Agneta Hjalmarson

Patients admitted to the emergency room with symptoms indicative of acute myocardial infarction

Abstract. All 7157 patients (55% men) admitted to the emergency room with chest pain or other symptoms indicative of acute myocardial infarction during a period of 21 months were registered consecutively. Chest pain was reported by 93% of the patients. On the basis of history, clinical examination, and electrocardiogram in the emergency room, all patients were prospectively classified in one of four categories: (i) obvious infarction (4% of all patients): (ii) strongly suspected infarction (20%): (iii) vague suspicion of infarction (35%); and (iv) no suspected infarction (41%). In patients with no suspected infarction (n = 2910), musculoskeletal (26%), obscure (21%) and psychogenic origins (16%) of the symptoms occurred most frequently. We conclude that few of the patients had an obvious infarction on admission, and that a musculoskeletal origin of the symptoms occurred most frequently in patients with no suspected infarction.

Are patients truthful about their smoking habits? A validation of self-report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease.

Abstract. From Attebring M, Herlitz J, Berndt A‐K, Karlsson T, Hjalmarson A (Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden). Are patients truthful about their smoking habits? A validation of self‐report about smoking cessation with biochemical markers of smoking activity amongst patients with ischaemic heart disease. J Intern Med 2001; 249: 145–151.

Smoking cessation in patients with diabetes mellitus: Results from a controlled study of an intervention programme in primary healthcare in Sweden

Objective. To evaluate an intervention programme on smoking cessation in patients with diabetes mellitus in primary healthcare. Design. Regional controlled intervention study. Setting. Seventeen primary healthcare centres in Sweden. Intervention. In the intervention centres, nurses with education in diabetes were given one half-day of training in motivational interviewing and smoking cessation. An invitation to participate in a smoking cessation group was mailed to patients from the intervention centres followed by a telephone call from the patients diabetes nurse. The nurses who intervened were specially educated in smoking cessation. The control group received a letter containing advice to stop smoking and information about a one-year follow-up. Patients. Daily smokers with diabetes mellitus, 30–75 years of age. In the intervention centres 241 patients fulfilled the criteria and in the control centres 171 patients. Main outcome measures. Self-reported smoking habits after one year. Results. In total, 21% of the smokers accepted group treatment. After 12 months, 20% (42/211) in the intervention centres reported that they had stopped smoking and 7% (10/140) in the control centres; 40% (19/47) of the smokers who had participated in group treatment reported that they had stopped smoking. Conclusion. A computerized record system for patients in primary healthcare was used to identify diabetic patients who were smokers. The selected group was invited to a stop smoking programme. At a one-year follow-up significantly more patients in the intervention centres had stopped smoking compared with patients in the control centres.

Smoking Habits in Consecutive Patients with Acute Myocardial Infarction: Prognosis in Relation to Other Risk Indicators and to Whether or Not they Quit Smoking

In all patients hospitalized in one single hospital due to acute myocardial infarction (AMI) during a period of 21 months, we describe the prognosis in relation to smoking habits and other risk indicators with death. Of 862 AMI patients, 37% reported smoking at the onset of AMI. Of the patients who smoked at the onset of AMI and who survived the first year, 53% reported having quit smoking. Patients who had quit smoking reported fewer symptoms of chest pain (p < 0.01), headache (p < 0.01) and dizziness (p < 0.001) as compared with patients who continued to smoke after one year. Of the patients who had quit smoking, the mortality during the subsequent 4 years was 17% as compared with 31% for patients who continued to smoke (p < 0.05). However, patients who quit smoking less frequently had a previous history of myocardial infarction and congestive heart failure. When correcting for such dissimilarities, quitting smoking did not remain significantly associated with prognosis.

The epidemiology of a coronary waiting list A description of all of the patients

Abstract. Objectives. To describe the characteristics and the severity of symptoms amongst patients on the waiting list for possible coronary revascularization.

Mortality and morbidity during one year of follow-up in suspected acute myocardial infarction in relation to early diagnosis : experiences from the MIAMI trial

Abstract. From a large randomized multicentre trial of metoprolol in suspected acute myocardial infarction (n = 5778) we report on the outcome during 1 year of follow‐up, in relation to early diagnosis. Patients who developed a confirmed infarction had a 1‐year mortality rate of 12.8%. This was significantly higher than the mortality rate of 6.3% (P < 0.001) in patients with possible infarction and it was also higher than that in patients with no infarction, which was 5.0% (P < 0.001). A multivariate analysis showed that independent risk predictors in the clinical history of patients without confirmed infarction were a history of angina pectoris, chronic use of digitalis and advanced age. After 1 year, angina pectoris was most common in patients with an initial possible infarction. These patients were also in most urgent need of bypass surgery. We thus conclude that the mortality during 1 year of follow‐up among patients with an initially strongly suspected acute myocardial infarction was clearly related to whether or not the patient developed a myocardial infarction.

Secondary prevention in coronary artery disease. Achieved goals and possibilities for improvements

AIM To describe presence of risk indicators of recurrence 6 months after hospitalisation due to coronary artery disease at a university clinic. METHODS The presence of risk indicators, including tobacco use, lipid levels, blood pressure and glucometabolic status, including 24-hour blood pressure monitoring and an oral glucose-tolerance test, was analysed. RESULTS Of 1465 patients who were screened, 402 took part in the survey (50% previous myocardial infarction and 50% angina pectoris). Mean age was 64 years (range 40-85 years) and 23% were women. Present medications were: lipid lowering drugs (statins; 94%), beta-blockers (85%), aspirin or warfarin (100%) and ACE-inhibitors or angiotensin II blockers (66%). Values above target levels recommended in guidelines were: a) low density lipoprotein (LDL) in 40%; b) mean blood pressure (day or night) in 38% and c) smoking in 13%. Of all patients, 66% had at least one risk factor (LDL or blood pressure above target levels or current smoking). An abnormal glucose-tolerance test was found in 59% of patients without known diabetes. If no history of diabetes, 85% had either LDL or blood pressure above target levels, current smoking or an abnormal glucose-tolerance test. However, with treatment intensification to patients with elevated risk factors 56% reached target levels for blood pressure and 79% reached target levels for LDL. CONCLUSION Six months after hospitalisation due to coronary artery disease, despite the high use of medication aimed at prophylaxis against recurrence, the majority were either above target levels for LDL or blood pressure or continued to smoke.