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  • 1. Frisk Torell, Matilda
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Herlitz, Johan
    Claesson, Andreas
    Svensson, Leif
    Börjesson, Mats
    Outcome of exercise-related out-of-hospital cardiac arrest is dependent on location: Sports arenas vs outside of arenas.2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 2, article id e0211723Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The chance of surviving an out-of-hospital cardiac arrest (OHCA) seems to be increased if the cardiac arrests occurs in relation to exercise. Hypothetically, an exercise-related OHCA at a sports arena would have an even better prognosis, because of an increased likelihood of bystander cardiopulmonary resuscitation (CPR) and higher availability of automated external defibrillators (AEDs). The purpose of the study was to compare survival rates between exercise-related OHCA at sports arenas versus outside of sports arenas.

    METHODS: Data from all treated exercise-related OHCA outside home reported to the Swedish Register of Cardiopulmonary Resuscitation (SRCR) from 2011 to 2014 in 10 counties of Sweden was analyzed (population 6 million). The registry has in those counties a coverage of almost 100% of all OHCAs.

    RESULTS: 3714 cases of OHCA outside of home were found. Amongst them, 268(7%) were exercise-related and 164 (61.2%) of those occurred at sports arenas. The 30-day survival rate was higher for exercise-related OHCA at sports arenas compared to outside (55.7% vs 30.0%, p<0.0001). OHCA-victims at sports arenas were younger (mean age±SD 57.6±16.3 years compared to 60.9±17.0 years, p = 0.05), less likely female (4.3% vs 12.2%, p = 0.02) and had a higher frequency of shockable rhythm (73.0% vs 54.3%, p = 0.004). OHCAs at arenas were more often witnessed (83.9% vs 68.9%, p = 0.007), received bystander CPR to a higher extent (90.0% vs 56.8%, p<0.0001) and the AED-use before EMS-arrival was also higher in this group (29.8% vs 11.1%, p = 0.009).

    CONCLUSION: The prognosis is markedly better for exercise-related OHCA occurring at sports arenas compared to outside. Victims of exercise-related OHCA at sports arenas are more likely to receive bystander CPR and to be connected to a public AED. These findings support an increased use of public AEDs and implementation of Medical Action Plans (MAP), to possibly increase survival of exercise-related OHCA even further.

  • 2.
    Gelberg, Jan
    et al.
    Lund Univ, Dept Pediat Anesthesia & Intens Care, Skane Univ Hosp, Lund, Sweden..
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Karolinska Institutet.
    Hollenberg, Jacob
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Radell, Peter
    Karolinska Univ Hosp, Astrid Lindgrens Childrens Hosp, Det Pediat Anesthesia & Intens Care, Stockholm, Sweden..
    Claesson, Andreas
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Svensson, Leif
    Soder Sjukhuset, Karolinska Inst, Dept Clin Sci & Educ, Dept Educ,Cardiol Sect, Stockholm, Sweden..
    Herlitz, Johan
    Univ Coll Boras, Ctr Prehosp Res Western Sweden, Dept Caring Sci, Boras, Sweden.;Sahlgrens Univ Hosp, Inst Med, Dept Med & Mol Biol, Gothenburg, Sweden..
    Improving survival and neurologic function for younger age groups after out-of-hospital cardiac arrest in Sweden: a 20-year comparison2015In: Pediatric Critical Care Medicine, ISSN 1529-7535, E-ISSN 1947-3893, Vol. 16, no 8, p. 750-757Article in journal (Refereed)
    Abstract [en]

    Objective: To describe changes in the epidemiology of out-of-hospital cardiac arrest in Sweden with the emphasis on the younger age groups.

    Design: Prospective observational study. Setting: Sweden.

    Patients: Patients were recruited from the Swedish Registry of Cardiopulmonary Resuscitation from 1990 to 2012. Only non-crew-witnessed cases were included.

    Intervention: Cardiopulmonary resuscitation.

    Measurement and Main Results: The endpoint was 30-day survival. Cerebral function among survivors was estimated according to the cerebral performance category scores. In all, 50,879 patients in the survey had an out-of-hospital cardiac arrest, of which 1,321 (2.6%) were 21 years old or younger and 1,543 (3.0%) were 22-35 years old. On the basis of results from 2011 and 2012, we estimated that there are 4.9 cases per 100,000 person-years in the age group 0-21 years. The highest survival was found in the 13- to 21-year age group (12.6%). Among patients 21 years old or younger, the following were associated with an increased chance of survival: increasing age, male gender, witnessed out-of-hospital cardiac arrest, ventricular-fibrillation, and a short emergency medical service response time. Among patients 21 years old or younger, there was an increase in survival from 6.2% in 1992-1998 to 14.0% in 2007-2012. Among 30-day survivors, 91% had a cerebral performance category score of 1 or 2 (good cerebral performance or moderate cerebral disability) at hospital discharge.

    Conclusions: In Sweden, among patients 21 years old or younger, five out-of-hospital cardiac arrests per 100,000 person-years occur and survival in this patient group has more than doubled during the past two decades. The majority of survivors have good or relatively good cerebral function.

  • 3. Herlitz, Johan
    et al.
    Svensson, Leif
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Several factors affect the prognosis2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112Article in journal (Other academic)
  • 4. Hessulf, F.
    et al.
    Karlsson, T.
    Lundgren, P.
    Aune, S.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Södersved Källestedt, M. -L
    Djärv, T.
    Herlitz, J.
    Engdahl, J.
    Factors of importance to 30-day survival after in-hospital cardiac arrest in Sweden - A population-based register study of more than 18,000 cases2018In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 255, p. 237-242Article in journal (Refereed)
  • 5.
    Libungan, Berglind
    et al.
    Sahlgrens university hospital.
    Lindqvist, Jonny
    Sahlgrens university hospital.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Nordberg, Per
    Karolinska institutet.
    Hollenberg, Jacob
    Karolinska institutet.
    Albertsson, Per
    Sahlgrens university hospital.
    Karlsson, Thomas
    Göteborgs universitet.
    Herlitz, Johan
    Högskolan Väst.
    Out-of-hospital cardiac arrest in the elderly: a large-scale population-based study2015In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 94, p. 28-32Article in journal (Refereed)
    Abstract [en]

    Background: There is little information on elderly people who suffer from out-of-hospital cardiac arrest (OHCA). Aim: To determine 30-day mortality and neurological outcome in elderly patients with OHCA.

    Methods: OHCA patients >= 70 years of age who were registered in the Swedish Cardiopulmonary Resuscitation Register between 1990 and 2013 were included and divided into three age categories (70-79, 80-89, and >= 90 years). Multiple logistic regression analyses were performed to identify independent predictors of 30-day survival.

    Results: Altogether, 36,605 cases were included in the study. Thirty-day survival was 6.7% in patients aged 70-79 years, 4.4% in patients aged 80-89 years, and 2.4% in those over 90 years. For patients with witnessed OHCA of cardiac aetiology found in a shockable rhythm, survival was higher: 20%, 15%, and 11%, respectively. In 30-day survivors, the distribution according to the cerebral performance categories (CPC) score at discharge from hospital was similar in the three age groups. In multivariate analysis, in patients over 70 years of age, the following factors were associated with increased chance of 30-day survival: younger age, OHCA outside the home, witnessed OHCA, CPR before arrival of EMS, shockable first-recorded rhythm, and short emergency response time.

    Conclusions: Advanced age is an independent predictor of mortality in OHCA patients over 70 years of age. However, even in patients above 90 years of age, defined subsets with a survival rate of more than 10% exist. In survivors, the neurological outcome remains similar regardless of age. 

  • 6. Magnusson, Carl
    et al.
    Axelsson, Christer
    Nilsson, Lena
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Munters, Monica
    Herlitz, Johan
    Andersson Hagiwara, Magnus
    The final assessment and its association with field assessment in patients who were transported by the emergency medical service2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 111Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment.

    AIM: In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge.

    METHODS: Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment.

    RESULTS: In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%.

    CONCLUSION: Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored.

  • 7. Masterson, Siobhán
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Cullinan, John
    Deasy, Conor
    Vellinga, Akke
    Apples to apples: can differences in out-of-hospital cardiac arrest incidence and outcomes between Sweden and Ireland be explained by core Utstein variables?2018In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 26, no 1, article id 37Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Variation in reported incidence and outcome based on aggregated data is a persistent feature of out-of-hospital cardiac arrest (OHCA) epidemiology.

    OBJECTIVE: To investigate the extent to which patient-level analysis using core 'Utstein' variables explains inter-country variation between Sweden and the Republic of Ireland.

    METHODS: A retrospective cross-sectional comparative study was performed, including all Swedish and Irish OHCA cases attended by Emergency Medical Services (EMS-attended OHCA) where resuscitation was attempted from 1st January 2012 to 31st December 2014. Incidence rates per 100,000 population were adjusted for age and gender. Two subgroups were extracted: (1) Utstein - adult patients, bystander-witnessed collapse, presumed medical aetiology, initial shockable rhythm and (2) Emergency Medical Service (EMS)-witnessed events. Multivariable logistic regression analysis was used to identify predictors of survival following multiple imputations of data.

    RESULTS: Five thousand eight hundred eighty six Irish and 15,303 Swedish patients were included. Swedish patients were older than Irish patients (median age 71 vs. 66 years respectively). Adjusted incidence was significantly higher in Sweden compared to the Republic of Ireland (52.9 vs. 43.1 per 100,000 population per year). Proportionate survival in Sweden was greater for both subgroups and all age categories. Regression analysis of the Utstein subgroup predicted approximately 17% of variation in outcome, but there was a large unexplained 'country effect' for survival in favour of Sweden (OR 4.40 (95% CI 2.55-7.56)).

    CONCLUSIONS: Using patient level data, a proportion of inter-country variation was explained, but substantial variation was not explained by the core Utstein variables. Researchers and policy makers should be aware of the potential for unmeasured differences when comparing OHCA incidence and outcomes between countries.

  • 8. Nishiyama, Chika
    et al.
    Brown, Siobhan P.
    May, Susanne
    Iwami, Taku
    Koster, Rudolph W.
    Beesems, Stefanie G.
    Kuisma, Markku
    Salo, Ari
    Jacobs, Ian
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Apples to apples or apples to oranges?: International variation in reporting of process and outcome of care for out-of-hospital cardiac arrest2014In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, no 11, p. 1599-1609Article in journal (Refereed)
    Abstract [en]

    Objectives: Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care, and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. Study design: Retrospective study.

    Setting: This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified, and then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects' research by a research ethics committee.

    Measurements and main results: Thirteen registries with 265 first-responding EMS agencies in 13 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9 +/- 2.2%. The proportion of unknown was mean 4.8 +/- 6.4%. Among time variables, missingness was mean 9.0 +/- 6.3%.

    Conclusions: International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities.

  • 9.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2009In: XXII Nordic-Baltic Congress of Cardiology, Reykjavik, 2009Conference paper (Other academic)
  • 10.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Förbättrade resultat för patienter som drabbats hjärtstopp utanför sjukhus – en uppföljning från 1992 till 20112013Conference paper (Refereed)
    Abstract [sv]

    Syfte: Att beskriva patienter som drabbats av hjärtstopp utanför sjukhus och dess resultatsförändringar i behandling och överlevnad.

    Metod: Patienter (n=59 926) som drabbats av hjärtstopp utanför sjukhus i samtliga Sveriges län och som rapporterats till Svenska hjärt-lungräddningsregistret från 1992 till 2011.

    Resultat: Antalet rapporterade hjärtstopp utanför sjukhus ökade från 27 (1992) till 52 (2011) per 100 000 invånare och år. Vidare så ökade bevittnandegraden av hjärtstopp utanför sjukhus av ambulanspersonalen, en ökad förekomst av hjärtlungräddning innan ambulansen kom fram till patienten samt att tiden ökade från larm till dess att ambulansen kom fram till patienten.

    1-månads-överlevnad ökade från 4,8% (1992) till 10,7% (2011). De som framförallt överlevde 1 månad eller mer var de patienter som levde vid ankomst till sjukhus. Av de patienter som drabbats av hjärtstopp utanför sjukhus mellan 2008 till 2010, var det 41% som genomgick kylbehandling på sjukhus samt 28% som behandlades med ballongvidgning av hjärtats kranskärl. De patienter som överlevde (2008-2011), hade 94% en god eller relativ god hjärnfunktion.

    Sammanfattning: De patienter som drabbats av hjärtstopp utanför sjukhus 1992-2011, påvisar en fördubblad överlevnad. De patienter som framförallt överlever, är de som lever vid ankomst till sjukhus och som senare läggs in på vårdavdelning.   

  • 11.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Utbildning i HLR i Sverige och dess kliniska konsekvenser2008In: HLR kongressen, Stockholm, 2008Conference paper (Other academic)
  • 12.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden2012Conference paper (Refereed)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in 4 Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2398 and retrospective cases n=3198 which indicates a 30% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3198 cases of OHCA in 4 regions in Sweden 800 (30%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 13.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Validity of reported data in the out-of-hospital cardiac arrest register in chosen parts in Sweden: [HLR-registrets tillförlitlighet]2013Conference paper (Refereed)
    Abstract [en]

    Aim: To describe differences between reported and non reported data in the out-of-hospital cardiac arrest (OHCA) register in Sweden.

    Methods: Prospective and retrospective data of treated OHCA patients in Sweden, 2008-2010 were compared in the Swedish OHCA register. Data were investigated in three Swedish counties with various recording models. Prospective data are those reported by the ambulance crew and retrospective data those missed by the ambulance crew but discovered afterwards by crosschecking with the local ambulance register.

    Result: In 2008-2010, the number of prospective reported cases was n=2, 398 and retrospective cases n=3, 198 which indicates a 25% missing rate.

    When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years versus 67 years; p=0.003). There was no difference between groups with regard to sex, time of day and year of OHCA, witnessed status or initial rhythm.

    However, bystander CPR was more frequent among patients in who were reported prospectively (65% versus 60%; p= 0.023) where as survival to 1 month was higher among patients who were reported retrospectively (9,2% versus 11,9%;p=0.035)

     

    Conclusion: Among 3, 198 cases of OHCA in three regions in Sweden 800 (25%) were not reported prospectively by the ambulance crew but retrospectively when discovered as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, less frequently receiving bystander CPR but having a higher survival. Our data suggest that patients who suffer OHCA and are prospectively reported to a quality register may be influenced by selection bias.

  • 14.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Afzelius, S.
    Axelsson, C.
    Kallestedt, M. L. Sodersved
    Enlund, M.
    Svensson, L.
    Herlitz, J.
    Improvements in logistics could increase survival after out-of-hospital cardiac arrest in Sweden2013In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 273, no 6, p. 622-627Article in journal (Refereed)
    Abstract [en]

    Objectives. In a review based on estimations and assumptions, to report the estimated number of survivors after out-of-hospital cardiac arrest (OHCA) in whom cardiopulmonary resuscitation (CPR) was started and to speculate about possible future improvements in Sweden.

    Design. An observational study. Setting All ambulance organisations in Sweden. Subjects Patients included in the Swedish Cardiac Arrest Registry who suffered an OHCA between January 1, 2008 and December 31, 2010. Approximately 80% of OHCA cases in Sweden in which CPR was started are included. Interventions None

    Results. In 11005 patients, the 1-month survival rate was 9.4%. There are approximately 5000 OHCA cases annually in which CPR is started and 30-day survival is achieved in up to 500 patients yearly (6 per 100000 inhabitants). Based on findings on survival in relation to the time to calling for the Emergency Medical Service (EMS) and the start of CPR and defibrillation, it was estimated that, if the delay from collapse to (i) calling EMS, (ii) the start of CPR, and (iii) the time to defibrillation were reduced to <2min, <2min, and <8min, respectively, 300400 additional lives could be saved.

    Conclusion. Based on findings relating to the delay to calling for the EMS and the start of CPR and defibrillation, we speculate that 300400 additional OHCA patients yearly (4 per 100000 inhabitants) could be saved in Sweden.

  • 15.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Andersson, B.
    Ekstrom, L.
    Herlitz, J.
    Axelsson, A.
    Goransson, K. E.
    Svensson, L.
    Holmberg, S.
    Education in cardiopulmonary resuscitation in Sweden and its clinical consequences2010In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 81, no 2, p. 211-216Article in journal (Refereed)
    Abstract [en]

    Aim: To describe the use of cardiopulmonary resuscitation (CPR) training programmes in Sweden for 25 years and relate those to changes in the percentage of patients with out of hospital cardiac arrest (OHCA) who receive bystander CPR.

    Methods: Information was gathered from (a) the Swedish CPR training registry established in 1983 and includes most Swedish education programmes in CPR and (b) the Swedish Cardiac Arrest Register (SCAR) established in 1990 and currently covers about 70% of ambulance districts in Sweden.

    Results: CPR education in Sweden functions according to a cascade principle (instructor-trainers who train instructors who then train rescuers in CPR). Since 1989, 5000 instructor-trainers have taught more than 50,000 instructors who have taught nearly 2 million of Sweden's 9 million inhabitants adult CPR. This is equivalent to one new rescuer per 100 inhabitants every year in Sweden. In addition, since 1989, there are 51,000 new rescuers in Advanced Life Support (ALS), since 1996, 41,000 new Basic Life Support (BLS) rescuers with Automated External Defibrillation (AED) training, and since 1998, there are 93,000 new rescuers in child CPR. As a result of this CPR training the number of bystander CPR attempts for OHCA in Sweden increased from 31% in 1992 to 55% in 2007.

    Conclusion: By using a cascade principle for CPR education nearly 2 million rescuers were educated in Sweden (9 million inhabitants) between 1989 and 2007. This resulted in a marked increase in bystander CPR attempts. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  • 16.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Sahlgrens Univ Hosp, Dept Metab & Cardiovasc Res, Inst Internal Med, SE-41345 Gothenburg, Sweden.
    Svensson, L.
    Axelsson, A. B.
    Goransson, K.
    Todorova, L.
    Herlitz, J.
    Validity of reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden2013In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 84, no 7, p. 952-956Article in journal (Refereed)
    Abstract [en]

    Aim: To describe differences and similarities between reported and non-reported data in the Swedish Cardiac Arrest Register in selected parts in Sweden. 

    Methods: Prospective and retrospective data for treated OHCA patients in Sweden, 2008-2010, were compared in the Swedish Cardiac Arrest Register. Data were investigated in three Swedish counties, which represented one third of the population. The recording models varied. Prospective data are those reported by the emergency medical service (EMS) crews, while retrospective data are those missed by the EMS crews but discovered afterwards by cross-checking with the local ambulance register. 

    Result: In 2008-2010, the number of prospectively (n = 2398) and retrospectively (n = 800) reported OHCA cases was n = 3198, which indicates a 25% missing rate. When comparing the two groups, the mean age was higher in patients who were reported retrospectively (69 years vs. 67 years; p = 0.003). There was no difference between groups with regard to gender, time of day and year of OHCA, witnessed status or initial rhythm. Bystander cardiopulmonary resuscitation (CPR) was more frequent among patients who were reported prospectively (65% vs. 60%; p = 0.023), whereas survival to one month was higher among patients who were reported retrospectively (9.2% vs. 11.9%; p = 0.035). 

    Conclusion: Among 3198 cases of OHCA in three counties in Sweden, 800 (25%) were not reported prospectively by the EMS crews but were discovered retrospectively as missing cases. Patients who were reported retrospectively differed from prospectively reported cases by being older, having less frequently received bystander CPR but having a higher survival rate. Our data suggest that reports on OHCA from national quality registers which are based on prospectively recorded data may be influenced by selection bias. 

  • 17.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Svensson, L.
    Axelsson, Å.
    Göransson, K.
    Todorova, L.
    Herlitz, J.
    Kvalitetsbedömning - nationella hjärtstoppsregistret 2008-20102012Conference paper (Other academic)
  • 18.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Svensson, L.
    Claesson, A.
    Lindkvist, J.
    Lundström, A.
    Herlitz, J.
    Association between population density and reported incidence, characteristics and outcome after out–of–hospital cardiac arrest in Sweden2011In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 82, no 10Article in journal (Refereed)
    Abstract [en]

    Aim. To describe the reported incidence of out of hospital cardiac arrest (OHCA) and the characteristics and outcome after OHCA in relation to population density in Sweden. Methods All patients participating in the Swedish Cardiac Arrest Register between 2008 and 2009 in (a) 20 of 21 regions (n = 6457) and in (b) 165 of 292 municipalities (n = 3522) in Sweden, took part in the survey.

    Results. The regional population density varied between 3 and 310 inhabitants per km2 in 2009. In 2008–2009, the number of reported cardiac arrests varied between 13 and 52 per 100,000 inhabitants and year. Survival to 1 month varied between 2% and 14% during the same period in different regions. With regard to population density, based on municipalities, bystander CPR (p = 0.04) as well as cardiac etiology (p = 0.002) were more frequent in less populated areas. Ambulance response time was longer in less populated areas (p < 0.0001). There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA.

    Conclusion. There was no significant association between population density and survival to 1 month after OHCA or incidence (adjusted for age and gender) of OHCA. However, bystander CPR, cardiac etiology and longer response times were more frequent in less populated areas.

  • 19.
    Strömsöe, Anneli
    et al.
    Dalarna University, School of Education, Health and Social Studies, Medical Science. Sahlgrenska University Hospital, Gothenburg.
    Svensson, Leif
    South Hospital, Stockholm.
    Axelsson, Åsa B.
    Sahlgrenska Academy at Gothenburg University, Gothenburg.
    Claesson, Andreas
    Prehospen University College of Borås, Borås; Kungälv Ambulance Service, Kungälv.
    Göransson, Katarina E.
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Nordberg, Per
    Section of Cardiology, Södersjukhuset, Stockholm.
    Herlitz, Johan
    Sahlgrenska University Hospital, Gothenburg; Prehospen University College of Borås.
    Improved outcome in Sweden after out-of-hospital cardiac arrest and possible association with improvements in every link in the chain of survival2015In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 36, no 14, p. 863-871Article in journal (Refereed)
    Abstract [en]

    Aims: To describe out-of-hospital cardiac arrest (OHCA) in Sweden from a long-term perspective in terms of changes in outcome and circumstances at resuscitation.

    Methods and results: All cases of OHCA (n = 59 926) reported to the Swedish Cardiac Arrest Register from 1992 to 2011 were included. The number of cases reported (n/100 000 person-years) increased from 27 (1992) to 52 (2011). Crew-witnessed cases, cardiopulmonary resuscitation prior to the arrival of the emergency medical service (EMS), and EMS response time increased (P < 0.0001). There was a decrease in the delay from collapse to calling for the EMS in all patients and from collapse to defibrillation among patients found in ventricular fibrillation (P< 0.0001). The proportion of patients found in ventricular fibrillation decreased from 35 to 25% (P < 0.0001). Thirty-day survival increased from 4.8 (1992) to 10.7% (2011) (P < 0.0001), particularly among patients found in a shockable rhythm and patients with return of spontaneous circulation (ROSC) at hospital admission. Among patients hospitalized with ROSC in 2008–2011, 41% underwent therapeutic hypothermia and 28% underwent percutaneous coronary intervention. Among 30-day survivors in 2008–2011, 94% had a cerebral performance category score of 1 or 2 at discharge from hospital and the results were even better if patients were found in a shockable rhythm.

    Conclusion: From a long-term perspective, 30-day survival after OHCA in Sweden more than doubled. The increase in survival was most marked among patients found in a shockable rhythm and those hospitalized with ROSC. There were improvements in all four links in the chain of survival, which might explain the improved outcome.

  • 20. Torell, Matilda F
    et al.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Zagerholm, Ellen
    Herlitz, Johan
    Claesson, Andreas
    Svensson, Leif
    Börjesson, Mats
    Higher survival rates in exercise-related out-of-hospital cardiac arrests, compared to non-exercise-related - a study from the Swedish Register of Cardiopulmonary Resuscitation2017In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, no 15, p. 1673-1679Article in journal (Refereed)
    Abstract [en]

    Background: Despite the positive effects of physical activity, the risk of sudden cardiac arrest is transiently increased during and immediately after exercise. The purpose of this study was to assess the incidence of exercise-related out-of-hospital cardiac arrest in the general population and to compare characteristics and prognosis of these cardiac arrests with non-exercise-related out-of-hospital cardiac arrests.

    Methods: Data from all cases of treated out-of-hospital cardiac arrest outside of home reported to the Swedish Register of Cardiopulmonary Resuscitation from 2011-2015 in three counties of Sweden were investigated (population 2.1 m). This registry captures almost 100% of all out-of-hospital cardiac arrests in Sweden. Results Of 1825 out-of hospital cardiac arrests, 137 (7.5%) were exercise-related, resulting in an incidence of 1.2 per 100,000 person-years. The 30-day survival rate was significantly higher among exercise-related out-of hospital cardiac arrests compared to non-exercise-related out-of-hospital cardiac arrests (54.3 % vs 19.4%, p < 0.0001). Patients suffering an exercise-related out-of-hospital cardiac arrest were on average 10 years younger than those who had a non-exercise-related out-of-hospital cardiac arrest, 56.4 years compared to 67.2 years. Exercise-related out-of-hospital cardiac arrests were more often witnessed (89.4% vs 78.6%, p = 0.002), had higher rates of bystander cardiopulmonary resuscitation (80.3% vs 61.0%, p < 0.0001) and were more frequently connected to an automated external defibrillator (20.4% vs 4.6%, p < 0.0001).

    Conclusions: Cardiac arrests that occur in relation to exercise have a significantly better prognosis and outcome than non-exercise-related cardiac arrests. This may be explained by favourable circumstances but may also reflect that these persons experience a sudden cardiac arrest at a lower degree of coronary artery disease, due to their younger age and to exercise being a trigger.

  • 21. Tärnqvist, J.
    et al.
    Dahlén, E.
    Norberg, G.
    Magnusson, C.
    Herlitz, J.
    Strömsöe, Anneli
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Axelsson, C.
    Andersson Hagiwara, M.
    On-scene and final assessments and their interrelationship among patients who use the EMS on multiple occasions2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 5, p. 528-535Article in journal (Refereed)
    Abstract [en]

    Introduction: The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem: There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. Method: Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. Results: In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Conclusion:: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. 

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