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  • 1.
    Forslund, Ann-Sofie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    A second chance at life: A study about people suffering out-of-hospital cardiac arrest2014Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    AimThe overall aim of this thesis was to describe people’s lives before and aftersuffering out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V). The following specific aims were formulated: describe trends in incidence, outcome and background characteristics among people who suffered OHCA-V (I), describe risk factors and thoughts about lifestyle among survivors(II),elucidate meanings of people’s lived experiences of surviving 1month after the event (III),and elucidate meanings of people’s lived experiencesof surviving 6 and 12 months after the event (IV)MethodsData were collected from the Northern Sweden MONICA myocardial registryand from interviews with people surviving OHCA-V. Quantitative and qualitative methodologies were used for analysis.ResultsThe incidence of OHCA-V decreased during the 19 years studied, and people aged 25-64 had an increased survival rate. The proportion of people with a history of ischemic heart disease (IHD) before the event decreased over theyears. Among people surviving OHCA-V, 60% had no prior history of IHD, but 20% had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus,hypercholesterolemia and/or lipid lowering medication, current smoker). People surviving were aware of their risk factors and their descriptions of their lifestylefocused on the importance of having people around, feeling happy and having a positive outlook on life. They made their own choices regarding how to livetheir lives, which they often referred to as “living a good life.” Meanings of surviving during the first year can be understood as a pendulum ́s motion.Participants narrated they thought about the fact that they had been dead and returned to life. They also expressed they wished to know what had happened tothem while they were dead, but at the same time they wanted to put the event behind them and look forward. People surviving OHCA-V were striving to gettheir ordinary life back, but they also wondered if life would be the same. The cardiac arrest affected their body, which felt unfamiliar to them, and they felt they had to learn to feel secure in their body again. People survivingexpressed they had been given a second chance at life, and they described the event had affected their outlook on life.ConclusionThis thesis shows that people suffering OHCA-V are the most likely to die, but the survival rate is increasing. Many people had no known history of IHD beforethe event, but some had known risk factors for cardiovascular disease. To address these facts it is important for health care to focus both on primary andsecondary preventive measures to avoid complications connected to cardiovascular disease. Participants described their thoughts about their lifestyle,which was connected to what they found important in their lives; preventive 3 measures should be linked to those things to be more successful. People thatsurvived experienced pendulum emotions during their first year, and amovement back and forth in time was expressed. Health care personnel could support people surviving OHCA-V by talking with them about their thoughts connected to the past, present and future.Keywordsincidence, myocardial infarction, out-of-hospital cardiac arrest, survival, trends,life experiences, qualitative research

  • 2.
    Forslund, Ann-Sofie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Gemensamt HLV.
    Att ha överlevt hjärtstopp utanför sjukhus2014Inngår i: Att leva med sjukdom, Lund: Studentlitteratur AB, 2014, 2, s. 61-69Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 3.
    Forslund, Ann-Sofie
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Preventing cardiac death in diabetes2011Inngår i: Nursing Times, ISSN 0954-7762, E-ISSN 1338-6263, Vol. 107, nr 40, s. 34-Artikkel i tidsskrift (Annet vitenskapelig)
  • 4.
    Forslund, Ann-Sofie
    et al.
    Department of Medicine, Sunderby hospital.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Jansson, Jan-Håkan
    Skelleftea Hospital, Department of Medicine .
    Zingmark, Karin
    Department of Medicine, Sunderby Hospital.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle2013Inngår i: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, nr Suppl. 1, s. S13-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To describe risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about lifestyle.Design: An explanatory mixed methods design was used.Methods: All people registered in the northern Sweden Monica myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n=71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis.Results: The quantitative results showed that about 60% of the people had no history of ischemic heart disease or hypertension before the out-of-hospital cardiac arrest whereas 25% and 17% had been diagnosed with myocardial infarction and diabetes mellitus, respectively. Eighty percent of the people had total cholesterol levels greater than 5.0 mmol/l and/or were taking lipid lowering medications. Almost half were smokers and overweight. The qualitative results are presented in three categories ‘descriptions of lifestyle after surviving’, ‘modifying the lifestyle to the new life situation’ and ‘a changed view on life’. The participants described that their lifestyle focused on the importance of being needed and meaning something to others, feeling well and doing things of their choice. They tried to find a reason why the cardiac arrest happened and make appropriate lifestyle changes although they made their own assessmnet of risk behaviours. The participants expressed being grateful for a second chance at life and tried to have a positive outlook on life.Conclusions: For most people in this study out-of-hospital cardiac arrest was the first symptom of coronary heart disease. In the interviews the participants expressed that they were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some of the patricipants chose to ignore this knowledge to some extent and preferred to live a ‘good life’. A life where risk factor treatment played a minor part. The results of this study indicates that health care workers and patients should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours and lifestyle changes linked to these things.

  • 5.
    Forslund, Ann-Sofie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Umeå university.
    Zingmark, Karin
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Risk factors among people surviving out-of-hospital cardiac arrest and their thoughts about what lifestyle means to them: a mixed methods study2013Inngår i: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, nr August, artikkel-id 62Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background The known risk factors for coronary heart disease among people prior suffering an out-of-hospital cardiac arrest with validated myocardial infarction aetiology and their thoughts about what lifestyle means to them after surviving have rarely been described. Therefore the aim of the study was to describe risk factors and lifestyle among survivors. Methods An explanatory mixed methods design was used. All people registered in the Northern Sweden MONICA myocardial registry between the year 1989 to 2007 who survived out-of-hospital cardiac arrest with validated myocardial infarction aetiology and were alive at the 28th day after the onset of symptoms (n = 71) were included in the quantitative analysis. Thirteen of them participated in interviews conducted in 2011 and analysed via a qualitative manifest content analysis. Results About 60 % of the people had no history of ischemic heart disease before the out-of-hospital cardiac arrest, but 20 % had three cardiovascular risk factors (i.e., hypertension, diabetes mellitus, total cholesterol of more or equal 5 mmol/l or taking lipid lowering medication, and current smoker). Three categories (i.e., significance of lifestyle, modifying the lifestyle to the new life situation and a changed view on life) and seven sub-categories emerged from the qualitative analysis. Conclusions For many people out-of-hospital cardiac arrest was the first symptom of coronary heart disease. Interview participants were well informed about their cardiovascular risk factors and the benefits of risk factor treatment. In spite of that, some chose to ignore this knowledge to some extent and preferred to live a "good life", where risk factor treatment played a minor part. The importance of the support of family members in terms of feeling happy and having fun was highlighted by the interview participants and expressed as being the meaning of lifestyle. Perhaps the person with illness together with health care workers should focus more on the meaningful and joyful things in life and try to adopt healthy behaviours linked to these things.

  • 6.
    Forslund, Ann-Sofie
    et al.
    The Northern Sweden MONICA Myocardial Registry, Department of Research, Norrbotten County Council.
    Lundblad, Dan
    Department of Medicine, Sunderby Hospital.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Sudden cardiac death among people with diabetes: preventive measures documented in their medical records2010Inngår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 23/24, s. 3401-3409Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: The purpose of this study was to examine how prevention of complications for people with diabetes mellitus had been conducted, as described in their medical records, focusing particularly on sudden cardiac death. A further aim was to compare the documentation with guidelines for diabetes care. Background: Diabetes mellitus is associated with an increased risk of cardiovascular disease, death and sudden cardiac death. About half of those affected by sudden cardiac death are assumed to have had one or more risk factors for cardiovascular disease that could have been treated effectively resulting in a reduced risk of sudden death. Design: Survey. Method: Fifty-six people diagnosed with diabetes mellitus, who had died of a sudden cardiac arrest between the years 2003-2005, from the Northern Sweden MONICA myocardial registry were included. These people's medical records were examined with regard to documentation of the care given during the year prior to the person's sudden cardiac death. Results: The qualitative content analysis resulted in four categories: individualised goals for diabetes care; prevention of complications; self-care; and factors which may affect ability to adhere to treatment. The quantitative analysis showed that few people with diabetes mellitus achieved goals for metabolic control, compared with those set in guidelines for diabetes mellitus care.Conclusion. To prevent complications for people with diabetes mellitus, it is a challenge for nurses and physicians to involve people with diabetes mellitus in their own care to improve the prognosis. Relevance to clinical practice: Examination of medical records of people with diabetes mellitus showed that documentation could be more informative and systematic. It is important to achieve better adherence to treatment and to increase people's understanding of their illness

  • 7.
    Forslund, Ann-Sofie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Jansson, Jan-Håkan
    Department of Medicine, Skellefteå Hospital.
    Lundblad, Dan
    Department of Public Health and Clinical Medicine, University of Umeå.
    Trends in incidence and outcome of out-of-hospital cardiac arrest among people with validated myocardial infarction2013Inngår i: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 20, nr 2, s. 260-267Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: To describe trends in incidence, outcome, and background characteristics among people who suffered an out-of-hospital cardiac arrest with validated myocardial infarction aetiology (OHCA-V).Methods and results: People from the northern Sweden MONICA myocardial registry (1989–2007) with OHCA-V (n = 2977) were divided in two age groups (25–64 and 65–74 years). Both those who were resuscitated outside hospital and those who died before resuscitation was started were included in the study. The younger age group was studied during 1989–2007 and the older group during 2000–2007. The incidence of OHCA-V decreased in both the younger group (men p < 0.0001, women p = 0.04) and the older group (men p < 0.0001, women p < 0.0007, respectively). The proportion with a history of ischaemic heart disease prior to the event decreased (p < 0.0001). The proportion of previous myocardial infarction decreased (p < 0.0001), diabetes mellitus increased (p = 0.001), coronary interventions increased (p < 0.0001), and survival after OHCA-V increased (p < 0.0001) in the younger group but not in the older group. Long-term survival after OHCA-V was better in the younger than in the older group (p = 0.026).Conclusion: The incidence of OHCA-V decreased in both sexes. The proportion surviving after OHCA-V was small but increased, and long-term survival (≥28 days) was better in the younger age group. Primary preventive measures may explain most of the improvements. However, the effects of secondary preventive measures cannot be excluded.

  • 8.
    Forslund, Ann-Sofie
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Zingmark, Karin
    County Council of Norrbotten, Department of Research and Development.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Lundblad, Dan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Söderberg, Siv
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Omvårdnad.
    Meanings of people's lived experiences of surviving an out-of-hospital cardiac arrest, 1 month after the event2014Inngår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 29, nr 5, s. 464-471Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The out-of-hospital cardiac arrest (OHCA) survival rate has been poor and stable for a long time, but more recent studies describe its increase. However, there are few studies in which people narrate their experiences from surviving. Objective: The aim of this study was to elucidate meanings of people's lived experiences of surviving an OHCA with validated myocardial infarction (MI) etiology, 1 month after the event. Methods: A purposive sample of 2 women and 9 men was interviewed between February 2011 and May 2012. A phenomenological hermeneutical method was used for analysis, which involved 3 steps: naive reading and understanding, structural analysis, and comprehensive understanding. Results: There were 2 themes, (1) returning to life and (2) revaluing life, and five subthemes, (1a) waking up and missing the whole picture, (1b) realizing it was not time to die, (2a) wondering why and seeking explanations, (2b) feeling ambiguous in relations, and (2c) wondering whether life will be the same. All were constructed from the analysis. Conclusions: Surviving an OHCA with validated MI etiology meant waking up and realizing that one had experienced a cardiac arrest and had been resuscitated. These survivors had memory loss and a need to know what had happened during the time they were dead/unconscious. They searched for a reason why they experienced an MI and cardiac arrest and had gone from being "heart-healthy" to having a lifelong illness. They all had the experience of passing from life to death and back to life again. For the participants, these differences led to a revaluation of what is important in life.

  • 9.
    Höglund, Henrik
    et al.
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Jansson, Jan-Håkan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Forslund, Ann-Sofie
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Lundblad, Dan
    Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University.
    Prodromal symptoms and health care consumption prior to out-of-hospital cardiac arrest in patients without previously known ischaemic heart disease2014Inngår i: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 85, nr 7, s. 864-868Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AimsTo describe prodromal symptoms and health care consumption prior to an out-of-hospital cardiac arrest (OHCA) in patients without previously known ischaemic heart disease (IHD).BackgroundThe most common lethal event of cardiovascular disease is sudden cardiac death, and the majority occur outside hospital. Little is known about prodromal symptoms and health care consumption associated with OHCAs.DesignCase-crossover study.MethodsMedical records of 403 OHCA cases without previously known IHD, age 25-74 years in the MONICA myocardial registry in Norrbotten County 2000 to 2008, were reviewed. Presenting symptoms and emergency visits at public primary care facilities and internal medicine clinics in Norrbotten County were analysed from the week prior to the OHCA and from the same week one year previously, which served as a control week. Unlike most studies we included unwitnessed arrests and those where no cardiopulmonary resuscitation (CPR) was attempted.ResultsEmergency visits were more common during the week prior to the OHCA than during the control week, both for visits to primary care (29 vs. 6, p < 0.001) and to internal medicine clinics (16 vs. 0, p < 0.001). Symptoms were more prevalent during the week prior to the OHCA (36.7 vs. 6.7%, p < 0.001).The most prevalent symptoms were chest pain (14.6 vs. 0%, p < 0.001), gastrointestinal symptoms (7.7 vs. 1.2%, p < 0.001) and dyspnea/peripheral oedema (6.9 vs. 0.2%, p < 0.001).ConclusionsPatients who suffer an OHCA seek health care and present prodromal symptoms significantly more often the week prior to the event than the same week one year earlier.

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