OBJECTIVES: This study sought to assess the impact of the selective aldosterone blocker eplerenone on mortality 30 days after randomization in patients after acute myocardial infarction(AMI) with a left ventricular ej...OBJECTIVES: This study sought to assess the impact of the selective aldosterone blocker eplerenone on mortality 30 days after randomization in patients after acute myocardial infarction(AMI) with a left ventricular ejection fraction(LVEF) ≤40%and clinical signs of heart failure. BACKGROUND: In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study(EPHESUS), eplerenone reduced all-cause mortality by 15%(p=0.008) over a mean followup of 16 months when used with standard therapy in patients after AMI with an LVEF ≤40%and clinical signs of heart failure. METHODS: We analyzed the effect of eplerenone 25 mg/day initiated 3 to 14 days after AMI(mean, 7.3 days) on the co-primary end points of time to death from any cause and the composite end point of time to death from cardiovascular(CV) causes or hospitalization for CV events, and the secondary end points of CV mortality, sudden cardiac death, and fatal/nonfatal hospitalization for heart failure, after 30 days of therapy in the EPHESUS trial. RESULTS: At 30 days after randomization, eplerenone reduced the risk of all-cause mortality by 31%(3.2%vs. 4.6%in eplerenone and placebo-treated patients, respectively; p=0.004) and reduced the risk of CV mortality/CV hospitalization by 13%(8.6%vs. 9.9%in eplerenone and placebo-treated patients, respectively; p=0.074). Eplerenone also reduced the risk of CV mortality by 32%(p=0.003) and the risk of sudden cardiac death by 37%(p=0.051). CONCLUSIONS: Eplerenone 25 mg/day significantly reduced all-cause mortality 30 days after randomization(when initiated at a mean of 7.3 days after AMI) in addition to conventional therapy in patients with an LVEF ≤40%and signs of heart failure. Based on its early survival benefit, eplerenone should be administered in the hospital after AMI.展开更多
Background: We compared cost-effectiveness of pravastatin in a placebo-controlled trial in 5500 younger(31-64 years) and 3514 older patients(65-74 years) with previous acute coronary syndromes. Methods: Hospitalizatio...Background: We compared cost-effectiveness of pravastatin in a placebo-controlled trial in 5500 younger(31-64 years) and 3514 older patients(65-74 years) with previous acute coronary syndromes. Methods: Hospitalizations and long-term medication within the 6 years of the trial were estimated in all patients. Drug dosage, nursing home, and ambulatory care costs were estimated from substudies. Incremental costs per life saved of pravastatin relative to placebo were estimated from treatment effects and resource use. Results: Over 6 years, pravastatin reduced all-cause mortality by 4.3%in the older patients and by 2.3%in the younger patients. Older patients assigned pravastatin had marginally lower cost of pravastatin and other medication over 6 years(A＄4442 vs A＄4637), but greater cost offsets(A＄2061 vs A＄897) from lower rates of hospitalizations. The incremental cost per life saved with pravastatin was A＄55 500 in the old and A＄167 200 in the young. Assuming no treatment effect beyond the study period, the life expectancy to age 82 years of additional survivors was 9.1 years in the older and 17.3 years in the younger. Estimated additional life-years saved from pravastatin therapy were 0.39 years for older and 0.40 years for younger patients. Incremental costs per life-year saved were A＄7581 in the older and A＄14 944 in the younger, if discounted at 5%per annum. Conclusions: Pravastatin therapy was more cost-effective among older than younger patients, because of their higher baseline risk and greater cost offsets, despite their shorter life expectancy.展开更多
文摘OBJECTIVES: This study sought to assess the impact of the selective aldosterone blocker eplerenone on mortality 30 days after randomization in patients after acute myocardial infarction(AMI) with a left ventricular ejection fraction(LVEF) ≤40%and clinical signs of heart failure. BACKGROUND: In the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study(EPHESUS), eplerenone reduced all-cause mortality by 15%(p=0.008) over a mean followup of 16 months when used with standard therapy in patients after AMI with an LVEF ≤40%and clinical signs of heart failure. METHODS: We analyzed the effect of eplerenone 25 mg/day initiated 3 to 14 days after AMI(mean, 7.3 days) on the co-primary end points of time to death from any cause and the composite end point of time to death from cardiovascular(CV) causes or hospitalization for CV events, and the secondary end points of CV mortality, sudden cardiac death, and fatal/nonfatal hospitalization for heart failure, after 30 days of therapy in the EPHESUS trial. RESULTS: At 30 days after randomization, eplerenone reduced the risk of all-cause mortality by 31%(3.2%vs. 4.6%in eplerenone and placebo-treated patients, respectively; p=0.004) and reduced the risk of CV mortality/CV hospitalization by 13%(8.6%vs. 9.9%in eplerenone and placebo-treated patients, respectively; p=0.074). Eplerenone also reduced the risk of CV mortality by 32%(p=0.003) and the risk of sudden cardiac death by 37%(p=0.051). CONCLUSIONS: Eplerenone 25 mg/day significantly reduced all-cause mortality 30 days after randomization(when initiated at a mean of 7.3 days after AMI) in addition to conventional therapy in patients with an LVEF ≤40%and signs of heart failure. Based on its early survival benefit, eplerenone should be administered in the hospital after AMI.
文摘Background: We compared cost-effectiveness of pravastatin in a placebo-controlled trial in 5500 younger(31-64 years) and 3514 older patients(65-74 years) with previous acute coronary syndromes. Methods: Hospitalizations and long-term medication within the 6 years of the trial were estimated in all patients. Drug dosage, nursing home, and ambulatory care costs were estimated from substudies. Incremental costs per life saved of pravastatin relative to placebo were estimated from treatment effects and resource use. Results: Over 6 years, pravastatin reduced all-cause mortality by 4.3%in the older patients and by 2.3%in the younger patients. Older patients assigned pravastatin had marginally lower cost of pravastatin and other medication over 6 years(A＄4442 vs A＄4637), but greater cost offsets(A＄2061 vs A＄897) from lower rates of hospitalizations. The incremental cost per life saved with pravastatin was A＄55 500 in the old and A＄167 200 in the young. Assuming no treatment effect beyond the study period, the life expectancy to age 82 years of additional survivors was 9.1 years in the older and 17.3 years in the younger. Estimated additional life-years saved from pravastatin therapy were 0.39 years for older and 0.40 years for younger patients. Incremental costs per life-year saved were A＄7581 in the older and A＄14 944 in the younger, if discounted at 5%per annum. Conclusions: Pravastatin therapy was more cost-effective among older than younger patients, because of their higher baseline risk and greater cost offsets, despite their shorter life expectancy.
