Har pasienter rett til behanding med legemidler som Beslutningsforum har avslått?

Statsforvalteren i Agder har nylig gitt en pasient rett til behandling med et legemiddel som Beslutningsforum har avslått. Hvilke konsekvenser får dette

Outcomes after coronary angiography for unstable angina compared to stable angina, myocardial infarction and an asymptomatic general population

Background: The outcomes of real-world unstable angina (UA) in the high-sensitivity troponin era are unclear. We aimed to investigate the outcomes of UA referred to coronary angiography compared to stable angina (SA), nonST-segment elevation myocardial infarction (NSTEMI), STEMI and a general population. Methods: We included the 9,694 patients with no prior coronary artery disease (CAD) referred to invasive or CT coronary angiography from 2013 to 2018 in Northern Norway (51% SA, 12% UA, 23% NSTEMI and 14% STEMI), and 11,959 asymptomatic individuals recruited from the Tromsø Study. We used Cox models to estimate the hazard ratios (HR) for all-cause mortality and major adverse cardiovascular events (MACE), defined as cardiovascular death, MI or obstructive CAD. Results: The median follow-up time was 2.8 years. The incidence rate of death was 8.5 per 1000 person-years (95 % confidence interval [CI] 8.0–9.0) in the general population, 9.7 (95 % CI 8.3–11.5) in SA, 14.9 (95 % CI 11.4–19.6) in UA, 29.7 (95 % CI 25.6–34.3) in NSTEMI and 36.5 (95 % CI 30.9–43.2) in STEMI. In multivariable adjusted analyses, compared with UA, SA had a 38 % lower risk of death and a non-significant lower risk of MACE (HR 0.62, 95 % CI 0.44–0.89; HR 0.86, 95 % CI 0.66–1.11). NSTEMI had a 2.4-fold higher risk of death (HR 2.39, 95 % CI 1.38–4.14) and a 1.6-fold higher risk of MACE (HR 1.62, 95 % CI 1.11–2.38) compared tox UA during the first year after coronary angiography, but a similar risk thereafter. There was no difference in the risk of death for UA with non-obstructive CAD and obstructive CAD (HR 0.78, 95 % CI 0.39–1.57). Conclusion: UA had a higher risk of death but a similar risk of MACE compared to SA and a lower 1-year risk of death and MACE compared to NSTEMI

Machine-learning-derived heart and brain age are independently associated with cognition

BACKGROUND AND PURPOSE: A heart age biomarker has been developed using deep neural networks applied to electrocardiograms. Whether this biomarker is associated with cognitive function was investigated. METHODS: Using 12-lead electrocardiograms, heart age was estimated for a population-based sample (N = 7779, age 40-85 years, 45.3% men). Associations between heart delta age (HDA) and cognitive test scores were studied adjusted for cardiovascular risk factors. In addition, the relationship between HDA, brain delta age (BDA) and cognitive test scores was investigated in mediation analysis. RESULTS: Significant associations between HDA and the Word test, Digit Symbol Coding Test and tapping test scores were found. HDA was correlated with BDA (Pearson's r = 0.12, p = 0.0001). Moreover, 13% (95% confidence interval 3-36) of the HDA effect on the tapping test score was mediated through BDA. DISCUSSION: Heart delta age, representing the cumulative effects of life-long exposures, was associated with brain age. HDA was associated with cognitive function that was minimally explained through BDA

Subarachnoid hemorrhage : incidence, risk factors and sex differences

Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain. SAH may occur spontaneously, or following traumatic brain injury. Spontaneous SAH is in 85% of cases caused by rupture of an outpouching (aneurysm) of an intracranial artery. This is called an aneurysmal SAH (aSAH). The main findings of the present thesis concerned the incidence of aSAH in Norway, and sex differences in the risk factors for aSAH. The data source was the Norwegian Patient Register, and a combined cohort of the Tromsø study and the Nord-Trøndelag Health Study. The crude incidence of aSAH in Norway decreased from 11.1 per 100,000 person-years (95% confidence interval, CI: 10.5–11.6) in the period 1999–2001 to 8.9 per 100,000 person-years (95% CI: 8.4–9.4) in the period 2005–2007. Significant regional variations were observed, indicating an increasing gradient from south to north. Daily cigarette smoking was approximately twice as hazardous in women as in men (Hazard ratio, HR 6.5, 95% CI 3.56-11.9 vs HR 3.5, 95% CI 1.6-7.4). After adjusting for age, hypertension, and alcohol consumption, current cigarette smoking was 3.4 times more hazardous in female than male participants (HR 9.8, 95% CI 5.1-18.7 vs HR 2.9, 95% CI 1.3-6.3)

Rationality or organized anarchy? A study of the decision making establishment of PCI-treatment in Nordlandssykehuset Bodø.

Masteroppgave i helseledelse (EMBA) - Nord universitet 2018Sperret til 2021-06-2

Intravenous thrombolytic treatment and endovascular thrombectomy for ischaemic wake-up stroke

Background About one in five strokes occur during sleep (wake-up stroke). People with wake-up strokes have previously been considered to be ineligiblefor thrombolytic treatment because the time of stroke onset is unknown. However, recent studies suggest benefit from recanalisationtherapies in selected patients. Objectives To assess the effects of intravenous thrombolysis and endovascular thrombectomy versus control in people with acute ischaemic strokepresenting on awakening from sleep. Search methods We searched the Cochrane Stroke Group Trials Register (last search 24 of May 2021). In addition, we searched the following electronicdatabases in May 2021: Cochrane Central Register of Controlled Trials (CENTRAL; 2021, Issue 4 of 12, April 2021) in the Cochrane Library,MEDLINE, Embase, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform. We searched theStroke Trials Registry (last search 7 December 2017, as the site is currently inactive). We also screened references lists of relevant trials,contacted trialists, and undertook forward tracking of relevant references. Selection criteria Randomised controlled trials (RCTs) of intravenous thrombolytic drugs or endovascular thrombectomy treatments in people with acuteischaemic stroke presenting upon awakening. Data collection and analysis Two review authors applied the inclusion criteria, extracted data, and assessed risk of bias and the certainty of the evidence using theGRADE approach. We obtained both published and unpublished data for participants with wake-up strokes. We excluded participants withstrokes of unknown onset if the symptoms did not begin upon awakening. Main results We included seven trials with a total of 980 participants, of which five trials with 775 participants investigated intravenous thrombolytictreatment and two trials with 205 participants investigated endovascular thrombectomy in large vessel occlusion in the anteriorintracranial circulation. All trials used advanced imaging for selecting patients to treat

Reinnleggelser ved en hjertemedisinsk avdeling

BAKGRUNN - Reinnleggelse av pasienter kan være uttrykk for uhensiktsmessige pasientforløp eller kvalitetssvikt. Formålet med studien var å se om vi kunne identifisere områder for forbedring ved å gjennomgå 50 ikke-planlagte reinnleggelser. MATERIALE OG METODE - Vi gjennomgikk 50 fortløpende ikke-planlagte reinnleggelser ved Hjertemedisinsk avdeling ved Universitetssykehuset Nord-Norge. Journalene ble gjennomgått med utgangspunkt i en forenklet versjon av metoden «50 siste dødsfall». RESULTATER - Totalt hadde 29 pasienter minst én påvirkbar risikofaktor for reinnleggelse, hvorav mangelfull oppfølging etter utskrivelse og svikt i overlevering av informasjon til kommunehelsetjenesten var de vanligste. Mangelfull registrering og oppfølging av avvikende blodprøvesvar, nye symptomer like før utskrivelse og manglende informasjon i epikriser og til pasienter var andre risikofaktorer for reinnleggelse. FORTOLKNING - Gjennomgang av reinnleggelser kan være et verktøy for å identifisere områder for forbedring av behandlingskvalitet ved sykehus. Svikt i kommunikasjon mellom sykehus, kommunehelsetjeneste og pasient var den viktigste medvirkende årsaken til reinnleggelser

Endovascular thrombectomy and intra-arterial interventions for acute ischaemic stroke

Background - Most disabling strokes are due to a blockage of a large artery in the brain by a blood clot. Prompt removal of the clot with intra‐arterial thrombolytic drugs or mechanical devices, or both, can restore blood flow before major brain damage has occurred, leading to improved recovery. However, these so‐called endovascular interventions can cause bleeding in the brain. This is a review of randomised controlled trials of endovascular thrombectomy or intra‐arterial thrombolysis, or both, for acute ischaemic stroke. Objectives - To assess whether endovascular thrombectomy or intra‐arterial interventions, or both, plus medical treatment are superior to medical treatment alone in people with acute ischaemic stroke. Search methods - We searched the Trials Registers of the Cochrane Stroke Group and Cochrane Vascular Group (last searched 1 September 2020), CENTRAL (the Cochrane Library, 1 September 2020), MEDLINE (May 2010 to 1 September 2020), and Embase (May 2010 to 1 September 2020). We also searched trials registers, screened reference lists, and contacted researchers. Selection criteria - Randomised controlled trials (RCTs) of any endovascular intervention plus medical treatment compared with medical treatment alone in people with definite ischaemic stroke. Data collection and analysis - Two review authors (MBR and MJ) applied the inclusion criteria, extracted data, and assessed trial quality. Two review authors (MBR and HL) assessed risk of bias, and the certainty of the evidence using GRADE. We obtained both published and unpublished data if available. Our primary outcome was favourable functional outcome at the end of the scheduled follow‐up period, defined as a modified Rankin Scale score of 0 to 2. Eighteen trials (i.e. all but one included trial) reported their outcome at 90 days. Secondary outcomes were death from all causes at in the acute phase and by the end of follow‐up, symptomatic intracranial haemorrhage in the acute phase and by the end of follow‐up, neurological status at the end of follow‐up, and degree of recanalisation. Main results - We included 19 studies with a total of 3793 participants. The majority of participants had large artery occlusion in the anterior circulation, and were treated within six hours of symptom onset with endovascular thrombectomy. Treatment increased the chance of achieving a good functional outcome, defined as a modified Rankin Scale score of 0 to 2: risk ratio (RR) 1.50 (95% confidence interval (CI) 1.37 to 1.63; 3715 participants, 18 RCTs; high‐certainty evidence). Treatment also reduced the risk of death at end of follow‐up: RR 0.85 (95% CI 0.75 to 0.97; 3793 participants, 19 RCTs; high‐certainty evidence) without increasing the risk of symptomatic intracranial haemorrhage in the acute phase: RR 1.46 (95% CI 0.91 to 2.36; 1559 participants, 6 RCTs; high‐certainty evidence) or by end of follow‐up: RR 1.05 (95% CI 0.72 to 1.52; 1752 participants, 10 RCTs; high‐certainty evidence); however, the wide confidence intervals preclude any firm conclusion. Neurological recovery to National Institutes of Health Stroke Scale (NIHSS) score 0 to 1 and degree of recanalisation rates were better in the treatment group: RR 2.03 (95% CI 1.21 to 3.40; 334 participants, 3 RCTs; moderate‐certainty evidence) and RR 8.25 (95% CI 1.63 to 41.90; 198 participants, 2 RCTs; moderate‐certainty evidence), respectively. Authors' conclusions - In individuals with acute ischaemic stroke due to large artery occlusion in the anterior circulation, endovascular thrombectomy can increase the chance of survival with a good functional outcome without increasing the risk of intracerebral haemorrhage or death