forfattere av denne artikkelen] (2023). Within and beyond 12-month efficacy and safety of antithrombotic strategies in patients with established coronary artery disease: two companion network meta-analyses of the 2022 joint clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), European Association for Acute CardioVascular Care (ACVC), and European Association of Preventive Cardiology (EAPC). European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 9(3), s. 271–290. doi: 10.1093/ehjcvp/pvad016. Fulltekst i vitenarkiv
• Knutsen, Thomas M; Skretteberg, Torger; Vanberg, Paul; Kamal, Ziaullah; Halvorsen, Sigrun & Liestøl, Knut [Vis alle 8 forfattere av denne artikkelen] (2023). Transvenous lead extractions in a single high-volume center over a 24-year period: High success rate and low complication rate. Heart Rhythm O2. 4(4), s. 232–240. doi: 10.1016/j.hroo.2023.01.003. Fulltekst i vitenarkiv Vis sammendrag

  Background Transvenous lead extraction (TLE) procedures can be complicated and are associated with a small but significant risk of cardiovascular complications. However, methods and tools vary among centers. Objective The purpose of this study was to the present the methods and results of pacemaker and implantable cardioverter-defibrillator TLE procedures in our center over a 24-year period. Methods From April 1997 through 2020, we attempted to extract 2964 leads in 1780 procedures and 1642 patients. We mainly utilized single sheath technique using snaring or mechanical rotational sheaths and steel sheaths when necessary. Difficult procedures were performed by an experienced cardiologist, and close supervision was emphasized. Most of the extractions were performed using local anesthesia with sedation. Results Median age of patients was 65.0 [interquartile range 20.00] years, and median dwelling time of leads was 5.0 [7.0] years. Clinical success was achieved in 1739 procedures (97.7%) and complete technical success in 2841 leads (95.8%). Clinical success (leaving <4 cm of the lead in the body and achieving the clinical goal for the patient) was achieved for 79 leads (2.7%). TLE failed in 44 leads (1.1%) and 41 procedures (2.3%) among 36 patients (2.2%). There were 23 cases (1.3%) of major complications, with only 1 death directly related to the procedure (<0.1%). In addition, 2 patients with sepsis died within the first 24 hours after the procedure. No caval tears occurred. Conclusion Single sheath lead extractions utilizing snaring or mechanical rotational sheaths were effective and safe in our high-volume center as performed by experienced operators.

• Valgimigli, Marco; Aboyans, Victor; Angiolillo, Dominick; Atar, Dan; Capodanno, Davide & Halvorsen, Sigrun [Vis alle 23 forfattere av denne artikkelen] (2023). Antithrombotic treatment strategies in patients with established coronary atherosclerotic disease. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 9(5), s. 462–496. doi: 10.1093/ehjcvp/pvad032. Fulltekst i vitenarkiv
• Vistisen, Dorte; Carstensen, Bendix; Elisabetta, Patorno; Lanzinger, Stefanie; Tan, Elise Chia-Hui & Yabe, Daisuke [Vis alle 29 forfattere av denne artikkelen] (2023). Empagliflozin is associated with lower cardiovascular risk compared with dipeptidyl peptidase-4 inhibitors in adults with and without cardiovascular disease: EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study results from Europe and Asia. Cardiovascular Diabetology. 22(1). doi: 10.1186/s12933-023-01963-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Studies that have reported lower risk for cardiovascular outcomes in users of Sodium–Glucose Cotransporter-2 Inhibitors (SGLT-2i) are limited by residual cofounding and lack of information on prior cardiovascular disease (CVD). This study compared risk of cardiovascular events in patients within routine care settings in Europe and Asia with type 2 diabetes (T2D) initiating empagliflozin compared to dipeptidyl peptidase-4 inhibitors (DPP-4i) stratified by pre-existing CVD and history of heart failure (HF). Methods and results Adults initiating empagliflozin and DPP-4i in 2014–2018/19 from 11 countries in Europe and Asia were compared using propensity score matching and Cox proportional hazards regression to assess differences in rates of primary outcomes: hospitalisation for heart failure (HHF), myocardial infarction (MI), stroke; and secondary outcomes: cardiovascular mortality (CVM), coronary revascularisation procedure, composite outcome including HHF or CVM, and 3-point major adverse cardiovascular events (MACE: MI, stroke and CVM). Country-specific results were meta-analysed and pooled hazard ratios (HR) with 95% confidence intervals (CI) from random-effects models are presented. In total, 85,244 empagliflozin/DPP4i PS-matched patient pairs were included with overall mean follow-up of 0.7 years. Among those with pre-existing CVD, lower risk was observed for HHF (HR 0.74; 95% CI 0.64–0.86), CVM (HR 0.55; 95% CI 0.38–0.80), HHF or CVM (HR 0.57; 95% CI 0.48–0.67) and stroke (HR 0.79; 95% CI 0.67–0.94) in patients initiating empagliflozin vs DPP-4i. Similar patterns were observed among patients without pre-existing CVD and those with and without pre-existing HF. Conclusion These results from diverse patient populations in routine care settings across Europe and Asia demonstrate that initiation of empagliflozin compared to DPP-4i results in favourable cardioprotective effects regardless of pre-existing CVD or HF status.

• Mehilli, Julinda & Halvorsen, Sigrun (2023). The '10 commandments' for the 2022 European Society of Cardiology guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal. ISSN 0195-668X. 44(5), s. 336–337. doi: 10.1093/eurheartj/ehac703. Fulltekst i vitenarkiv
• Karasik, Avraham; Lanzinger, Stefanie; Tan, Elise Chia-Hui; Yabe, Daisuke; Kim, Dae Jung & Sheu, Wayne H-H [Vis alle 28 forfattere av denne artikkelen] (2023). Empagliflozin cardiovascular and renal effectiveness and safety compared to dipeptidyl peptidase-4 inhibitors across 11 countries in Europe and Asia: Results from the EMPagliflozin compaRative effectIveness and SafEty (EMPRISE) study. Diabetes & Metabolism. ISSN 1262-3636. 49(2). doi: 10.1016/j.diabet.2022.101418. Fulltekst i vitenarkiv Vis sammendrag

  Background Continued expansion of indications for sodium-glucose cotransporter-2 inhibitors increases importance of evaluating cardiovascular and kidney efficacy and safety of empagliflozin in patients with type 2 diabetes compared to similar therapies. Methods The EMPRISE Europe and Asia study is a non-interventional cohort study using data from 2014–2019 in seven European (Denmark, Finland, Germany, Norway, Spain, Sweden, United Kingdom) and four Asian (Israel, Japan, South Korea, Taiwan) countries. Patients with type 2 diabetes initiating empagliflozin were 1:1 propensity score matched to patients initiating dipeptidyl peptidase-4 inhibitors. Primary endpoints included hospitalization for heart failure, all-cause mortality, myocardial infarction and stroke. Other cardiovascular, renal, and safety outcomes were examined. Findings Among 83,946 matched patient pairs, (0·7 years overall mean follow-up time), initiation of empagliflozin was associated with lower risk of hospitalization for heart failure compared to dipeptidyl peptidase-4 inhibitors (Hazard Ratio 0·70; 95% CI 0.60 to 0.83). Risks of all-cause mortality (0·55; 0·48 to 0·63), stroke (0·82; 0·71 to 0·96), and end-stage renal disease (0·43; 0·30 to 0·63) were lower and risk for myocardial infarction, bone fracture, severe hypoglycemia, and lower-limb amputation were similar between initiators of empagliflozin and dipeptidyl peptidase-4 inhibitors. Initiation of empagliflozin was associated with higher risk for diabetic ketoacidosis (1·97; 1·28 to 3·03) compared to dipeptidyl peptidase-4 inhibitors. Results were consistent across continents and regions. Interpretation Results from this EMPRISE Europe and Asia study complements previous clinical trials and real-world studies by providing further evidence of the beneficial cardiorenal effects and overall safety of empagliflozin compared to dipeptidyl peptidase-4 inhibitors.

• Kristensen, Anna Meta Dyrvig; Munkhaugen, John; Halvorsen, Sigrun; Olsen, Michael Hecht; Bakken, Arnhild & Sehested, Thomas Steen Gyldenstierne [Vis alle 12 forfattere av denne artikkelen] (2023). The Danish-Norwegian randomized trial on beta-blocker therapy after myocardial infarction: Design, rationale, and baseline characteristics. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 10(3), s. 175–183. doi: 10.1093/ehjcvp/pvad093. Fulltekst i vitenarkiv
• Vinter, Nicklas; Halminen, Olli; Lehto, Mika; Airaksinen, K. E. Juhani; Andersson, Tomas & Wändell, Per [Vis alle 12 forfattere av denne artikkelen] (2023). Geographical variation in persistence to oral anticoagulation therapy and clinical outcomes among patients with atrial fibrillation initiating therapy in Denmark, Sweden, Norway and Finland. Basic & Clinical Pharmacology & Toxicology. ISSN 1742-7835. doi: 10.1111/bcpt.13902. Fulltekst i vitenarkiv Vis sammendrag

  Aim To examine inter-national and regional variations in persistence of oral anticoagulation (OAC) therapy and incidence of clinical outcomes and mortality, among patients with incident atrial fibrillation (AF) in the Nordic countries. Methods We conducted a registry-based multinational cohort study of OAC-naïve patients diagnosed with AF that redeemed at least one prescription of OAC after AF in Denmark (N = 25 585), Sweden (N = 59 455), Norway (N = 40 046) and Finland (N = 22 415). Persistence was dispensing at least one prescription of OAC from Day 365 after the first prescription and 90 days forward. Results Persistence was 73.6% (95% confidence interval 73.0–74.1) in Denmark, 71.1% (70.7–71.4) in Sweden, 89.3% (88.2–90.1) in Norway and 68.6% (68.0–69.3) in Finland. One-year risk of ischemic stroke varied between 2.0% (1.8–2.1) in Norway and 1.5% (1.4–1.6) in Sweden and 1.5% (1.3–1.6) in Finland. One-year risk of major bleeding other than intracranial bleeding varied between 2.1% (1.9–2.2) in Norway and 5.9% (5.6–6.2) in Denmark. One-year mortality risk varied between 9.3% (8.9–9.6) in Denmark and 4.2% (4.0–4.4) in Norway. Conclusion In OAC-naïve patients with incident AF, persistence of OAC therapy and clinical outcomes vary across Denmark, Sweden, Norway and Finland. Initiation of real-time efforts are warranted to ensure uniform high-quality care across nations and regions.

• Andreotti, Felicita; Geisler, Tobias; Collet, Jean-Philippe; Gigante, Bruna; Gorog, Diana A. & Halvorsen, Sigrun [Vis alle 16 forfattere av denne artikkelen] (2023). Acute, periprocedural and longterm antithrombotic therapy in older adults 2022 Update by the ESC Working Group on Thrombosis. European Heart Journal. ISSN 0195-668X. 44(4), s. 262–279. doi: 10.1093/eurheartj/ehac515. Fulltekst i vitenarkiv
• Sandberg, Edvard Liljedahl; Halvorsen, Sigrun; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Fensli, Rune Werner [Vis alle 8 forfattere av denne artikkelen] (2023). Fully digital self-screening for atrial fibrillation with patch electrocardiogram. Europace. ISSN 1099-5129. 25(5). doi: 10.1093/europace/euad075. Fulltekst i vitenarkiv Vis sammendrag

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

• Engebretsen, Ingrid; Munkhaugen, John; Bugge, Christoffer; Halvorsen, Sigrun; Ødegaard, Kristina Malene & Støvring, Henrik [Vis alle 7 forfattere av denne artikkelen] (2022). Gaps and discontinuation of statin treatment in Norway: potential for optimizing management of lipid lowering drugs. European Heart Journal Open (EHJ Open). 2(6). doi: 10.1093/ehjopen/oeac070. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aims In clinical practice many patients do not reach the recommended treatment targets for LDL-cholesterol levels. We aimed to examine treatment patterns and adherence for patients on lipid lowering drugs in Norway to inform future strategies to improve therapies. Methods and results We obtained information on all dispensed statins, ezetimibe and PCSK9 inhibitors 2010-2019 from the Norwegian Prescription Database. Treatment gaps were assessed assuming patients take one tablet per day and was defined to occur if a patient did not refill a prescription when the previous one should have been depleted. Treatment was defined as discontinued when the preceding prescription would have been used and no new subsequent prescription was filled. The mean proportion of days covered (PDC) was calculated by aggregating the total number of tablets dispensed during each calendar year and dividing by 365. Patients >80 years were excluded. A considerable proportion of statin users in Norway had long treatment gaps or discontinuation in treatment. 19.6% of the patients had treatment gaps of 180 days or more, and 10.8% had gaps or greater than 365 days. Similar results were found for patients on antidiabetics and hypertensives. PDC ranged from 84.9% for simvastatin to 72.2% for ezetimibe (2019). The most common lipid lowering drugs in 2019 were atorvastatin, simvastatin and ezetimibe. Conclusion There is a great potential for improving drug adherence and optimizing lipid lowering therapy by switching to more effective statins in greater doses, and more Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation often add ezetimibe and PCSK9 inhibitors to treatment.

• Meer, Dennis van der; Gurholt, Tiril Pedersen; Sønderby, Ida Elken; Shadrin, Alexey; Hindley, Guy Frederick Lanyon & Rahman, Zillur [Vis alle 18 forfattere av denne artikkelen] (2022). The link between liver fat and cardiometabolic diseases is highlighted by genome-wide association study of MRI-derived measures of body composition. Communications Biology. 5(1). doi: 10.1038/s42003-022-04237-4. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Obesity and associated morbidities, metabolic associated fatty liver disease (MAFLD) included, constitute some of the largest public health threats worldwide. Body composition and related risk factors are known to be heritable and identification of their genetic determinants may aid in the development of better prevention and treatment strategies. Recently, large-scale whole-body MRI data has become available, providing more specific measures of body composition than anthropometrics such as body mass index. Here, we aimed to elucidate the genetic architecture of body composition, by conducting genome-wide association studies (GWAS) of these MRI-derived measures. We ran both univariate and multivariate GWAS on fourteen MRI-derived measurements of adipose and muscle tissue distribution, derived from scans from 33,588 White European UK Biobank participants (mean age of 64.5 years, 51.4% female). Through multivariate analysis, we discovered 100 loci with distributed effects across the body composition measures and 241 significant genes primarily involved in immune system functioning. Liver fat stood out, with a highly discoverable and oligogenic architecture and the strongest genetic associations. Comparison with 21 common cardiometabolic traits revealed both shared and specific genetic influences, with higher mean heritability for the MRI measures (h 2  = .25 vs. .13, p  = 1.8x10 −7 ). We found substantial genetic correlations between the body composition measures and a range of cardiometabolic diseases, with the strongest correlation between liver fat and type 2 diabetes (r g  = .49, p  = 2.7x10 −22 ). These findings show that MRI-derived body composition measures complement conventional body anthropometrics and other biomarkers of cardiometabolic health, highlighting the central role of liver fat, and improving our knowledge of the genetic architecture of body composition and related diseases.

• Ødegaard, Kristina Malene; Lirhus, Sandre Svatun; Melberg, Hans Olav; Hallen, Jonas & Halvorsen, Sigrun (2022). Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014–2020. ESC Heart Failure. doi: 10.1002/ehf2.14206. Fulltekst i vitenarkiv Vis sammendrag

  Aims - We aimed to study initiation, adherence, and long-term persistence to beta-blockers (BB), renin–angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) in a nationwide cohort of patients with heart failure (HF).<p> <p>Methods - Patients aged 18–80 years in Norway with a first diagnosis of HF from 2014 until 2020 that survived ≥30 days were identified from the Norwegian Patient Registry and linked to the Norwegian Prescription Database. We collected information about BB, RASi [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and angiotensin receptor-neprilysin inhibitors (ARNI)], and MRA. Dual HF therapy was defined as taking at least two out of three drug classes, whereas triple HF therapy was defined as taking all three. Initiation (time to initiation) and persistence (time to discontinuation using a grace period of 30 days) of HF drugs was calculated by the Kaplan–Meier method, followed to outcome of interest, death, or December 2020. One-year adherence was measured as proportion of days covered (PDC) using a cut-off at 80%. For adherence and persistence measurements, we allowed for maximum 60 days of stockpiling and switching within drug groups. We performed sensitivity analyses to test the robustness of our findings.<p> <p>Results - Out of 54 899 patients included in the cohort, 75%, 69%, and 21% initiated a BB, RASi, and MRA, respectively, whereas 13% did not receive any. Dual and triple HF therapy was prescribed to 61% and 16%, respectively. The proportion of adherent patients during the first year following initiation was 83%, 81%, 84%, and 61% for BB, RASi, ARNI, and MRA, whereas 42% and 5% were adherent to dual and triple HF therapy, respectively. From 2 to 5 years following initiation, persistence decreased from 58% to 38%, 57% to 37%, and 31% to 15% for BB, RASi, and MRA, respectively. Within the RASi group, persistence was higher for ARNI than for ACEI and ARB. There were no major changes in either initiation or adherence of the drug classes from 2014 to 2019, except for an increase in initiation and adherence of MRA.<p> <p>Conclusions - We found low adherence to dual and triple HF therapies in this nationwide cohort study of newly diagnosed HF patients. Efforts are needed to increase adherence and persistence to HF therapies into clinical practice, emphasizing maintenance of multiple drug therapies in patients with such an indication.

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

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

• Kemp, Berlinde von; Halvorsen, Sigrun & Nohria, Anju (2022). The new 2022 ESC Guidelines on Cardio-oncology and their impact on the Acute Cardiovascular Care Society. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 11(11), s. 844–849. doi: 10.1093/ehjacc/zuac129. Fulltekst i vitenarkiv
• Jortveit, Jarle; Pripp, Are Hugo; Langørgen, Jørund & Halvorsen, Sigrun (2022). Time trends in incidence, treatment, and outcome in acute myocardial infarction in Norway 2013-19. European Heart Journal Open (EHJ Open). 2(5), s. 1–10. doi: 10.1093/ehjopen/oeac052. Fulltekst i vitenarkiv Vis sammendrag

  Aims Acute myocardial infarction (AMI) is a common cause of morbidity and mortality. The aim of the present study was to assess time trends in the incidence, treatment, and outcome of AMI in a nationwide registry–based cohort of patients. Methods and results All patients with a first AMI registered in the Norwegian Myocardial Infarction Registry between 2013 and 2019 were included in this cohort study. The number of patients admitted to Norwegian hospitals with a first AMI decreased from 8933 in 2013 to 8383 in 2019. The proportion of patients with ST-elevation myocardial infarction (STEMI) was stable at 30% throughout the period, and the percentage of STEMI undergoing coronary angiography was stable at 87%. The proportion of patients with non-STEMI undergoing coronary angiography increased by 2.4% per year (95% confidence interval 1.6–3.3) from 58% in 2013 to 68% in 2019. More patients were discharged with secondary preventive medication at the end of study period. Age-adjusted 1-year mortality was reduced from 16.4% in 2013 to 15.1% in 2018. The changes over time were primarily seen in the oldest patient groups. Conclusion In the period 2013–19 in Norway, we found a reduction in hospitalizations due to a first AMI. Both the percentage of patients undergoing coronary angiography as well as the percentage discharged with recommended secondary preventive therapy increased during the period, and the age-adjusted 1-year mortality after AMI decreased. A national AMI register provides important information about trends in incidence, treatment, and outcome, and may improve adherence to guideline recommendations.

• Krychtiuk, Konstantin A.; Ahrens, Ingo; Drexel, Heinz; Halvorsen, Sigrun; Hassager, Christian & Huber, Kurt [Vis alle 17 forfattere av denne artikkelen] (2022). Acute LDL-C reduction post ACS: strike early and strike strong: from evidence to clinical practice. A clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 11(12), s. 939–949. doi: 10.1093/ehjacc/zuac123. Fulltekst i vitenarkiv
• Bahit, M. Cecilia; Vora, Amit N.; Li, Zhuokai; Wojdyla, Daniel M.; Thomas, Laine & Goodman, Shaun G. [Vis alle 18 forfattere av denne artikkelen] (2022). Apixaban or Warfarin and Aspirin or Placebo After Acute Coronary Syndrome or Percutaneous Coronary Intervention in Patients With Atrial Fibrillation and Prior Stroke: A Post Hoc Analysis From the AUGUSTUS Trial. JAMA cardiology. ISSN 2380-6583. 7(7), s. 682–689. doi: 10.1001/jamacardio.2022.1166. Fulltekst i vitenarkiv
• Gevaert, Sofie; Halvorsen, Sigrun; Sinnaeve, Peter; Sambola, Antonia; Gulati, Geeta & Lancellotti, Patrizio [Vis alle 14 forfattere av denne artikkelen] (2022). Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Clinical Consensus Statement of the Acute CardioVascular Care Association (ACVC) and the ESC council of Cardio-Oncology-part 2: acute heart failure, acute myocardial diseases, acute venous thromboembolic diseases, and acute arrhythmias. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 11(11), s. 865–874. doi: 10.1093/ehjacc/zuac107. Fulltekst i vitenarkiv
• Baigent, Colin; Windecker, Stephan; Andreini, Daniele; Arbelo, Elena; Barbato, Emanuele & Bartorelli, Antonio L. [Vis alle 67 forfattere av denne artikkelen] (2022). ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. European Heart Journal. ISSN 0195-668X. 43(11), s. 1059–1103. doi: 10.1093/eurheartj/ehab697. Fulltekst i vitenarkiv
• Edfors, Robert; Jernberg, Tomas; Lewinter, Christian; Blöndal, Mai; Eha, Jaan & Lõiveke, Piret [Vis alle 15 forfattere av denne artikkelen] (2022). Differences in characteristics, treatments and outcomes in patients with non-ST-elevation myocardial infarction: novel insights from four national European continuous real-world registries. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. 8(4), s. 429–436. doi: 10.1093/ehjqcco/qcab013. Fulltekst i vitenarkiv
• Baigent, Colin; Windecker, Stephan; Andreini, Daniele; Arbelo, Elena; Barbato, Emanuele & Bartorelli, Antonio L. [Vis alle 67 forfattere av denne artikkelen] (2022). European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1 - epidemiology, pathophysiology, and diagnosis. Cardiovascular Research (CVR). ISSN 0008-6363. 118(6), s. 1385–1412. doi: 10.1093/cvr/cvab342. Fulltekst i vitenarkiv
• Jortveit, Jarle; Sandberg, Edvard Liljedahl; Pripp, Are Hugo & Halvorsen, Sigrun (2022). Time trends in adherence to guideline recommendations for anticoagulation therapy in patients with atrial fibrillation and myocardial infarction. Open heart. 9(1). doi: 10.1136/openhrt-2021-001934. Fulltekst i vitenarkiv Vis sammendrag

  Background Poor adherence to guideline recommendations for anticoagulation in patients with acute myocardial infarction (MI) and atrial fibrillation (AF) is previously reported. The aim of the present cohort study was to assess time trends in prescription of anticoagulation therapy in a nationwide registry-based cohort of patients with acute MI and AF. Methods All patients, registered in the Norwegian Myocardial Infarction Registry (NORMI) between 2013 and 2019 with ECG-verified AF at hospitalisation, were included in the cohort study. The primary outcome was the prescription rate of anticoagulation therapy at hospital discharge and follow-up through 2019. Results AF was observed in 8565 (10.9% of 78369) patients registered in the NORMI from 2013 through 2019. The congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65–75, and sex (female) score was ≥2 in 7845 (92%) of the hospitalised patients with AF, and in 7174 (96%) of 7440 patients discharged alive. Only 3704 (47.2%) of these patients were treated with anticoagulation prior to the MI. The prescription rate of anticoagulation therapy at discharge was 55% in 2013, increasing to 78% in 2019 (annual per cent change 6.0 (95% CI 0.7 to 11.6)). Patients prescribed anticoagulation therapy had reduced risk of all types of stroke or death at follow-up compared with patients without prescription of anticoagulation therapy (multivariate-adjusted HR 0.8, 95% CI 0.7 to 0.8, p&lt;0.001). Conclusions The prescription rate of anticoagulation therapy in patients with MI and AF increased during the study period, but many patients were still undertreated with respect to stroke prevention.

• Hellgren, Tora; Blöndal, Mai; Jortveit, Jarle; Ferenci, Tamas; Faxen, Jonas & Lewinter, Christian [Vis alle 16 forfattere av denne artikkelen] (2022). Sex-related differences in the management and outcomes of patients hospitalized with ST-elevation myocardial infarction: a comparison within four European myocardial infarction registries. European Heart Journal Open (EHJ Open). 2(4), s. 1–10. doi: 10.1093/ehjopen/oeac042. Fulltekst i vitenarkiv Vis sammendrag

  Aims Data on how differences in risk factors, treatments, and outcomes differ between sexes in European countries are scarce. We aimed to study sex-related differences regarding baseline characteristics, in-hospital managements, and mortality of ST-elevation myocardial infarction (STEMI) patients in different European countries. Methods and results Patients over the age of 18 with STEMI who were treated in hospitals in 2014–17 and registered in one of the national myocardial infarction registers in Estonia (n = 5817), Hungary (n = 30 787), Norway (n = 33 054), and Sweden (n = 49 533) were included. Cardiovascular risk factors, hospital treatment, and recommendation of discharge medications were obtained from the infarction registries. The primary outcome was mortality, in-hospital, after 30 days and after 1 year. Logistic and cox regression models were used to study the associations of sex and outcomes in the respective countries. Women were older than men (70–78 and 62–68 years, respectively) and received coronary angiography, percutaneous coronary intervention, left ventricular ejection fraction assessment, and evidence-based drugs to a lesser extent than men, in all countries. The crude mortality in-hospital rates (10.9–15.9 and 6.5–8.9%, respectively) at 30 days (13.0–19.9 and 8.2–10.9%, respectively) and at 1 year (20.3–28.1 and 12.4–17.2%, respectively) after hospitalization were higher in women than in men. In all countries, the sex-specific differences in mortality were attenuated in the adjusted analysis for 1-year mortality. Conclusion Despite improved awareness of the sex-specific inequalities on managing patients with acute myocardial infarction in Europe, country-level data from this study show that women still receive less guideline-recommended management.

• Baigent, Colin; Windecker, Stephan; Andreini, Daniele; Arbelo, Elena; Barbato, Emanuele & Bartorelli, Antonio L. [Vis alle 67 forfattere av denne artikkelen] (2022). European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. European Heart Journal. ISSN 0195-668X. 43(11), s. 1033–1058. doi: 10.1093/eurheartj/ehab696. Fulltekst i vitenarkiv
• Vahanian, Alec; Beyersdorf, Friedhelm; Praz, Fabien; Milojevic, Milan; Baldus, Stephan & Bauersachs, Johann [Vis alle 131 forfattere av denne artikkelen] (2022). 2021 ESC/EACTS Guidelines for the management of valvular heart disease. European Heart Journal. ISSN 0195-668X. 43(7), s. 561–632. doi: 10.1093/eurheartj/ehab395. Fulltekst i vitenarkiv
• Blöndal, Mai; Ainla, Tiia; Eha, Jaan; Lõiveke, Piret; Marandi, Toomas & Saar, Aet [Vis alle 17 forfattere av denne artikkelen] (2022). Comparison of management and outcomes of ST-segment elevation myocardial infarction patients in Estonia, Hungary, Norway, and Sweden according to national ongoing registries. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. 8(3), s. 307–314. doi: 10.1093/ehjqcco/qcaa098. Fulltekst i vitenarkiv
• Kluge, Karsten Engseth; Seljeflot, Ingebjørg; Arnesen, Harald; Jensen, Torstein; Halvorsen, Sigrun & Helseth, Ragnhild (2022). Coagulation factors XI and XII as possible targets for anticoagulant therapy. Thrombosis Research. ISSN 0049-3848. 214, s. 53–62. doi: 10.1016/j.thromres.2022.04.013. Fulltekst i vitenarkiv
• Kvakkestad, Kristin Marie; Gran, Jon Michael & Halvorsen, Sigrun (2022). Short-and long-term survival after ST-elevation myocardial infarction treated with pharmacoinvasive versus primary percutaneous coronary intervention strategy: a prospective cohort study. BMJ Open. 12(7). doi: 10.1136/bmjopen-2022-061590. Fulltekst i vitenarkiv Vis sammendrag

  Objective Compare survival in patients with ST-elevation myocardial infarction (STEMI) treated with a pharmacoinvasive (PI) or primary percutaneous coronary intervention (pPCI) strategy based on estimated time to PCI. Design Prospective observational cohort study. Consecutive STEMI patients were registered on admission to our PCI centre and classified in a PI or pPCI group, based on the reperfusion strategy chosen in the prehospital or local hospital location. Time and cause of death was provided by the Norwegian Cause of Death registry. Mortality at 30 days, Kaplan-Meier survival and incidence of cardiovascular (CV) death was estimated. Adjusted effect of PI versus pPCI strategy on survival was estimated using logistic and Cox regression and propensity score weighting. Setting Single-centre registry in Norway during 2005–2011, within a regional STEMI network allocating patients to a PI strategy if estimated time to PCI >120 min. Primary outcomes 30-day mortality and survival during follow-up. Secondary outcome Incidence of CV death during follow-up. Results 4061 STEMI patients <80 years were included, 527 (13%) treated with a PI strategy and 3534 (87%) with a pPCI strategy. Median symptom-to-needle time was 110 min (25–75th percentile 75–163) in the PI group vs symptom-to-balloon 230 min (149–435) in the pPCI group. 30-day mortality was 3.2% and 5.0% in the PI and pPCI groups (ORadjusted0.58 (95% CI 0.30 to 1.13)) and 8-year survival was 85.9% (95% CI 80.9% to 89.6%) and 79.3% (95% CI 76.9% to 81.6%), respectively (HRadjusted 0.72 (95% CI 0.53 to 0.99)). Unadjusted incidence of 8-year CV death was 7.0% (95% CI 4.4% to 10.4%) in the PI group vs 12.4% (95% CI 9.9% to 15.2%) in the pPCI group. Adjusted long-term CV death was also lower in the PI group. Conclusion STEMI patients treated with a PI strategy experienced better survival compared with a pPCI strategy, also when adjusting for baseline characteristics. This supports using a PI strategy for eligible STEMI patients when pPCI cannot be performed within 120 min.

• Ødegaard, Kristina Malene; Lirhus, Sandre Svatun; Melberg, Hans Olav; Hallen, Jonas & Halvorsen, Sigrun (2022). A nationwide registry study on heart failure in Norway from 2008 to 2018: variations in lookback period affect incidence estimates. BMC Cardiovascular Disorders. 22(1). doi: 10.1186/s12872-022-02522-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: The incidence of heart failure (HF) has declined in Europe during the past two decades. However, incidence estimates from registry-based studies may vary, partly because they depend on retrospective searches to exclude previous events. The aim of this study was to assess to what extent diferent lookback periods (LPs) afect temporal trends in incidence, and to identify the minimal acceptable LP. Further, we wanted to estimate temporal trends in incidence and prevalence of HF in a nationwide population, using the minimal acceptable LP.<p> <p>Methods: We identifed all in- and out-patient contacts for HF in Norway during 2008 to 2018 from the Norwegian Patient Registry. To calculate the infuence of varying LP on incident cases, we defned 2018 with 10 years of LP as a reference and calculated the relative diference by using one through 9 years of lookback. Temporal trends in incidence rates were estimated with sensitivity analyses applying varying LPs and diferent case defnitions. Standardised incidence rates and prevalence were calculated by applying direct age- and sex-standardization to the 2013 European Standard Population. <p>Results: The overestimation of incident cases declined with increasing number of years included in the LP. Compared to a 10-year LP, application of 4, 6, and 8 years resulted in an overestimation of incident cases by 13.5%, 6.2% and 2.3%, respectively. Temporal trends in incidence were afected by the number of years in the LP and whether the LP was fxed or varied. Including all available data mislead to conclusions of declining incidence rates over time due to increasing LPs. <p>Conclusions: When taking the number of years with available data and HF mortality and morbidity into consideration, we propose that 6 years of fxed lookback is sufcient for identifcation of incident HF cases. HF incidence rates and prevalence increased from 2014 to 2018.

• Welsh, Robert C.; Dehghani, Payam; Lopes, Renato; Wojdyla, Daniel M; Aronson, Ronald & Granger, Christopher B [Vis alle 14 forfattere av denne artikkelen] (2022). Impact of prior oral anticoagulant use and outcomes on patients from secondary analysis in the AUGUSTUS trial. Open heart. 9(1). doi: 10.1136/openhrt-2021-001892. Fulltekst i vitenarkiv Vis sammendrag

  Objective Managing antithrombotic therapy in patients with atrial fibrillation (AF) and an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) is challenging and can be affected by prior oral anticoagulant (OAC) treatment. We examined the relationship between prior OAC use and outcomes in the AUGUSTUS trial. Methods This prespecified secondary analysis is from AUGUSTUS, an open-label, 2-by-2 factorial, RCT to evaluate the safety of apixaban versus vitamin K antagonist (VKA) and aspirin versus placebo in patients with AF and ACS and/or PCI. The primary endpoint, major or clinically relevant non-major bleeding and clinical outcomes were compared in patients receiving (n=2262) or not receiving (n=2352) an OAC prior to enrolment. Results Patients with prior OAC use had more comorbidities, higher CHA2DS2-VASC and HAS-BLED scores, and were more likely enrolled following elective PCI. There was no difference in major or clinically relevant non-major bleeding with or without prior OAC (30 days: 5.1% vs 5.9% (adjusted HR (aHR) 0.82, 95% CI 0.63 to 1.06); 180 days: 13.5% vs 13.5% (aHR 0.98, 95% CI 0.83 to 1.16)). Patients with prior OAC use had a lower risk of death or ischaemic events (30 days: 1.7% vs 2.8% (aHR 0.61, 95% CI 0.41 to 0.92); 180 days: 5.4% vs 7.6% (aHR 0.70, 95% CI 0.55 to 0.88)). No interactions between randomised treatment (apixaban vs VKA, aspirin vs placebo) and prior OAC status were observed for outcomes, apart from apixaban (vs VKA) being associated with a lower risk of myocardial infarction with prior OAC use (180 days: 2.0% vs 3.7% (aHR 0.56, 95% CI 0.33 to 0.91(). Conclusions In AUGUSTUS, prior OAC use was associated with fewer ischaemic events but not more bleeding. In patients with AF and ACS and/or undergoing PCI, clinicians can be assured that the trial results can be applied to patients regardless of their prior OAC status.

• Visseren, Frank L.J.; Mach, Francois; Smulders, Yvo M.; Carballo, David; Koskinas, Konstantinos C. & Back, Maria [Vis alle 30 forfattere av denne artikkelen] (2022). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 29(1), s. 5–115. doi: 10.1093/eurjpc/zwab154. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2022). Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08697-6. Fulltekst i vitenarkiv Vis sammendrag

  Aims: Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods: A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results: Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion: Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.

• Kluge, Karsten Engseth; Langseth, Miriam Sjåstad; Andersen, Geir Øystein; Halvorsen, Sigrun; Opstad, Trine Baur & Arnesen, Harald [Vis alle 9 forfattere av denne artikkelen] (2022). Complement activation in association with clinical outcomes in ST-elevation myocardial infarction. American Heart Journal Plus: Cardiology Research and Practice (AHJ Plus). 24. doi: 10.1016/j.ahjo.2022.100228. Fulltekst i vitenarkiv Vis sammendrag

  Introduction The complement system and neutrophil extracellular traps (NETs) might contribute to ischemia-reperfusion injury in ST-elevation myocardial infarction (STEMI). We aimed to estimate associations between complement activation and NETs in STEMI, and their prognostic value on clinical endpoints. Methods In this cohort study, 864 patients admitted for PCI during STEMI were included. Complement activation was analyzed by the terminal complement complex (TCC), while NETs were analyzed by myeloperoxidase-DNA, citrullinated histone 3 (CitH3) and dsDNA. The composite endpoint was reinfarction, unscheduled revascularization, stroke, hospitalization due to heart failure, or death, and the secondary endpoint was total mortality. The association between TCC and clinical endpoints was assessed by Cox regression and ROC curve analysis. Results TCC was weakly correlated to dsDNA (r = 0.127, p < 0.001) and CitH3 (r = 0.102, p = 0.003). After a median follow-up time of 4.6 years, 184 (21.3 %) patients had reached a clinical endpoint. TCC was not associated with the composite endpoint, but with total mortality (HR: 1.673, 95 % CI: [1.014, 2.761], p = 0.044). The significant association was lost when adjusting for CRP, NT-proBNP, LVEF and time from symptoms to PCI. In ROC curve analysis of total mortality, the AUC for TCC alone was 0.549 (95 % CI: [0.472, 0.625]), AUC for dsDNA alone was 0.653 (95 % CI: [0.579, 0.720]), while AUC for TCC and dsDNA combined was 0.660 (95 % CI: [0.590, 0.730]). Conclusions In this STEMI cohort, TCC was not associated with the composite endpoint, but somewhat with total mortality. Combining TCC and dsDNA did not increase the prognostic value compared to dsDNA alone.

• Halvorsen, Sigrun; Smith, Jørgen Anton; Söderdahl, Fabian; Thuresson, Marcus; Solli, Oddvar & Ulvestad, Maria [Vis alle 7 forfattere av denne artikkelen] (2022). Changes in primary care management of atrial fibrillation patients following the shift from warfarin to non-vitamin K antagonist oral anticoagulants: a Norwegian population based study. BMC Primary Care. 23(1). doi: 10.1186/s12875-022-01824-6. Fulltekst i vitenarkiv Vis sammendrag

  Background To assess baseline characteristics, drug utilisation and healthcare use for oral anticoagulants (OACs) following the introduction of non-vitamin K antagonist oral anticoagulants among patients with atrial fibrillation in primary care in Norway. Methods In this retrospective longitudinal cohort study, 92,936 patients with atrial fibrillation were identified from the Norwegian Primary Care Registry between 2010 and 2018. Linking to the Norwegian Prescription Database, we identified 64,112 patients (69.0%) treated with OACs and 28,824 (31%) who were untreated. Participants were followed until 15 May 2019, death, or loss to follow-up, whichever came first. For each OAC, predictors of initiation were assessed by modelling the probability of initiating the OAC using logistic regression, and predictors of the first switch after index date were assessed using multivariable Cox proportional hazards models. The numbers of primary care visits per quarter by index OAC were plotted and analysed with negative binomial regression analyses offset for the log of days at risk. Results Patients treated with OACs were older, had more comorbidities, and higher CHA2DS2-VASc scores than untreated patients. However, the mean CHA2DS2-VASc in the non-OAC group was 1.58 for men and 3.13 for women, suggesting an indication for OAC therapy. The percentage of patients with atrial fibrillation initiating OACs increased from 59% in 2010 to 79% in 2018. Non-vitamin K antagonist oral anticoagulant use increased throughout the study period to 95% of new OAC-treated patients in 2018, and switches from warfarin to non-vitamin K antagonist oral anticoagulants were common. The persistence of OAC treatment was > 60% after four years, with greatest persistence for apixaban. Patients treated with non-vitamin K antagonist oral anticoagulants had fewer primary care visits compared with those treated with warfarin (incidence rate ratio: 0.73, 95% confidence interval 0.71 to 0.75). Conclusion In this Norwegian primary care study, we found that the shift from warfarin to non-vitamin K antagonist oral anticoagulants was successful with 95% use in patients initiating OACs in 2018, and associated with fewer general practitioner visits. Persistence with OACs was high, particularly for apixaban. However, many patients eligible for treatment with OACs remained untreated.

• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan & Vallersnes, Odd Martin (2022). Performance of the Novel Observation Group Criteria of the European Society of Cardiology (ESC) 0/1-Hour Algorithm in a Low-Risk Population. Journal of the American Heart Association (JAHA). 11(7). doi: 10.1161/JAHA.121.024927. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Mehilli, Julinda; Cassese, Salvatore; Hall, Trygve Sørdahl; Schirmer, Henrik & Atar, Dan [Vis alle 7 forfattere av denne artikkelen] (2022). 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. European Heart Journal. ISSN 0195-668X. doi: 10.1093/eurheartj/ehac270. Fulltekst i vitenarkiv
• Gencer, Baris; Gale, Chris P; Aktaa, Suleman; Halvorsen, Sigrun; Beska, Ben & Abdelhamid, Magdy [Vis alle 16 forfattere av denne artikkelen] (2022). European Society of Cardiology quality indicators for the cardiovascular pre-operative assessment and management of patients considered for non-cardiac surgery. Developed in collaboration with the European Society of Anaesthesiology and Intensive Care. European Heart Journal - Quality of Care and Clinical Outcomes. ISSN 2058-5225. 9(4), s. 331–341. doi: 10.1093/ehjqcco/qcac057. Fulltekst i vitenarkiv
• Halvorsen, Sigrun (2021). Evaluation and management of cancer patients presenting with acute cardiovascular disease: a Consensus Document of the Acute CardioVascular Care (ACVC) association and the ESC council of Cardio-Oncology-Part 1: acute coronary syndromes and acute pericardial diseases. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 10(8), s. 947–959. doi: 10.1093/ehjacc/zuab056. Fulltekst i vitenarkiv
• Krychtiuk, Konstantin A.; Speidl, Walter S.; Giannitsis, Evangelos; Gigante, Bruna; Gorog, Diana A. & Jaffe, Allan S. [Vis alle 18 forfattere av denne artikkelen] (2021). Biomarkers of coagulation and fibrinolysis in acute myocardial infarction: A joint position paper of the Association for Acute CardioVascular Care and the European Society of Cardiology Working Group on Thrombosis. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 10(3), s. 343–355. doi: 10.1093/ehjacc/zuaa025. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Johnsen, Søren P.; Madsen, Morten; Linder, Marie; Sulo, Gerhard & Ghanima, Waleed [Vis alle 12 forfattere av denne artikkelen] (2021). Effectiveness and safety of non-vitamin K antagonist oral anticoagulants and warfarin in atrial fibrillation: a Scandinavian population-based cohort study. European Heart Journal. ISSN 0195-668X. 8(5), s. 577–587. doi: 10.1093/ehjqcco/qcab048. Fulltekst i vitenarkiv Vis sammendrag

  Aims Using Scandinavian population-based registries, we assessed risk of stroke/systemic embolism (SE) and bleeding with non-vitamin K antagonist oral anticoagulants compared with warfarin in anticoagulation-naïve patients with atrial fibrillation (AF). Methods and results This historical cohort study included 219 545 AF patients [median age 74 years; 43% women; mean CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischaemic attack, vascular disease, age 65–74 years, sex category) score 3.3] initiating apixaban, dabigatran, rivaroxaban, or warfarin in Denmark, Norway, and Sweden (1 January 2013 to 31 December 2016). The primary endpoints were stroke/SE and major bleeding. The median follow-up times were 9.7 (3.9–21.5) months for stroke/SE and 9.6 (3.8–21.3) months for bleeding. Apixaban and warfarin initiators were older and had higher CHA2DS2-VASc scores compared with dabigatran and rivaroxaban initiators. After 1:1 propensity score matching, three cohorts were created: apixaban–warfarin (n = 111 162), dabigatran–warfarin (n = 56 856), and rivaroxaban–warfarin (n = 61 198). Adjusted hazard ratios (HRs) were estimated using a Cox regression. For stroke/SE, adjusted HRs against warfarin were 0.96 [95% confidence interval (CI): 0.87–1.06] for apixaban, 0.89 (95% CI: 0.80–1.00) for dabigatran, and 1.03 (95% CI: 0.92–1.14) for rivaroxaban. For major bleeding, the HRs against warfarin were 0.73 (95% CI: 0.67–0.78) for apixaban, 0.89 (95% CI: 0.82–0.97) for dabigatran, and 1.15 (95% CI: 1.07–1.25) for rivaroxaban. The results in the dabigatran cohort did not hold in all dose-defined subgroups. Conclusion In this large Scandinavian study among AF patients initiating oral anticoagulation, those initiating dabigatran, apixaban, and rivaroxaban had similar rates of stroke/SE to patients initiating warfarin. Rates of major bleeding were lower with apixaban and dabigatran and higher with rivaroxaban, each compared with warfarin.

• Schiele, François; Aktaa, Suleman; Rossello, Xavier; Ahrens, Ingo; Claeys, Marc J & Collet, Jean-Philippe [Vis alle 30 forfattere av denne artikkelen] (2021). 2020 Update of the quality indicators for acute myocardial infarction: A position paper of the Association for Acute Cardiovascular Care: The study group for quality indicators from the ACVC and the NSTE-ACS guideline group. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 10(2), s. 224–233. doi: 10.1093/ehjacc/zuaa037. Fulltekst i vitenarkiv
• Rutherford, Ole-Christian Walter; Jonasson, Christian; Ghanima, Waleed; Söderdahl, Fabian & Halvorsen, Sigrun (2021). Effectiveness and safety of oral anticoagulants in elderly patients with atrial fibrillation. Heart. ISSN 1355-6037. s. 1–8. doi: 10.1136/heartjnl-2020-318753. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To assess the risk of stroke/systemic embolism (SE) and major bleeding associated with the use of oral anticoagulants in elderly patients with atrial fibrillation (AF) in a real-world population. Methods We identified all anticoagulant-naive initiators of warfarin, dabigatran, rivaroxaban and apixaban for the indication AF in Norway between January 2013 and December 2017. Multivariate competing risk regression was used to calculate subhazard ratios (SHRs) describing associations between non-vitamin K antagonist oral anticoagulants (NOACs) compared with warfarin for risk of stroke/SE and major bleeding. Results Among 30 401 patients ≥75 years identified (median age 82 years, 53% women, mean CHA2DS2-VaSc score 4.5), 3857 initiated dabigatran, 6108 rivaroxaban, 13 786 apixaban and 6650 warfarin. Reduced dose was initiated in 11 559 (49%) of the NOAC-treated patients. For stroke, the SHRs for standard dose NOAC against warfarin were 0.80 (95% CI 0.57 to 1.13) for dabigatran; 1.07 (95% CI 0.89 to 1.30) for rivaroxaban and 0.95 (95% CI 0.78 to 1.15) for apixaban. For major bleeding, the SHRs against warfarin were 0.75 (95% CI 0.52 to 1.08) for dabigatran; 0.96 (95% CI 0.78 to 1.16) for rivaroxaban and 0.74 (95% CI 0.60 to 0.91) for apixaban. Comparing reduced doses of NOACs with warfarin yielded similar results. Sensitivity analyses were in accordance with the main results. Conclusion In this nationwide cohort study of patients ≥75 years initiating oral anticoagulation for AF, standard and reduced dose NOACs were associated with similar risks of stroke/SE as warfarin and lower or similar risks of bleeding. The NOACs seem to be a safe option also in elderly patients.

• Visseren, Frank; Mach, Francois; Smulders, Yvo M.; Carballo, David; Koskinas, Konstantinos C. & Bäck, Maria [Vis alle 32 forfattere av denne artikkelen] (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal. ISSN 0195-668X. 42(34), s. 3227–3337. doi: 10.1093/eurheartj/ehab484. Fulltekst i vitenarkiv
• Peterson, Benjamin E.; Bhatt, Deepak L.; Steg, Ph. Gabriel; Oldgren, Jonas; Maeng, Michael & Zeymer, Uwe [Vis alle 15 forfattere av denne artikkelen] (2021). Evaluation of Dual Versus Triple Therapy by Landmark Analysis in the RE-DUAL PCI Trial. JACC: Cardiovascular Interventions. ISSN 1936-8798. 14(7), s. 768–780. doi: 10.1016/j.jcin.2021.02.022. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The aim of this study was to explore the early versus late benefits and risks of dabigatran dual therapy versus warfarin triple therapy in the RE-DUAL PCI (Randomized Evaluation of Dual Antithrombotic Therapy With Dabigatran Versus Triple Therapy With Warfarin in Patients With Nonvalvular Atrial Fibrillation Undergoing Percutaneous Coronary Intervention) trial. Background Patients with atrial fibrillation who undergo percutaneous coronary intervention are at increased risk for both bleeding and thrombotic events. Methods A total of 2,725 patients with atrial fibrillation underwent percutaneous coronary intervention and were randomized to receive dabigatran 110 mg, or dabigatran 150 mg plus a P2Y12 inhibitor (and no aspirin), or warfarin plus a P2Y12 inhibitor plus aspirin. Landmark analysis was performed at 30 and 90 days. Results There was a consistent and large reduction in major or clinically relevant nonmajor bleeding in patients randomized to dual therapy during the first 30 days (110 mg: hazard ratio [HR]: 0.45; 95% confidence interval [CI]: 0.31 to 0.66; p < 0.0001; 150 mg: HR: 0.46; 95% CI: 0.30 to 0.72; p = 0.0006) compared with warfarin triple therapy. There was early net clinical benefit in both dabigatran groups versus warfarin (110 mg: HR: 0.65; 95% CI: 0.47 to 0.88; p = 0.0062; 150 mg: HR: 0.54; 95% CI: 0.37 to 0.79; p = 0.0015), due to larger reductions in bleeding than increased thrombotic events for dabigatran 110 mg and bleeding reduction without increased thrombotic risk for dabigatran 150 mg dual therapy versus warfarin triple therapy. After the removal of aspirin in the warfarin group, bleeding remained lower with dabigatran 110 mg and was similar with dabigatran 150 mg versus warfarin. Conclusions In RE-DUAL PCI, in which patients in the dual-therapy arms were treated with aspirin for an average of only 1.6 days, there was early net clinical benefit with both doses of dabigatran dual therapy, without an increase in thrombotic events with dabigatran 150 mg. This could be helpful in the subset of patients with elevated risk for both bleeding and thrombotic events.

• Gorog, DIana A; Price, Susanna; Sibbing, Dirk; Baumbach, Andreas; Capodanno, Davide & Gigante, Bruna [Vis alle 16 forfattere av denne artikkelen] (2021). Antithrombotic therapy in patients with acute coronary syndrome complicated by cardiogenic shock or out-of-hospital cardiac arrest: A joint position paper from the European Society of Cardiology (ESC) Working Group on Thrombosis, in association with the Acute Cardiovascular Care Association (ACCA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI). European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 7(2), s. 125–140. doi: 10.1093/ehjcvp/pvaa009. Fulltekst i vitenarkiv
• Hijazi, Ziad; Alexander, John H.; Li, Zhuokai; Wojdyla, Daniel M.; Mehran, Roxana & Granger, Christopher B. [Vis alle 17 forfattere av denne artikkelen] (2021). Apixaban or Vitamin K Antagonists and Aspirin or Placebo According to Kidney Function in Patients with Atrial Fibrillation after Acute Coronary Syndrome or Percutaneous Coronary Intervention: Insights from the AUGUSTUS Trial. Circulation. ISSN 0009-7322. 143(12), s. 1215–1223. doi: 10.1161/CIRCULATIONAHA.120.051020. Fulltekst i vitenarkiv
• Sandberg, Edvard Liljedahl; Grenne, Bjørnar; Berge, Trygve; Grimsmo, Jostein; Atar, Dan & Halvorsen, Sigrun [Vis alle 8 forfattere av denne artikkelen] (2021). Diagnostic Accuracy and Usability of the ECG247 Smart Heart Sensor Compared to Conventional Holter Technology. Journal of Healthcare Engineering. ISSN 2040-2295. 2021. doi: 10.1155/2021/5230947. Fulltekst i vitenarkiv Vis sammendrag

  Background. Heart rhythm disorders, especially atrial fibrillation (AF), are increasing global health challenges. Conventional diagnostic tools for assessment of rhythm disorders suffer from limited availability, limited test duration time, and usability challenges. There is also a need for out-of-hospital investigation of arrhythmias. Therefore, the Norwegian ECG247 Smart Heart Sensor has been developed to simplify the assessment of heart rhythm disorders. The current study aimed to evaluate the diagnostic accuracy and usability of the ECG247 Smart Heart Sensor compared to conventional Holter monitors. Methods. Parallel tests with ECG247 Smart Heart Sensor and a Holter monitor were performed in 151 consecutive patients referred for out-of-hospital long-term ECG recording at Sorlandet Hospital Arendal, Norway. All ECG data were automatically analysed by both systems and evaluated by hospital physicians. Participants were asked to complete a questionnaire scoring usability parameters after the test. Results. A total of 150 patients (62% men, age 54 (±17) years) completed the study. The ECG quality from both monitors was considered satisfactory for rhythm analysis in all patients. AF was identified in 9 (6%) patients during the period with parallel tests. The diagnostic accuracy for automatic AF detection was 95% (95% CI 91–98) for the ECG247 Smart Heart Sensor and 81% (95% CI 74–87) for the Holter system. The proportion of false-positive AF was 4% in tests analysed by the ECG247 algorithm and 16% in tests analysed by the Holter algorithm. Other arrhythmias were absent/rare. The system usability score was significantly better for ECG247 Smart Heart Sensor compared to traditional Holter technology (score 87.4 vs. 67.5, ). Conclusions. The ECG247 Smart Heart Sensor showed at least comparable diagnostic accuracy for AF and improved usability compared to conventional Holter technology. ECG247 allows for prolonged monitoring and may improve detection of AF. Trial reg: https://clinicaltrials.gov/ct2/show/NCT04700865.

• Awoyemi, Ayodeji Olawale; Mayerhofer, Christiane Caroline; Felix, Alex S.; Hov, Johannes Espolin Roksund; Moscavitch, Samuel D. & Lappegård, Knut Tore [Vis alle 23 forfattere av denne artikkelen] (2021). Rifaximin or Saccharomyces boulardii in heart failure with reduced ejection fraction: Results from the randomized GutHeart trial. EBioMedicine. 70. doi: 10.1016/j.ebiom.2021.103511. Fulltekst i vitenarkiv Vis sammendrag

  Background The gut microbiota represents a potential treatment target in heart failure (HF) through microbial metabolites such as trimethylamine N-oxide (TMAO) and systemic inflammation. Treatment with the probiotic yeast Saccharomyces boulardii have been suggested to improve left ventricular ejection fraction (LVEF). Methods In a multicentre, prospective randomized open label, blinded end-point trial, we randomized patients with LVEF <40% and New York Heart Association functional class II or III, despite optimal medical therapy, to treatment (1:1:1) with the probiotic yeast Saccharomyces boulardii, the antibiotic rifaximin, or standard of care (SoC) only. The primary endpoint, the baseline-adjusted LVEF at three months, was assessed in an intention-to-treat analysis. Findings We enrolled a total of 151 patients. After three months’ treatment, the LVEF did not differ significantly between the SoC arm and the rifaximin arm (mean difference was -1•2 percentage points; 95% CI -3•2 - 0•7; p=0•22) or between the SoC arm and the Saccharomyces boulardii arm (mean difference -0•2 percentage points; 95% CI -2•2 - 1•9; p=0•87). We observed no significant between-group differences in changes in microbiota diversity, TMAO, or C-reactive protein. Interpretation Three months’ treatment with Saccharomyces boulardii or rifaximin on top of SoC had no significant effect on LVEF, microbiota diversity, or the measured biomarkers in our population with HF.

• Ghanima, Waleed Khalid; Schultze, Anna; Donaldson, Robert; Brodin, Ellen Elisabeth; Halvorsen, Sigrun & Graham, Sophie [Vis alle 9 forfattere av denne artikkelen] (2021). Oral Anticoagulation Therapy for Venous Thromboembolism in Norway: Time Trends and Treatment Patterns. Clinical Therapeutics. ISSN 0149-2918. 43(7), s. 1179–1190.e3. doi: 10.1016/j.clinthera.2021.04.017. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Data describing treatment patterns of patients with venous thromboembolism (VTE) patients in Scandinavia are scarce. This study sought to address this scarcity by describing demographic and clinical characteristics, trends in the use of oral anticoagulants (OACs), and treatment patterns in patients treated for VTE in Norway between 2013 and 2017. Methods Using data from Norway's nationwide registries, a cohort study included patients newly (after 2008) treated OACs who were diagnosed with VTE between January 2013 and December 2017 and were dispensed an OAC (warfarin, apixaban, rivaroxaban, dabigatran, or edoxaban) within 30 days. Patient characteristics and the percentage of patients with VTE who initiated treatment with each OAC for each calendar year were reported. Initial therapy persistence was assessed using Kaplan-Meier curves and compared between the OAC groups using the log-rank test. Findings The comorbidity burden was similar between patients taking warfarin and those taking apixaban but lower among patients taking rivaroxaban. Direct oral anticoagulant (DOAC) use increased from 33.2% to 93.6% during the study period, whereas warfarin use decreased. Persistence was higher in the apixaban cohort compared with the warfarin cohort, with the difference mostly apparent after 6 months, whereas persistence was similar between the patients taking rivaroxaban and those taking warfarin. Implications Between 2013 and 2017, DOAC use among patients with VTEs increased markedly in Norway, whereas the use of warfarin decreased. Patients taking apixaban had higher persistence compared with those taking warfarin, whereas patients taking warfarin and those taking rivaroxaban had similar persistence. Further studies with longer follow-up are required to examine the use of extended OAC treatment for VTE.

• Chieffo, Alaide; Dudek, Dariusz; Hassager, Christian; Combes, Alain; Gramegna, Mario & Halvorsen, Sigrun [Vis alle 19 forfattere av denne artikkelen] (2021). Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. EuroIntervention. ISSN 1774-024X. 17(4), s. E274–E286. doi: 10.4244/EIJY21M05_01. Fulltekst i vitenarkiv
• RØNNING, PÅL ANDRE; Helseth, Eirik; Skaansar, Ola Fougner; Tverdal, Cathrine Buaas; Andelic, Nada & Bhatnagar, Rahul [Vis alle 11 forfattere av denne artikkelen] (2021). Impact of Preinjury Antithrombotic Therapy on 30-Day Mortality in Older Patients Hospitalized With Traumatic Brain Injury (TBI). Frontiers in Neurology. doi: 10.3389/fneur.2021.650695. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Elderly patients are frequently in need of antithrombotic therapy for reducing thrombotic events. The association between antithrombotic drugs and survival after traumatic brain injury (TBI) is, nevertheless, unclear. Methods: This retrospective study included patients ≥65 years admitted to a Norwegian Level 1 trauma center with TBI identified on cerebral computed tomography (cerebral-CT) during 2014–2019. Preinjury use of antiplatelets and anticoagulants was compared to the prescription rate in the general Norwegian population. The primary outcome was 30-day mortality. Uni- and multivariate logistic regression analyses estimated the association between the use of antithrombotic drugs and mortality. Results: The study includes 832 consecutive TBI patients ≥65 years. The median age was 76 years, 58% were males, 51% had moderate or severe TBI, and 39% had multiple traumas. Preinjury use of antithrombotics was registered in 471/832 (55.6%) patients; antiplatelet therapy alone in 268, anticoagulant therapy alone in 172, and combined antiplatelet and anticoagulant therapy in 31. Antiplatelet use did not differ between the study cohort and the general Norwegian population ≥65 years (31 vs. 31%, p = 0.87). Anticoagulant therapy was used more commonly in the study cohort than in the general Norwegian population (24 vs. 19%, p = 0.04). Combined use of antiplatelet and anticoagulant therapy was significantly associated with 30-day mortality, while preinjury antiplatelet or anticoagulation treatment alone was not. No difference in 30-day mortality between patients using VKA, DOACs, or LMWH was encountered. Conclusions: In this cohort, neither antiplatelet nor anticoagulant therapy alone was associated with increased 30-day mortality. Anticoagulant use was more prevalent among TBI patients than the general population, suggesting that anticoagulation might contribute to the initiation of intracranial bleeding after blunt head trauma. Combined antiplatelet and anticoagulant therapy posed increased risk of 30-day mortality.

• Jortveit, Jarle; Pripp, Are Hugo & Halvorsen, Sigrun (2021). Outcomes after delayed primary percutaneous coronary intervention vs. pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 8(5), s. 442–451. doi: 10.1093/ehjcvp/pvab041. Fulltekst i vitenarkiv
• Chieffo, Alaide; Dudek, Dariusz; Hassager, Christian; Combes, Alain; Gramegna, Mario & Halvorsen, Sigrun [Vis alle 19 forfattere av denne artikkelen] (2021). Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 10(5), s. 570–583. doi: 10.1093/ehjacc/zuab015. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2021). Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open. 11(2), s. e046024–e046024. doi: 10.1136/bmjopen-2020-046024. Fulltekst i vitenarkiv Vis sammendrag

  Objective This study aims to compare the rule-out safety of a single high-sensitivity cardiac troponin T (hs-cTnT) with the History, ECG, Age, Risk factors and Troponin (HEART) score in a low-prevalence primary care setting of acute myocardial infarction (AMI). Participants Patients with non-specific symptoms suggestive of AMI were consecutively enroled at a primary care emergency clinic in Oslo, Norway from November 2016 to October 2018. Methods After initial assessment by a general practitioner, hs-cTnT samples were drawn. AMI was ruled-out by a single hs-cTnT <5 ng/L measured ≥3 hours after symptom onset. The HEART score was calculated retrospectively; a score ≤3 of 10 points was considered low risk. We also calculated a modified HEART score using more sensitive hs-cTnT thresholds. The primary outcome was the diagnostic performance for the rule-out of AMI at the index event; the secondary the composite of AMI or all-cause death at 90 days. Results Among 1711 patients, 61 (3.6%) were diagnosed with AMI, and 569 (33.3%) patients were assigned to single rule-out (<5 ng/L). With no AMIs in this group, the negative predictive value (NPV) and sensitivity were both 100.0% (95% CI 99.4% to 100.0% and 94.1% to 100.0%, respectively), and the specificity 34.5% (32.2% to 36.8%). The original HEART score triaged more patients as low risk (n=871), but missed five AMIs (NPV 99.4% (98.7% to 99.8%); sensitivity 91.8% (81.9% to 97.3%) and specificity 52.5% (50.0% to 54.9%)). The modified HEART score increased the low-risk sensitivity to 98.4% (91.2% to 100.0%), with specificity 38.7% (36.3% to 41.1%). The 90-day incidence of AMI or death in the single rule-out and the original and modified low-risk HEART groups were 0.0%, 0.7%, and 0.2%, respectively. Conclusion In a primary care emergency setting, a single hs-cTnT strategy was superior to the HEART score in ruling out AMI. This rapid and safe approach may enhance the assessment of patients with chest pain outside of hospitals.

• Blichfeldt-Ærø, Stine Camilla Flydal; Halvorsen, Sigrun & Trondalen, Gro (2021). Music therapy in invasive cardiac procedures: Expanded perspective. British Journal of Music Therapy (BJMT). ISSN 1359-4575. doi: 10.1177/13594575211039090. Fulltekst i vitenarkiv
• Stepinska, Janina; Lettino, Maddelena; Ahrens, Ingo; Bueno, Hector; Garcia-Castrillo, Luis & Khoury, Abdo [Vis alle 20 forfattere av denne artikkelen] (2020). Diagnosis and risk stratification of chest pain patients in the emergency department: focus on acute coronary syndromes. A position paper of the Acute Cardiovascular Care Association. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 9(1), s. 76–89. doi: 10.1177/2048872619885346. Fulltekst i vitenarkiv
• Bogsrud, Martin Prøven; Øyri, Linn Kristin Lie; Halvorsen, Sigrun; Atar, Dan; Leren, Trond Paul & Holven, Kirsten Bjørklund (2020). Prevalence of genetically verified familial hypercholesterolemia among young (<45 years) Norwegian patients hospitalized with acute myocardial infarction. Journal of Clinical Lipidology. ISSN 1933-2874. 14(3), s. 339–345. doi: 10.1016/j.jacl.2020.04.002. Fulltekst i vitenarkiv Vis sammendrag

  Background Patients with familial hypercholesterolemia (FH) have an increased risk of premature myocardial infarction (MI). Objectives The objective of the study is to investigate the prevalence of FH among young patients hospitalized with acute MI. Methods Data were collected from medical charts of all patients aged <45 years admitted with acute MI to the Department of Cardiology, Oslo University Hospital Ullevål, in the period 2012 to 2016. Patients who had not already been genetically tested for FH were contacted and offered genetic testing if the pretreatment or the statin-adjusted low-density lipoprotein cholesterol level was >4.0 mmol/L (155 mg/dL). Results Of 9332 patients admitted with acute MI, 357 were aged <45 years. Sixteen patients were deceased, and 13 patients did not have MI on an atherosclerotic basis. Of the remaining 328 patients eligible for investigation, 130 had the pretreatment or statin-adjusted low-density lipoprotein cholesterol level >4.0 mmol/L (155 mg/dL). Of these, data from 52 patients genetically tested for FH were available. Eleven patients had genetically verified FH constituting 3.4% of the total eligible population (n = 328), 8.5% of those with indications for genetic testing (n = 130), and 21.2% of those actually tested (n = 52). A Dutch Lipid Clinic Network score for clinical FH diagnosis of “definite FH” identified only 5 of the 11 patients with positive genetic test (45%). Including a score of “probable FH” identified all patients with FH but also 17 of the 41 patients (41%) with a negative genetic test. Conclusion The prevalence of FH in young patients with acute MI was higher than in the general population. Routine evaluation of FH diagnosis among these patients could identify more patients with FH, thereby increasing the possibility of initiating early and adequate treatment also among affected relatives.

• Blichfeldt-Ærø, Stine Camilla; Knutsen, Thomas M; Hagen, Hege Merethe; Diep, Lien My; Trondalen, Gro & Halvorsen, Sigrun (2020). Music therapy as an adjunct in cardiac device lead extraction procedures: A randomized controlled trial. Applied Nursing Research. ISSN 0897-1897. 56:151376, s. 1–8. doi: 10.1016/j.apnr.2020.151376. Fulltekst i vitenarkiv Vis sammendrag

  Background Evidence of music therapy as an effective supportive therapy in invasive cardiac procedures is increasing, but more research is needed. Aims To evaluate the impact of music therapy on stress responses during cardiac device lead extraction procedures performed in local anaesthesia. Methods Sixty-four patients undergoing cardiac implantable electronic device lead extraction at Oslo University Hospital Ulleval from March 2018 to September 2019 were randomized to music therapy (n = 32) or control (n = 32). Primary endpoints were patient satisfaction with pain management and average pain intensity during the procedure. Secondary endpoints were average anxiety intensity, need for analgesic/anxiolytic drugs, blood pressure, heart and respiration rate. Results All patients in the music therapy group completed the intervention. Patient satisfaction with pain management was 10.00 (8.00, 10.00) in the music therapy vs. 10.00 (9.00, 10.00) in the control group (p = 0.85), and average level of pain 0.89 (0.22, 1.13) vs. 0.96 (0.36, 1.58), respectively (p = 0.38). Average anxiety score was 1.00 (0.33, 2.17) in the music therapy vs 1.67 (0.71, 3.35) in the control group (p = 0.056). The use of analgesic/anxiolytic drugs and physiological parameters were similar across groups. Conclusions In this study of music therapy during cardiac device lead extractions, no effect was found on patient satisfaction with pain management or average pain level. A decrease in patient anxiety of borderline significance was observed in the music therapy group. More studies with more sensitive measures of pain and anxiety are needed to determine the value of music therapy in invasive cardiac procedures.

• Chieffo, Alaide; Stefanini, Giulio G.; Price, Susanna; Barbato, Emanuele; Tarantini, Giuseppe & Karam, Nicole [Vis alle 20 forfattere av denne artikkelen] (2020). EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. EuroIntervention. ISSN 1774-024X. 16(3), s. 233–246. doi: 10.4244/EIJY20M05_01. Fulltekst i vitenarkiv
• Chieffo, Alaide; Stefanini, Giulio G.; Price, Susanna; Barbato, Emanuele; Tarantini, Giuseppe & Karam, Nicole [Vis alle 20 forfattere av denne artikkelen] (2020). EAPCI position statement on invasive management of acute coronary syndromes during the COVID-19 pandemic. European Heart Journal. ISSN 0195-668X. 41(19), s. 1839–1851. doi: 10.1093/eurheartj/ehaa381. Fulltekst i vitenarkiv
• Jortveit, Jarle; Pripp, Are Hugo; Langørgen, Jørund & Halvorsen, Sigrun (2020). Incidence, risk factors and outcome of young patients with myocardial infarction. Heart. ISSN 1355-6037. 106(18), s. 1–7. doi: 10.1136/heartjnl-2019-316067. Fulltekst i vitenarkiv
• Ødegaard, Kristina Malene; Hallen, Jonas; Lirhus, Sandre Svatun; Melberg, Hans Olav & Halvorsen, Sigrun (2020). Incidence, prevalence, and mortality of heart failure: a nationwide registry study from 2013-2016. ESC Heart Failure. doi: 10.1002/ehf2.12773. Fulltekst i vitenarkiv Vis sammendrag

  Aims Large‐scaled population studies of incidence and prevalence of heart failure (HF) are needed for the development of healthcare policies and priorities. The aim of this study was to estimate the incidence, prevalence, and all‐cause mortality of HF in Norway from 2013 to 2016 on the basis of a national registry. Methods and results Using data from the nationwide Norwegian Prescription Database, we identified all patients ≥18 years of age in Norway with at least one drug prescription with HF during 2013–2016, defined by 10th revision of the International Classification of Diseases (ICD‐10) codes I50, I11, I13, or I42. The individual index date was the date of the first prescription. Patients were followed up until death or end of follow‐up (31 October 2017). Annual incidence and prevalence were estimated from 2013 to 2016, using a look‐back period starting from 1 March 2008. We calculated standardized estimates by applying direct age and sex standardization to the 2013 European standard population. All‐cause mortality from 2013 to 2016 was calculated among the prevalent HF patients. Standardized mortality ratio (SMR) was calculated by indirect standardization using general mortality in the Norwegian population as reference. We identified 54 542 unique patients (58% men) with a first‐time diagnosis of HF. The median age was 72 ±14 years, and women were older than men (median age 76 vs. 70 years, respectively). The crude (standardized) incidence of HF was 3.44/1000 (4.23/1000) person‐years in 2016 and did not increase over the 4 year period, while the prevalence increased from 2.0% (2.3%) to 2.4% (2.8%). Both incidence and prevalence were higher in men than in women and strongly associated with age. Crude mortality rates in the HF population declined from 94 to 82/1000 person‐years from 2013 to 2016, and SMR declined from 2.01 to 1.84. Age‐adjusted mortality rates were higher in men than in women. Conclusions This nationwide registry study in Norway showed an increase in the prevalence of HF from 2013 to 2016, with stable incidence rates and improved survival.

• Sinning, Christoph; Ahrens, Ingo; Cariou, Alain; Beygui, Farzin; Lamhaut, Lionel & Halvorsen, Sigrun [Vis alle 15 forfattere av denne artikkelen] (2020). The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause – aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care M... European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 9(4), s. S193–S202. doi: 10.1177/2048872620963492. Fulltekst i vitenarkiv
• Rutherford, Ole-Christian Walter; Jonasson, Christian; Ghanima, Waleed Khalid; Söderdahl, Fabian & Halvorsen, Sigrun (2020). Comparison of dabigatran, rivaroxaban and apixaban for effectiveness and safety in atrial fibrillation; a nationwide cohort study. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 6(2), s. 75–85. doi: 10.1093/ehjcvp/pvz086. Fulltekst i vitenarkiv Vis sammendrag

  The aim of this study was to compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. Methods and results Using nationwide registries in Norway from January 2013 to December 2017, we established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pairwise-matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). Hazard ratios (HRs) for the risk of stroke or SE and major bleeding were estimated. In the propensity-matched comparisons of the risk of stroke or SE, the HRs were 0.88 [95% confidence interval (CI) 0.76–1.02] for dabigatran vs. rivaroxaban, 0.88 (95% CI 0.75–1.02) for dabigatran vs. apixaban, and 1.00 (95% CI 0.89–1.14) for apixaban vs. rivaroxaban. For the risk of major bleeding, the HRs were 0.75 (95% CI 0.64–0.88) for dabigatran vs. rivaroxaban, 1.03 (95% CI 0.85–1.24) for dabigatran vs. apixaban, and 0.79 (95% CI 0.68–0.91) for apixaban vs. rivaroxaban. Conclusion In this nationwide study of patients with AF in Norway, we found no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban. However, dabigatran and apixaban were both associated with significantly lower risk of major bleeding compared with rivaroxaban.

• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2020). Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study. Open heart. 7:e001296, s. 1–9. doi: 10.1136/openhrt-2020-001296. Fulltekst i vitenarkiv Vis sammendrag

  Objective The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability for acute coronary syndrome. Methods This prospective, observational, diagnostic study included patients with acute non-specific chest pain admitted to a primary care emergency clinic in Oslo, Norway, from November 2016 to October 2018. hs-cTnT was measured after 0, 1 and 4 hours. The primary outcome measure was the diagnostic performance of the 0/1-hour algorithm, the 90-day incidence of AMI or all-cause death the secondary. Results Among 1711 included patients, 61 (3.6%) were diagnosed with AMI. By applying the algorithm, 1311 (76.6%) patients were assigned to the rule-out group. The negative predictive value was 99.9% (95% CI 99.5% to 100.0%), the sensitivity and specificity 98.4% (91.2–100.0) and 79.4% (77.4–81.3), respectively. Sixty-six (3.9%) patients were triaged towards rule-in, where 45 were diagnosed with AMI. The corresponding positive predictive value was 68.2% (58.3–76.7), sensitivity 73.8% (60.9–84.2), and specificity 98.7% (98.1–99.2). Among 334 (19.5%) patients assigned to the observation group in need of further tests, 15 patients had an AMI. The following 90 days, five new patients experienced an AMI and nine patients died, with a low incidence in the rule-out group (0.3%). Conclusion The 0/1-hour algorithm for hs-cTnT seems safe, efficient and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting.

• Bittner, Vera A.; Szarek, Michael; Aylward, Philip; Bhatt, Deepak L.; Diaz, Rafael & Edelberg, Jay M. [Vis alle 25 forfattere av denne artikkelen] (2020). Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome. Journal of the American College of Cardiology. ISSN 0735-1097. 75(2), s. 133–144. doi: 10.1016/j.jacc.2019.10.057. Fulltekst i vitenarkiv
• Jortveit, Jarle; Halvorsen, Sigrun & Langørgen, Jørund (2020). Pharmacy-dispensed drugs for secondary prevention after myocardial infarction. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 140(4). doi: 10.4045/tidsskr.19.0416. Fulltekst i vitenarkiv
• Gorenek, Bulent; Halvorsen, Sigrun; Kudaiberdieva, Gulmira; Bueno, Hector; Gelder, Isabelle C Van & Lettino, Maddalena [Vis alle 14 forfattere av denne artikkelen] (2020). Atrial fibrillation in acute heart failure: A position statement from the Acute Cardiovascular Care Association and European Heart Rhythm Association of the European Society of Cardiology. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 9(4), s. 348–357. doi: 10.1177/2048872619894255. Fulltekst i vitenarkiv
• Szarek, Michael; Bittner, Vera A.; Aylward, Philip; Baccara-Dinet, Marie T.; Bhatt, Deepak L. & Diaz, Rafael [Vis alle 22 forfattere av denne artikkelen] (2020). Lipoprotein(a) lowering by alirocumab reduces the total burden of cardiovascular events independent of low-density lipoprotein cholesterol lowering: ODYSSEY OUTCOMES trial. European Heart Journal. ISSN 0195-668X. 41(44), s. 4245–4255. doi: 10.1093/eurheartj/ehaa649. Fulltekst i vitenarkiv Vis sammendrag

  Aims Lipoprotein(a) concentration is associated with first cardiovascular events in clinical trials. It is unknown if this relationship holds for total (first and subsequent) events. In the ODYSSEY OUTCOMES trial in patients with recent acute coronary syndrome (ACS), the proprotein convertase subtilisin/kexin type 9 inhibitor alirocumab reduced lipoprotein(a), low-density lipoprotein cholesterol (LDL-C), and cardiovascular events compared with placebo. This post hoc analysis determined whether baseline levels and alirocumab-induced changes in lipoprotein(a) and LDL-C [corrected for lipoprotein(a) cholesterol] independently predicted total cardiovascular events. Methods and results Cardiovascular events included cardiovascular death, non-fatal myocardial infarction, stroke, hospitalization for unstable angina or heart failure, ischaemia-driven coronary revascularization, peripheral artery disease events, and venous thromboembolism. Proportional hazards models estimated relationships between baseline lipoprotein(a) and total cardiovascular events in the placebo group, effects of alirocumab treatment on total cardiovascular events by baseline lipoprotein(a), and relationships between lipoprotein(a) reduction with alirocumab and subsequent risk of total cardiovascular events. Baseline lipoprotein(a) predicted total cardiovascular events with placebo, while higher baseline lipoprotein(a) levels were associated with greater reduction in total cardiovascular events with alirocumab (hazard ratio Ptrend = 0.045). Alirocumab-induced reductions in lipoprotein(a) (median −5.0 [−13.6, 0] mg/dL) and corrected LDL-C (median −51.3 [−67.1, −34.0] mg/dL) independently predicted lower risk of total cardiovascular events. Each 5-mg/dL reduction in lipoprotein(a) predicted a 2.5% relative reduction in cardiovascular events. Conclusion Baseline lipoprotein(a) predicted the risk of total cardiovascular events and risk reduction by alirocumab. Lipoprotein(a) lowering contributed independently to cardiovascular event reduction, supporting the concept of lipoprotein(a) as a treatment target after ACS.

• Langseth, Miriam Sjåstad; Helseth, Ragnhild; Ritschel, Vibeke Nordmo; Hansen, Charlotte Holst; Andersen, Geir Øystein & Eritsland, Jan [Vis alle 12 forfattere av denne artikkelen] (2020). Double-Stranded DNA and NETs Components in Relation to Clinical Outcome After ST-Elevation Myocardial Infarction. Scientific Reports. 10(1). doi: 10.1038/s41598-020-61971-7. Fulltekst i vitenarkiv Vis sammendrag

  Neutrophil extracellular traps (NETs) have been implicated in atherothrombosis; however, their potential role as markers of risk is unclear. We investigated whether circulating NETs-related components associated with clinical outcome and hypercoagulability in ST-elevation myocardial infarction (STEMI). In this observational cohort study, STEMI patients admitted for PCI (n = 956) were followed for median 4.6 years, recording 190 events (reinfarction, unscheduled revascularization, stroke, heart failure hospitalization, or death). Serum drawn median 18 hours post-PCI was used to quantify double-stranded DNA (dsDNA) and the more specific NETs markers myeloperoxidase-DNA and citrullinated histone 3. Levels of the NETs markers did not differ significantly between groups with/without a primary composite endpoint. However, patients who died (n = 76) had higher dsDNA compared to survivors (p < 0.001). Above-median dsDNA was associated with an increased number of deaths (54 vs. 22, p < 0.001). dsDNA in the upper quartiles (Q) was associated with increased mortality (Q3 vs. Q1 + 2 adjusted HR: 1.89 [95% CI 1.03 to 3.49], p = 0.041 and Q4 vs. Q1 + 2 adjusted HR: 2.28 [95% CI 1.19 to 4.36], p = 0.013). dsDNA was weakly correlated with D-dimer (rs = 0.17, p < 0.001). dsDNA levels associated with increased all-cause mortality, yet weakly with hypercoagulability in STEMI patients. The prognostic significance of potentially NETs-related markers requires further exploration.

• Kjeldsen, Sverre; Halvorsen, Sigrun; Wyller, Torgeir Bruun; Bath, Philip M. & Sandercock, Peter (2020). Eivind Berge, MD, PhD, 1964-2020: Cardiologist Who Was Fighting Stroke. Stroke. ISSN 0039-2499. 51(5), s. 1353–1355. doi: 10.1161/STROKEAHA.120.029351. Fulltekst i vitenarkiv
• Stensjøen, Anne Line; Hommerstad, Anders; Halvorsen, Sigrun; Arheden, Håkan; Engblom, Henrik & Erlinge, David [Vis alle 11 forfattere av denne artikkelen] (2020). Worst lead ST deviation and resolution of ST elevation at one hour for prediction of myocardial salvage, infarct size, and microvascular obstruction in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Annals of Noninvasive Electrocardiology. ISSN 1082-720X. 25(6). doi: 10.1111/anec.12784. Fulltekst i vitenarkiv Vis sammendrag

  Background ECG changes after revascularization predicts improved outcome for patients with ST‐elevation myocardial infarction (STEMI). Worst lead residual (WLR) ST deviation and resolution of worst lead ST elevation (rST elevation) are simple measures that can be obtained early after PCI. The objective of the current study was to investigate whether simple ECG measures, obtained one hour following PCI, could predict cardiac magnetic resonance (CMR)‐derived myocardial salvage index (MSI), infarct size (IS), and microvascular obstruction (MVO) in patients with STEMI included in the MITOCARE trial. Methods The MITOCARE trial included 165 patients with a first‐time STEMI presenting within six hours of symptom onset. The current analysis included patients that had an ECG recorded at baseline and one hour after PCI and underwent CMR imaging after 3–5 days. Independent core laboratories determined WLR ST deviation, rST elevation, and the CMR variables (MSI, IS, and MVO). Results 83 patients with a mean age of 61 years were included. 83.1% were males and 41% had anterior infarctions. In logistic regression models, WLR ST deviation was a statistically significant predictor of IS (OR 2.2, 95% CI 1.3–3.8) and MVO (OR 2.8, 95% CI 1.5–5.2), but not of MSI (OR 0.8, 95% CI 0.5–1.2). rST elevation showed a trend toward a significant association with IS (OR 0.3, 95% CI 0.1–1.0), but not with the other CMR variables. Conclusion WLR ST deviation one hour after PCI was a predictor of IS and MVO. WLR ST deviation, a measure easily obtained from ECGs following PCI, may provide important prognostic information in patients with STEMI.

• Ahrens, Ingo; Averkov, Oleg; Zúñiga, Eduardo C.; Fong, Alan Y.Y.; AlHabib, Khalid F. & Halvorsen, Sigrun [Vis alle 11 forfattere av denne artikkelen] (2019). Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox. Clinical Cardiology. ISSN 0160-9289. s. 1–13. doi: 10.1002/clc.23232. Fulltekst i vitenarkiv
• Garcia, David A.; Fisher, Deborah A.; Mulder, H; Wruck, L; Caterina, R De & Halvorsen, Sigrun [Vis alle 11 forfattere av denne artikkelen] (2019). Gastrointestinal bleeding in patients with atrial fibrillation treated with Apixaban or warfarin: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. American Heart Journal. ISSN 0002-8703. doi: 10.1016/j.ahj.2019.10.013. Fulltekst i vitenarkiv
• Gelbenegger, Georg; Postula, Marek; Pecen, Ladislav; Halvorsen, Sigrun; Lesiak, MacIej & Schoergenhofer, Christian [Vis alle 9 forfattere av denne artikkelen] (2019). Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups. BMC Medicine. 17(1), s. 1–16. doi: 10.1186/s12916-019-1428-0. Fulltekst i vitenarkiv
• Munkhaugen, John; Ruddox, Vidar; Halvorsen, Sigrun; Dammen, Toril; Fagerland, Morten & Hernæs, Kjersti Helene [Vis alle 23 forfattere av denne artikkelen] (2019). BEtablocker Treatment After acute Myocardial Infarction in revascularized patients without reduced left ventricular ejection fraction (BETAMI): Rationale and design of a prospective, randomized, open, blinded end-point study. American Heart Journal. ISSN 0002-8703. 208, s. 37–46. doi: 10.1016/j.ahj.2018.10.005. Fulltekst i vitenarkiv Vis sammendrag

  Background - Current guidelines on the use of β-blockers in post–acute myocardial infarction (MI) patients without reduced left ventricular ejection fraction (LVEF) are based on studies before the implementation of modern reperfusion and secondary prevention therapies. It remains unknown whether β-blockers will reduce mortality and recurrent MI in contemporary revascularized post-MI patients without reduced LVEF. Design - BETAMI is a prospective, randomized, open, blinded end point multicenter study in 10,000 MI patients designed to test the superiority of oral β-blocker therapy compared to no β-blocker therapy. Patients with LVEF ≥40% following treatment with percutaneous coronary intervention or thrombolysis and/or no clinical signs of heart failure are eligible to participate. The primary end point is a composite of all-cause mortality or recurrent MI obtained from national registries over a mean follow-up period of 3 years. Safety end points include rates of nonfatal MI, all-cause mortality, ventricular arrhythmias, and hospitalizations for heart failure obtained from hospital medical records 30 days after randomization, and from national registries after 6 and 18 months. Key secondary end points include recurrent MI, heart failure, cardiovascular and all-cause mortality, and clinical outcomes linked to β-blocker therapy including drug adherence, adverse effects, cardiovascular risk factors, psychosocial factors, and health economy. Statistical analyses will be conducted according to the intention-to-treat principle. A prespecified per-protocol analysis (patients truly on β-blockers or not) will also be conducted. Conclusions - The results from the BETAMI trial may have the potential of changing current clinical practice for treatment with β-blockers following MI in patients without reduced LVEF. EudraCT number 2018-000590-75.

• Windecker, Stephan; Lopes, Renato D.; Massaro, Tyler; Jones-Burton, Charlotte; Granger, Christopher B. & Aronson, Ronald [Vis alle 33 forfattere av denne artikkelen] (2019). Antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome treated medically or with percutaneous coronary intervention or undergoing elective percutaneous coronary intervention. Circulation. ISSN 0009-7322. 140(23), s. 1921–1932. doi: 10.1161/CIRCULATIONAHA.119.043308. Fulltekst i vitenarkiv
• Blichfeldt-Ærø, Stine Camilla Flydal; Trondalen, Gro & Halvorsen, Sigrun (2019). Facilitated music listening: Music therapy in an invasive cardiac procedure. British Journal of Music Therapy (BJMT). ISSN 1359-4575. doi: 10.1177/1359457519840131. Fulltekst i vitenarkiv Vis sammendrag

  Abstract This article presents and discusses a clinical music therapy protocol for use during an invasive cardiac procedure and the theoretical rationale behind it. The protocol was developed for a specific invasive cardiac procedure performed transvenously with local anaesthesia: cardiac implantable electronic device lead extraction. The music listening intervention presented in the protocol aims to optimise stress and pain management for patients through patient involvement, communication, individualised music listening and relaxation techniques. The Music Therapist remains present throughout the peri-operative phase (in the operating theatre during the operation). The music is chosen from a limited set of prepared playlists through a process involving assessment and patient preference. Biological, psychological and social components are integrated into the protocol, which is also informed by the theory of music therapy as procedural support, the neuromatrix theory of pain and receptive music therapy techniques. The protocol was developed to be standardised for implementation into the existing medical procedure, yet flexible enough to meet individual patient needs. It is the cornerstone of the research protocol of an ongoing randomised controlled trial at the Department of Cardiology at Oslo University Hospital Ulleval. Results of the randomised controlled trial, focussing on quantitative efficacy outcomes, are expected in 2020.

• Fossum, Stine; Næss, Øyvind; Halvorsen, Sigrun; Tell, Grethe S. & Vikanes, Åse (2019). Long-term cardiovascular morbidity following hyperemesis gravidarum: A Norwegian nationwide cohort study. PLOS ONE. 14:e0218051(6), s. 1–12. doi: 10.1371/journal.pone.0218051. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To investigate whether exposure to hyperemesis gravidarum (hyperemesis) is associated with subsequent maternal cardiovascular morbidity. Design: Nationwide cohort study. Setting: Medical Birth Registry of Norway (1967–2002) linked to the nationwide Cardiovascular Disease in Norway project 1994–2009 (CVDNOR) and the Cause of Death Registry. Population: Women in Norway with singleton births from 1967 to 2002, with and without hyperemesis, were followed up with respect to cardiovascular outcomes from 1994 to 2009. Methods: Cox proportional hazards regression model was applied to estimate hazard ratios (HRs) with 95% confidence interval (CI). Main outcome measures The first hospitalisation due to nonfatal stroke, myocardial infarction or angina pectoris, or cardiovascular death. Results: Among 989 473 women with singleton births, 13 212 (1.3%) suffered from hyperemesis. During follow-up, a total of 43 482 (4.4%) women experienced a cardiovascular event. No association was found between hyperemesis and the risk of a fatal or nonfatal cardiovascular event (adjusted HR 1.08; 95% CI 0.99–1.18). Women with hyperemesis had higher risk of hospitalisation due to angina pectoris (adjusted HR 1.28; 95% CI 1.15–1.44). The risk of cardiovascular death was lower among hyperemetic women in age-adjusted analysis (HR 0.73; 95% CI 0.59–0.91), but the association was no longer significant when adjusting for possible confounders. Conclusion: Women with a history of hyperemesis did not have increased risk of a cardiovascular event (nonfatal myocardial infarction or stroke, angina pectoris or cardiovascular death) compared to women without.

• Mach, Francois; Baigent, Colin; Catapano, Alberico L.; Koskinas, Konstantinos C.; Casula, Manuela & Badimon, Lina [Vis alle 96 forfattere av denne artikkelen] (2019). 2019 ESC/EAS guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk. Atherosclerosis. ISSN 0021-9150. 290, s. 140–205. doi: 10.1016/j.atherosclerosis.2019.08.014. Fulltekst i vitenarkiv
• Jortveit, Jarle; Pripp, Are Hugo; Langørgen, Jørund & Halvorsen, Sigrun (2019). Poor adherence to guideline recommendations among patients with atrial fibrillation and acute myocardial infarction. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 26(13), s. 1373–1382. doi: 10.1177/2047487319841940. Fulltekst i vitenarkiv
• Bhatt, Ankeet S.; Luo, Nancy; Solomon, Nicole; Pagidipati, Neha J.; Ambrosio, Giuseppe & Green, Jennifer B. [Vis alle 15 forfattere av denne artikkelen] (2019). International variation in characteristics and clinical outcomes of patients with type 2 diabetes and heart failure: Insights from TECOS. American Heart Journal. ISSN 0002-8703. 218, s. 57–65. doi: 10.1016/j.ahj.2019.08.016. Fulltekst i vitenarkiv
• Fernandes, Amanda; McEvoy, John William & Halvorsen, Sigrun (2019). Doctor, Should I Keep Taking an Aspirin a Day? New England Journal of Medicine. ISSN 0028-4793. doi: 10.1056/NEJMclde1903004. Fulltekst i vitenarkiv
• Jortveit, Jarle; Halvorsen, Sigrun; Kaldal, Anete; Pripp, Are Hugo; Govatsmark, Ragna Elise Støre & Langørgen, Jørund (2019). Unsatisfactory risk factor control and high rate of new cardiovascular events in patients with myocardial infarction and prior coronary artery disease. BMC Cardiovascular Disorders. 19(71). doi: 10.1186/s12872-019-1062-y. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with established coronary artery disease (CAD) have an increased risk of new cardiovascular events. An underuse of secondary preventive drugs has been observed, and many patients may not attain the treatment goals for secondary prevention. The aims of the present nationwide register-based cohort study were to assess the degree of risk factor control and long-term outcomes in patients < 80 years with Type 1 myocardial infarction (MI) with and without prior CAD. Methods: Data concerning all patients with MI admitted to hospitals in Norway from 2013 to 2016 were retrieved from the Norwegian Myocardial Infarction Register (NORMI). Long-term mortality was obtained through linkage with the Norwegian Cause of Death Registry. Results: In total, 47,204 patients were registered in the NORMI from 2013 to 2016. Prior CAD was recorded in 7219 (25.2%) of the 28,607 patients < 80 years old with Type 1 MIs. On average, 3 of the 6 defined treatment targets for secondary preventive therapy were attained, and only 1% of the patients achieved all targets. Patients with MI and prior CAD had increased risk of death or new MI compared to patients without prior CAD during long-term follow-up (adjusted HR 1.6, 95% CI 1.5–1.7). Conclusions: Prior CAD was frequent in patients with acute MI. The attainment of secondary preventive treatment targets in patients with MI and prior CAD was not optimal, and the long-term outcomes were reduced compared to patients without prior CAD. Increased efforts to improve risk factor control are needed.

• Bjørnnes, Ann Kristin; Moons, Philip; Parry, Monica; Halvorsen, Sigrun; Tønnessen, Theis & Lie, Irene (2019). Experiences of informal caregivers after cardiac surgery: a systematic integrated review of qualitative and quantitative studies. BMJ Open. 9:e032751(11), s. 1–10. doi: 10.1136/bmjopen-2019-032751. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To provide a comprehensive synthesis of informal caregivers’ experiences of caring for a significant other following discharge from cardiac surgery. Design: Systematic integrated review without meta-analysis. Data sources: A bibliographic search for publications indexed in six databases (Cochrane Library, CINAHL, MEDLINE, EMBASE, AMED and PsycINFO), including a scan of grey literature sources (GreyNet International, Google Scholar, Web of Science, WorldCat and the Clinical Trials Registry) was conducted in October 2018. Eligibility criteria for selecting: studies Studies were included if they described views and perspectives of informal caregivers of cardiac surgery patients (non-intervention studies (qualitative and quantitative)), and the effectiveness of interventions to evaluate support programme for informal caregivers of cardiac surgery patients (intervention studies). Results: Of the 4912 articles identified in searches, 42 primary research studies were included in a narrative synthesis with 5292 participants, including 3231 (62%) caregivers of whom 2557 (79%) were women. The median sample size across studies was 96 (range 6–734). Three major themes emerged from the qualitative study data: (1) caregiver information needs; (2) caregiver work challenges and (3) caregivers adaption to recovery. Across the observational studies (n=22), similar themes were found. The trend across seven intervention studies focused on caregiver information needs related to patient disease management and symptom monitoring, and support for caregivers to reduce symptoms of emotional distress. Conclusion: Informal caregivers want to assist in the care of their significant others after hospital discharge postcardiac surgery. However, caregivers feel insecure and overwhelmed and they lack clear/concise discharge information and follow-up support during the early at-home recovery period. The burden of caregiving has been recognised and reported since the early 1990s, but there remains a limited number of studies that assesses the effectiveness of caregiver interventions.

• Kvakkestad, Kristin Marie; Gran, Jon Michael; Eritsland, Jan; Hansen, Charlotte Holst; Fossum, Eigil & Andersen, Geir Øystein [Vis alle 7 forfattere av denne artikkelen] (2019). Long-term survival after invasive or conservative strategy in elderly patients with non-ST-elevation myocardial infarction: A prospective cohort study. Cardiology. ISSN 0008-6312. s. 1–11. doi: 10.1159/000503442. Fulltekst i vitenarkiv Vis sammendrag

  Background: The optimal management of elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still discussed. We aimed to study short- and long-term survival in NSTEMI patients ≥75 years managed with an invasive or a conservative strategy. Methods: NSTEMI patients admitted to Oslo University Hospital Ulleval during 2005–2011 were included consecutively in a prospective registry. Vital status until December 31, 2013, was obtained from the Norwegian Cause of Death Registry. Patients ≥75 years were identified, and 30-day and 7-year survival were analyzed. Logistic- and Cox regression was used to estimate OR and hazard ratio (HR) for death in the invasive versus conservative group, adjusting for registered confounders. Results: There were 2,064 NSTEMI patients ≥75 years (48.2% women); 1,200 (58.1%) were treated with an invasive strategy, and were younger, more likely to be male and previously revascularized compared to 864 (41.9%) patients treated conservatively (p < 0.0001 for all). Survival at 30-day was 94.9% in the invasive and 76.6% in the conservative group. For 30-day survivors, 7-year survival was 47.4% (95% CI 42.9–51.8) and 11.6% (95% CI 8.3–15.6), respectively. After multivariate adjustment, an invasive strategy was associated with lower long-term risk (adjusted HR [aHR] 0.49 [95% CI 0.41–0.59]). Actual revascularization was associated with lower risk of long-term mortality compared to angiography only (aHRPCI 0.73 [95% CI 0.59–0.90], aHRCABG 0.43 [95% CI 0.28–0.65]). Conclusion: In this real-life cohort of NSTEMI patients ≥75 years, 30-day survival was 95%, and 7-year survival was 47% with an invasive strategy. Revascularized patients had a superior long-term prognosis. With a conservative strategy, short- and long-term survival was lower, probably due to selection bias and unmeasured confounding.

• Lip, Gregory Y.H.; Collet, Jean-Phillippe; Haude, Michael; Byrne, Robert; Chung, Eugene H. & Fauchier, Laurent [Vis alle 35 forfattere av denne artikkelen] (2019). 2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: A joint consensus document of the European Heart Rhythm Association (EHRA), European Society of Cardiology Working Group on Thrombosis, European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Hea. Europace. ISSN 1099-5129. 21(2), s. 192–193y. doi: 10.1093/europace/euy174. Fulltekst i vitenarkiv
• Kopin, David; Jones, W. Schuyler; Sherwood, Matthew W.; Wojdyla, Daniel M.; Wallentin, Lars & Lewis, Basil S. [Vis alle 15 forfattere av denne artikkelen] (2018). Percutaneous coronary intervention and antiplatelet therapy in patients with atrial fibrillation receiving apixaban or warfarin: Insights from the ARISTOTLE trial. American Heart Journal. ISSN 0002-8703. 197, s. 133–141. doi: 10.1016/j.ahj.2017.11.005. Fulltekst i vitenarkiv
• Bugge, Christoffer; Sæther, Erik Magnus; Pahle, Andreas; Halvorsen, Sigrun & Kristiansen, Ivar Sønbø (2018). Diagnosing heart failure with NT-proBNP point-of-care testing: lower costs and better outcomes. A decision analytic study. British Journal of General Practice. ISSN 0960-1643. doi: 10.3399/bjgpopen18X101596. Fulltekst i vitenarkiv
• Berwanger, Otavio; Abdelhamid, Magdy; Alexander, Thomas; Alzubaidi, Abdulmajeed; Averkov, Oleg & Aylward, Philip [Vis alle 12 forfattere av denne artikkelen] (2018). Use of ticagrelor alongside fibrinolytic therapy in patients with ST-segment elevation myocardial infarction: Practical perspectives based on data from the TREAT study. Clinical Cardiology. ISSN 0160-9289. 41(10), s. 1322–1327. doi: 10.1002/clc.23043. Fulltekst i vitenarkiv
• Ibanez, Borja; Halvorsen, Sigrun; Roffi, Marco; Bueno, Héctor; Thiele, Holger & Vranckx, Pascal [Vis alle 9 forfattere av denne artikkelen] (2018). Integrating the results of the CULPRIT-SHOCK trial in the 2017 ESC ST-elevation myocardial infarction guidelines: viewpoint of the task force. European Heart Journal. ISSN 0195-668X. 39(48), s. 4239–4242. doi: 10.1093/eurheartj/ehy294. Fulltekst i vitenarkiv
• Mayerhofer, Christiane Caroline; Awoyemi, Ayodeji Olawale; Moscavitch, Samuel D.; Lappegård, Knut Tore; Hov, Johannes Espolin Roksund & Aukrust, Pål [Vis alle 13 forfattere av denne artikkelen] (2018). Design of the GutHeart-targeting gut microbiota to treat heart failure-trial: a Phase II, randomized clinical trial. ESC Heart Failure. 5, s. 978–985. doi: 10.1002/ehf2.12332. Fulltekst i vitenarkiv Vis sammendrag

  <p><i>Aims</i>: Heart failure (HF) is a multifactorial disease. Current treatments target only a fraction of the putative pathophysiological pathways. In patients with HF, reduced cardiac output and congestion cause increased gut wall permeability. It has been suggested that leakage of microbial products is detrimental to the heart, at least partly through activation of systemic inflammatory pathways, which again could promote gut leakage. Whether manipulating the gut microbiota can improve cardiac function in patients with HF remains unknown. We aim to evaluate the effect of drugs targeting the gut microbiota on left ventricular function, quality of life, and functional capacity, as well as on markers of gut leakage and inflammation, in stable patients with HF with reduced ejection fraction.</p> <p><i>Methods and results</i>: GutHeart is a randomized, open‐label, controlled trial. Four centres will randomize 150 patients with stable HF and a left ventricular ejection fraction <40% to receive the antibiotic rifaximin, the probiotic yeast <i>Saccharomyces boulardii</i> (ATCC 74012), or no treatment (control) in a 1:1:1 fashion. Treatment will last for 3 months. The primary endpoint is baseline‐adjusted left ventricular ejection fraction as measured by echocardiography after 3 months. A further follow‐up 6 months after randomization will be undertaken.</p> <p><i>Conclusions</i>: This trial is likely to give new insights into important disease processes involving the gut microbiota in HF patients, hereby leading to new potential therapeutic strategies to prevent and down‐regulate the inflammation seen in these patients.</p>

• Rocca, Bianca; Fox, Keith A.A.; Ajjan, Ramzi A.; Andreotti, Felicita; Baigent, Colin & Collet, Jean-Philippe [Vis alle 22 forfattere av denne artikkelen] (2018). Antithrombotic therapy and body mass: An expert position paper of the ESC Working Group on Thrombosis. European Heart Journal. ISSN 0195-668X. 39(19), s. 1672–1686. doi: 10.1093/eurheartj/ehy066. Fulltekst i vitenarkiv
• Opstad, Trine Baur; Seljeflot, Ingebjørg; Bøhmer, Ellen; Arnesen, Harald & Halvorsen, Sigrun (2018). MMP-9 and its regulators TIMP-1 and EMMPRIN in patients with acute ST-elevation myocardial infarction: a NORDISTEMI substudy. Cardiology. ISSN 0008-6312. 139(1), s. 17–24. doi: 10.1159/000481684. Fulltekst i vitenarkiv
• Kvakkestad, Kristin Marie; Sandvik, Leiv; Andersen, Geir Øystein; Sunde, Kjetil & Halvorsen, Sigrun (2018). Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: A prospective cohort study. Resuscitation. ISSN 0300-9572. 122, s. 41–47. doi: 10.1016/j.resuscitation.2017.11.047. Fulltekst i vitenarkiv Vis sammendrag

  Aim: To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA). Methods: Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons. Results: We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n = 4522) or non-STEMI (NSTEMI, n = 4903). Mean age was 63.6 ± standard deviation (SD) 12.5, 63.8 ± 13.1 and 69.7 ± 13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30 days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR)OHCAvsSTEMI 1.15 [95% CI 0.82–1.60], aHROHCAvsNSTEMI 0.89 [95% CI 0.64-1.24]). Conclusions: Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30 days had similar long-term risk as AMI patients without OHCA.

• Jia, Xiaoming; Heiberg, Einar; Ripa, Maria Sejersten; Engblom, Henrik; Halvorsen, Sigrun & Arheden, Håkon [Vis alle 9 forfattere av denne artikkelen] (2018). Correlation of ST changes in leads V4?V6 to area of ischemia by CMR in inferior STEMI. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 52(4), s. 189–195. doi: 10.1080/14017431.2018.1458145. Fulltekst i vitenarkiv
• Pahlm, Ulrika; Seemann, Felicia; Engblom, Henrik; Gyllenhammar, Tom; Halvorsen, Sigrun & Hansen, Henrik Steen [Vis alle 11 forfattere av denne artikkelen] (2018). Longitudinal left ventricular function is globally depressed within a week of STEMI. Clinical Physiology and Functional Imaging. ISSN 1475-0961. 38(6), s. 1029–1037. doi: 10.1111/cpf.12521. Fulltekst i vitenarkiv Vis sammendrag

  Sixty percent of stroke volume (SV) is generated by atrioventricular plane displacement (AVPD) in a healthy left ventricle (LV). The aims were to determine the effect of ST‐elevation myocardial infarction (STEMI) on AVPD and contribution of AVPD to SV and to study the relationship between AVPD and infarct size (IS) and location. Patients from CHILL‐MI and MITOCARE studies with cardiovascular magnetic resonance within a week of STEMI (n = 177, 59 ± 11 years) and healthy controls (n = 20, 62 ± 11 years) were included. Left ventricular volumes were quantified in short‐axis images. AVPD was measured in six locations in long‐axis images. Longitudinal contribution to SV was calculated as AVPD multiplied by the short‐axis epicardial area. Patients (IS 17 ± 10% of LV) had decreased ejection fraction (48 ± 8%) compared to controls (60 ± 5%, P<0·001). Global AVPD was decreased in patients (11 ± 2 mm versus 15 ± 2 mm in controls, P<0·001) and this held true for both infarcted and remote segments. AVPD contribution to SV was lower in patients (58 ± 9%) than in controls (64 ± 8%) (P<0·001). There was a weak negative correlation between IS and AVPD (r2=0·06) but no differences in global AVPD linked to infarct location. Decrease in global and regional AVPD occur even in remote myocardium within 1 week of STEMI. Global AVPD decrease is independent of MI location, and MI size has only minor effect. Longitudinal pumping is slightly lower compared to controls but remains to be the main component to SV even after STEMI. These results highlight the difficulty in determining infarct location and size from longitudinal measures of LV function.

• Hansen, Charlotte Holst; Ritschel, Vibeke Nordmo; Andersen, Geir Øystein; Halvorsen, Sigrun; Eritsland, Jan & Arnesen, Harald [Vis alle 7 forfattere av denne artikkelen] (2018). Markers of thrombin generation are associated with long-term clinical outcome in patients With ST-segment elevation myocardial infarction. Clinical and applied thrombosis/hemostasis. ISSN 1076-0296. 24(7), s. 1088–1094. doi: 10.1177/1076029618764847. Fulltekst i vitenarkiv Vis sammendrag

  Hypercoagulability in ST-segment elevation myocardial infarction (STEMI) as related to long-term clinical outcome is not clarified. We aimed to investigate whether prothrombin fragment 1+2 (F1+2), d-dimer, and endogenous thrombin potential (ETP) measured in the acute phase of STEMI were associated with outcome. Blood samples were drawn median 24 hours after symptom onset in 987 patients with STEMI. Median follow-up time was 4.6 years. Primary outcome was a composite of all-cause mortality, reinfarction, stroke, unscheduled revascularization, or rehospitalization for heart failure; secondary outcome was total mortality. The number of combined end points/total mortality was 195/79. Higher levels of d-dimer and F1+2 were observed with both end points (all P < .005), whereas ETP was significantly lower (P < .01). Dichotomized at medians, increased risk was observed for levels above median for F1+2 and d-dimer (combined end point P = .020 and P = .010 and total mortality P < .001, both), while an inverse pattern was observed for ETP (P < .02, both). Adjusting for covariates, d-dimer was still associated with reduced risk of total mortality (P = .034) and receiver operating characteristic curve analyses showed area under the curve of 0.700 (95% confidence interval, 0.640-0.758). The hypercoagulable state in acute STEMI seems to be of importance for clinical outcome.

• Christersson, Christina; Wallentin, Lars; Andersson, Ulrika; Alexander, John H.; Alings, Marco & Caterina, Raffaele de [Vis alle 15 forfattere av denne artikkelen] (2018). Effect of apixaban compared with warfarin on coagulation markers in atrial fibrillation. Heart. ISSN 1355-6037. s. 1–6. doi: 10.1136/heartjnl-2018-313351. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Compare the effect of apixaban and warfarin on coagulation and primary haemostasis biomarkers in atrial fibrillation (AF). Methods: The biomarker substudy from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial included 4850 patients with AF randomised to treatment with apixaban or warfarin. Sixty per cent of patients used vitamin K antagonist (VKA) within 7 days before randomisation. Prothrombin fragment 1+2 (F1+2), D-dimer, soluble CD40 ligand (sCD40L) and von Willebrand factor (vWF) antigen were analysed at randomisation and after 2 months of study treatment. Results: In patients not on VKA treatment at randomisation, F1+2 and D-dimer levels were decreased by 25% and 23%, respectively, with apixaban, and by 59% and 38%, respectively, with warfarin (p<0.0001 for treatment differences for both). In patients on VKA at randomisation, F1+2 and D-dimer levels increased by 41% and 10%, respectively, with apixaban and decreased by 37% and 11%, respectively, with warfarin (p<0.0001 for treatment differences for both). sCD40L levels were slightly increased at 2 months, regardless of VKA or randomised treatment. Apixaban and warfarin also both reduced vWF antigen regardless of VKA treatment. The efficacy (stroke) and safety (bleeding) of apixaban compared with warfarin was similar irrespectively of biomarker levels at 2 months. Conclusions: Treatment with apixaban compared with warfarin for stroke prevention in patients with AF was associated with less reduction in thrombin generation and fibrin turnover. This effect of apixaban could contribute to the clinical results where apixaban was superior to warfarin both in stroke prevention and in reducing bleeding risk.

• Pol, Tymon; Held, Claes; Westerbergh, Johan; Lindbäck, Johan; Alexander, John H. & Alings, Marco [Vis alle 15 forfattere av denne artikkelen] (2018). Dyslipidemia and risk of cardiovascular events in patients with atrial fibrillation treated with oral anticoagulation therapy: Insights from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. Journal of the American Heart Association (JAHA). 7(3), s. 1–11. doi: 10.1161/JAHA.117.007444. Fulltekst i vitenarkiv Vis sammendrag

  Background: Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. Methods and Results: Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow‐up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; P<0.0001). Similar results were observed for the individual components of the composite outcome. ApoB was not significantly associated with the composite ischemic outcome (P=0.8240). Neither apolipoprotein was significantly associated with major bleeding. There was no interaction between lipoproteins and randomized treatment for the primary outcome (both P values ≥0.2448). Conclusions: In patients with atrial fibrillation on oral anticoagulation, higher levels of ApoA1 were independently associated with lower risk of ischemic cardiovascular outcomes. Investigating therapies targeting dyslipidemia may thus be useful to improve cardiovascular outcomes in patients with atrial fibrillation.

• Allencherril, Joseph; Fakhri, Yama; Engblom, Henrik; Heiberg, Einar; Carlsson, Marcus & Dubois-Rande, Jean-Luc [Vis alle 15 forfattere av denne artikkelen] (2018). Correlation of anteroseptal ST elevation with myocardial infarction territories through cardiovascular magnetic resonance imaging. Journal of Electrocardiology. ISSN 0022-0736. 51(4), s. 563–568. doi: 10.1016/j.jelectrocard.2018.03.016. Fulltekst i vitenarkiv
• Rutherford, Ole-Christian Walter; Jonasson, Christian; Ghanima, Waleed Khalid; Holst, René & Halvorsen, Sigrun (2018). New score for assessing bleeding risk in patients with atrial fibrillation treated with NOACs. Open heart. 5(1). doi: 10.1136/openhrt-2018-000931. Fulltekst i vitenarkiv Vis sammendrag

  Background Information is needed on bleeding risk factors specific for patients with atrial fibrillation (AF) treated with non-vitamin K oral anticoagulants (NOACs). We aimed to identify risk factors in a large real-world cohort and to derive a bleeding risk score for patients with AF treated with NOACs. Methods From nationwide registries (the Norwegian Patient Registry and the Norwegian Prescription Database), we identified patients with AF with a first prescription of a NOAC between January 2013 and June 2015. Cox proportional-hazards analysis was used to identify the strongest risk factors for major or clinically relevant non-major (CRNM) bleeding. Based on these, a risk prediction score was derived. Discrimination was assessed with Harrel’s C-index. C-indexes for the modified Hypertension, Age, Stroke, Bleeding tendency/predisposition, Labile international normalised ratios, Elderly age, Drugs or alcohol excess (HAS-BLED), the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT) scores were also calculated from the same cohort. Results Among 21 248 NOAC-treated patients with a median follow-up time of 183 days, 1257 (5.9%) patients experienced a major or CRNM bleeding. Ten independent risk factors for bleeding were identified, which when included in a risk prediction model achieved a C-index of 0.68 (95% CI 0.66 to 0.70). A simplified score comprising three variables; age, history of bleeding and non-bleeding related hospitalisation within the last 12 months, yielded a c-index of 0.66 (95% CI 0.65 to 0.68). In the same cohort, the modified HAS-BLED, ATRIA and ORBIT scores achieved c-indexes of 0.62 (95% CI 0.60 to 0.63), 0.66 (95% CI 0.64 to 0.67) and 0.66 (95% CI 0.64 to 0.67), respectively. Conclusions Our proposed simplified bleeding score could be a useful clinical tool for quick estimation of risk of bleeding in patients with AF treated with NOACs.

• Allencherril, Joseph; Fakhri, Yama; Engblom, Henrik; Heiberg, Einar; Carlsson, Marcus & Dubois-Rande, Jean-Luc [Vis alle 15 forfattere av denne artikkelen] (2018). The significance of ST-elevation in aVL in anterolateral myocardial infarction: An assessment by cardiac magnetic resonance imaging. Annals of Noninvasive Electrocardiology. ISSN 1082-720X. 23:e12580(6), s. 1–7. doi: 10.1111/anec.12580. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To describe the prevalence and trajectory of family caregivers’ post-traumatic stress symptoms during the first year after a patient’s admission to the intensive care unit and identify associations between family caregivers’ background characteristics, hope and post-traumatic stress symptoms. Research methodology/designs Family caregivers of intensive care unit patients (n = 211) completed questionnaires at patient admission to the intensive care unit and thereafter at 1, 3, 6, and 12 months. Mixed-model analyses were performed. Setting Four intensive care units in a university hospital in Norway. Main outcome measures Impact of Event Scale—Revised and Herth Hope Index. Results On admission, 54% of family caregivers reported high post-traumatic stress symptom levels, which decreased during the first six  months after patient discharge. Lower levels of hope, being younger, having more comorbidities and being on sick leave were associated with higher post-traumatic stress symptom levels. Being the parent of the patient was associated with decreased post-traumatic stress symptom levels. Conclusions Family caregivers of intensive care unit patients report high levels of post-traumatic stress symptoms. Higher levels of hope were associated with fewer post-traumatic stress symptoms. Keywords Family caregiverHopeIntensive carePost-traumatic stress symptoms

• Alexander, Karen P.; Brouwer, Marc A.; Mulder, Hillary; Vinereanu, Dragos; Lopes, Renato D. & Proietti, Marco [Vis alle 14 forfattere av denne artikkelen] (2018). Outcomes of apixaban versus warfarin in patients with atrial fibrillation and multi-morbidity: Insights from the ARISTOTLE trial. American Heart Journal. ISSN 0002-8703. 208, s. 123–131. doi: 10.1016/j.ahj.2018.09.017. Fulltekst i vitenarkiv
• Jia, Xiaoming; Heiberg, Einar; Ripa, Maria Sejersten; Engblom, Henrik; Carlsson, Marcus & Halvorsen, Sigrun [Vis alle 10 forfattere av denne artikkelen] (2018). Cardiac magnetic resonance evaluation of the extent of myocardial injury in patients with inferior ST elevation myocardial infarction and concomitant ST depression in leads V1-V3: Analysis from the MITOCARE Study. Cardiology. ISSN 0008-6312. 140(3), s. 178–185. doi: 10.1159/000491745. Fulltekst i vitenarkiv
• Fossum, Stine; Halvorsen, Sigrun; Vikanes, Åse Vigdis; Roseboom, Tessa J.; Ariansen, Inger Kristine Holtermann & Næss, Øyvind (2018). Cardiovascular risk profile at the age of 40?45 in women with previous hyperemesis gravidarum or hypertensive disorders in pregnancy: A population-based study. Pregnancy Hypertension. ISSN 2210-7789. 12, s. 129–135. doi: 10.1016/j.preghy.2018.04.013. Fulltekst i vitenarkiv
• Sandhu, Roopinder K.; Ezekowitz, Justin A.; Hijazi, Ziad; Westerbergh, Johan; Aulin, Julia & Alexander, John H. [Vis alle 12 forfattere av denne artikkelen] (2018). Obesity paradox on outcome in atrial fibrillation maintained even considering the prognostic influence of biomarkers: Insights from the Aristotle trial. Open heart. 5:e000908(2), s. 1–9. doi: 10.1136/openhrt-2018-000908. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We investigated the association between obesity and biomarkers indicating cardiac or renal dysfunction or inflammation and their interaction with obesity and outcomes. Methods: A total of 14 753 patients in the Apixaban for Reduction In STroke and Other ThromboemboLic Events in Atrial Fibrillation (ARISTOTLE) trial provided plasma samples at randomisation to apixaban or warfarin. Median follow-up was 1.9 years. Body Mass Index (BMI) was measured at baseline and categorised as normal, 18.5–25  kg/m2; overweight, >25 to <30 kg/m2; and obese, ≥30 kg/m2. We analysed the biomarkers high-sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), growth differentiation factor-15 (GDF-15), troponin T and N-terminal B-type natriuretic peptide (NT-pro-BNP). Outcomes included stroke/systemic embolism (SE), myocardial infarction (MI), composite (stroke/SE, MI, or all-cause mortality), all-cause and cardiac mortality, and major bleeding. Results: Compared with normal BMI, obese patients had significantly higher levels of hs-CRP and IL-6 and lower levels of GDF-15, troponin T and NT-pro-BNP. In multivariable analyses, higher compared with normal BMI was associated with a lower risk of all-cause mortality (overweight: HR 0.73 (95% CI 0.63 to 0.86); obese: 0.67 (0.56 to 0.80), p<0.0001), cardiac death (overweight: HR 0.74 (95% CI 0.60 to 0.93); obese: 0.71 (0.56 to 0.92), p=0.01) and composite endpoint (overweight: 0.80 (0.70 to 0.92); obese: 0.72 (0.62 to 0.84), p<0.0001). Conclusions: Regardless of biomarkers indicating inflammation or cardiac or renal dysfunction, obesity was independently associated with an improved survival in anticoagulated patients with AF.

• Russo, Juan J.; Goodman, Shaun G.; Cantor, Warren J.; Ko, Dennis T.; Bagai, Akshay & Tan, Mary K. [Vis alle 16 forfattere av denne artikkelen] (2017). Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis. American Heart Journal. ISSN 0002-8703. 193, s. 46–54. doi: 10.1016/j.ahj.2017.07.015. Fulltekst i vitenarkiv
• Ritschel, Vibeke Nordmo; Shetelig, Christian; Seljeflot, Ingebjørg; Shanmuganathan, Limalanathan; HOFFMANN, PAVEL & Halvorsen, Sigrun [Vis alle 9 forfattere av denne artikkelen] (2017). Evaluation of circulating levels of CCN2/connective tissue growth factor in patients with ST-elevation myocardial infarction. Scientific Reports. 7:11945(1), s. 1–9. doi: 10.1038/s41598-017-12372-w. Fulltekst i vitenarkiv Vis sammendrag

  CCN2/Connective tissue growth factor seems to be involved in development of cardiac hypertrophy and fibrosis, but a possible cardioprotective role in left ventricular (LV) remodelling following myocardial infarction has also been suggested. The main objectives of the study were therefore to investigate whether circulating CCN2 levels were associated with infarct size, LV function, adverse remodelling or clinical outcome in two cohorts of patients with ST-elevation myocardial infarction (STEMI). CCN2 was measured in 988 patients 18 hours after PCI and clinical events were recorded after 55 months in the BAMI cohort. In the POSTEMI trial, serial measurements of CCN2 were performed in 258 STEMI patients during index hospitalisation and cardiac magnetic resonance imaging was performed in the acute phase and after 4 months. Clinical events were also recorded. There were no significant associations between levels of CCN2 and infarct size, LV ejection fraction, changes in LV end-diastolic or end-systolic volume, myocardial salvage or microvascular obstruction. There were no significant associations between CCN2 levels and clinical events including mortality, in either of the study cohorts. In conclusion, circulating levels of CCN2 measured in the acute phase of STEMI were not associated with final infarct size, left ventricular function or new clinical events.

• Patrono, Carlo; Morais, João; Baigent, Colin; Collet, Jean-Philippe; Fitzgerald, Desmond & Halvorsen, Sigrun [Vis alle 10 forfattere av denne artikkelen] (2017). Antiplatelet agents for the treatment and prevention of coronary atherothrombosis. Journal of the American College of Cardiology. ISSN 0735-1097. 70(14), s. 1760–1776. doi: 10.1016/j.jacc.2017.08.037. Fulltekst i vitenarkiv
• Fossum, Stine; Vikanes, Åse Vigdis; Næss, Øyvind; Vos, Linda; Grotmol, Tom & Halvorsen, Sigrun (2017). Hyperemesis gravidarum and long-term mortality: a population-based cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 124(7), s. 1080–1087. doi: 10.1111/1471-0528.14454. Fulltekst i vitenarkiv Vis sammendrag

  Objective To investigate whether exposure to hyperemesis gravidarum (HG) is associated with increased maternal long-term mortality. Results Of 999 161 women with singleton births, 13 397 (1.3%) experienced HG. During a median follow up of 26 years (25 902 036 person-years), 43 470 women died (4.4%). Women exposed to HG had a lower risk of long-term all-cause mortality compared with women without HG (crude HR 0.82; 95% CI 0.75–0.90). When adjusting for confounders, this reduction was no longer significant (adjusted HR 0.92; 95% CI 0.84–1.01). Women exposed to HG had a similar risk of cardiovascular death as women not exposed (adjusted HR 1.04; 95% CI 0.83–1.29), but a lower long-term risk of death from cancer (adjusted HR 0.86; 95% CI 0.75–0.98). Conclusion In this large population-based cohort study, HG was not associated with an increased risk of long-term all-cause mortality. Women exposed to HG had no increase in mortality due to cardiovascular disease, but had a reduced risk of death from cancer.

• Lettino, Maddalena; Leonardi, Sergio; Maria, Elia De & Halvorsen, Sigrun (2017). Antiplatelet and antithrombotic treatment for secondary prevention in ischaemic heart disease. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 24(3), s. 61–70. doi: 10.1177/2047487317707854. Fulltekst i vitenarkiv
• Pagidipati, Neha J.; Navar, Ann Marie; Pieper, Karen S.; Green, Jennifer B.; Bethel, Mary Angelyn & Armstrong, Paul W. [Vis alle 15 forfattere av denne artikkelen] (2017). Secondary prevention of cardiovascular disease in patients with type 2 diabetes mellitus: International insights from the TECOS trial (trial evaluating cardiovascular outcomes with sitagliptin). Circulation. ISSN 0009-7322. 136(13), s. 1193–1203. doi: 10.1161/CIRCULATIONAHA.117.027252. Fulltekst i vitenarkiv
• Kvakkestad, Kristin Marie; Fagerland, Morten; Eritsland, Jan & Halvorsen, Sigrun (2017). Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study. BMC Cardiovascular Disorders. 17:75, s. 1–10. doi: 10.1186/s12872-017-0508-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Gender differences in short-term mortality in acute myocardial infarction (AMI) have been studied extensively, whereas gender differences in long-term mortality and cause of death largely remain unknown. The aim of this study was to assess the long-term risk of all-cause, cardiovascular and cancer death after AMI in women compared to men. Methods Consecutive AMI patients were enrolled in a prospective registry between 2005 and 2011. Date and cause of death were obtained by linkage with the Norwegian Cause of Death Registry, with censoring date 31 December 2012. AMI patients with ST-segment elevation (STEMI, n = 5159) and without (NSTEMI, n = 4899) were analysed separately. Results The 5-years all-cause mortality rates in STEMI were 29% in women vs. 17% in men, and 42% vs. 29% in NSTEMI, respectively. After adjustment for age and other confounders, women with STEMI had similar (HR 1.13 [95% CI: 0.98–1.32]) and women with NSTEMI lower (HR 0.82 [95% CI: 0.73–0.92]) risk of long-term all-cause mortality compared to men. Competing-risks analysis showed no significant gender differences in age-adjusted risk of cardiovascular death nor of cancer death. In both genders, the annual risk of cardiovascular death was low after 1 year, but exceeded annual risk of cancer death throughout follow-up. Conclusion During long-term follow-up, women with STEMI had similar and women with NSTEMI lower adjusted risk of all-cause mortality compared to men. Age-adjusted risk of death due to cardiovascular disease was similar in both genders and higher than risk of death due to cancer throughout the follow-up period.

• Halvorsen, Sigrun; Storey, Robert F.; Rocca, Bianca; Sibbing, Dirk; Berg, Jurrien M. ten & Grove, Erik L. [Vis alle 19 forfattere av denne artikkelen] (2017). Management of antithrombotic therapy after bleeding in patients with coronary artery disease and/or atrial fibrillation: expert consensus paper of the European Society of Cardiology Working Group on Thrombosis. European Heart Journal. ISSN 0195-668X. 38(19), s. 1455–1462. doi: 10.1093/eurheartj/ehw454. Fulltekst i vitenarkiv
• Allencherril, Joseph; Fakhri, Yama; Engblom, Henrik; Heiberg, Einar; Carlsson, Marcus & Dubois-Rande, Jean-Luc [Vis alle 17 forfattere av denne artikkelen] (2017). Appropriateness of anteroseptal myocardial infarction nomenclature evaluated by late gadolinium enhancement cardiovascular magnetic resonance imaging. Journal of Electrocardiology. ISSN 0022-0736. 51, s. 218–223. doi: 10.1016/j.jelectrocard.2017.09.013. Fulltekst i vitenarkiv
• Blanch, Gemma Chiva; Bratseth, Vibeke; Ritschel, Vibeke Nordmo; Andersen, Geir Øystein; Halvorsen, Sigrun & Eritsland, Jan [Vis alle 9 forfattere av denne artikkelen] (2017). Monocyte-derived circulating macroparticles (CD14+,CD14+/CD11b and CD14+/CD142+) as related to long-term prognosis for cardiovascular mortality in STEMI patient. International Journal of Cardiology. ISSN 0167-5273. 227, s. 876–881. doi: 10.1016/j.ijcard.2016.11.302. Fulltekst i vitenarkiv Vis sammendrag

  Background Circulating microparticles (cMPs) have been proposed as novel biomarkers of cardiovascular disease (CVD). We aimed to investigate the prognostic relevance of cMPs for future major adverse cardiovascular events (MACE) in STEMI patients. Methods We included 200 STEMI patients treated with percutaneous coronary intervention (PCI). One hundred patients with a primary composite end point (recurrent nonfatal acute MI, rehospitalization for heart failure, unscheduled PCI or death because of CV causes) were case-matched for sex, age, and CVD risk factors to 100 patients without a primary endpoint at the end of study follow-up (4.4 (1.4) years). cMPs from vascular cells were measured by flow cytometer at a mean of 28 h after onset of symptoms. Results No differences were observed in MP shedding between patients with or without a MACE at the end of the study follow-up. However, compared to patients who survived during follow-up, patients who died because of CV causes (n = 24) presented with increased total cMPs (Annexin V-AV-+), cMPs carrying tissue factor, and increased MP shedding from platelets, lymphocytes, monocytes, and activated leukocytes, and ~ 10% lower left ventricular ejection fraction (LVEF). ROC-curve analyses showed that monocyte-derived cMPs (CD14+/AV+, CD11b+/CD14+/AV+ and CD142+/CD14+/AV+) considered together with LVEF best predicted cardiovascular mortality. Conclusions Monocyte-derived cMPs assessed in the acute phase relate to the prognosis of CV death at the long term. These findings may be of clinical interest in the risk assessment of STEMI patients. © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

• Butt, Noreen; Bache-Mathiesen, Lena Kristin; Nordrehaug, Jan Erik; Tuseth, Vegard; Munk, Peter Scott & Bonarjee, Vernon V S [Vis alle 12 forfattere av denne artikkelen] (2017). Administration of the Mitochondrial Permeability Transition Pore Inhibitor, TRO40303, prior to Primary Percutaneous Coronary Intervention, Does Not Affect the Levels of Pro-Inflammatory Cytokines or Acute-Phase Proteins. Cardiology. ISSN 0008-6312. 138(2), s. 122–132. doi: 10.1159/000475460. Fulltekst i vitenarkiv
• Alexander, John H.; Andersson, Ulrika; Lopes, Renato D.; Hijazi, Ziad; Hohnloser, Stefan H. & Ezekowitz, Justin A. [Vis alle 14 forfattere av denne artikkelen] (2016). Apixaban 5 mg Twice Daily and Clinical Outcomes in Patients With Atrial Fibrillation and Advanced Age, Low Body Weight, or High Creatinine: A Secondary Analysis of a Randomized Clinical Trial. JAMA cardiology. ISSN 2380-6583. 1(6), s. 673–681. doi: 10.1001/jamacardio.2016.1829. Fulltekst i vitenarkiv
• Shavadia, Jay; Welsh, Robert; Gershlick, Anthony; Zheng, Yinggan; Huber, Kurt & Halvorsen, Sigrun [Vis alle 9 forfattere av denne artikkelen] (2016). Relationship between arterial access and outcomes in ST-elevation myocardial infarction with a pharmacoinvasive versus primary percutaneous coronary intervention strategy: Insights from the STrategic reperfusion early after myocardial infarction (STREAM) study. Journal of the American Heart Association (JAHA). 5:e003559(6). doi: 10.1161/JAHA.116.003559. Fulltekst i vitenarkiv
• McGuire, Darren; Werf, Frans Van de; Armstrong, Paul W.; Standl, E.; Koglin, Joerg & Green, J.B. [Vis alle 19 forfattere av denne artikkelen] (2016). Association Between Sitagliptin Use and Heart Failure Hospitalization and Related Outcomes in Type 2 Diabetes Mellitus: Secondary Analysis of a Randomized Clinical Trial. JAMA cardiology. ISSN 2380-6583. 1(2), s. 126–135. doi: 10.1001/jamacardio.2016.0103. Fulltekst i vitenarkiv
• Ritschel, Vibeke Nordmo; Seljeflot, Ingebjørg; Arnesen, Harald; Halvorsen, Sigrun; Eritsland, Jan & Fagerland, Morten [Vis alle 7 forfattere av denne artikkelen] (2016). Circulating levels of IL-6 receptor and gp130 and long-term clinical outcomes in ST-elevation myocardial infarction. Journal of the American Heart Association (JAHA). 5(6). doi: 10.1161/JAHA.115.003014. Fulltekst i vitenarkiv Vis sammendrag

  Background Reports on soluble interleukin‐6 (IL‐6) receptor (sIL‐6R) and glycoprotein 130 (sgp130) in ST‐elevation myocardial infarction (STEMI) are few and include a small number of patients. The aim of this study was to investigate the possible association between levels of these biomarkers in the acute phase of STEMI and future cardiovascular events. Methods and Results Circulating IL‐6, sgp130, sIL‐6R, and C‐reactive protein (CRP) were measured in 989 STEMI patients during 2007–2011, and cardiovascular events were recorded during follow‐up. The primary endpoint was composite of all‐cause mortality, myocardial infarction, stroke, unscheduled revascularization, or rehospitalization for heart failure. Cox regression models were used to estimate hazard ratios (HRs) for cardiovascular events in relation to biomarker levels. Median levels of sIL‐6R, sgp130, IL‐6, and CRP measured 24 hours (median) after symptom onset were 39.2 ng/mL, 240 ng/mL, 18.8 pg/mL, and 13.7 mg/L, respectively. During a median follow‐up time of 4.6 years, 200 patients (20.2%) experienced a primary endpoint, and 82 patients (8.3%) died. Patients with sIL‐6R levels in the upper quartile (>47.7 ng/mL) had significantly higher risk of future adverse events (primary endpoint) and mortality compared to patients with lower levels (adjusted HR, 1.54 [1.08, 2.21]; P=0.02 and 1.81 [1.04, 3.18]; P=0.04, respectively). Neither IL‐6 nor sgp130 levels were related to future events, but patients with CRP levels in the upper quartile (>31.5 mg/L) had higher risk of death. Conclusion High levels of sIL‐6R were associated with future cardiovascular events and mortality in STEMI patients, suggesting an important role of the IL‐6 signaling system.

• Jortveit, Jarle; Govatsmark, Ragna Elise; Langørgen, Jørund; Hole, Torstein; Mannsverk, Jan Torbjørn & Olsen, Siv Jorunn Storli [Vis alle 8 forfattere av denne artikkelen] (2016). Kjønnsforskjeller i utredning og behandling av hjerteinfarkt [Gender differences in the assessment and treatment of myocardial infarction]. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 136(14), s. 1215–1222. doi: 10.4045/tidsskr.16.0224. Fulltekst i vitenarkiv
• Bainey, Kevin R.; Fresco, Claudio; Zheng, Yinggan; Halvorsen, Sigrun; Carvalho, Antonio & Ostojic, Miodrag [Vis alle 11 forfattere av denne artikkelen] (2016). Implications of ischaemic area at risk and mode of reperfusion in ST-elevation myocardial infarction. Heart. ISSN 1355-6037. 102(7), s. 527–533. doi: 10.1136/heartjnl-2015-308075. Fulltekst i vitenarkiv
• Sandhu, Roopinder K.; Ezekowitz, Justin; Andersson, Ulrika; Alexander, John H.; Granger, Christopher B. & Halvorsen, Sigrun [Vis alle 11 forfattere av denne artikkelen] (2016). The 'obesity paradox' in atrial fibrillation: Observations from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial. European Heart Journal. ISSN 0195-668X. 37(38), s. 2869–2878. doi: 10.1093/eurheartj/ehw124. Fulltekst i vitenarkiv
• Caterina, Raffaele De; Husted, Steen E.; Wallentin, Lars; Andreotti, Felicita; Arnesen, Harald & Bachmann, Fedor [Vis alle 22 forfattere av denne artikkelen] (2016). Oral anticoagulants in coronary heart disease (Section IV): Position paper of the ESC working group on thrombosis – Task force on anticoagulants in heart disease. Thrombosis and Haemostasis. ISSN 0340-6245. 115(4), s. 685–711. doi: 10.1160/TH15-09-0703. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Jortveit, Jarle; Hasvold, Pål; Thuresson, Marcus & Øie, Erik (2016). Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction. BMC Cardiovascular Disorders. 16(115). doi: 10.1186/s12872-016-0283-6. Fulltekst i vitenarkiv
• Engblom, Henrik; Heiberg, Einar; Erlinge, David; Jensen, Svend Eggert; Nordrehaug, Jan Erik & Dubois-Rande, Jean-Luc [Vis alle 12 forfattere av denne artikkelen] (2016). Sample size in clinical cardioprotection trials using myocardial salvage index, infarct size, or biochemical markers as endpoint. Journal of the American Heart Association (JAHA). 5:e002708(3), s. 1–13. doi: 10.1161/JAHA.115.002708. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Ghanima, Waleed Khalid; Tvete, Ingunn Fride; Hoxmark, Cecilie; Falck, Pål & Solli, Oddvar [Vis alle 7 forfattere av denne artikkelen] (2016). A nationwide registry study to compare bleeding rates in patients with atrial fibrillation being prescribed oral anticoagulants. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 3(1), s. 28–36. doi: 10.1093/ehjcvp/pvw031. Fulltekst i vitenarkiv Vis sammendrag

  Aims: We aimed to evaluate bleeding risk in clinical practice in patients with atrial fibrillation (AF) being prescribed dabigatran, rivaroxaban, or apixaban compared with warfarin. Methods: Using nationwide registries (Norwegian Patient Registry and Norwegian Prescription Database), we identified AF patients with a first prescription of oral anticoagulants between January 2013 and June 2015. Patients were followed until discontinuation or switching of oral anticoagulants, death, or end of follow-up. The primary endpoint was major or clinically relevant non-major (CRNM) bleeding. Results: In total 32 675 AF patients were identified (58% men, median age 74 years): 11 427 patients used warfarin, 7925 dabigatran, 6817 rivaroxaban, and 6506 apixaban. After a median follow-up of 173 days (25th, 75th percentile 84, 340), 2081 (6.37%) patients experienced a first major or CRNM bleeding. Using a Cox proportional hazard model adjusting for baseline characteristics, use of apixaban [hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.61–0.80, P < 0.001] and dabigatran (HR 0.74, 95% CI 0.66–0.84, P < 0.001) were associated with a lower risk of major or CRNM bleeding compared with warfarin whereas use of rivaroxaban was not (HR: 1.05, 95% CI 0.94–1.17, P = 0.400). Use of dabigatran and rivaroxaban were associated with higher risk of gastrointestinal bleeding, whereas use of apixaban and dabigatran were associated with lower risk of intracranial bleeding, compared with warfarin. Conclusion: In this nationwide cohort study in AF patients, apixaban and dabigatran were associated with a lower risk of major or CRNM bleeding compared with warfarin. The risk of gastrointestinal bleeding was higher with rivaroxaban and dabigatran compared with warfarin.

• Graham, John J.; Yan, Andrew T.; Tan, Mary K.; Cantor, Warren J.; DiMario, Carlo & Jolly, Sanjit S. [Vis alle 14 forfattere av denne artikkelen] (2016). Radial versus femoral access for percutaneous coronary intervention in ST-elevation myocardial infarction patients treated with fibrinolysis: Results from the randomized routine early invasive clinical trials. Cardiovascular Revascularization Medicine. ISSN 1553-8389. 17(5), s. 295–301. doi: 10.1016/j.carrev.2016.03.008. Fulltekst i vitenarkiv
• Sticherling, C; Marin, F; Birnie, D; Boriani, Giuseppe; Calkins, H & Dan, GA [Vis alle 14 forfattere av denne artikkelen] (2015). Antithrombotic management in patients undergoing electrophysiological procedures: a European Heart Rhythm Association (EHRA) position document endorsed by the ESC Working Group Thrombosis, Heart Rhythm Society (HRS), and Asia Pacific Heart Rhythm Society (APHRS). Europace. ISSN 1099-5129. 17, s. 1197–1214. doi: 10.1093/europace/euv190. Fulltekst i vitenarkiv
• Abdel-Qadir, Husam; Yan, Andrew T.; Tan, Mary; Borgia, Francesco; Piscione, Federico & Mario, Carlo Di [Vis alle 15 forfattere av denne artikkelen] (2015). Consistency of benefit from an early invasive strategy after fibrinolysis: A patient-level meta-analysis. Heart. ISSN 1355-6037. 101(19), s. 1554–1561. doi: 10.1136/heartjnl-2015-307815. Fulltekst i vitenarkiv
• Madan, Mina; Halvorsen, Sigrun; Mario, Carlo Di; Tan, Mary; Westerhout, Cynthia M. & Cantor, Warren J. [Vis alle 16 forfattere av denne artikkelen] (2015). Relationship between time to invasive assessment and clinical outcomes of patients undergoing an early invasive strategy after fibrinolysis for ST-segment elevation myocardial infarction: A patient-level analysis of the randomized early routine invasive clinical trials. JACC: Cardiovascular Interventions. ISSN 1936-8798. 8(1), s. 166–174. doi: 10.1016/j.jcin.2014.09.005. Fulltekst i vitenarkiv
• Shavadia, J; Zheng, Y; Maleki, N Dianati; Huber, Kurt; Halvorsen, Sigrun & Goldstein, Patrick [Vis alle 10 forfattere av denne artikkelen] (2015). Infarct Size, Shock, and Heart Failure: Does Reperfusion Strategy Matter in Early Presenting Patients With ST-Segment Elevation Myocardial Infarction? Journal of the American Heart Association (JAHA). 4, s. e002049–e002049. doi: 10.1161/JAHA.115.002049. Fulltekst i vitenarkiv
• Halvorsen, Sigrun (2015). Non-vitamin K avhengige orale antikoagulantia (NOAK) - hva må man vite og hvordan bruke dem i praksis. Hjerteforum. ISSN 0802-1465. 28(3), s. 21–32. Fulltekst i vitenarkiv
• Mueller, Christian; Auer, Johannn & Halvorsen, Sigrun (2015). Cardiac troponin elevations in acute non-coronary disease: Helpful or not? European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 4, s. 429–430. doi: 10.1177/2048872615573921. Fulltekst i vitenarkiv
• Rao, Meena; Halvorsen, Sigrun; Wojdyla, Daniel; Wallentin, Lars; Granger, Christopher B & Hylek, Elaine M [Vis alle 16 forfattere av denne artikkelen] (2015). Blood pressure control and risk of stroke or systemic embolism in patients with atrial fibrillation: Results from the apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation (ARISTOTLE) trial. Journal of the American Heart Association (JAHA). 4:e002015(12), s. 1–9. doi: 10.1161/JAHA.115.002015. Fulltekst i vitenarkiv
• Bethke, Anne; Halvorsen, Sigrun; Bøhmer, Ellen; Abdelnoor, Michael; Arnesen, Harald & HOFFMANN, PAVEL (2015). Myocardial perfusion grade predicts final infarct size and left ventricular function in patients with ST-elevation myocardial infarction treated with a pharmaco-invasive strategy (thrombolysis and early angioplasty). EuroIntervention. ISSN 1774-024X. 11(5), s. 518–524. doi: 10.4244/eijy15m04_02. Fulltekst i vitenarkiv
• Atar, Dan; Arheden, Hakan; Berdeaux, Alain; Bonnet, Jean-Louis; Carlsson, Marcus & Clemmensen, Peter [Vis alle 29 forfattere av denne artikkelen] (2015). Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: MITOCARE study results. European Heart Journal. ISSN 0195-668X. 36(2), s. 112–119. doi: 10.1093/eurheartj/ehu331. Fulltekst i vitenarkiv
• Lindholm, Daniel; Storey, Robert F.; Christersson, Christina; Halvorsen, Sigrun; Grove, Erik L. & Braun, Oscar Ö. [Vis alle 8 forfattere av denne artikkelen] (2015). Design and rationale of TROCADERO: A TRial of Caffeine to Alleviate DyspnEa Related to ticagrelOr. American Heart Journal. ISSN 0002-8703. 170(3), s. 465–470. doi: 10.1016/j.ahj.2015.06.014. Fulltekst i vitenarkiv
• Vinereanu, Dragos; Stevens, Susanna R.; Alexander, John H.; Al-Khatib, Sana M.; Avezum, Alvaro & Bahit, Maria C [Vis alle 15 forfattere av denne artikkelen] (2015). Clinical outcomes in patients with atrial fibrillation according to sex during anticoagulation with apixaban or warfarin: a secondary analysis of a randomized controlled trial. European Heart Journal. ISSN 0195-668X. 36(46), s. 3268–3275. doi: 10.1093/eurheartj/ehv447. Fulltekst i vitenarkiv
• Kvakkestad, Kristin Marie; Abdelnoor, Michael; Claussen, Peter Andreas; Eritsland, Jan; Fossum, Eigil & Halvorsen, Sigrun (2015). Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: A prospective cohort study. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. doi: 10.1177/2048872615574706. Fulltekst i vitenarkiv Vis sammendrag

  Aim: We aimed to study in-hospital mortality and long-term survival in elderly compared to younger patients with STsegment elevation myocardial infarction (STEMI) in the era of primary angioplasty. Methods and results: This was a prospective cohort study. All consecutive STEMI-patients admitted to our hospital between September 2005–December 2011 were included in a local registry. Predefined variables were registered during hospital admission. Vital status was obtained from the Norwegian Cause of Death Registry with censoring date 31 December 2011. Adjusted effects of age ⩾80 years on in-hospital- and long-term mortality were determined using propensity score analysis. Of 4525 registered STEMI patients, 600 (13%) were octogenarians or older. In-hospital mortality was 17% in patients ⩾80 years and 4% in patients <80 years. In invasively treated patients (83% of patients ⩾80 years; 98% of patients <80 years), in-hospital mortality was 13% and 3.4%, respectively. Median follow-up time was 2.5 years. Three-year cumulative survival was 52% in patients ⩾80 years vs 89% in patients <80 years. In invasively treated patients ⩾80 years, three-year survival was 58%. The adjusted odds ratio of in-hospital mortality was 2.61 (1.94–3.52) and adjusted incidence rate ratio of long-term mortality was 4.07 (3.43–4.84) in very elderly compared to younger patients. Conclusion: Short-term prognosis was acceptable in very elderly STEMI patients, especially in the invasively treated subgroup. However, only 52% of STEMI patients ⩾80 years were alive after three years of follow-up. Very elderly patients had 2.6 times higher risk of in-hospital mortality and 4.1 times the risk of not surviving during long-term followup compared to patients <80 years, after adjustment for confounding factors and selection bias.

• Andreotti, Felicita; Rocca, Bianca; Husted, Steen; Ajjan, Ramzi A.; Berg, Jurrien M. Ten & Cattaneo, Marco [Vis alle 20 forfattere av denne artikkelen] (2015). Antithrombotic therapy in the elderly: Expert position paper of the European society of cardiology working group on thrombosis. European Heart Journal. ISSN 0195-668X. 36(46), s. 3238–3249. doi: 10.1093/eurheartj/ehv304. Fulltekst i vitenarkiv
• Gershlick, Anthony H.; Westerhout, Cynthia M.; Armstrong, Paul W.; Huber, Kurt; Halvorsen, Sigrun & Steg, Philippe Gabriel [Vis alle 11 forfattere av denne artikkelen] (2015). Impact of a pharmacoinvasive strategy when delays to primary PCI are prolonged. Heart. ISSN 1355-6037. 101(9), s. 692–698. doi: 10.1136/heartjnl-2014-306686. Fulltekst i vitenarkiv
• Jortveit, Jarle; Govatsmark, Ragna Elise; Digre, Tormod Aarlott; Risøe, Cecilie; Hole, Torstein & Mannsverk, Jan Torbjørn [Vis alle 8 forfattere av denne artikkelen] (2014). Hjerteinfarkt i Norge i 2013. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(19), s. 1841–1846. doi: 10.4045/tidsskr.14.0804. Fulltekst i vitenarkiv
• Sinnaeve, Peter; Armstrong, Paul W; Gershlick, Anthony H.; Goldstein, Patrick; Wilcox, Robert & Lambert, Yves [Vis alle 15 forfattere av denne artikkelen] (2014). ST-segment-elevation myocardial infarction patients randomized to a pharmaco-invasive strategy or primary percutaneous coronary intervention: Strategic Reperfusion Early After Myocardial Infarction (STREAM) 1-year mortality follow-up. Circulation. ISSN 0009-7322. 130(14), s. 1139–1145. doi: 10.1161/CIRCULATIONAHA.114.009570. Fulltekst i vitenarkiv
• Kristiansen, Annette; Brandt, Linn; Agoritsas, Thomas; Akl, Elie A.; Berge, Eivind & Bondi, Johan Fridtjof [Vis alle 19 forfattere av denne artikkelen] (2014). Adaptation of trustworthy guidelines developed using the GRADE methodology: a novel five-step process. Chest. ISSN 0012-3692. 146(3), s. 727–734. doi: 10.1378/chest.13-2828. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: Adaptation of guidelines for use at the national or local level can facilitate their implementation. We developed and evaluated an adaptation process in adherence with standards for trustworthy guidelines and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, aiming for efficiency and transparency. This article is the first in a series describing our adaptation of Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines for a Norwegian setting. METHODS: Informed by the ADAPTE framework, we developed a five-step adaptation process customized to guidelines developed using GRADE: (1) planning, (2) initial assessment of the recommendations, (3) modification, (4) publication, and (5) evaluation. We developed a taxonomy for describing how and why recommendations from the parent guideline were modified and applied a mixed-methods case study design for evaluation of the process. RESULTS: We published the adapted guideline in November 2013 in a novel multilayered format. The taxonomy for adaptation facilitated transparency of the modification process for both the guideline developers and the end users. We excluded 30 and modified 131 of the 333 original recommendations according to the taxonomy and developed eight new recommendations. Unforeseen obstacles related to acquiring a licensing agreement and procuring a publisher resulted in a 9-month delay. We propose modifications of the adaptation process to overcome these obstacles in the future. CONCLUSIONS: This case study demonstrates the feasibility of a novel guideline adaptation process. Replication is needed to further validate the usefulness of the process in increasing the organizational and methodologic efficiency of guideline adaptation.

• Halvorsen, Sigrun & Huber, Kurt (2014). Fibrinolytic treatment of ST-elevation myocardial infarction. Hämostaseologie. ISSN 0720-9355. 34(1), s. 47–53. doi: 10.5482/HAMO-13-07-0040. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Atar, Dan; Yang, Hongqiu; Caterina, Raffaele De; Erol, Cetin & Garcia, David [Vis alle 16 forfattere av denne artikkelen] (2014). Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: Observations from the ARISTOTLE trial. European Heart Journal. ISSN 0195-668X. 35(28), s. 1864–1872. doi: 10.1093/eurheartj/ehu046. Fulltekst i vitenarkiv
• Vartdal, Trond; Fetveit, Arne; Kristiansen, Annette; Brandt, Linn; Halvorsen, Sigrun & Berge, Eivind [Vis alle 9 forfattere av denne artikkelen] (2014). Antitrombotisk behandling og profylakse: - ny generasjon retningslinjer for allmennleger. Utposten. ISSN 0800-5680. 3, s. 41–43. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Andreotti, Felicita; Berg, Jurrien M. Ten; Cattaneo, Marco; Coccheri, Sergio & Marchioli, Roberto [Vis alle 9 forfattere av denne artikkelen] (2014). Aspirin therapy in primary cardiovascular disease prevention: A position paper of the european society of cardiology working group on thrombosis. Journal of the American College of Cardiology. ISSN 0735-1097. 64(3), s. 319–327. doi: 10.1016/j.jacc.2014.03.049. Fulltekst i vitenarkiv
• Bagai, Akshay; Tan, Mary; Mario, Carlo Di; Halvorsen, Sigrun; Cantor, Warren J. & May, Michel R. Le [Vis alle 15 forfattere av denne artikkelen] (2014). Routine invasive management early after fibrinolysis: Relationship between baseline risk and treatment effects in a pooled patient-level analysis of 7 randomized controlled trials. American Heart Journal. ISSN 0002-8703. 168(5), s. 757–765.e3. doi: 10.1016/j.ahj.2014.07.027. Fulltekst i vitenarkiv
• Claussen, Peter Andreas; Abdelnoor, Michael; Kvakkestad, Kristin Marie; Eritsland, Jan & Halvorsen, Sigrun (2014). Prevalence of risk factors at presentation and early mortality in patients aged 80 years or older with ST-segment elevation myocardial infarction. Vascular Health and Risk Management. ISSN 1176-6344. 10, s. 683–689. doi: 10.2147/VHRM.S72764. Fulltekst i vitenarkiv
• Bøhmer, Ellen; Kristiansen, Ivar Sønbø; Arnesen, Harald & Halvorsen, Sigrun (2014). Health-related quality of life after myocardial infarction, does choice of method make a difference? Scandinavian Cardiovascular Journal. ISSN 1401-7431. 48(4), s. 216–222. doi: 10.3109/14017431.2014.923581. Fulltekst i vitenarkiv
• Kristiansen, Annette; Brandt, Linn; Agoritsas, Thomas; Akl, Elie A; Berge, Eivind & Jacobsen, Anne Flem [Vis alle 10 forfattere av denne artikkelen] (2014). Applying new strategies for the national adaptation, updating and dissemination of trustworthy guidelines: Results from the Norwegian adaptation of the American College of chest physicans evidence-based guidelines on antithrombotic therapy and the prevention of thrombosis, 9th edidion. Chest. ISSN 0012-3692. 146(3), s. 735–761. doi: 10.1378/chest.13-2993. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND: The Antithrombotic Therapy and the Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (AT9) represent trustworthy international guidelines for antithrombotic treatment and thromboprophylaxis. We describe major changes to the format and content resulting from applying new strategies for guideline adaptation and dissemination. METHODS: A Norwegian guideline panel of 46 experts completed a structured and systematic adaptation process, updated the recommendations based on new evidence, and rewrote the recommendations in an electronic multilayered presentation format. We published the adapted guideline using the web-based Making GRADE the Irresistible Choice Guideline Authoring and Publication Platform. RESULTS: We applied a novel presentation format to 333 recommendations from 11 of the 15 management chapters in AT9 and condensed and restructured them into 249 recommendations in a multilayered format. We added additional relevant information, such as 29 best-practice statements about new oral anticoagulants and practical information sections for 121 recommendations. Common reasons for modifications included feasibility of the recommendations in a national context, disagreement with applied baseline risk estimates, and reevaluation of the balance between the benefits and harms of interventions in relation to assumed typical patient preferences and values. The adapted guideline was published and disseminated online in November 2013. CONCLUSIONS: New strategies for adapting, updating, and disseminating trustworthy guidelines proved feasible and will provide Norwegian health-care professionals and patients with up-to-date guidance tailored to national circumstances.

• Ritschel, Vibeke Nordmo; Seljeflot, Ingebjørg; Arnesen, Harald; Halvorsen, Sigrun; Weiss, Thomas & Eritsland, Jan [Vis alle 7 forfattere av denne artikkelen] (2014). IL-6 signalling in patients with acute ST-elevation myocardial infarction. Results in Immunology. 4(1), s. 8–13. doi: 10.1016/j.rinim.2013.11.002. Fulltekst i vitenarkiv Vis sammendrag

  Cytokines of the IL-6 family have been related to infarct size and prognosis in patients with myocardial infarction. The aims of the present study were to elucidate possible associations between myocardial necrosis and left ventricular impairment and members of the IL-6 transsignalling system including soluble (s) IL-6R and (s) glycoprotein 130 (sgp130) in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI. In blood samples from 1028 STEMI patients, collected in-hosptial, we found significant correlations between peak TnT and IL-6 and CRP (p < 0.001, all) and between IL-6 and CRP and LV ejection fraction and NT-proBNP (p < 0.001, all). On the contrary, no significant associations were found between peak TnT and sgp130 or sIL-6R. Furthermore sgp130 was significantly elevated in diabetic patients and also associated with the glucometabolic state. In conclusion, circulating levels of IL-6 and CRP, but not the soluble forms of the receptor (sIL-6R) or the receptor signalling subunit (sgp130) were associated with the extent of myocardial necrosis. The biological importance of the IL-6/gp130-mediated signalling pathways in patients with acute myocardial infarction and dysglycemia should be further elucidated.

• Radke, Peter W.; Halvorsen, Sigrun; Jukema, J. Wouter; Kolh, Philippe; Annemans, Lieven & Postma, Maarten J. [Vis alle 13 forfattere av denne artikkelen] (2014). Networks for improving care in patients with acute coronary syndrome: A framework. Acute Cardiac Care. ISSN 1748-2941. 16(2), s. 41–48. doi: 10.3109/17482941.2014.881502. Fulltekst i vitenarkiv
• Armstrong, Paul W.; Gershlick, Anthony H.; Goldstein, Patrick; Wilcox, Robert; Danays, Thierry & Lambert, Yves [Vis alle 22 forfattere av denne artikkelen] (2013). Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction. New England Journal of Medicine. ISSN 0028-4793. 368(15), s. 1379–1387. doi: 10.1056/NEJMoa1301092. Fulltekst i vitenarkiv
• Shuvy, Mony; Atar, Dan; Steg, Philippe Gabriel; Halvorsen, Sigrun; Jolly, Sanjit & Yusuf, Salim [Vis alle 7 forfattere av denne artikkelen] (2013). Oxygen therapy in acute coronary syndrome: are the benefits worth the risk? European Heart Journal. ISSN 0195-668X. 34(22), s. 1630–1635. doi: 10.1093/eurheartj/eht110. Fulltekst i vitenarkiv
• Atar, Dan; Abitbol, Jean-Louis; Arheden, Hakan; Berdeaux, Alain; Bonnet, Jean-Louis & Carlsson, Marcus [Vis alle 27 forfattere av denne artikkelen] (2012). Rationale and Design of the 'MITOCARE' Study: A Phase II, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Assess the Safety and Efficacy of TRO40303 for the Reduction of Reperfusion Injury in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction. Cardiology. ISSN 0008-6312. 123(4), s. 201–207. doi: 10.1159/000342981. Fulltekst i vitenarkiv
• Wisløff, Torbjørn; Selmer, Randi; Halvorsen, Sigrun; Fretheim, Atle; Norheim, Ole Frithjof & Kristiansen, Ivar Sønbø (2012). Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis. BMC Cardiovascular Disorders. 12. doi: 10.1186/1471-2261-12-26. Fulltekst i vitenarkiv Vis sammendrag

  Background: Hypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease. Methods: We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources. Results: In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs. Conclusions: Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.

• Halvorsen, Sigrun; Seljeflot, Ingebjørg; Weiss, Thomas; Bøhmer, Ellen & Arnesen, Harald (2012). Inflammatory and thrombotic markers in patients with ST-elevation myocardial infarction treated with thrombolysis and early PCI: A NORDISTEMI substudy. Thrombosis Research. ISSN 0049-3848. 130(3), s. 495–500. doi: 10.1016/j.thromres.2012.04.016. Fulltekst i vitenarkiv
• Steg, Philippe Gabriel; James, Stefan; Atar, Dan; Badano, Luigi P.; Lundqvist, Carina Blomstrom & Borger, Michael A. [Vis alle 23 forfattere av denne artikkelen] (2012). ESC Guidelines for the management of acute myocardial infarction in patientspresenting with ST-segment elevation. European Heart Journal. ISSN 0195-668X. 33(20), s. 2569–2619. doi: 10.1093/eurheartj/ehs215. Fulltekst i vitenarkiv
• Kubon, Christer; Mistry, Nisha; Grundvold, Irene; Halvorsen, Sigrun; Kjeldsen, Sverre Erik & Westheim, Arne (2011). The role of beta-blockers in the treatment of chronic heart failure. TIPS - Trends in Pharmacological Sciences. ISSN 0165-6147. 32(4), s. 206–212. doi: 10.1016/j.tips.2011.01.006. Fulltekst i vitenarkiv
• Mistry, Nisha; Abdelnoor, Michael; Seljeflot, Ingebjørg; HOFFMANN, PAVEL; Bøhmer, Ellen & Bjørnerheim, Reidar [Vis alle 8 forfattere av denne artikkelen] (2011). Amino-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Levels 3 Months After Myocardial Infarction Are More Strongly Associated With Magnetic Resonance-Determined Ejection Fraction Than NTproBNP Levels in the Acute Phase. Journal of Cardiac Failure. ISSN 1071-9164. 17(6), s. 479–486. doi: 10.1016/j.cardfail.2011.02.006. Fulltekst i vitenarkiv
• Mistry, Nisha; Beitnes, Jan Otto; Halvorsen, Sigrun; Abdelnoor, Michael; HOFFMANN, PAVEL & Kjeldsen, Sverre Erik [Vis alle 9 forfattere av denne artikkelen] (2011). Assessment of left ventricular function in ST-elevation myocardial infarction by global longitudinal strain: a comparison with ejection fraction, infarct size, and wall motion score index measured by non-invasive imaging modalities. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 12(9), s. 678–683. doi: 10.1093/ejechocard/jer113. Fulltekst i vitenarkiv
• Halvorsen, Sigrun & Huber, K. (2011). The role of fibrinolysis in the era of primary percutaneous coronary intervention. Thrombosis and Haemostasis. ISSN 0340-6245. 105(3), s. 390–395. doi: 10.1160/TH10-08-0513. Fulltekst i vitenarkiv
• Bøhmer, Ellen; Kristiansen, Ivar Sønbø; Arnesen, Harald & Halvorsen, Sigrun (2011). Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarction. European Journal of Cardiovascular Prevention & Rehabilitation. ISSN 1741-8267. 18(5), s. 717–723. doi: 10.1177/1741826711398425. Fulltekst i vitenarkiv
• Mistry, Nisha; Bøhmer, Ellen; HOFFMANN, PAVEL; Muller, Carl; Bjørnerheim, Reidar & Kjeldsen, Sverre Erik [Vis alle 7 forfattere av denne artikkelen] (2010). Left ventricular function in acute myocardial infarction treated with thrombolysis followed by early versus late invasive strategy. American Heart Journal. ISSN 0002-8703. 160(1), s. 73–79. doi: 10.1016/j.ahj.2010.04.011. Fulltekst i vitenarkiv
• Borgia, Francesco; Goodman, Shaun G.; Halvorsen, Sigrun; Cantor, Warren J.; Piscione, Federico & May, Michel R. Le [Vis alle 12 forfattere av denne artikkelen] (2010). Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis. European Heart Journal. ISSN 0195-668X. 31(17), s. 2156–2169. doi: 10.1093/eurheartj/ehq204. Fulltekst i vitenarkiv
• Mistry, Nisha; Halvorsen, Sigrun; HOFFMANN, PAVEL; Muller, Carl; Bøhmer, Ellen & Kjeldsen, Sverre Erik [Vis alle 7 forfattere av denne artikkelen] (2010). Assessment of left ventricular function with magnetic resonance imaging vs. echocardiography, contrast echocardiography, and single-photon emission computed tomography in patients with recent ST-elevation myocardial infarction. European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 11(9), s. 793–800. doi: 10.1093/ejechocard/jeq069. Fulltekst i vitenarkiv
• Bøhmer, Ellen; HOFFMANN, PAVEL; Abdelnoor, Michael; Arnesen, Harald & Halvorsen, Sigrun (2010). Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction). Journal of the American College of Cardiology. ISSN 0735-1097. 55(2), s. 102–110. doi: 10.1016/j.jacc.2009.08.007. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVES: The goal of this study was to compare a strategy of immediate transfer for percutaneous coronary intervention (PCI) with an ischemia-guided approach after thrombolysis in patients with very long transfer distances to PCI. BACKGROUND: Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary PCI cannot be performed within 90 to 120 min. The optimal treatment after thrombolysis is still unclear. METHODS: A total of 266 patients with acute STEMI living in rural areas with more than 90-min transfer delays to PCI were treated with tenecteplase, aspirin, enoxaparin, and clopidogrel and randomized to immediate transfer for PCI or to standard management in the local hospitals with early transfer, only if indicated for rescue or clinical deterioration. The primary outcome was a composite of death, reinfarction, stroke, or new ischemia at 12 months, and analysis was by intention to treat. RESULTS: The primary end point was reached in 28 patients (21%) in the early invasive group compared with 36 (27%) in the conservative group (hazard ratio: 0.72, 95% confidence interval: 0.44 to 1.18, p = 0.19). The composite of death, reinfarction, or stroke at 12 months was significantly reduced in the early invasive compared with the conservative group (6% vs. 16%, hazard ratio: 0.36, 95% confidence interval: 0.16 to 0.81, p = 0.01). No significant differences in bleeding or infarct size were observed. CONCLUSIONS: Immediate transfer for PCI did not improve the primary outcome significantly, but reduced the rate of death, reinfarction, or stroke at 12 months in patients with STEMI, treated with thrombolysis and clopidogrel in areas with long transfer distances. (Norwegian Study on District Treatment of ST-Elevation Myocardial Infarction; NCT00161005).

• Mistry, Nisha; Bøhmer, Ellen; HOFFMANN, PAVEL; Bjørnerheim, Reidar; Kjeldsen, Sverre Erik & Halvorsen, Sigrun (2010). Effect of thrombolysis with immediate transport to PCI vs. thrombolysis with ischemiaguided strategy on left ventricular function in ST-elevation myocardial infarction. American Heart Journal. ISSN 0002-8703. 160(1), s. 73–79. Fulltekst i vitenarkiv
• Mistry, Nisha; Halvorsen, Sigrun; Bøhmer, Ellen; HOFFMANN, PAVEL; Kjeldsen, Sverre Erik & Bjørnerheim, Reidar (2010). Are there agreements between standard and contrast echocardiography, SPECT and MRI in the assessment of LV function after ST-elevation myocardial infarction ? European Heart Journal-Cardiovascular Imaging. ISSN 2047-2404. 11(9), s. 793–800. doi: 10.1093/ejechocard/jeq069. Fulltekst i vitenarkiv
• Bøhmer, Ellen; Seljeflot, Ingebjørg; Arnesen, Harald; HOFFMANN, PAVEL; Halvorsen, Sigrun & Abdelnoor, Michael (2010). The association between metabolic syndrome and infarct size in patients with acute myocardial infarction. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 70(4), s. 287–293. doi: 10.3109/00365513.2010.481819. Fulltekst i vitenarkiv
• Bøhmer, Ellen; Hoffmann, Pavel; Abdelnoor, Michael; Seljeflot, Ingebjørg & Halvorsen, Sigrun (2009). Troponin T Concentration 3 Days after Acute ST-Elevation Myocardial Infarction Predicts Infarct Size and Cardiac Function at 3 Months. Cardiology. ISSN 0008-6312. 113(3), s. 207–212. doi: 10.1159/000201991. Fulltekst i vitenarkiv
• Halvorsen, Sigrun & Risøe, Cecilie (2009). Symptomer og diagnostikk av koronarsykdom hos kvinner. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 129(18), s. 1853–1857. doi: 10.4045/tidsskr.09.0115. Fulltekst i vitenarkiv
• Selmer, Randi; Halvorsen, Sigrun; Myhre, Kurt I; Wisløff, Torbjørn Fosen & Kristiansen, Ivar Sønbø (2005). Cost-effectiveness of primary percutaneous coronary intervention versus throbolytic therapy for acute myocardial infarction. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 39(5), s. 276–85. doi: 10.1080/14017430510035988. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Thorsby, Per & Haug, Egil (2004). Akutt hjerteinfarkt hos ung mann som brukte androgene anabole steroider. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 124(2), s. 170–2. Fulltekst i vitenarkiv
• Jensen, Torstein; Halvorsen, Sigrun; Godal, HC; Sandset, Per Morten & Skjønsberg, Ole Henning (2004). The viscosity of fibrinogen subfractions and of EDTA denatured fibrinogen do not differ from that of native fibrinogen. Thrombosis Research. ISSN 0049-3848. 113, s. 51–56. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Myhre, KI; Steigen, Terje; Nordrehaug, J.E & Wiseth, Rune (2003). Primær angioplastikk eller trombolyse ved akutt hjerteinfarkt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 123, s. 152–155. Fulltekst i vitenarkiv
• Jensen, Torstein; Halvorsen, Sigrun; Godal, Hans Christian & Skjønsberg, Ole Henning (2002). Influence of freeze-drying on clotting properties of fibrinogen i plasma. Thrombosis Research. ISSN 0049-3848. 105, s. 499–502. Fulltekst i vitenarkiv
• Strømme, Johan Henrik; Halvorsen, Sigrun & Frederichsen, Sverre (2001). Utskrivningsdiagnoser ved forhøyede troponin T-verdier. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 121(26), s. 3041–3045. Fulltekst i vitenarkiv
• Strømme, Johan Henrik; Halvorsen, Sigrun & Fredriksen, Per Morten (2001). Diagnoses and maximal troponin T values of patients discharged from hospital. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 121(26), s. 3041–3045. Fulltekst i vitenarkiv
• Strømme, Johan Henrik; Halvorsen, Sigrun & Frederichsen, Per (2001). Diagnoses and maximal troponin T values of patients discharged from hospital. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 121(26), s. 3041–3045. Fulltekst i vitenarkiv
• Jensen, Torstein; Halvorsen, Sigrun; Godal, Hans Christian; Sandset, Per Morten & Skjønsberg, Ole Henning (2000). Discrepancy between fibrinogen concentrations determined by clotting rate and clottability assays during the acute-phase reaction. Thrombosis Research. ISSN 0049-3848. 100, s. 397–403. Fulltekst i vitenarkiv
• Jensen, Torstein; Halvorsen, Sigrun; Godal, Hans Christian; Sandset, Per Morten & Skjønsberg, Ole Henning (2000). Discrepancy between fibrinogen concentrations determined by clotting rate and clottability assays during the acute-phase reaction. Thrombosis Research. ISSN 0049-3848. 100, s. 397–403. Fulltekst i vitenarkiv
• Giercksky, Karl-Erik; Boberg, Kirsten Muri; Farstad, Inger Nina; Halvorsen, Sigrun & Schrumpf, Erik (1999). Severe liver failure in exertional heat stroke. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 34, s. 824–827. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Husebye, T. & Arnesen, Harald (1999). Prostethic heart valve thrombosis during dicloxacillin therapy. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 33, s. 366–368. Fulltekst i vitenarkiv
• Kowalczyk, M.; Halvorsen, Sigrun; Øvrebø, Steinar; Bredesen, Jan & Jacobsen, Dag (1998). Ethanol treatment in ethylene glycol poisoned patients. Veterinary and human toxicology. ISSN 0145-6296. 40, s. 225–228. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Jacobsen, Dag; Giæver, Petter & Lippe, E. von der (1998). Bilaterale lungefortetninger hos pasienter i overvåkningsavdelingen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 118, s. 3776–3781. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Jacobsen, Dag; Giæver, Petter & Lippe, E. von der (1998). Bilaterale lungefortetninger hos pasienter i medisinsk overvåkingsavdeling. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 24, s. 3776–3781. Fulltekst i vitenarkiv
• Bach-Gansmo, Edvin; Halvorsen, Sigrun; Godal, Hans Christian & Skjønsberg, Ole Henning (1996). D-dimers are degraded by human neutrophil elastase. Thrombosis Research. ISSN 0049-3848. 82(2), s. 177–186. Fulltekst i vitenarkiv Vis sammendrag

  To see if D-dimers were degraded by human neutrophil elastase (HNE), cross-linked fibrin was obtained by adding thrombin to purified fibrinogen in the presence of calcium ions and factor XIII, and the fibrin clot subsequently degraded by plasmin. Thereafter, the supernatant containing fibrin degradation products was removed and incubated with HNE. D-dimer levels were measured by two rapid semiquantitative tests, a latex agglutination test and the Nycocard immunofiltration test, and a quantitative ELISA-method. With increasing incubation time, D-dimer levels as measured by the latex and Nycocard tests rapidly decreased and subsequently became undetectable, while the ELISA D-dimer values remained essentially unchanged. By using SDS-electrophoresis and immunoblotting, the degradation of plasmic derivatives of cross-linked fibrin by HNE was visualised. We conclude that in a purified system, D-dimers formed during plasmin mediated lysis of cross linked fibrin are further degraded by HNE. Such HNE degradation reduces the D-dimer concentration as measured by rapid semiquantitive tests, and may be partly responsible for discrepant results when using different D-dimer assays.

• Sletnes, Kari; Holte, H.; Halvorsen, Sigrun; Jacobsen, Eva Marie; Wisløff, Finn Georg B & Kvaløy, Stein (1996). Activation of coagulation and deep vein thrombosis after bone marrow harvesting and insertion of a Hickman-catheter in ABMT candidates with malignant lymphoma. Bone Marrow Transplantation. ISSN 0268-3369. 17, s. 577–81. Fulltekst i vitenarkiv
• Halvorsen, Sigrun (1992). jhg ghjh hlj. Thrombosis Research. ISSN 0049-3848. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Informasjonsmøte for helsepersonell, Hjerte-sjekken studien. Fulltekst i vitenarkiv
• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Introduksjon av Hjerte-sjekken studien, inklusjon. Fulltekst i vitenarkiv
• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Hjerte-sjekken studien, inklusjon på HiO. Fulltekst i vitenarkiv
• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Informasjon om Hjerte-sjekken studien, for helsepersonell. Fulltekst i vitenarkiv
• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Introduksjon av Hjerte-sjekken studien. Fulltekst i vitenarkiv
• Nyen, J; Kristensen, A M D; Fagerland, Morten; Dammen, Toril; Zwisler, A D & Olsen, M H [Vis alle 13 forfattere av denne artikkelen] (2026). Beta-blocker therapy and sexual dysfunction after myocardial infarction: a sub-study of the BETAMI-DANBLOCK trial. European Heart Journal. ISSN 0195-668X. 47(Supplement_1). doi: 10.1093/eurheartj/ehag785.4110. Fulltekst i vitenarkiv Vis sammendrag

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

• Nilsen, Ida Ormstad; Nes, Lise Solberg; Jortveit, Jarle & Halvorsen, Sigrun (2026). Informasjon om Hjerte-sjekken studien. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Atar, Dan; Halvorsen, Sigrun; Munkhaugen, John; Vallersnes, Odd Martin & Bakken, Arnhild [Vis alle 7 forfattere av denne artikkelen] (2026). Point-of-Care High-Sensitivity Troponin Testing for Rapid Chest Pain Triage in Emergency Primary Care: Preliminary Single-Sample Efficacy Findings from the OUT-POC Study. Fulltekst i vitenarkiv
• Rolland, J; Ovrebotten, T; Berge, Kristian; Nahoui, Hamza; Bjorkelund, O A & Broch, Kaspar [Vis alle 15 forfattere av denne artikkelen] (2026). Contemporary post-discharge management in heart failure at home (STRONG@HOME). European Journal of Heart Failure. ISSN 1388-9842. 28(Supplement_2). doi: 10.1093/ejhf/xuag193.1424. Fulltekst i vitenarkiv Vis sammendrag

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

• Kristensen, A M D; Holmager, T L F; Halvorsen, Sigrun; Olsen, M H; Bakken, Arnhild & Atar, Dan [Vis alle 8 forfattere av denne artikkelen] (2026). Beta-blocker therapy and angina pectoris after myocardial infarction: a BETAMI-DANBLOCK substudy. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 33(Supplement_2). doi: 10.1093/eurjpc/zwag249.435. Fulltekst i vitenarkiv Vis sammendrag

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

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

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

• Nyen, Johanne; Kristensen, Anna Meta; Fagerland, Morten; Dammen, Toril; Zwisler, Ann-Dorthe & Olsen, Michael Hecht [Vis alle 14 forfattere av denne artikkelen] (2026). Beta-blocker therapy and sleep disturbances after myocardial infarction: a prespecified sub-study of the BETAMI-DANBLOCK trial. doi: https:/esc365.escardio.org/preventive-cardiology/sessions/18499-risk-management-in-acute-coronary-syndrome. Fulltekst i vitenarkiv
• Kristensen, Anna Meta Dyrvik; Rosello, Xavier; Atar, Dan; Yndigegn, Troels; Kimura, Takeshi & Latini, Roberto [Vis alle 25 forfattere av denne artikkelen] (2026). Bata-Blocker therapy after myocardial infraction in patients with preserved left ventricular ejection fraction: An individual patient data meta-analysis of randomized controlled trials. Hjerteforum. ISSN 0802-1465. 39(1), s. 120–121. Fulltekst i vitenarkiv
• Vranckx, Pascal; Pavlov, Marin & Halvorsen, Sigrun (2025). The NEO-MINDSET trial: immediate aspirin withdrawal after percutaneous coronary intervention for acute coronary syndrome—remains a therapeutic no-man’s land. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 14(9), s. 568–570. doi: 10.1093/ehjacc/zuaf116. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Atar, Dan; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Vallersnes, Odd Martin (2025). One-hoUr Troponin using a high-sensitivity Point-Of-Care assay in emergency primary care: OUT-POC-pilotstudien. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). Authors' Response Letter - Expanding the Use of Point-of-Care hs-cTnI in Emergency Primary Care: Insights from the OUT-POC Pilot Study. Cardiology. ISSN 0008-6312. s. 3–3. doi: 10.1159/000546344. Fulltekst i vitenarkiv
• Bønaa, Kaare Harald; Leiren, Olav Magne; Våga, Bjørn Inge; Vangberg, Gunnar; Govatsmark, Ragna Elise Støre & Kristensen, Andreas Harald [Vis alle 11 forfattere av denne artikkelen] (2025). Flere bør få trombolytisk behandling ved STEMI-infarkt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 145(8). doi: 10.4045/tidsskr.25.0202. Fulltekst i vitenarkiv
• Tørris, Christine; Bjørnnes, Ann Kristin; Hagen, Milada; Halvorsen, Sigrun; Jernberg, Tomas & Lie, Irene (2025). Sex differences in acute myocardial infarction: protocol for an umbrella review | BMJ Open. doi: 10.1136/bmjopen-2025-104834. Fulltekst i vitenarkiv Vis sammendrag

  Introduction In recent decades, differences in the risk factors, presentations, management strategies and outcomes of acute myocardial infarction (AMI) between the sexes have emerged. Several systematic reviews and meta-analyses (SMRAs) on this specific topic have been conducted, and an overall assessment of the information available on the subject is needed. The protocol details our proposed methodology for conducting an umbrella review (systematic review of SRMAs) on sex differences related to AMI treatment. Methods and analysis An umbrella review will be conducted following the guidelines of the Joanna Briggs Institute. Papers published from database inception until November 25th, 2024, were searched in Ovid Medline, Embase, APA PsycInfo, the Cochrane Database of Systematic Reviews, Epistemonikos and Scopus using controlled vocabulary and text words expressing sex differences AND myocardial infarction . An updated search will be conducted near the end of the umbrella review process to ensure that not recently published SMRAs are missed. No language restrictions will be applied in the database searches, but only SRMAs reported in English will be eligible for inclusion. The inclusion criteria include SMRAs reporting sex differences in outcomes related to AMI treatment among adults. All review steps will be conducted independently by two reviewers. Data will be extracted using a recommended standardised data extraction form. A critical appraisal checklist will be used to assess the risk of bias within the included SMRAs. The findings will be summarised through narrative synthesis using text and tables. Ethics and dissemination Ethics approval is not required, as this review will use publicly available data. The results will be disseminated as a peer-reviewed journal article and through national/international conferences. Trial registration number PROSPERO, CRD42024561159.

• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Halvorsen, Sigrun & Atar, Dan (2025). One-Hour Troponin Using a High-Sensitivity Point-of-Care Assay in Emergency Primary Care: The OUT-POC Pilot Study. Fulltekst i vitenarkiv
• Engebretsen, Ingrid; Ødegaard, Kristina Malene; Halvorsen, Sigrun; Bugge, Christoffer; Kristiansen, Ivar Sønbø & Støvring, Henrik [Vis alle 7 forfattere av denne artikkelen] (2024). High discontinuation rate of statins among PCSK9i users: a nationwide study from 2015-2023. European Heart Journal, Supplement. ISSN 1520-765X. 45. doi: 10.1093/eurheartj/ehae666.2863. Fulltekst i vitenarkiv
• Tørris, Christine; Bjørnnes, Ann Kristin; Hagen, Milada; Halvorsen, Sigrun; Lie, Irene & Jernberg, Tomas (2024). Sex differences in acute myocardial infarction - Preliminary results from an umbrella review. Fulltekst i vitenarkiv
• Boskovic, Miroslav; Jortveit, Jarle; Haraldsen, Marius Blørstad; Berge, Trygve; Engdahl, Johan & Løchen, Maja-Lisa [Vis alle 14 forfattere av denne artikkelen] (2024). The NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial: rationale and design of a randomized controlled trial. Europace. ISSN 1099-5129. 26(10). doi: 10.1093/europace/euae228. Fulltekst i vitenarkiv Vis sammendrag

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

• Engebretsen, Ingrid; Ødegaard, Kristina Malene; Halvorsen, Sigrun; Bugge, Christoffer; Kristiansen, Ivar Sønbø & Støvring, Henrik [Vis alle 7 forfattere av denne artikkelen] (2024). High discontinuation rate of statins among PCSK9i users:A nationwide study from 2015-2023. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Nilsen, Beate [Vis alle 7 forfattere av denne artikkelen] (2024). Rapid rule-out of acute myocardial infarction using troponins in emergency primary care: the OUT-ACS implementation study. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Mehilli, Julinda; Choorapoikayil, Suma & Zacharowski, Kai (2024). extract from the 2022 esc guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery - patient blood management. Blood Transfusion. ISSN 1723-2007. 22(2), s. 122–129. doi: 10.2450/BloodTransfus.708. Fulltekst i vitenarkiv Vis sammendrag

  The 2022 Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery of the European Society of Cardiology are an update on the previous guidelines reported in 2014. The revised guidelines provide standardized perioperative cardiovascular management of surgical patients and emphasis on risk assessment of the patient combined with the inherent risk of the surgical procedure. One of the novelties in these guidelines is the Patient Blood Management programme, which is based on a three pillar concept: preoperative hemoglobin optimization, minimize iatrogenic blood loss and bleeding, and harness tolerance to anemia in an effort to improve patient outcome. In this review, we highlight the three pillars of Patient Blood Management and recommendations made by the 2022 ESC Guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery.

• Løchen, Maja-Lisa; Jortveit, Jarle; Boskovic, Miroslav & Halvorsen, Sigrun (2024). Sjekk om du har kaotisk hjerte og unngå hjerneslag. Fulltekst i vitenarkiv
• Landi, Antonio; Aboyans, Victor; Angiolillo, Dominick J.; Atar, Dan; Capodanno, Davide & Fox, Keith A.A. [Vis alle 22 forfattere av denne artikkelen] (2024). Antithrombotic therapy in patients with acute coronary syndrome: similarities and differences between a European expert consensus document and the 2023 European Society of Cardiology guidelines. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 13(1), s. 173–180. doi: 10.1093/ehjacc/zuad158. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen & Ruud, Sven Eirik [Vis alle 7 forfattere av denne artikkelen] (2024). Rapid rule-out of acute myocardial infarction using the 0/1-hour algorithm for cardiac troponins in emergency primary care. The OUT-ACS implementation study. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Vallersnes, Odd Martin; Atar, Dan; Halvorsen, Sigrun; Melessen, Indra & Manten, Amy [Vis alle 7 forfattere av denne artikkelen] (2024). Identifying low-risk chest pain in out-of-hours primary care: the diagnostic performance of preHEAR and preHEART scores based on two European cohorts. Fulltekst i vitenarkiv
• Melessen, Indra; Vallersnes, Odd Martin; Harskamp, Ralf E.; Atar, Dan; Halvorsen, Sigrun & Manten, Amy [Vis alle 7 forfattere av denne artikkelen] (2024). Safety and efficiency of modified HEART scores without troponin or electrocardiography: an analysis based on two European out-of-hours primary care cohorts. Fulltekst i vitenarkiv
• Gorog, Diana A.; Ferreiro, Jose Luis; Ahrens, Ingo; Ako, Junya; Geisler, Tobias & Halvorsen, Sigrun [Vis alle 18 forfattere av denne artikkelen] (2023). De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis. Nature Reviews Cardiology. ISSN 1759-5002. doi: 10.1038/s41569-023-00901-2. Fulltekst i vitenarkiv
• Engebretsen, Ingrid; Bugge, Christoffer; Husebye, Einar; Stovring, Henrik; Halvorsen, Sigrun & Sverre, Elise Christine Bjørkholen [Vis alle 7 forfattere av denne artikkelen] (2023). Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event. European Heart Journal. ISSN 0195-668X. 44. doi: 10.1093/eurheartj/ehad655.2524. Fulltekst i vitenarkiv
• Sverre, Elise Christine Bjørkholen; Halvorsen, Sigrun; Løchen, Maja-Lisa & Munkhaugen, John (2023). E. Sverre og medarbeidere svarer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(3). doi: 10.4045/tidsskr.23.0062. Fulltekst i vitenarkiv
• Bakken, Arnhild; Atar, Dan; Ruddox, Vidar; Halvorsen, Sigrun & Munkhaugen, John (2023). BETABLOKKERE ETTER HJERTEINFARKT– SKAL DEN FORTSATT GIS? Hjerteposten : fagtidsskrift for NSFs landsgruppe av kardiologiske sykepleiere. ISSN 1891-2532. s. 28–32. Fulltekst i vitenarkiv Vis sammendrag

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

• Engebretsen, Ingrid; Christoffer, Bugge; Husebye, Einar; Støvring, Henrik; Halvorsen, Sigrun & Sverre, Elise Christine Bjørkholen [Vis alle 7 forfattere av denne artikkelen] (2023). Treatment patterns and adherence to lipid-lowering drugs during 8 years of follow-up after a cardiovascular event. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Mehilli, Julinda & Geisler, Tobias (2023). Continue or discontinue aspirin before non-cardiac surgery? European Heart Journal. ISSN 0195-668X. 44(26), s. 2410–2410. doi: 10.1093/eurheartj/ehad246. Fulltekst i vitenarkiv
• Højskov, Ida; Bjørnnes, Ann Kristin; Tønnessen, Theis; Halvorsen, Sigrun; Blakø, Mitti & Møller, Christian H. [Vis alle 10 forfattere av denne artikkelen] (2023). Informal caregivers must open the door to information during heart surgery patients hospitalization. A qualitative study. Fulltekst i vitenarkiv
• Lie, Irene; Moons, Philip; Tønnessen, Theis; Halvorsen, Sigrun; Blakø, Mitti & Christian, Møller [Vis alle 10 forfattere av denne artikkelen] (2023). Experiences of informal caregivers taking care of heart surgery patients after discharge from hospital: A qualitative study. Fulltekst i vitenarkiv
• Sverre, Elise Christine Bjørkholen; Halvorsen, Sigrun; Løchen, Maja-Lisa & Munkhaugen, John (2022). Persontilpasset hjerte- og karforebygging i nye retningslinjer. 142(17), s. 1–6. doi: 10.4045/tidsskr.22.0508. Fulltekst i vitenarkiv Vis sammendrag

  I de nye europeiske retningslinjene for forebygging av hjerte- og karsykdommer introduseres en trinnvis tiltaksmodell. Livsstilstiltak er basis. Bruk av medikamenter anbefales basert på en risikovurdering der man tar hensyn til pasientens skrøpelighet, komorbiditet og egne preferanser.

• Gulati, Geeta; Tjessem, Kristin Holm; Horndalsveen, Henrik; Halvorsen, Sigrun & Haakensen, Vilde Drageset (2022). Sjekkpunkthemmerindusert myokardi. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(18). doi: 10.4045/tidsskr.21.0817. Fulltekst i vitenarkiv Vis sammendrag

  Immunologiske sjekkpunkthemmere har vært revolusjonerende innen kreftbehandlingen. En sjelden, men alvorlig bivirkning er utviklingen av hjertemuskelbetennelse (myokarditt). Forekomsten av denne typen myokarditt er økende etter hvert som flere kreftpasienter mottar behandling med sjekkpunkthemmere. Kunnskap om sjekkpunkthemmerindusert myokarditt er viktig for å kunne stille diagnosen og igangsette behandling tidlig. I denne artikkelen gir vi en klinisk oversikt over dette.

• Fudim, Marat; Wojdyla, Daniel M.; Alexander, John H.; Goodman, Shaun G.; Mehran, Roxana & Windecker, Stephan [Vis alle 12 forfattere av denne artikkelen] (2021). Efficacy and Safety of Antithrombotic Therapy in Patients With Atrial Fibrillation, Recent Acute Coronary Syndrome, or Percutaneous Coronary Intervention and a History of Heart Failure: Insights From the AUGUSTUS Trial. Journal of the American Heart Association (JAHA). 10(24), s. e023143–e023143. doi: 10.1161/JAHA.121.023143. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2021). Cost-minimization analysis of acute myocardial infarction rule-out in low-risk patients: emergency primary care versus hospital. Fulltekst i vitenarkiv
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Vis alle 7 forfattere av denne artikkelen] (2021). Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting. Fulltekst i vitenarkiv
• Ghanima, Waleed; Brodin, Ellen Elisabeth; Schultze, Anna; Shepherd, Leah; Lambrelli, Dimitra & Ulvestad, Maria [Vis alle 8 forfattere av denne artikkelen] (2020). Incidence and prevalence of venous thromboembolism in Norway 2010–2017. Thrombosis Research. ISSN 0049-3848. 195, s. 165–168. doi: 10.1016/j.thromres.2020.07.011. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu; Atar, Dan & Halvorsen, Sigrun (2020). Fast prehospital rule-out using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (The OUT-ACS study). Fulltekst i vitenarkiv
• Mach, Francois; Baigent, Colin; Catapano, Alberico L.; Koskinas, Konstantinos C.; Casula, Manuela & Badimon, Lina [Vis alle 96 forfattere av denne artikkelen] (2020). Erratum to “2019 ESC/EAS guidelines for the management of dyslipidemias: Lipid modification to reduce cardiovascular risk” (Atherosclerosis (2019) 290 (140–205), (S0021915019314595), (10.1016/j.atherosclerosis.2019.08.014)). Atherosclerosis. ISSN 0021-9150. 292, s. 160–162. doi: 10.1016/j.atherosclerosis.2019.11.020. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. European Heart Journal. ISSN 0195-668X. 41. doi: 10.1093/ehjci/ehaa946.1680. Fulltekst i vitenarkiv
• Mach, Francois; Baigent, Colin; Catapano, Alberico L.; Koskinas, Konstantinos C.; Casula, Manuela & Badimon, Lina [Vis alle 96 forfattere av denne artikkelen] (2020). Corrigendum to “2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk” (Atherosclerosis (2019) 290 (140–205), (S0021915019314595), (10.1016/j.atherosclerosis.2019.08.014)). Atherosclerosis. ISSN 0021-9150. 294, s. 80–82. doi: 10.1016/j.atherosclerosis.2019.12.004. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Poster og vitenskaplig foredrag). Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). European Heart Journal. ISSN 0195-668X. 40. doi: 10.1093/eurheartj/ehz745.0062. Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Mdala, Ibrahimu; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan & Halvorsen, Sigrun (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS study). Fulltekst i vitenarkiv
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). OUT-ACS studien: Anvendelse av 0/1-times algoritme for høysensitiv hjertespesifikk Troponin-T for avklaring av NSTEMI på Observasjonsposten ved Legevakten i Oslo. Fulltekst i vitenarkiv
• Blichfeldt-Ærø, Stine Camilla Flydal; Trondalen, Gro & Halvorsen, Sigrun (2019). I got something you might need! Development and implementation of a music therapy intervention protocol in invasive cardiac procedure. Fulltekst i vitenarkiv
• Bonnefoy-Cudraz, Eric; Bueno, Hector; Casella, Gianni; Maria, Elia De; Fitzsimons, Donna & Halvorsen, Sigrun [Vis alle 27 forfattere av denne artikkelen] (2018). Editor's Choice - Acute Cardiovascular Care Association Position Paper on Intensive Cardiovascular Care Units: An update on their definition, structure, organisation and function. European Heart Journal: Acute Cardiovascular Care. ISSN 2048-8726. 7(1), s. 80–95. doi: 10.1177/2048872617724269. Fulltekst i vitenarkiv
• Holven, Kirsten Bjørklund; Øyri, Linn Kristin Lie; Halvorsen, Sigrun; Atar, Dan; Leren, Trond Paul & Bogsrud, Martin Prøven (2018). PREVALENCE OF GENETICALLY VERIFIED FH AMONG YOUNG NORWEGIAN SUBJECTS (<45 YEARS)HOSPITALIZED WITH ACUTE MYOCARDIAL INFARCTION. Fulltekst i vitenarkiv
• Jortveit, Jarle & Halvorsen, Sigrun (2017). Geographical differences in prescription of secondary preventive drug therapy after acute myocardial infarction in Norway. European Heart Journal (EHJ) - Cardiovascular Pharmacotherapy. ISSN 2055-6837. 3(3), s. 132–133. doi: 10.1093/ehjcvp/pvx008. Fulltekst i vitenarkiv
• Kristiansen, Annette; Brandt, Linn; Berge, Eivind; Dahm, Anders Erik A; Halvorsen, Sigrun & Sandset, Per Morten [Vis alle 7 forfattere av denne artikkelen] (2014). Nye retningslinjer for antitrombotisk behandling og tromboseprofylakse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 134(9), s. 921–922. doi: 10.4045/tidsskr.13.1582. Fulltekst i vitenarkiv Vis sammendrag

  Nye retningslinjer med 250 anbefalinger for antitrombotisk behandling og tromboseprofylakse er nå tilgjengelig på nett. Retningslinjene fra Norsk selskap for trombose og hemostase imøtekommer nye standarder for troverdige retningslinjer og benytter seg av innovative teknologiske løsninger.

• Seljeflot, Ingebjørg; Andersen, Geir Ove; Halvorsen, Sigrun; Bjørnerheim, Reidar; Eritsland, Jan & Arnesen, Harald (2013). Clopidogrel resistance in patients with ST-elevation myocardial infarction is associated with high body mass index. European Heart Journal. ISSN 0195-668X. 34, s. 882–883. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Wallentin, Lars; Yang, H; Caterina, Raffaele De; Erol, Cetin & Garcia, David [Vis alle 16 forfattere av denne artikkelen] (2013). EFFICACY AND SAFETY OF APIXABAN COMPARED WITH WARFARIN ACCORDING TO AGE FOR STROKE PREVENTION IN ATRIAL FIBRILLATION. Journal of the American College of Cardiology. ISSN 0735-1097. 61(10), s. E315–E315. Fulltekst i vitenarkiv
• Prendergast, Bernard; Cooper, Leslie T.; Crijns, Harry J.; Falkenstein, Elisabeth; Fölsch, Ulrich & Halvorsen, Sigrun [Vis alle 22 forfattere av denne artikkelen] (2012). The German Centre for Cardiovascular Research. European Heart Journal. ISSN 0195-668X. 33(9), s. 1033–U18. Fulltekst i vitenarkiv
• Halvorsen, Sigrun; Seljeflot, Ingebjørg; Bøhmer, Ellen & Arnesen, Harald (2010). Inflammatory and thrombotic markers in patients with ST-elevation myocardial infarction treated with fibrinolysis and early PCI. Journal of Thrombosis and Haemostasis. ISSN 1538-7933. 8, s. 23–23. Fulltekst i vitenarkiv
• Mistry, Nisha; Abdelnoor, Michael; Seljeflot, Ingebjørg; HOFFMANN, PAVEL; Bøhmer, Ellen & Bjørnerheim, Reidar [Vis alle 8 forfattere av denne artikkelen] (2010). NT-proBNP correlates strongly with ejection fraction measured by MRI in patients treated for ST-elevation myocardial infarction. European Heart Journal. ISSN 0195-668X. 31, s. 450–450. Fulltekst i vitenarkiv
• Nicholls, Mark & Halvorsen, Sigrun (2010). Spotlight: Sigrun Halvorsen, MD, PhD, FESC. Circulation. ISSN 0009-7322. 121(2), s. F10–F11. Fulltekst i vitenarkiv
• Bøhmer, Ellen; Kristiansen, Ivar Sønbø; Arnesen, H & Halvorsen, Sigrun (2010). Cost-effectiveness of an early invasive versus conservative strategy in ST-elevation myocardial infarction treated with thrombolysis. European Heart Journal. ISSN 0195-668X. 31, s. 225–226. Fulltekst i vitenarkiv
• Os, Ingrid & Halvorsen, Sigrun (2003). Kvinner og koronarsykdom. Fulltekst i vitenarkiv
• Jensen, Torstein; Halvorsen, Sigrun; Godal, Hans Christian & Skjønsberg, Ole Henning (2002). Influence of freeze-dryingon clotting properties of fibrinogen in plasma. Fulltekst i vitenarkiv
• Strømme, Johan Henrik; Halvorsen, Sigrun & Frederichsen, Per (2001). Increased incidence of acute myocardial infarction using the new consensus criteria. Fulltekst i vitenarkiv
• Strømme, Johan Henrik; Halvorsen, Sigrun & Fredriksen, Per Morten (2001). Relationship between discharge diagnoses and maximal troponin T values observed in a patient material from a university hospital. Fulltekst i vitenarkiv Vis sammendrag

  The recent proposal of lowering the decision level of cardiac troponin T (cTnT) for diagnosing acute myocardial infarction (Eur.Heart J,2000;21:1502-13) has made it more important to know the incidence of increased cTnT due to other diseases than acute coronary syndromes (ACS). On this purpose we selected from the hospital databases 3461 in-hospital patients in whom cTnT had been determined in year 2000, along with the respective cTnT results and the diagnoses given these patients on discharge. Only one diagnosis was used on each patient. These diagnoses were selected on the basis of their ICD-10 codes in a priority order favouring those diseases that are known most often to cause increased cTnT, starting with the codes for acute myocardial infarct. In the group of patients (no 2319) with cTnT < 0.03 mg/L, 4.6% were considered having ACS. In the group with cTnT ³ 0.03 (no 1142), cTnT ³ 0.10 (no 688), or cTnT ³ 0.20, the percentages were 35%, 52% and 60%, respectively. Forty four percent of patients with cTnT ³ 0.03, 35% with cTnT ³ 0.10, and 30% with cTnT ³ 0.20 mg/L had other heart diseases, particularly congestive heart failure, atrial fibrillation unspecified (stable) angina pectoris or precordial pain of unknown cause. Of the remaining patients with no heart diagnoses, those with renal diseases, sepsis, pulmonary embolism and several other respiratory diagnoses had more often cTnT above 0.03 than others. Most of the 22 patients with myocardial infarction and cTnT less than 0.03 had been referred from other hospitals several days after onset of symptoms for angiography. In conclusion, although cTnT is heart specific, it is not specific for ACS. A lowering of the decision level will markedly increase the incidence of patients with increased cTnT due to other reasons than ACS.

• Bach-Gansmo, Edvin; Halvorsen, Sigrun; Godal, Hans Christian & Skjønsberg, Ole Henning (1996). D-dimers are degraded by human neutrophil elastase. Fulltekst i vitenarkiv
• Wisløff, Torbjørn; Selmer, Randi M.; Halvorsen, Sigrun & Kristiansen, Ivar Sønbø (2008). Norwegian Cardiovascular Disease Model (NorCaD) – a simulation model for estimating health benefi ts and cost consequences of cardiovascular interventions. Folkehelseinstituttet. ISSN 9788281212206. Fulltekst i vitenarkiv Vis sammendrag

  Norwegian Cardiovascular Disease Model (NorCaD) – en simuleringsmodell for estimering av helse og kostnader relatert til hjerte- og karsykdom

• Wisløff, Torbjørn; Norheim, Ole Frithjof; Halvorsen, Sigrun; Selmer, Randi & Kristiansen, Ivar Sønbø (2008). Kostnader og leveårsgevinster ved medikamentell primærforebygging av hjertekarsykdom. Folkehelseinstituttet. ISSN 9788281212374. Fulltekst i vitenarkiv Vis sammendrag

  BACKGROUND Cardiovascular disease (CVD) has for decades been the most common cause of death in Norway and most other Western countries. Several groups of drugs have shown in clinical trials to prevent CVD. In this report, we have evaluated the cost-effectiveness of these drugs. METHODS Based on a model of the progression of CVD from healthy to death, we explored which drugs that might be cost-effective. Analyses were conducted both compared to no treatment and between different drugs. Analyses were conducted on different risk levels and in different age groups for both men and women. We also performed probabilistic sensitivity analyses. Our analyses were accompanied by a systematic review of other economic evaluations of preventive strategies against CVD. RESULTS Calcium channel blockers, thiazides, beta blockers, aspirin and statins were all cost-effective compared to no treatment for all groups of men and women in age groups between 40 and 69. The life year gains for each of the drugs varied between 3 and 17 months. Calcium channel blockers and thiazides were the most cost-effective combination of two antihypertensive drugs. In the base case analyses, the combination of calcium channel blockers, thiazides and ACE-inhibitors was the most cost-effective combination of three drugs. The sensitivity analyses indicate considerable uncertainty related to the question of which was the most cost-effective of the antihypertensive drugs. Whether treatment was cost-effective compared to no treatment was concerned with less uncertainty. Our systematic review of other economic evaluations showed considerable discrepancies between analyses of prevention strategies against CVD. DISCUSSION The results of this study indicate that statins, several antihypertensives and aspirin are cost-effective in all analysed groups between 40 and 69 years old. It is worthwhile noting, however, that the model is built on numerous assumptions, and this introduces considerable uncertainty with respect to optimal choice of therapies.

• Halvorsen, Sigrun; Kristiansen, Ivar Sønbø; Linnestad, Kristin Kamilla; Myhre, Kurt I; Selmer, Randi & Wisløff, Torbjørn (2004). Kostnader og nytte ved å erstatte trombolyse med PCI ved akutt hjerteinfarkt. Folkehelseinstituttet. ISSN 9788281210035. Fulltekst i vitenarkiv Vis sammendrag

  Senter for medisinsk metodevurdering (SMM) publiserte i desember 2002 en rapport som sammenlignet effekten av PCI og trombolyse ved akutt hjerteinfarkt, og som konkluderte med at PCI ga et klart bedre behandlingsresultat. Senteret har ønsket at også de helseøkonomiske konsekvensene av de ulike strategier skulle belyses. Det er derfor utviklet en simuleringsmodell for dette.

• Wiseth, Rune; Gundersen, Torstein; Halvorsen, Sigrun; Nordrehaug, Jan Erik; Steigen, Terje & Myhre, Kurt I. (2002). PCI ved akutt hjerteinfarkt. Sintef Unimed. Fulltekst i vitenarkiv
• Wiseth, Rune; Nordrehaug, J.E; Myhre, KI; Gundersen, Torstein; Steigen, Terje & Halvorsen, Sigrun (2002). PCI ved akutt hjerteinfarkt. [Mangler utgivernavn]. ISSN 9788214027976. Fulltekst i vitenarkiv

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