Biomedical subjects

Kjell I Pettersen

Publications and source records attributed to Kjell I Pettersen.

7 recordsLinked to original sources

PubMed2006

High mortality in diabetic patients with acute myocardial infarction: cardiovascular co-morbidities contribute most to the high risk.

BACKGROUND: High mortality rates have been reported in diabetic patients after acute myocardial infarction (AMI). The excess mortality has been attributed to the diabetic state itself. We aimed to investigate how other risk factors along with diabetes per se may predict mortality in an unselected AMI population. METHODS: A representative sample of an unselected AMI population was collected over a three-month period. Data on patients' histories, co-morbidity, presenting features and treatment were collected from medical records. The data sets included outcome variables at discharge, after 6 months and after 2.5 years. Patients with confirmed diabetes on admission to hospital were registered as diabetic patients. RESULTS: Of the 901 patients admitted to hospital with AMI, 121 (14%) were diabetic patients. Compared with the nondiabetic patients significantly fewer of the diabetic patients were alive at discharge (78% vs 86%), after 6 months (64% vs 78%) and after 2.5 years (42% vs 65%). In multiple logistic regression analyses adjusted for age, sex and smoking status, the most important predictor of death at 2.5 years was heart failure, followed by previous MI, diabetes, and angina pectoris. The population attributable risk (PAR) of death after 2.5 years was 7% for diabetes, 17% for previous MI, 13% for heart failure and 12% for angina pectoris. CONCLUSION: Among patients with diabetes suffering an AMI the already established cardiovascular co-morbidities, which previously partly or fully might have been caused by diabetes, contributed more than diabetes per se to high mortality in-hospital and in the follow-up period.

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PubMed2006

Treatment with statins after acute myocardial infarction in patients >or=80 years: underuse despite general acceptance of drug therapy for secondary prevention.

PURPOSE: It has not been decided to what extent the results from statin trials should be transferred to clinical practice in the very old. The aim of the study was to assess the use of cardiovascular drugs after an acute myocardial infarction (MI), with particular focus on statins, in very old patients as compared to younger patients. METHOD: A sample of 901 acute MI patients was drawn from 16 hospitals in 1999/2000; the patients were followed up for 2.5 years. Information on demographic variables and drug therapy was obtained from hospital records, and in the follow-up period by direct patient contact or questionnaire. The main indications for prescribing the various cardiovascular drugs were recorded. RESULTS: At discharge, drug use in patients >or=80 and <80 years, respectively, was as follows: ACE-inhibitors 48 versus 32%, nitrates 55 versus 32%, diuretics 64 versus 26%, aspirin 72 versus 86%, and beta-blockers 67 versus 85%. A striking difference was found for statins: 9% in the very old and 72% in younger patients. The pattern of drug use generally remained unchanged after 2.5 years. Survival rates for patients >or=80 and <80 years: at discharge 72 versus 90%, after 2.5 years 34 versus 73%. CONCLUSIONS: Drug therapy was widely accepted for the indication secondary prevention after MI in patients above 80 years of age. The various cardiovascular drugs were prescribed to about the same extent for very old and younger patients. The exception was lipid lowering drugs which, despite the physicians' recognition of the indication secondary prevention in the very old patients, were prescribed to a limited extent.

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PubMed2005

Reliability and validity of the Kansas City cardiomyopathy questionnaire in patients with previous myocardial infarction.

BACKGROUND: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is a recently developed disease-specific instrument for measuring health-related quality of life (HRQoL) in patients with chronic heart failure (CHF) regardless of aetiology. AIM: To assess the reliability and validity of the KCCQ in patients with previous myocardial infarction (MI). METHODS AND RESULTS: In 754 myocardial infarction patients who were discharged alive, we collected clinical data from the patients' medical records. Two and a half years after the acute myocardial infarction, we mailed a self-administered questionnaire to the 548 patients still alive. The response rate was 74%. Internal consistency reliability, assessed with Cronbach's alpha, ranged 0.66-0.95. Test-retest reliability, tested with an intraclass correlation coefficient (ICC), ranged 0.41-0.83. The pattern of association between similar and dissimilar scales of the KCCQ and Short Form 36 (SF-36) supported the convergent/divergent validity of the KCCQ. Four of the KCCQ scales and the two summary scores discriminated between patients with and without medication for heart failure, and between different levels of left ventricular ejection fraction (LVEF) supporting different groups validity. CONCLUSIONS: The Norwegian version of the KCCQ showed acceptable reliability and cross-sectional validity, which support the use of this questionnaire to measure health-related quality of life after myocardial infarction.

Activities of Daily Living↗

PubMed2005

Reliability and validity of the Norwegian translation of the Seattle Angina Questionnaire following myocardial infarction.

The aim of this study was to validate the Norwegian version of the Seattle Angina Questionnaire (SAQ), a self-administered 19-item questionnaire designed to assess health-related quality of life in patients with chest pain or coronary artery disease. In 885 patients with prior myocardial infarction (MI), we abstracted clinical data from the patients' medical records. Two to three years after the MI, we mailed a self-administered questionnaire including the SAQ, the Short Form 36 (SF-36), and questions about current medication, to the 548 patients still alive. The response rate was 74%. Internal consistency reliability of the SAQ, assessed with Cronbach's alpha, ranged 0.75-0.92. Test-retest reliability, tested with an intraclass correlation coefficient, ranged 0.29-0.84. The pattern of association between similar and dissimilar scales of the SAQ and SF-36 mainly supported the construct validity of the SAQ. Four of the five SAQ scales discriminated between patients with different medication regimens as a proxy for severity of angina pectoris. We conclude that the Norwegian version of the SAQ showed acceptable reliability and cross-sectional validity following MI, with properties in line with the original US version.

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PubMed2004

Association of changes in health-related quality of life in coronary heart disease with coronary procedures and sociodemographic characteristics.

BACKGROUND: Few studies have focused on the association between the sociodemographic characteristics of a patient with the change in health-related quality of life (HRQOL) following invasive coronary procedures, and the results remain inconclusive. The objective of the present study was to measure the temporal changes in HRQOL of patients with coronary heart disease, and assess how these changes are associated with invasive coronary procedures and sociodemographic characteristics. METHODS: This was a prospective study of 254 patients with angina pectoris and 90 patients with acute coronary syndrome. HRQOL was assessed with the multi-item scales and summary components of the SF-36, both 6 weeks and 2 years after baseline hospitalization in 1998. Paired t-tests and multiple regression analyses were used to assess temporal changes in HRQOL and to identify the associated factors. RESULTS: Physical components of HRQOL had improved most during the 2 years following invasive coronary procedures. Our findings indicated that patients with angina pectoris who were younger, male, and more educated were most likely to increase their HRQOL following invasive coronary procedures. When adjusting for baseline HRQOL scores, invasive coronary procedures and sociodemographic characteristics did not explain temporal changes in patients with acute coronary syndrome, possibly due to higher comorbidity. CONCLUSION: Sociodemographic characteristics should be taken into account when comparing and interpreting changes in HRQOL scores in patients with and without invasive coronary procedures.

Activities of Daily Living↗

PubMed2004

The Patient Experiences Questionnaire: development, validity and reliability.

OBJECTIVE: . To describe the development of the Patient Experiences Questionnaire (PEQ) and to evaluate reliability and validity of constructed summed rating scales. DESIGN: Literature review, focus groups and pilot surveys. Two national cross-sectional studies performed in 1996 and 1998. SETTING: Two postal surveys in a national sample of 14 hospitals stratified by geographical region and hospital size. Subjects. Patients consecutively discharged from surgical wards and wards of internal medicine. The surveys included 36 845 patients and 19 578 responded (53%). RESULTS: We constructed 10 summed rating scales based on factor analysis and theoretical considerations: Information on future complaints, Nursing services, Communication, Information examinations, Contact with next-of-kin, Doctor services, Hospital and equipment, Information medication, Organization and General satisfaction. Eight scales had a Cronbach alpha coefficient of >0.70, the remaining two were >0.60. Repeatability was >0.70 for five scales and >0.60 for the remaining scales. CONCLUSIONS: The PEQ is a self-report instrument covering the most important subjects of interest to hospital patients. Results are presented as 10 scales with good validity and reliability. It emphasizes practicability and comprehensibility while at the same time providing sufficient information about domains applicable to most patients admitted to medical and surgical wards.

Cross-Sectional Studies↗

PubMed2003

[Patient experiences in Norwegian hospitals--changes over time?].

BACKGROUND: Patient experience has been identified as a national indicator of hospital quality. We describe the changes in patient experiences 1996-2000 for seven Norwegian hospitals. MATERIAL AND METHODS: A patient experience questionnaire was sent to medical and surgical patients in a stratified random sample of hospitals in 1996. The same questionnaire was used in similar surveys in 1998 and 2000. Responses from hospital wards included in all three surveys were compared on ten summated rating scales. Changes were identified by multiple linear regression. RESULTS: Responses from a total of 10 600 patients were analysed. For six scales no change was noted: general satisfaction, information on medication, information on examinations, nursing services, doctor services, and organization. Statistically significant improvement was found for three indices: communication, contact with next-of-kin, and information regarding future complaints. For one scale, scores changed for the worse: hospital and equipment. All changes were small. INTERPRETATION: Patient experiences with Norwegian hospitals did not change much between 1996 and 2000. On some indices, our data indicate slight improvement. Patient assessment of buildings and equipment changed negatively.

Communication↗