Aim To examine sex differences in care-seeking when afflicted by an acute myocardial infarction (AMI). Method This was a cross-sectional study in the region of Stockholm, Sweden. All patients from the Swedish national registry SWEDEHEART who were hospitalized due to an acute myocardial infarction in Stockholm, between March and June 2020, were asked to participate. A self-administered questionnaire Patients’ appraisal, emotions, and action tendencies preceding care-seeking in acute myocardial infarction’ (PA-AMI) including demographical questions, was sent out via mail, which was answered by a total of 326 participants. Additional variables for each participant were obtained from SWEDEHEART. Results There were no differences between women and men regarding patients’ thoughts, feelings, and actions prior to care-seeking, as well as the time from symptom onset to care-seeking, both the patients’ own assessed time, and the times reported to SWEDEHEART. However, the results shows that both women and men experience a high degree of uncertainty when afflicted by an AMI. Conclusions Our results indicate that there are no significant sex differences in care-seeking patterns when afflicted by an AMI. Regardless of sex, AMI is associated with a high level of uncertainty among patients. To address this uncertainty and improve timely care, it is crucial to implement enhanced educational initiatives at both the individual and community levels. These efforts should focus on increasing awareness of the diverse symptom presentation of AMI and emphasize the critical importance of seeking immediate medical attention. Such interventions could help reduce delays in care and improve patient outcomes.

Background. Invasive coronary angiography (ICA) is the gold standard in evaluating stent patency after percutaneous coronary intervention (PCI), but it carries a risk of potentially life-threatening complications. Third-generation coronary computed tomography angiography (CCTA) offers a non-invasive, safer follow-up method, but real-world data are lacking. This study evaluated the ability of CCTA to rule out in-stent restenosis (ISR) in long stents at long-term follow-up. Methods. This prospective, single-centre study (NCT06543641) included consecutive patients treated with PCI for coronary chronic total occlusion with long stents (left anterior descending coronary artery and right coronary artery ≥38 mm, left circumflex coronary artery ≥30 mm) in 2014–2019. All patients underwent third-generation dual-source CCTA. Patients with CCTA showing significant ISR, inconclusive results, or symptomatic native artery lesions underwent ICA. Results. The study included 45 patients (median age 67 (IQR 62–73) years, 87% males) with 47 stents (median length 51 mm, range 36–132 mm). CCTA ruled out significant ISR in 87% (n = 39) of the patients. CCTA indicated five ISRs and one inconclusive result in six (13%) patients, all of whom underwent ICA. Additionally, ICA was conducted for five patients due to a native artery lesion(s) on CCTA and angina. ICA showed significant stenosis in all six patients (100%) with ISR or inconclusive CCTA finding in the long stent. Conclusions. Third-generation CCTA could rule out significant ISR in a vast majority of cases (87%, n = 39) and without a risk of complications associated with ICA. CCTA provides a non-invasive, lower risk method for long-term revascularization follow-up.

Objectives. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to provide cardiorespiratory support in cardiogenic shock (CS), but selection of patients and timing of ECMO-start remain a challenge. This study aims to describe the 1 year outcome of VA-ECMO for CS with focus on etiology and severity of shock. Methods. VA-ECMO was used on 371 occasions between 2004 and 2019 at our center. Of these, 177 patients received VA-ECMO for CS and were included in this retrospective single-center study. Univariable and multivariable logistic regression models were used to determine predictors of all-cause mortality at 1 year. Results. Patients were grouped according to underlying etiology: non-ischemic heart failure (NIHF, N = 49), ischemic heart disease (IHD, N = 83) and miscellaneous diagnoses (Misc, N = 45). Markers of disease severity were lower for patients with NIHF. One year survival was 40% for all patients, 57%, 36% and 27% for the NIHF-, IHD and Misc-groups, respectively (p < .01). Univariable logistic regression analysis identified several variables associated with 1-year mortality, such as underlying etiology, pH and lactate, while biventricular failure was associated with a better prognosis. However, in the multivariable analysis, only ECPR remained significantly associated with increased mortality (OR 3.67, (CI 1.66–8.31), p < .01) Conclusions. In this retrospective study of VA-ECMO for CS, we found an acceptable one-year survival rate of 40%, with a more favorable outcome for NIHF-patients. The negative association of ECPR with a higher 1 year mortality suggests the importance of patient selection as well as timing of the VA-ECMO before deterioration to cardiac arrest.

Aim. Exercise-based cardiac rehabilitation (exCR) reduces morbidity and mortality after acute coronary syndrome (ACS). Little is known about physical activity (PA) levels at exCR program completion and associated demographic, medical, and psychosocial factors. Methods. Cross-sectional data from the ongoing Keep-Up-Going study were used, including 100 participants with recent ACS and ≥80% attendance to 3 months supervised exCR program. Physical activity was assessed by an accelerometer and self-reported psychosocial characteristics were collected at the end of the exCR. Associations between achieving the PA target (>150 min of moderate-to-vigorous-intensity PA/week) and biopsychosocial characteristics were assessed using univariable logistic regression analyses. Results. Mean age was 67 years and 24% were women. Participants achieving the PA target (76%) were more likely to have higher levels of social support, higher outcome expectations for PA, and higher intrinsic regulation (motivation, p < .05 for all). Those not achieving the PA target (24%) had a higher proportion of sedentary time, fewer steps/day, and were more likely to be older, retired, and have reduced left ventricular ejection fraction (LVEF) (p < .05 for all). Conclusions. Although exCR participation provides exercise routines, one-fourth of individuals did not reach the guideline-directed PA targets after an ACS. In addition to higher age and reduced LVEF, lower levels of social support, outcome expectations, and motivation were associated with low levels of PA. Exploring these factors could be of importance to support individuals’ behavior change toward increased PA during the exCR period.

Background Patients with atrial fibrillation (AF) are often treated with antiarrhythmic drugs (AADs) to maintain sinus rhythm and with heart rate-lowering drugs to achieve the optimal rate control. In this study, we investigated trends in the use of AADs and rate control drugs in Finnish patients with AF. Methods and results The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study including all patients with AF in Finland from 2007 to 2018. The number of AAD purchases and the proportions of all prevalent AF patients in a certain year of interest were calculated. In total, 391030 AF patients were identified between 2007 and 2018, and 39,816 (10.2%) of them had purchased either class I or III AADs. The proportion of patients using classes I and III AADs decreased from 8.6% to 6.3%. Flecainide and amiodarone were the most often used AADs. The use of flecainide and amiodarone decreased from 4.9% to 3.9% and 1.9% to 1.5%, respectively. The proportion of patients on beta-blockers remained stable at 75%. Dronedarone became available in 2011 when it also was the most used (0.8% of patients), but the use decreased thereafter. The use of sotalol and digoxin decreased from 1.5% to 0.6% and 24.6% to 11.0% over the study period. Conclusion The number of AAD purchases increased alongside with the increasing prevalence of AF, whereas the proportion of AF patients on classes I and III AADs and digoxin decreased between 2007 and 2018. Flecainide remained the most used AAD followed by amiodarone.

Background. Antibiotic therapy is the primary treatment for infective endocarditis (IE), yet up to 50% of patients still require surgical intervention. However, surgical intervention carries significant risks of mortality and complications for IE patients, and there remains a lack of consensus on which preoperative characteristics of infective endocarditis have a substantial impact on patient prognosis. Particularly, some IE patients develop periannular abscesses, leading to more severe complications. Objectives. The objective of our study is to identify predictors of poor outcomes in infective endocarditis and to further evaluate the impact of surgical intervention on patient prognosis, with the aim of adding value to the existing factors known to affect IE prognosis. Methods. In this retrospective cohort study, we evaluated 210 patients treated for infective endocarditis (IE) at our hospital between December 2016 and June 2023. To analyze short-term outcomes, the patients were divided into two groups based on whether they experienced poor outcomes. We compared demographic characteristics, echocardiographic findings, laboratory test results, surgical details, and postoperative outcomes between the two groups. Patients’ long-term outcomes, including survival status and time of death, were assessed through follow-up, which involved telephone contact with the patient or their family. The follow-up period concluded on June 30, 2024. Results. The median age of the patients was 55 years, with most patients ranging from 42 to 64 years. Male patients accounted for 67.1%, and 21.4% had underlying cardiac conditions. During hospitalization, 125 out of 210 patients (59.5%) underwent surgery, with an emergency surgery rate of 6.2% and an in-hospital mortality rate of 13.8%.Regarding short-term outcomes, multivariate logistic regression analysis indicated that surgical treatment (OR 0.211, 95% CI 0.073–0.621) was associated with better patient prognosis. Periannular abscess (OR 4.948, 95% CI 1.005–24.349) and poorer cardiac function (NYHA II [OR 0.041, 95% CI 0.008–0.224], NYHA III [HR 0.207, 95% CI 0.057–0.757], with NYHA IV as the reference group) were significantly associated with poor prognosis in IE patients. For long-term outcomes, multivariate Cox survival analysis showed that surgical treatment (HR 0.200, 95% CI 0.091–0.437) was associated with improved long-term survival. Cerebral infarction (HR 1.939, 95% CI 1.050–3.582) and poorer cardiac function (NYHA II [HR 0.108, 95% CI 0.037–0.313], NYHA III [HR 0.308, 95% CI 0.118–0.805], with NYHA IV as the reference group) were significant factors associated with long-term mortality in IE patients. Conclusions. Surgical treatment was associated with improved short-term prognosis and long-term survival rates in patients with infective endocarditis. In terms of short-term outcomes, the presence of periannular abscesses and poor cardiac function were significant factors associated with poor prognosis. For long-term outcomes, cerebral infarction and poor cardiac function were significant factors associated with increased long-term mortality in these patients.

Objectives. Current guidelines recommend that surveillance imaging should be performed at least every third year for patients with ascending thoracic aortic aneurysm (ATAA) even though such aneurysms’ growth rate is mostly minimal. The purpose of this study was to clarify the pattern of the growth of ATAAs in a real-life patient population to adjust the optimal timing of aortic surveillance for each patient. Methods. This study includes patients (n = 209) who had been followed due to ATAA in the central hospital of North Karelia in Eastern Finland between years 2007 and 2023. Aortic imaging was performed using either computed tomography (CT) or transthoracic echocardiography (TTE). In the CT images, the aortic dimensions were measured according to guidelines in four levels of the ascending aorta. TTE measurements were collected from medical records. Measurements were used to explore the pattern of the ATAA growth. Results. During the mean surveillance time 5.0 ± 3.5 years, the median growth rate of ATAAs was 0.37 mm/year. One fifth (21.5%) of the aneurysms showed no expansion during the follow-up. Despite the minimal growth rate during surveillance, some patients ended up exceeding the cut-off for preventive surgery. Among the patients, who showed expansion during the follow-up, the linear model seemed to best describe the growth of ATAA. Conclusions. The majority of the patients had a very low ATAA growth rate. Based on this study, the growth of ATAAs could be described using a linear model, which could, in turn, be used to predict the growth of an aneurysm.

Purpose The risk of sudden cardiac death (SCD) is increased during endurance competitive sports. Coronary artery disease (CAD) is the most common cause of SCD in master athletes ≥ 35 years old (MAs). To reduce the risk of SCD self-assessment of symptoms by questionnaire, and evaluation of cardiovascular risk-score, are recommended as pre-participation cardiovascular evaluation (PCVE). We aimed to examine whether PCVE predicts CVD in MAs with or without increased risk as measured by validated score instruments. Methods We performed a single-site observational cohort study of healthy MAs based on findings at PCVE. They were allocated in two different groups: those MAs with reported symptoms on the questionnaire and/or with elevated cardiovascular risk score were allocated to a symptom group (SG), while MAs with no symptoms, nor raised risk score were defined as control group (CG). Thereafter, all were examined with extended examinations: resting-ECG, cardiorespiratory exercise testing and echocardiography. Results Total, 81 (18 women) MAs participated in the study. There were no differences at baseline between SG (n = 39) and CG (n = 42); sex (p = 0.11), age (55.0 ± 9.8 vs. 51.9 ± 11.1 years; p = 0.18), maximal oxygen uptake (49.8 ± 7.6 vs. 51.6 ± 7.0 ml/kg/min; p = 0.26), resting heart rate (61.4 ± 12.8 vs. 60.2 ± 11.0/min; p = 0.66), training hours/week (7.0 ± 3.2 vs. 7.1 ± 3.1; p = 0.88). After further examination, sixteen (20%) MAs were found with CVD: 12 in SG, 4 in CG (p = 0.024). The negative predictive value and specificity of the PCVE were 90% and 58%, respectively. Conclusion Negative findings on PCVE by questionnaire and cardiovascular risk-score may be a strategy to exclude subjects from preparticipation screening, thus saving resources.

Objectives To elucidate physical activity in the first year after myocardial infarction (MI), and to explore differences in various subgroups, delineated by age, participation in exercise-based cardiac rehabilitation (exCR), or restrictions due to the covid-19 pandemic. Secondly, to explore associations between changes in physical activity variables with blood pressure and lipid levels. Methods A longitudinal study in 2017-2023. Physical activity variables were assessed via accelerometers at two- and twelve months post-MI. The intensity was divided into, sedentary, light, moderate, and vigorous-intensity physical activity, according to established cut-offs. Blood pressure and lipids were measured by standardized procedures at the same time points. Results There were 178 patients included at baseline, 81% male, mean age of 64 (9 SD) years. Patients spent 72% of their time sedentary, followed by light (19%), moderate (8%), and vigorous physical activity (1%). Patients included during covid-19 restrictions and younger patients had a higher level of moderate-intensity physical activity compared to patients included during non-pandemic restrictions and older patients. At 12-month follow-up, patients overall increased time (1%) in sedentary behavior (p = 0.03) and decreased time (0.6%) in moderate-intensity physical activity (p = 0.04), regardless of participation in exCR or age. There was a positive association between the change in mean physical activity intensity and HDL-cholesterol (p = 0.047). Conclusions Participants had a low fraction of time in moderate-to-vigorous-intensity physical activity two months post-MI, which deteriorated during the first year. This emphasizes the need for improved implementation of evidence-based interventions to support and motivate patients to perform regular physical activity.