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  • 1. Ambegaonkar, B
    et al.
    Pettersson, B
    Sazonov, V
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Prevalence of lipid abnormalities before and after the introduction of lipid modifying therapy among Swedish patients with type 2 diabetes and/or coronary heart disease (PRIMULA Sweden)2009In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 52, no Suppl. 1, p. S495-S495Article in journal (Refereed)
  • 2. Banefelt, J.
    et al.
    Liede, A.
    Mesterton, J.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hernandez, R. K.
    Sobocki, P.
    Persson, Bo-Eric
    Uppsala University.
    Survival and clinical metastases among prostate cancer patients treated with androgen deprivation therapy in Sweden2014In: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 38, no 4, p. 442-447Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the incidence of metastases and clinical course of prostate cancer patients who are without confirmed metastasis when initiating androgen deprivation therapy (ADT). Methods: Retrospective cohort study conducted using electronic medical records from Swedish outpatient urology clinics linked to national mandatory registries to capture medical and demographic data. Prostate cancer patients initiating ADT between 2000 and 2010 were followed from initiation of ADT to metastasis, death, and/or end of follow-up. Results: The 5-year cumulative incidence (CI) of metastasis was 18%. Survival was 60% after 5 years; results were similar for bone metastasis-free survival. The 5-year CI of castration-resistant prostate cancer (CRPC) was 50% and the median survival from CRPC development was 2.7 years. Serum prostate-specific antigen (PSA) levels and PSA doubling time were strong predictors of bone metastasis, any metastasis, and death. Conclusion: This study provides understanding of the clinical course of prostate cancer patients without confirmed metastasis treated with ADT in Sweden. Greater PSA values and shorter PSA doubling time (particularly <= 6 months) were associated with increased risk of bone metastasis, any metastasis, and death.

  • 3.
    Boman, K.
    et al.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Wirta, S. Bruce
    Novartis Sweden AB, Stockholm, Sweden..
    Costa-Scharplatz, M.
    Novartis Sweden AB, Stockholm, Sweden..
    Calado, F.
    Novartis Pharma AG, Basel, Switzerland..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Healthcare resource utilization associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 346-346Article in journal (Other academic)
  • 4.
    Boman, K.
    et al.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Costa-Scharplatz, M.
    Novartis Sweden AB, Stockholm, Sweden..
    Wirta, S. Bruce
    Novartis Sweden AB, Stockholm, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Costs associated with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 346-347Article in journal (Other academic)
  • 5. Carlsson, Åsa
    et al.
    Borgström, Fredrik
    Stålhammar, Jan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences. Family Medicine and Clinical Epidemiology.
    Alemao, Evo
    Yin, Don
    Jönsson, Linus
    Cost of care for patients treated with lipid-lowering drugs.2004In: Pharmacoeconomics, ISSN 1170-7690, Vol. 22 Suppl 3, p. 25-35Article in journal (Refereed)
  • 6. Granstrom, O.
    et al.
    Kjeldsen, S. E.
    Russell, D.
    Thuresson, M.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bodegard, J.
    Hedegaard, M.
    Hospitalizations and primary care resource use: A real-life perspective2012In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 15, no 4, p. A130-A130Article in journal (Other academic)
  • 7. Hasvold, L. P.
    et al.
    Bodegard, J.
    Thuresson, M.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hammar, N.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Russell, D.
    Kjeldsen, S. E.
    Diabetes and CVD risk during angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker treatment in hypertension: a study of 15 990 patients2014In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 28, no 11, p. 663-669Article in journal (Refereed)
    Abstract [en]

    Differences in clinical effectiveness between angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) in the primary treatment of hypertension are unknown. The aim of this retrospective cohort study was to assess the prevention of type 2 diabetes and cardiovascular disease (CVD) in patients treated with ARBs or ACEis. Patients initiated on enalapril or candesartan treatment in 71 Swedish primary care centers between 1999 and 2007 were included. Medical records data were extracted and linked with nationwide hospital discharge and cause of death registers. The 11 725 patients initiated on enalapril and 4265 on candesartan had similar baseline characteristics. During a mean follow-up of 1.84 years, 36 482 patient-years, the risk of new diabetes onset was lower in the candesartan group (hazard ratio (HR) 0.81, 95% confidence interval (CI) 0.69-0.96, P = 0.01) compared with the enalapril group. No difference between the groups was observed in CVD risk (HR 0.99, 95% CI 0.87-1.13, P = 0.86). More patients discontinued treatment in the enalapril group (38.1%) vs the candesartan group (27.2%). In a clinical setting, patients initiated on candesartan treatment had a lower risk of new-onset type 2 diabetes and lower rates of drug discontinuation compared with patients initiated on enalapril. No differences in CVD risk were observed.

  • 8.
    Hellström, Per M.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Gastroenterology/Hepatology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Beydogan, H.
    QuintilesIMS, Real World Evidence Solut & HEOR, Solna, Sweden..
    Huetson, P.
    QuintilesIMS, Real World Evidence Solut & HEOR, Solna, Sweden..
    Skup, M.
    AbbVie Inc, N Chicago, IL USA..
    Agreus, L.
    Karolinska Institute.
    Indirect burden of patients with moderate inflammatory bowel disease in Uppsala County Council, Sweden: a retrospective study using real-world data2017In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 11, p. S457-S457Article in journal (Other academic)
  • 9. Henriksson, M.
    et al.
    Russell, D.
    Bodegard, J.
    Kjeldsen, S.
    Hasvold, P.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Levin, L-A
    Health-care costs of losartan and candesartan in the primary treatment of hypertension2011In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 25, no 2, p. 130-136Article in journal (Refereed)
    Abstract [en]

    A recent study of two widely used angiotensin receptor blockers reported a reduced risk of cardiovascular events (-14.4%) when using candesartan compared with losartan in the primary treatment of hypertension. In addition to clinical benefits, costs associated with treatment strategies must be considered when allocating scarce health-care resources. The aim of this study was to assess resource use and costs of losartan and candesartan in hypertensive patients. Resource use (drugs, outpatient contacts, hospitalizations and laboratory tests) associated with losartan and candesartan treatment was estimated in 14 100 patients in a real-life clinical setting. We electronically extracted patient data from primary care records and mandatory Swedish national registers for death and hospitalization. Patients treated with losartan had more outpatient contacts (+15.6%), laboratory tests (+13.8%) and hospitalizations (+13.8%) compared with the candesartan group. During a maximum observation time of 9 years, the mean total costs per patient were 10 369 Swedish kronor (95% confidence interval: 3109-17 629) higher in the losartan group. In conclusion, prescribing candesartan for the primary treatment of hypertension results in lower long-term health-care costs compared with losartan.

  • 10. Hernandez, Rohini K.
    et al.
    Banefelt, Jonas
    Mesterton, Johan
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Persson, Bo-Eric
    Ke, Chunlei
    Sobocki, Patrik
    Liede, Alexander
    Impact of PSA Doubling Time (DT) Calculation Method on Estimate of Association With Bone Metastases in a Cohort of Prostate Cancer Patients Treated With Androgen Deprivation Therapy (ADT)2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, no S1, p. 220-220Article in journal (Other academic)
  • 11. Hernandez, Rohini K.
    et al.
    Mesterton, Johan
    Banefelt, Jonas
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sobocki, Patrik
    Persson, Bo-Eric
    Liede, Alexander
    Predictors of Clinical Metastases and Survival among Non-Metastatic Prostate Cancer (PC) Patients (pts) Treated with Androgen-Deprivation Therapy (ADT) in Sweden2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, no S1, p. 6-6Article in journal (Other academic)
  • 12.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Karlsson, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerden, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svensson, Ann-Marie
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Resources and organisation in primary health care are associated with HbA1c level: A nationwide study of 230958 people with Type 2 diabetes mellitus.2018In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed)
    Abstract [en]

    AIMS: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM).

    METHODS: People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

    RESULTS: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).

    CONCLUSIONS: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

  • 13.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Adolfsson, Eva Thors
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Resource allocation and organisational features in Swedish primary diabetes care: Changes from 2006 to 20132017In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    AIMS: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

    METHODS: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

    RESULTS: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

    CONCLUSIONS: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

  • 14.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Svensson, Ann-Marie
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide surveyIn: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210Article in journal (Refereed)
  • 15.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Eliasson, Björn
    Sahlgrens Univ Hosp, Dept Med, Gothenburg, Sweden.
    Jansson, Stefan
    Örebro Univ, Univ Hlth Care Res Ctr, Sch Med Sci, Örebro, Sweden.
    Jerdén, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Center for Clinical Research Dalarna. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Sörmland Cty Council, Drug & Therapeut Comm, Eskilstuna, Sweden.
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Svensson, Ann-Marie
    Natl Diabet Register, Ctr Registers, Gothenburg, Sweden.
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.2019In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186, article id S1751-9918(18)30277-8Article in journal (Refereed)
    Abstract [en]

    Aims: To describe and analyse the associations between primary health care centres’ (PHCCs’) quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

    Methods: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

    Results: Of the participants, 56% had controlled (≤52 mmol/mol), 31.9% intermediate (53–69 mmol/mol), and 12.1% uncontrolled (≥70 mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs’ results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all < 0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (< 0.05).

    Conclusions: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs’ QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

  • 16.
    Husdal, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Thors Adolfsson, Eva
    Leksell, Janeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical diabetology and metabolism.
    Eliasson, Björn
    Jansson, Stefan
    Jerdén, Lars
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Steen, Lars
    Wallman, Thorne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Svensson, Ann-Marie
    Rosenblad, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Organisation of primary diabetes care in people with type 2 diabetes in relation to all-cause mortality: a nationwide register-based cohort studyManuscript (preprint) (Other academic)
  • 17. Karlsson, B
    et al.
    Stålhammar, Jan
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Wibell, L.
    Department of Medical Sciences.
    Att leva med kronisk sjukdom: om psykisk belastning vid diabetes1998In: DiabetologiArticle in journal (Other scientific)
  • 18. Kjeldsen, S. E.
    et al.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Hasvold, P.
    Bodegard, J.
    Olsson, U.
    Russell, D.
    Effects of losartan vs candesartan in reducing cardiovascular events in the primary treatment of hypertension2010In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 24, no 4, p. 263-273Article in journal (Refereed)
    Abstract [en]

    Although angiotensin receptor blockers have different receptor binding properties no comparative studies with cardiovascular disease (CVD) end points have been performed within this class of drugs. The aim of this study was to test the hypothesis that there are blood pressure independent CVD-risk differences between losartan and candesartan treatment in patients with hypertension without known CVD. Seventy-two primary care centres in Sweden were screened for patients who had been prescribed losartan or candesartan between the years 1999 and 2007. Among the 24 943 eligible patients, 14 100 patients were diagnosed with hypertension and prescribed losartan (n = 6771) or candesartan (n = 7329). Patients were linked to Swedish national hospitalizations and death cause register. There was no difference in blood pressure reduction when comparing the losartan and candesartan groups during follow-up. Compared with the losartan group, the candesartan group had a lower adjusted hazard ratio for total CVD (0.86, 95% confidence interval (CI) 0.77-0.96, P = 0.0062), heart failure (0.64, 95% CI 0.50-0.82, P = 0.0004), cardiac arrhythmias (0.80, 95% CI 0.65-0.92, P = 0.0330), and peripheral artery disease (0.61, 95% CI 0.41-0.91, P = 0.0140). No difference in blood pressure reduction was observed suggesting that other mechanisms related to different pharmacological properties of the drugs may explain the divergent clinical outcomes.

  • 19. Lindgren, P
    et al.
    Borgström, F
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Alemao, E
    Jönsson, L
    Determinants of cholesterol goal attainment at 12 months in patients with hypercholesterolaemia not at consensus goal after 3 months of treatment with lipid-lowering drugs2007In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 61, no 8, p. 1410-1414Article in journal (Refereed)
    Abstract [en]

    Background: Less than half of patients in Scandinavian societies achieve target cholesterol values established by consensus coronary prevention panels.

    Methods and results: Using logistic regression analysis, we determined that patients not at consensus cholesterol goals after 3 months of treatment using lipid-lowering medications were significantly more likely to achieve these goals at 12 months if they were treated with an active management strategy (changes in lipid-lowering therapy within 3 months), had a diagnosis of diabetes mellitus, or initiated lipid-lowering more recently, compared with their counterparts without these factors.

    Conclusion: An active management strategy is associated with a higher probability of achieving treatment goals in patients not at goal after 3 months following treatment initiation.

  • 20.
    Lindmark, K.
    et al.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Boman, K.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Gullberg, E.
    Novartis Sweden AB, Stockholm, Sweden..
    Johansson, D.
    Novartis Sweden AB, Stockholm, Sweden..
    Schlienger, R.
    Novartis Pharma AG, Basel, Switzerland..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Epidemiology of heart failure in Sweden: a retrospective population-based cohort study2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 364-364Article in journal (Other academic)
  • 21.
    Lindmark, K.
    et al.
    Umea Univ Hosp, Dept Publ Hlth & Clin Med, Umea, Sweden;Umea Univ Hosp, Ctr Heart, Umea, Sweden.
    Boman, K.
    Skelleftea Cty Hosp, Dept Publ Hlth & Clin Med, Res Unit, Med Geriatr, Umea, Sweden.
    Olofsson, M.
    Skelleftea Cty Hosp, Dept Publ Hlth & Clin Med, Res Unit, Med Geriatr, Umea, Sweden.
    Wirta, S. Bruce
    Novartis Sweden AB, Stockholm, Sweden.
    Proenca, C. C.
    Wellmera AG, Basel, Switzerland.
    Levine, A.
    IQVIA, Solna, Sweden.
    Castelo-Branco, A.
    IQVIA, Solna, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Increased all-cause mortality in newly diagnosed patients with heart failure between 2006 and 2012: a retrospective, population-based study in Sweden2018In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 20, no S1, p. 6-6Article in journal (Other academic)
  • 22.
    Lindmark, Krister
    et al.
    Umea Univ Hosp, Dept Publ Hlth & Clin Med, S-90187 Umea, Sweden;Umea Univ Hosp, Heart Ctr, S-90187 Umea, Sweden.
    Boman, Kurt
    Umea Univ, Res Unit, Med Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth & Clin Med, Umea, Sweden.
    Olofsson, Mona
    Umea Univ, Res Unit, Med Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth & Clin Med, Umea, Sweden.
    Tornblom, Michael
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Levine, Aaron
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Castelo-Branco, Anna
    IQVIA, Real World & Analyt Solut, Solna, Sweden.
    Schlienger, Raymond
    Novartis Pharma AG, Quantitat Safety & Epidemiol, Basel, Switzerland.
    Wirta, Sara Bruce
    Novartis Sweden AB, Global RWE Cardiometabol, Stockholm, Sweden.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Epidemiology of heart failure and trends in diagnostic work-up: a retrospective, population-based cohort study in Sweden2019In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 11, p. 231-244Article in journal (Refereed)
    Abstract [en]

    Purpose: The purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden.

    Methods: Adults with incident HF (>= 2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005-2013) and electronic medical records (cohort 2, 2010-2015; primary/secondary care patients from Uppsala and Vasterbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed.

    Results: Baseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged >= 85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06-1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02-1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997-2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time).

    Conclusion: The annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.

  • 23.
    Martinell, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Dorkhan, Mozhgan
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Storm, Petter
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Groop, Leif
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Gustavsson, Carin
    Lund Univ, Dept Clin Sci Malmo, Uppsala, Sweden..
    Prevalence and risk factors for diabetic retinopathy at diagnosis (DRAD) in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA)2016In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 30, no 8, p. 1456-1461Article in journal (Refereed)
    Abstract [en]

    PURPOSE: 

    To study prevalence of diabetic retinopathy (DR) at diagnosis (DRAD) and to estimate contributing risk by sociodemographic, cardiovascular and metabolic characteristics present in patients recently diagnosed with type 2 diabetes (T2D) or latent autoimmune diabetes in the adult (LADA).

    METHODS: 

    Patients (n=2174) recently diagnosed T2D (93%) or LADA (7%) were included upon arrival for their baseline DR screening. Fundus photographs of 4902 eyes were graded by a senior ophthalmologist according to the International Diabetic Retinopathy Disease Severity Scale. Official registers held by Statistics Sweden provided sociodemographic variables. The National Patient Register and Swedish Prescribed Drug Register were used to assess cardiovascular risk. Beta cell function (HOMA2%b) and insulin sensitivity (HOMA2%s) were estimated from fasting (f) C-Peptide using the homeostasis model assessment (HOMA) 2 calculator. Odds ratios (OR) for DRAD were estimated using generalized estimating equation models.

    RESULTS: 

    The prevalence of DRAD was 12% (7% mild and 5% moderate) and of diabetic macular edema it was 11% (all within vascular arch). The prevalence did not significantly differ between T2D and LADA. Due to sample size, the regression analysis of LADA patients did not yield any significant estimates. In T2D low educational level (≤9years) increased risk for DRAD by 44% (OR 1.44; 95% CI 1.07-1.93) and <50% beta-cell function adjusted for HbA1c and insulin sensitivity at diagnosis increased the risk by 77% (OR 1.77; 95% CI 1.28-2.44). For every unit increase in BMI, risk for DRAD decreased by 3% (OR 0.97; 95% CI 0.95-0.99).

    CONCLUSIONS: 

    DRAD prevalence in patients recently diagnosed with T2D or is 12%. Low educational level and low beta cell function at diagnosis are risk factors for DRAD. Estimation of beta cell function from (f)C-Peptide and (f)P-Glucose may be a valuable tool in identifying patients at risk for DRAD.

  • 24.
    Martinell, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Singh, Kailash
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Zhengkang, Luo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Espes, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sandler, Stellan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Characterization of Cellular Immunology in LADA PatientsManuscript (preprint) (Other academic)
    Abstract [en]

    Objective: Patients with latent autoimmune diabetes mellitus in adults (LADA) have antibodies against the insulin-producing b-cells but at disease onset they are not insulin-dependent. This study presents cellular immunological differences between LADA, type 1, type 2 diabetes and healthy controls.

    Research Design and Methods: All patients and matched (by age, gender and body mass index) healthy controls were recruited from the County of Uppsala, Sweden. Peripheral blood mononuclear cells were isolated from freshly collected blood to determine proportions of innate, adaptive and regulatory immune cells by using flow cytometry.

    Results: Included were 14 patients with LADA, 16 with type 1 diabetes, 16 with type 2 diabetes and 13 healthy controls. The proportion of CD11c+CD123- antigen presenting cells (APCs) was lower, whilst proportions of CD11c+CD123+ APCs and Interleukin (IL)-35+ tolerogenic APCs were higher in LADA patients compared to patients with type 1 diabetes. The proportion of CD3-CD56highCD16+ Natural Killer (NK) cells was higher in LADA patients than in both healthy controls and type 2 diabetes patients. IL-35+ Treg cell numbers were similar to those observed in both type 1 diabetes and type 2 diabetes patients, but a lower frequency of IL-35+ regulatory T (Treg) cells was observed in LADA patients than in healthy controls. The proportion of regulatory B (Breg) cells in LADA patients was higher than in healthy controls, type 1 and type 2 diabetes patients and IL-35+ Breg cell numbers were higher than in type 1 diabetes patients.

    Conclusions: LADA patients present a mixed cellular immunological pattern compared to type 1 and type 2 diabetes patients. Numbers of APCs, IL-35+ tolerogenic APCs and IL-35+ Breg cells in LADA patients are similar to those observed in type 2 diabetes patients, whereas the changes in NK cells are similar to those observed in type 1 diabetes patients. 

  • 25.
    Martinell, Mats
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Hallqvist, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Automated data extraction: A feasible way to construct patient registers of primary care utilization2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 52-56Article in journal (Refereed)
    Abstract [en]

    Introduction. Electronic medical records (EMRs) enable analysis of health care data by using data mining techniques to build research databases. Though the reliability of the data extraction process is crucial for the credibility of the final analysis, there are few published validations of this process. In this paper we validate the performance of an automated data mining tool on EMR in a primary care setting.

    Methods. The Pygargus Customized eXtraction Program (CXP) was programmed to find and then extract data from patients meeting criteria for type 2 diabetes mellitus (T2DM) at one primary health care clinic (PHC). The ability of CXP to extract relevant cases was assessed by comparing cases extracted by an EMR integrated search engine. The concordance of extracted data with the original EMR source was manually controlled.

    Results. Prevalence of T2DM was 4.0%, which correspond well to previous estimations. By searching for drug prescriptions, diagnosis codes, and laboratory values, 38%, 53%, and 91% of relevant cases were found, respectively. The sensitivity of CXP regarding extraction of relevant cases was 100%. The specificity was 99.9% due to 12 non-T2DM cases extracted. The congruity at single-item level was 99.6%. The 13 incorrect data items were all located in the same structural module.

    Conclusion. The CXP is a reliable and accurate data mining tool to extract selective data from EMR.

  • 26.
    Olofsson, M.
    et al.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Boman, K.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Wikstrom, G.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Proenca, C. C.
    Wellmera AG, Basel, Switzerland..
    Balas, B.
    Novartis Pharma AG, Basel, Switzerland..
    Calado, F.
    Novartis Pharma AG, Basel, Switzerland..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    A description of characteristics of very elderly patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 362-362Article in journal (Other academic)
  • 27. Pettersson, B
    et al.
    Lindgren, P
    Ringborg, A
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Resource consumption and cost of care the year before and after initiation of insulin theraphy in Swedish patients with type 2 diabetes2010In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 13, no 3, p. A58-A58Article in journal (Other academic)
  • 28. Pettersson, B.
    et al.
    Lindgren, P.
    Ringborg, A.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    RESOURCE CONSUMPTION AND COSTS OF CARE THE YEAR BEFORE AND AFTER INITIATION OF INSULIN THERAPY IN SWEDISH PATIENTS WITH TYPE 2 DIABETES2010In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 13, no 3, p. A58-A58Article in journal (Other academic)
  • 29. Pettersson, Billie
    et al.
    Ambegaonkar, Baishali
    Sazonov, Vasilisa
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Wändell, Per
    Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 737-Article in journal (Refereed)
    Abstract [en]

    Background. Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT). Methods. This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines. Results. Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk >20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters. Conclusions. Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.

  • 30. Ringborg, A.
    et al.
    Lindgren, P.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Yin, D. D.
    Schön, S.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Prevalence and incidence of Type 2 diabetes and its complications 1996-2003: estimates from a Swedish population-based study2008In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, no 10, p. 1178-1186Article in journal (Refereed)
    Abstract [en]

    AIMS

    To determine the prevalence and incidence of Type 2 diabetes and its complications in Uppsala county, Sweden between 1996 and 2003.

    METHODS

    Retrospective population-based study of patients with Type 2 diabetes identified in computerized medical records at 26 county primary care centres. Prevalence and incidence of Type 2 diabetes were estimated in the population aged 30-39, 40-49, 50-59, 60-69, 70-79 and > or = 80 years. Mortality, prevalence and incidence of complications in patients with Type 2 diabetes were determined through linkage to national inpatient, uraemia and cause-of-death registers.

    RESULTS

    Crude prevalence of Type 2 diabetes increased from 2.2 to 3.5% between 1996 and 2003. In the population aged > or = 30 years, the age- and sex-adjusted period increase was 53%[odds ratio (OR) 1.53, 95% confidence interval (CI) 1.47-1.58]. Crude population incidence was approximately stable after 1997 (3.7 cases/1000 residents in 1997 compared with 3.8/1000 in 2003). Age- and sex-adjusted mortality rates in Type 2 diabetic patients decreased by 4% per year (OR 0.96, 95% CI 0.94-0.97). Prevalence rates of cardiovascular disease in Type 2 diabetic patients were essentially stable, affecting 13.8% of females and 18.0% of males in 2003. No trend was detected for prevalence of renal failure or incidence of acute myocardial infarction, stroke and amputation.

    CONCLUSIONS

    Prevalence of Type 2 diabetes increased in Uppsala county between 1996 and 2003 as a consequence of approximately stable incidence since 1997 and declining mortality. Rates of diabetes-related complications, notably cardiovascular disease, continued to impose a substantial burden.

  • 31. Ringborg, A.
    et al.
    Lindgren, P.
    Yin, D. D.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Time to insulin treatment and factors associated with insulin prescription in Swedish patients with type 2 diabetes2010In: Diabetes & Metabolism, ISSN 1262-3636, E-ISSN 1878-1780, Vol. 36, no 3, p. 198-203Article in journal (Refereed)
    Abstract [en]

    Aims. - The purpose of this study was to investigate the time between the start of OAD treatment and the initiation of insulin therapy and to identify the factors associated with insulin prescription among Swedish patients with type 2 diabetes in Uppsala County. Methods. - Retrospective, population-based, primary-care data gathered within the Swedish RECAP-DM study were used to identify type 2 diabetic patients who initiated OAD treatment. A Kaplan-Meier survival estimate for time to initiation of insulin therapy was generated and factors associated with insulin prescription were tested using a Cox proportional-hazards model. Results. - Within 6 years of starting OAD treatment, an estimated 25% of Swedish patients with type 2 diabetes will be prescribed insulin (95% CI: 0.23-0.26) and, within 10 years, this figure will rise to 42% (95% CI: 0.39-0.45). The probability of insulin prescription was increased in patients aged less than 65 years (HR = 1.24, 95% CI: 1.03-1.50) and in those who initiated OAD treatment with more than one agent (HR = 2.71, 95% CI: 2.15-3.43). HbA(1c) at the time of starting OAD treatment was also related to the probability of insulin prescription (HR = 1.20, 95% CI: 1.146-1.25). Conclusion. - Many type 2 diabetic patients who begin treatment with an OAD will eventually be prescribed insulin. An, disease severity and the type of prior treatment may affect the rate of the transition.

  • 32. Ringborg, A.
    et al.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Yin, D. D.
    Lindgren, P.
    Resource use and costs of type 2 diabetes in Sweden: estimates from population-based register data2008In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 62, no 5, p. 708-716Article in journal (Refereed)
    Abstract [en]

    AIMS

    To examine medical resource use of Swedish patients with type 2 diabetes during 2000-2004 and to estimate annual costs of care.

    METHODS

    Retrospective population-based cohort study of patients with type 2 diabetes identified in computerised medical records at 26 primary care centres in Uppsala county, Sweden. Annual quantities of medical resources were determined for prevalent cases during 2000-2004 using register data from outpatient primary care, outpatient hospital care, the National Inpatient Register and a national register for treatment of uraemia. Average costs of care of patients with type 2 diabetes were estimated based on year 2004 resource quantities of 8230 prevalent study cases.

    RESULTS

    Annual quantities of medical resource use were stable in outpatient primary care and outpatient hospital care, with patients making an average of two General Practitioner visits and 3.5 outpatient hospital visits each year. Higher rates of hospitalisation [12% in 2000 (n = 6711) compared with 16% in 2004 (n = 8230)] led to an increase in the mean (SD) number of inpatient days from 2.3 (11.8) to 2.7 (11.9) (p = 0.040) between 2000 and 2004. Mean (SD) total costs of care in 2004 were EUR 3602 (EUR 9537). Inpatient care was the major contributor to costs, accounting for 57% of total costs while drug costs accounted for an average 7%.

    CONCLUSIONS

    Swedish type 2 diabetic patients in this large sample from Uppsala county required steady annual amounts of outpatient care and increasing amounts of inpatient care during 2000-2004. The associated costs in 2004 were substantial, with inpatient care identified as the most important component.

  • 33. Ringborg, Anna
    et al.
    Yin, Donald D
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Lindgren, Peter
    The impact of acute myocardial infarction and stroke on health care costs in patients with type 2 diabetes in Sweden2009In: European Journal of Cardiovascular Prevention & Rehabilitation, ISSN 1741-8267, E-ISSN 1741-8275, Vol. 16, no 5, p. 576-582Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Estimates of the economic impact of cardiovascular events in patients with type 2 diabetes are scarce. The aim of this study was to determine the health care costs associated with acute myocardial infarction (AMI) and stroke in patients with type 2 diabetes in Sweden. DESIGN: Population-based open cohort study of 9941 patients with type 2 diabetes retrospectively identified in primary care records at 26 centres in Uppsala County. METHODS: Episodes of AMI and stroke suffered by study patients were tracked in the Swedish National Inpatient Register. Annual per patient costs of health care were computed for the years 2000-2004 using register data covering inpatient care, outpatient hospital care, primary care and drugs. Panel data regression was applied to determine the impact of suffering a first or repeat AMI or stroke on health care costs during the year of the event and in subsequent years. RESULTS: Total health care costs of patients suffering a first AMI/stroke increased by 4.1/6.5 during the year of the event [95% confidence interval (CI): 3.1-5.4/4.9-8.5] and by 1.1/1.4 during subsequent years (95% CI: 1.0-1.3/1.2-1.6), controlling for age, sex, the event of amputation and presence of renal failure, heart failure and diabetic eye disease. Total health care costs of patients suffering a first or repeat AMI/stroke increased by 4.1/6.4 during the year of an event (95% CI: 3.2-5.2/5.0-8.1) but were not significantly higher during subsequent years. CONCLUSION: Estimates of the costs related to major cardiovascular complications of type 2 diabetes are critical input to economic evaluations.

  • 34. Russell, David
    et al.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Bodegard, Johan
    Hasvold, Pal
    Thuresson, Marcus
    Kjeldsen, Sverre E.
    Cardiovascular Events in Subgroups of Patients During Primary Treatment of Hypertension With Candesartan or Losartan2011In: Journal of Clinical Hypertension, ISSN 1524-6175, Vol. 13, no 3, p. 189-197Article in journal (Refereed)
    Abstract [en]

    Merging data from existing electronic patient records, and electronic hospital discharge and cause of death registers, is a fast and relatively inexpensive method for comparing different treatments with regard to clinical outcome. This study compared the effects of antihypertensive treatment with candesartan or losartan on cardiovascular disease (CVD) using Swedish registers. Patients without previous CVD who were prescribed candesartan (n=7329) or losartan (n=6771) for hypertension during 1999-2007 at 72 Swedish primary care centers were followed for up to 9 years. Both medications were given according to current recommendations, and there was no difference observed in achieved blood pressures. The authors have previously shown that candesartan lowered the risk of all CVD (primary composite end point) more so than losartan (adjusted hazard ratio, 0.86; 95% confidence interval, 0.77-0.96). Candesartan also had a significantly better effect with regards to reducing the development of heart failure, cardiac arrhythmias, and peripheral arterial disease. In the present analysis, the authors found that candesartan, compared with losartan, reduced the risk of all CVD, irrespective of sex, age, previous antihypertensive treatment, baseline blood pressure, and presence of diabetes. These clinical findings may reflect differences between candesartan and losartan in their binding characteristics to the angiotensin type 1 receptor.

  • 35.
    Singh, Kailash
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Martinell, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Luo, Zhengkang
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Espes, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Sandler, Stellan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology.
    Carlsson, Per-Ola
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Cell Biology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Transplantation and regenerative medicine.
    Cellular immunological changes in patients with LADA are a mixture of those seen in patients with type 1 and type 2 diabetes2019In: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 197, no 1, p. 64-73Article in journal (Refereed)
    Abstract [en]

    There is currently scarce knowledge of the immunological profile of patients with latent autoimmune diabetes mellitus in the adult (LADA) when compared with healthy controls (HC) and patients with classical type 1 diabetes (T1D) and type 2 diabetes (T2D). The objective of this study was to investigate the cellular immunological profile of LADA patients and compare to HC and patients with T1D and T2D. All patients and age-matched HC were recruited from Uppsala County. Peripheral blood mononuclear cells were isolated from freshly collected blood to determine the proportions of immune cells by flow cytometry. Plasma concentrations of the cytokine interleukin (IL)-35 were measured by enzyme-linked immunosorbent assay (ELISA). The proportion of CD11c(+)CD123(-) antigen-presenting cells (APCs) was lower, while the proportions of CD11c(+)CD123(+) APCs and IL-35(+) tolerogenic APCs were higher in LADA patients than in T1D patients. The proportion of CD3(-)CD56(high)CD16(+) natural killer (NK) cells was higher in LADA patients than in both HC and T2D patients. The frequency of IL-35(+) regulatory T cells and plasma IL-35 concentrations in LADA patients were similar to those in T1D and T2D patients, but lower than in HC. The proportion of regulatory B cells in LADA patients was higher than in healthy controls, T1D and T2D patients, and the frequency of IL-35(+) regulatory B cells was higher than in T1D patients. LADA presents a mixed cellular immunological pattern with features overlapping with both T1D and T2D.

  • 36.
    Stålhammar, J
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Berfenstam, R
    Korpela, M
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Akuta besök i primärvården: En studie vid hälsocentralen i Tierp1978In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 55, p. 429-34Article in journal (Refereed)
  • 37.
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Drug treatment practice in diabetes mellitus during 1975-1994: Population-based pharmacoepidemiological studies2000Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of these studies were to investigate pharmacological practice in diabetes mellitus in defined populations in Sweden and in France, the effects on glycaemic control and the change of hypoglycaemic drug treatment practice in Sweden during 1975-1994.

    Data from diabetic subjects were obtained from the Tierp Study Database during 1975 - 1994 by record-linkage of subjects with diabetes diagnosis at the primary health care centre and diabetes drugs purchased at the local pharmacies in Tierp. Data from diabetic subjects in Gotland. Skellefteå and France were obtained from drug sales statistics or laboratory test files.

    Even though only 2.8% of the general population were diabetes subjects they accounted for 10.2% of all drug prescriptions. Diabetic subjects used more of 9 out of 15 pharmacological groups than non-diabetic subjects, mostly accounted for by cardiovascular drugs. The higher use of cardiovascular drugs was most pronounced among those who were treated with oral hypoglycaemic drugs or on diet only.

    Oral hypoglycaemic drug treatment and glycaemic control in diabetic subjects was determined in three geographically areas, characterised by high (Gotland), average (Tierp) and low (Skellefteå) utilisation of hypoglycaemic drugs. Heavy drug use was associated with low HbAlc levels and high BMI. Regardless of treatment intensity, less than 20% of the patients in all three areas were within the defined standards of good overall metabolic control (HbAlc <7% and BMI <27 (males) or <25 (females).

    Oral hypoglycaemic drug treatment and glycaemic control in the three Swedish study populations combined was compared with a similar French population. Despite varying pharmacological practices in the two samples, only a minority of the patients met a predefined standard of good overall diabetic control.

    During 1975 - 1994 substantial changes in pharmacological practice towards a more intensive therapy took place. A shift from "diet only" via oral treatment to more insulin was found especially in the elderly where insulin use increased ten-fold from 1975-81 to 1990-94. The diabetes treatment practice followed issued guidelines and changes of the guidelines fairly closely.

  • 38.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Boman, K.
    Umea Univ, Res Unit, Skelleftea Cty Hosp, Med & Geriatr,Dept Publ Hlth, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Skelleftea Cty Hosp, Med & Geriatr,Dept Publ Hlth, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    A description of unselected patients with heart failure: a swedish population-based study2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 195-195Article in journal (Other academic)
  • 39.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Boman, K.
    Umea Univ, Res Unit, Med & Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med & Geriatr, Skelleftea Cty Hosp,Dept Publ Hlth, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Recent trends in diagnostic work-up among unselected patients newly diagnosed with heart failure: a Swedish population-based study2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 54-55Article in journal (Other academic)
  • 40.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Boman, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Res Unit, Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Dept Publ Hlth & Clin Med, Res Unit, Med, Umea, Sweden..
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Wintzell, V.
    QuintilesIMS, Solna, Sweden..
    Wirta, S. Bruce
    Novartis Sweden AB, Stockholm, Sweden..
    Proenca, C. C.
    Wellmera AG, Basel, Switzerland..
    Schlienger, R.
    Novartis Pharma AG, Basel, Switzerland..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Management of patients with heart failure with preserved versus reduced ejection fraction: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 54-55Article in journal (Other academic)
  • 41.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Smedby, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Förekomst av diabetes mellitus i ett sjukvårdsdistrikt: en prevalensstudie med case finding-metodik1984Report (Other academic)
  • 42.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Stern, Lee
    Linder, Ragnar
    Sherman, Steve
    Parikh, Rohan
    Ariely, Rinat
    Deschaseaux, Celine
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    The burden of preserved ejection fraction heart failure in a real-world Swedish patient population2014In: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 17, no 1, p. 43-51Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate resource use and associated costs in patients with a diagnosis of heart failure with preserved ejection fraction (HF-PEF) in Sweden.

    METHODS: This retrospective study identified real-world patients with an ICD-10 diagnosis code for heart failure (I50) for the period between July 1, 2005 and December 31, 2006 from electronic medical records of primary care centers in Uppsala County Council, and in the Swedish patient registry data. Patients were categorized as having HF-PEF (left ventricle ejection fraction [LVEF] > 50%) during the index period. The study assessed medication utilization, outpatient visits, hospitalizations, and associated healthcare costs, as well as the incidence rates and time to all-cause and heart failure mortality following the index period.

    RESULTS: The study included 137 HF-PEF patients with a mean age of 77.1 (SD = 9.1) years. Over 50% of HF-PEF patients were female and hypertensive. Nearly all patients received ≥ 1 medication post-index. Patients had an average of 1.5 heart failure related hospitalizations per follow-up year. The average annual per patient cost for the management of a HF-PEF patient was found in Sweden to be Swedish Krona (SEK) 108,246 (EURO [EUR] 11,344). Hospitalizations contributed to more than 80% of the total cost. All-cause mortality over the 18-month study period was 25.5%, and more than 50% of these deaths occurred within 1 year of index.

    LIMITATIONS: Due to the limitations of registry data, it is not possible to confirm the HF diagnosis, and therefore the accuracy of registry records must be assumed. Other factors such as short follow-up time, the study-mandated LVEF assessment, and a lack of drug duration data may also have an impact on the study results.

    CONCLUSIONS: All-cause mortality was high in the HF-PEF population, with more than half of patients dying within 1 year of study follow-up. Study results also indicate that 60% of HF-PEF patients have ≥ 1 hospitalization during follow-up. Hospitalizations, especially heart failure related admissions, represent a substantial proportion of the total healthcare burden of patients with HF-PEF in Sweden.

  • 43.
    Stålhammar, Jan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Stern, Lee
    Linder, Ragnar
    Sherman, Steven
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Parikh, Rohan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Ariely, Rinat
    Wikström, Gerhard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients2012In: Journal of medical economics, ISSN 1941-837X, Vol. 15, no 5, p. 938-946Article in journal (Refereed)
    Abstract [en]

    AIM:

    The purpose of this study was to assess healthcare utilization and costs for heart failure patients with reduced ejection fraction (HF-REF) in Sweden.

    METHODS AND RESULTS:

    This was a retrospective, population-based cohort study of patients diagnosed with HF-REF during a period of 18 months at 31 primary care centers in Uppsala County, Sweden. Data was obtained from computerized records from these centers, the Swedish Patient Registry, the Swedish Prescription Registry, the Cause of Death Registry, and a local echocardiography registry maintained by the Department of Physiology, Uppsala University Hospital. Main outcome measures were cardiovascular and heart-failure-related hospitalizations, outpatient visits, medication utilization, mortality (all-cause, cardiovascular, and heart-failure), and healthcare costs for HF-REF patients. During the index period, 252 heart failure patients had a left ventricular ejection fraction measurement ≤ 40% and were categorized as having HF-REF. More than half of the patients had ≥ 1 cardiovascular or heart failure-related hospitalization. On average, patients had >2 such hospitalizations annually. They also averaged ∼1 cardiovascular or heart-failure-related outpatient visit per year. All-cause mortality was high: 15.9% patients died within 1 year after the index date. The mean annual cost per patient for heart-failure-related hospitalizations was SEK 72,613 (EUR 7610). In contrast, annual prescription costs were low, on average 3% of total cost (SEK 3503, EUR 367 per patient)

    LIMITATIONS:

    The main limitations of this study include a short follow-up time and small sample size. Also, certain data were missing, such as echocardiograms (available for only 28% of patients), and information on patients' New York Heart Association (NYHA) functional class, validity period for prescriptions or the units of medication prescribed, and medication dosing. Furthermore, the overall mortality could have been under-estimated, as only the primary cause of death was included in the analysis.

    CONCLUSIONS:

    The main burden associated with HF-REF is related to hospitalizations for heart-failure events. Effective treatment options that decrease hospitalization rates could reduce patients' suffering and potentially offer considerable cost savings.

  • 44.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Boman, K.
    Umea Univ, Skelleftea Cty Hosp, Dept Publ Hlth, Res Unit,Med & Geriatr, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Skelleftea Cty Hosp, Dept Publ Hlth, Res Unit,Med & Geriatr, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Dosing of heart failure treatments in newly diagnosed unselected patients in sweden: compliance with european society of cardiology guidelines2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 341-341Article in journal (Other academic)
  • 45.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala Univ, Inst Med Sci, Uppsala, Sweden..
    Boman, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lindmark, K.
    Umea Univ, Ctr Heart, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Lahoz, R.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Wintzell, V.
    IMS Hlth Sweden, Stockholm, Sweden..
    Linder, R.
    IMS Hlth Sweden, Stockholm, Sweden..
    Gondos, A.
    IMS Hlth Germany, Berlin, Germany..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Exposure to heart failure treatments in newly diagnosed patients in Sweden2016In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 18, p. 48-48Article in journal (Other academic)
  • 46.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Boman, K.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Res Unit, Med, Dept Publ Hlth & Clin Med, Umea, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Wintzell, V.
    QuintilesIMS, Solna, Sweden..
    Balas, B.
    Novartis Pharma AG, Basel, Switzerland..
    Corda, S.
    Novartis Pharma AG, Basel, Switzerland..
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Suboptimal dosing of common heart failure treatments in newly diagnosed patients with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, p. 54-54Article in journal (Other academic)
  • 47.
    Wikström, Gerhard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lindmark, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Ctr Heart, Umea, Sweden..
    Olofsson, M.
    Umea Univ, Dept Publ Hlth & Clin Med, Res Unit, Med, Umea, Sweden..
    Stålhammar, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Bergman, G. J.
    QuintilesIMS, Solna, Sweden..
    Tornblom, M.
    QuintilesIMS, Solna, Sweden..
    Wintzell, V.
    QuintilesIMS, Solna, Sweden..
    Wirta, S. Bruce
    Novartis Pharma AG, Basel, Switzerland..
    Balas, B.
    Novartis Pharma AG, Basel, Switzerland..
    Boman, K.
    Umea Univ, Dept Publ Hlth & Clin Med, Res Unit, Med, Umea, Sweden..
    Drug treatment patterns in patients newly diagnosed with heart failure: a retrospective population-based cohort study in Sweden2017In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 19, no Suppl. 1, p. 55-55Article in journal (Other academic)
1 - 47 of 47
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