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Ek, A., Ekblom, Ö., Hambraeus, K., Cider, Å., Kallings, L. & Börjesson, M. (2019). Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.. Clinical Research in Cardiology, 108(3), 324-332
Open this publication in new window or tab >>Physical inactivity and smoking after myocardial infarction as predictors for readmission and survival: results from the SWEDEHEART-registry.
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2019 (English)In: Clinical Research in Cardiology, ISSN 1861-0684, E-ISSN 1861-0692, Vol. 108, no 3, p. 324-332Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Physical activity (PA) and smoking cessation are included in the secondary prevention guidelines after myocardial infarction (MI), but they are still underutilised. This study aims to explore how PA level and smoking status (6-10 weeks post-MI) were associated with 1-year readmission and mortality during full follow-up time, and with the cumulative 5-year mortality.

METHODS: A population-based cohort of all hospitals providing MI-care in Sweden (SWEDEHEART-registry) in 2004-2014. PA was expressed as the number of exercise sessions of ≥ 30 min in the last 7 days: 0-1 (low), 2-4 (medium) and 5-7 (high) sessions/week. Individuals were categorised as smokers, former smokers or never-smokers. The associations were analysed by unadjusted and adjusted logistic and Cox regressions.

RESULTS: During follow-up (M = 3.58 years), a total of 1702 deaths occurred among 30 644 individuals (14.1 cases per 1000 person-years). For medium and high PA, the hazard ratios (HRs) for mortality were 0.39 and 0.36, respectively, compared with low PA. For never-smokers, the HR was 0.45 and former smokers 0.56 compared with smokers. Compared with low PA, the odds ratios (ORs) for readmission in medium PA were 0.65 and 0.59 for CVD and non-CVD causes, respectively. For high PA, the corresponding ORs were 0.63 and 0.55. The association remained in adjusted models. There were no associations between smoking status and readmission.

CONCLUSIONS: The PA level and smoking status are strong predictors of mortality post-MI and the PA level also predicts readmission, highlighting the importance of adherence to the secondary prevention guidelines.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Hospitalisation, Myocardial ischaemia, Physical activity, Survival, Tobacco
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5405 (URN)10.1007/s00392-018-1360-x (DOI)000459158700012 ()30167806 (PubMedID)
Available from: 2018-09-04 Created: 2018-09-04 Last updated: 2019-03-21
Ekblom, Ö., Ek, A., Cider, Å., Hambraeus, K. & Börjesson, M. (2018). Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(24), Article ID e010108.
Open this publication in new window or tab >>Increased Physical Activity Post-Myocardial Infarction Is Related to Reduced Mortality; Results From the SWEDEHEART Registry
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 24, article id e010108Article in journal (Refereed) Published
Abstract [en]

Background

With increasing survival rates among patients with myocardial infarction (MI), more demands are placed on secondary prevention. While physical activity (PA) efforts to obtain a sufficient PA level are part of secondary preventive recommendations, it is still underutilized. Importantly, the effect of changes in PA after MI is largely unknown. Therefore, we sought to investigate the effect on survival from changes in PA level, post‐MI.

Methods and Results

Data from Swedish national registries were combined, totaling 22 227 patients with MI. PA level was self‐reported at 6 to 10 weeks post‐MI and 10 to 12 months post‐MI. Patients were classified as constantly inactive, increased activity, reduced activity, and constantly active. Proportional hazard ratios were calculated. During 100 502 person‐years of follow‐up (mean follow‐up time 4.2 years), a total of 1087 deaths were recorded. Controlling for important confounders (including left ventricular function, type of MI, medication, smoking, participation in cardiac rehabilitation program, quality of life, and estimated kidney function), we found lower mortality rates among constantly active (hazard ratio: 0.29, 95% confidence interval: 0.21–0.41), those with increased activity (0.41, 95% confidence interval: 0.31–0.55), and those with reduced activity (hazard ratio: 0.56, 95% confidence interval: 0.45–0.69) during the first year post‐MI, compared with those being constantly inactive. Stratified analyses indicated strong effect of PA level among both sexes, across age, MI type, kidney function, medication, and smoking status.

Conclusions

The present article shows that increasing the PA level, compared with staying inactive the first year post‐MI, was related to reduced mortality.

Place, publisher, year, edition, pages
American Heart Association, 2018
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-5506 (URN)10.1161/JAHA.118.010108 (DOI)000455184800009 ()30561263 (PubMedID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-01-24
Ek, A., Kallings, L. & Börjesson, M. (2015). Promoting physical activity - an established part of the clinical practice?. In: 23rd International Conference on Health Promoting Hospitals and Health Services: "Person-oriented health promotion in a rapidly changing world:Co-production – continuity – new media & technologies". Paper presented at 23rd International Conference on Health Promoting Hospitals and Health Services, June 10-12, 2015 Oslo, Norway.
Open this publication in new window or tab >>Promoting physical activity - an established part of the clinical practice?
2015 (English)In: 23rd International Conference on Health Promoting Hospitals and Health Services: "Person-oriented health promotion in a rapidly changing world:Co-production – continuity – new media & technologies", 2015Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Introduction

Insufficient physical activity is a considerable risk factor for mortality and premature death. The healthcare has a unique role in health promotion as they reach a large part of the population. The evidence based recommendation is that the healthcare sector should offer “counseling with the adjunct of exercise on prescription or a pedometer, as well as special follow-up” to promote patients physical activity. Despite this, physical activity is underutilized in prevention and treatment of disease, for reasons not fully known.

 

 

Purpose/Method

We aimed to study the attitudes of different healthcare professionals in the hospital setting, towards the importance of physical activity and its clinical use at different levels.

The study comprised 264 (78% women) health care professionals at the cardiac department/outpatient cardiac center in Stockholm (response rate 91%). Data was obtained in 2013, by questionnaire. Containing 28 multiple choice questions on participants attitudes towards physical activity behavior change, the perceived importance of such measures, practical implementation and possible barriers for implementation.

 

Results

All participants stated importance of physical activity promotion within healthcare. Forty-seven percent reported that they promoted physical activity in clinical practice, however only a minority fulfilled the evidence based recommendations (n=65), as brief advice (n=165) or counseling (n=111) were most common. Sixty-one percent aimed to improve the use of physical activity promotion, factors hampering were inadequate knowledge, follow-up possibilities and length of patient visits. Less than half group reported insufficient routines (46%), goals (37%) and lack of management support (42%).

 

Conclusion         

Although health professionals generally are positive towards promoting physical activity, just a small proportion actually use the evidence based methods in clinical practice. To improve the promotion of physical activity in patients there is need for further implementation strategies at all levels to create a well-functioning structure, clear goals and routines. Our study suggests, that implementation should focus at education, logistics for follow-up and increased amount of time with direct patient care. 

 

National Category
Medical and Health Sciences
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-4130 (URN)
Conference
23rd International Conference on Health Promoting Hospitals and Health Services, June 10-12, 2015 Oslo, Norway
Available from: 2015-09-09 Created: 2015-09-09 Last updated: 2015-09-15Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9833-8306

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