Henrik Hagström

Aims: The European Society of Cardiology (ESC) has developed quality indicators (QIs) specifically for evaluating the care and outcomes for patients undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to evaluate TAVI care in all patients undergoing such procedures in Sweden using the ESC 2023 QIs for TAVI. Methods and results: We used the Swedish Transcatheter Cardiac Intervention Registry to identify all TAVI procedures performed in Swedish centres (n = 8) between 2008 and 2021. 8524 patients (median 82 years, 52.8% male) were included. In total, 24 (88.8%) of the 27 QIs could be captured from the available registry data. The attainment levels were generally high [median 97.8%, interquartile range (IQR) 91.3–100%] with small variations in attainment levels between centres. The greatest variations were observed in the QIs related to patients undergoing TAVI through transfemoral route (median 90.3%, IQR 85.6–96.9%), and in the proportion undergoing transfemoral TAVI without general anaesthesia (median 87.6%, IQR 57.1–94.4%). In total, 80% of the QIs were associated with 1-year all-cause mortality, and 85% with 1-year cardiovascular mortality. The QIs with greatest impact on 1-year mortality were the absence of coronary obstruction (adjusted HR 0.12; 95% CI 0.07–0.22), in-hospital stroke (adjusted HR 0.25; 95% CI 0.18–0.33) and no new dialysis (adjusted HR 0.25; 95% CI 0.15–0.41). Conclusion: In this study, the majority of the QIs were associated with both all-cause and cardiovascular mortality. Hence, the ESC 2023 QIs for TAVI may serve as a valuable tool for evaluating TAVI care, benchmarking performance, and improving patient outcomes.

Introduction: Data are lacking about the risk for death and major adverse cardiovascular events (MACE) after transcatheter aortic valve implantation (TAVI), compared to the general population. Therefore, we assessed the risk for all-cause death and MACE after TAVI in patients aged 65 years and older, in comparison to an age- and sex-matched control population. Methods and results: In total, 5924 TAVI patients and 10 928 matched controls [mean age 82.1, standard deviation (SD) 6.0, and 81.9, SD 6.1, respectively] were included from 2014 to 2020. The SWEDEHEART registry and four mandatory national registers were used to collect data. Cox regression models were used to assess the association with all-cause mortality and MACE risk. In total, 1410 (23.8%) of the TAVI patients and 2115 (19.4%) controls died during the follow-up period. Median follow-up was 1.9 years (inter quartile range 0.9–3.3) respectively. The crude mortality and MACE risks were higher in TAVI patients than in controls {hazard ratios 1.27 [95% Confidence interval (CI): 1.19–1.36] and HR 1.44 (95% CI: 1.35–1.53), respectively}. After adjustment, there was a lower risk for both mortality and MACE in TAVI patients [adjusted hazard ratio (aHR) 0.77 (95% CI: 0.71–0.84) and aHR 0.90 (95% CI: 0.83–0.98), respectively]. Conclusion: After adjustments for comorbidities, the mortality risk was lower in TAVI patients, compared with an age- and sex-matched control population. These findings suggest that the high burden of comorbidities in TAVI patients has a strong impact on the risk for mortality and MACE after TAVI.

Background: Low carbohydrate high fat (LCHF) diet has been a popular low carbohydrate diet in Sweden for 15 years. Many people choose LCHF to lose weight or control diabetes, but there are concerns about the effect on long-term cardiovascular risks. There is little data on how a LCHF diet is composed in real-life. The aim of this study was to evaluate the dietary intake in a population with self-reported adherence to a LCHF diet.Methods: A cross-sectional study of 100 volunteers that considered themselves eating LCHF was conducted. Diet history interviews (DHIs) and physical activity monitoring for validation of the DHIs were performed.Results: The validation shows acceptable agreement of measured energy expenditure and reported energy intake. Median carbohydrate intake was 8.7 E% and 63% reported carbohydrate intake at potentially ketogenic levels. Median protein intake was 16.9 E%. The main source of energy was dietary fats (72.0 E%). Intake of saturated fat was 32 E% and cholesterol was 700 mg per day, both of which exceeded the recommended upper limits according to nutritional guidelines. Intake of dietary fiber was very low in our population. The use of dietary supplements was high, and it was more common to exceed the recommended upper limits of micronutrients than to have an intake below the lower limits.Conclusions: Our study indicates that in a well-motivated population, a diet with very low carbohydrate intake can be sustained over time and without apparent risk of deficiencies. High intake of saturated fats and cholesterol as well as low intake of dietary fiber remains a concern.