I spy efficiency.

BACKGROUND: In Sweden heart failure is the most frequent discharge diagnosis within internal medicine. The prevalence of heart failure seems to be increasing, mainly due to an ageing population, but also because of improved survival in patients with cardiovascular diseases. AIM: To describe the epidemiology of heart failure in Sweden from a perspective based on demographic and health care data. METHODS: The national registers in Sweden provide detailed information on health care consumption in relation to different diagnoses. Pharmaceutical sales are also registered. There are national epidemiological reports, reports on health care utilization and on health economics concerning heart failure patients. RESULTS: There has been structural changes in the Swedish health care system due to financial restraints in the health care budget. Aiming at reducing hospital costs, the total amount of hospital beds has been cut down markedly during the last decade. The number of heart failure patients and the number of hospital stays have increased during the same period. Hospital stays have become shorter. The number of patients and hospital stays more than double when heart failure as both primary and secondary discharge diagnoses are included. CONCLUSION: The available national registers provide a good opportunity to study epidemiology of heart failure in Sweden. The number of hospital beds has decreased markedly within the last decade due to changes in the Swedish health care system. Nevertheless, there has been an increase in the number of patients discharged with heart failure from the hospitals, suggesting an increase in prevalence.

Ambulatory Care Facilities↗

PubMed2001

Suspicion of aortic coarctation in an outpatient clinic: how should blood pressure measurements be performed?

We conducted a study on blood pressure (BP) measurements in 40 healthy children (aged 11.0 +/- 0.4 years), in 20 healthy students (18.8 +/- 0.9 years), and in 19 children with a history of coarctation (9.3 +/- 4.0 years). Both a standard sphygmomanometer and an oscillometric device (Dinamap, Critikon Inc, Tampa, FL, USA) were used. BP measurements in the arms, thighs and ankles were performed according to a fixed protocol. Although the site of measuring was switched each time successive measurements in the same limb resulted in lower systolic values than the first measurement. In patients with coarctation all gradient estimates correlated well with each other and with the gradient estimates obtained by Doppler-echocardiography. In healthy children, the systolic BP measured by Dinamap was 2 mmHg lower in the right arm than in the thighs, and 12 mmHg lower than in the ankles. In young adults, the differences were 12 and 16 mmHg, respectively. The BP difference between the right arm and the thighs by sphygmomanometer was +4 mmHg in children and -4 mmHg in adults. The cut point value to warrant further examinations was similar with both methods: 5-10 mmHg higher readings in the arm than in the leg. The first BP measurement should be ignored. After that, repetitive measurements in the arm with the higher systolic BP and the legs should be performed.

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