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Objective: The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinics separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. Design: We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF ≥40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. Setting: The prospective Swedish Heart Failure Registry. Subjects: Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. Main outcome measures: Comorbidities, risk factors and mortality. Results: Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p

To compare the registering of diabetic complications and metabolic control in type 2 diabetic subjects in primary health care in 1995 and 2001.Cross-sectional surveys of medical records.Two primary health care centres in Stockholm County.Diabetic patients aged 35-64 years; in 1995, 59 men and 42 women and in 2001, 80 men and 80 women.Rate of notified examinations in medical records, diabetic complications and metabolic control.Increased rates between 1995 and 2001 were found regarding examinations for neuropathy (46% vs 79%), albuminuria (74% vs 91%), micro-albuminuria (11% vs 59%), BMI (33% vs 66%), HbA1c (88% vs 99%), cholesterol (69% vs 92%) and LDL cholesterol (42% vs 89%) (p0.001). Increased rates of perceived treatment goals between 1995 and 2001 were found regarding HbA1c (6.5%) (28% vs 57%) and cholesterol (5.0 mmol/l) (23% vs 36%) (p0.001), and also regarding LDL cholesterol (30% vs 36%) (p0.01). In men, the number of subjects with any macrovascular complication decreased between 1995 and 2001 (34% vs 17%) (p0.01), and in women the number of subjects with coronary heart disease decreased (26% vs 6%) (p0.01).Documented examination rates and metabolic control improved between 1995 and 2001.

Five-year mortality in men and women with atrial fibrillation (AF).A follow-up of the medical records of patients with AF registered on September 30, 1993.One community health centre in Stockholm County.129 patients (76 men and 53 women).Observed and expected, age- and sex-standardised, 5-year mortality rates. Significant risk factors by multiple logistic regression.Women had a higher mean age (77.5 vs 72.8 years) and more often suffered from heart failure and hypothyreosis. Five-year mortality rate for men was 30% vs expected 27% in Sweden and 24% in the community; for women it was 43% vs expected 29% (p0.05) and 23% in the community (p0.001), i.e. an excess mortality of 49% and 88%, respectively. Significant factors predicting death by logistic regression among women were: age (odds ratio 1.39, p0.001), levothyroxine treatment (odds ratio 27.87, p0.05) and diabetes (odds ratio 20.75, p0.05).AF is related to an excess sex- and age-standardised, 5-year mortality in women but not in men, with levothyroxine treatment as one significant factor.

A review of articles on health-related quality of life (HRQoL) among diabetes patients in primary health care in the Nordic countries.Search in PubMed and related sources. Used MeSH terms were: "Diabetes Mellitus", "Quality of Life", "Primary Health Care", and "Scandinavia" or "Denmark", "Finland", "Iceland", "Norway", or "Sweden".In total, 19 relevant articles were found, 9 from Finland and 10 from Sweden. HRQoL questionnaires used were from the Medical Outcomes Study, i.e. the SWED-QUAL in seven, SF-20 in four and SF-36 in one, NHP in two, GQL in two, GHQ in one, and own questionnaires in two. HRQoL was moderately affected in diabetic patients, with macrovascular diseases, especially coronary heart disease, and non-vascular diseases as the most consistently found and strongest predictors. Weaker predictors were microvascular complications, age, sex, metabolic level, and education. Other groups at higher risk of worse HRQoL were diabetes patients with psychiatric disorders, especially depression, and foreign-born patients. Good continuity of care was associated with better HRQoL.Diabetes affects the HRQoL through macrovascular complications and associated non-vascular comorbidity, and also by adding to the total burden of disease. Future research areas include transcultural and ethnic aspects, and effects of lifestyle interventions.

Objective - Anticoagulant (AC) treatment in primary health care with regard to change over time, quality of care, and prevalence. Design - Surveys of patients on AC treatment during 3 months in 1992 and 1997. Setting - A community in the Stockholm metropolitan area. Main outcome measures - Main indications, rate of values within recommended treatment interval, prevalence. Results - The number of patients increased in primary health care in the community from 115 in 1992 to 170 in 1997. There were no differences in age and sex distribution, nor in the main indications. Values within the recommended treatment range 10-25% at the community health centre (CHC) were 74% in 1992 versus 86% in 1997 (p

To compare registering of diabetic complications and metabolic control in diabetic subjects in primary health care in 1992 and 1995.Cross-sectional surveys of medical records.Three community health centres in Stockholm County.Diabetic patients aged 18-84 years in 1992 (n = 177) and in 1995 (n = 413).Rate of noted diabetic complications and metabolic values.Retinopathy examination was noted in 64% in 1992 versus 65% in 1995, neuropathy examination in 44 versus 49%, and urine examination in 88% versus 73% (p0.001). HbA1c was examined in 52% in 1992 versus 68% (p0.001) in 1995, fasting blood glucose in 89 versus 90%, and cholesterol in 34 versus 42%. Acceptable HbA1c values were noted in 51% in 1992 versus 46% in 1995. Smoking habits were available in 26% in 1992 versus 53% in 1995 (p0.001) and BMI in 5 versus 39% (p0.001). Diabetic blindness was present in 2.2% in 1995, uraemia in 0.3%, and amputation due to gangrene in 1.2%.Documented examination rates of diabetic patients are unacceptably low, and the metabolic level unsatisfactory in most cases. Severe complications are, however, rare.

To evaluate the health-related quality of life in diabetic subjects in primary health care.A cross-sectional, questionnaire survey of diabetic patients registered with primary health services, compared with a standard population sample.Three community health centres in the Metropolitan Stockholm area.341 diabetic individuals aged 21-84 years, with 229 respondents, i.e. 67%. Matched controls of the same age and sex from a standard population sample of 2366 individuals.Quality of life was assessed by the Swedish Health-Related Quality of Life Survey (SWEDQUAL), adopted from the Medical Outcomes Study and consisting of 61 items covering aspects of physical, mental, social, and general health. Medical data were extracted from the medical records.Diabetic patients had significantly lower scores on all scales (p0.001 for ten, and p0.01 for one), except for social health, when compared with the standard population sample. Outcomes were correlated with vascular and non-vascular comorbidity, age, and income, but not with level of metabolic control.Diabetic patients in primary health care have a markedly lower health-related quality of life, compared with a standard population.