BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibi...BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibitors is also indicate d in these patients. However, life-threatening hyperkalemia can occur when thes e drugs are used together. METHODS: We conducted a population-based time-serie s analysis to examine trends in the rate of spironolactone prescriptions and the rate of hospitalization for hyperkalemia in ambulatory patients before and afte r the publication of RALES. We linked prescription-claims data and hospital-ad mission records for more than 1.3 million adults 66 years of age or older in Ont ario, Canada, for the period from 1994 through 2001. RESULTS: Among patients tre ated with ACE inhibitors who had recently been hospitalized for heart failure, t he spironolactone-prescription rate was 34 per 1000 patients in 1994, and it in creased immediately after the publication of RALES, to 149 per 1000 patients by late 2001 (P< 0.001). The rate of hospitalization for hyperkalemia rose from 2.4 per 1000 patients in 1994 to 11.0 per 1000 patients in 2001 (P< 0.001), and the associated mortality rose from 0.3 per 1000 to 2.0 per 1000 patients (P< 0.001) . As compared with expected numbers of events, there were 560(95 percent confide nce interval, 285 to 754) additional hyperkalemia-related hospitalizations and 73 (95 percent conf idence interval, 27 to 120) additional hospital deaths during 2001 among older p atients with heart failure who were treated with ACE inhibitors in Ontario. Publ ication of RALES was not associated with significant decreases in the rates of r eadmission for heart failure or death from all causes. CONCLUSIONS: The publicat ion of RALES was associated with abrupt increases in the rate of prescriptions f or spironolactone and in hyperkalemia- associated morbidity and mortality. Closer laboratory monitoring and more judi cious use of spironolactone may reduce the occurrence of this complication.展开更多
Description Générale de la Chine is an important sinology masterpiece published in France in the late 18^(th) century.Its author Jean-Baptiste Grosier summarized and rearranged a large number of first-hand m...Description Générale de la Chine is an important sinology masterpiece published in France in the late 18^(th) century.Its author Jean-Baptiste Grosier summarized and rearranged a large number of first-hand materials to systematically introduce China’s national traditions and culture.A great part of this book introduced ancient Chinese medicine,which facilitated the unbiased understanding of traditional Chinese medicine(TCM)in Europe and fostered a knowledge dialogue between the Chinese and Western medicine systems.Such content also provided a historical reference for how to promote the further going out of TCM to the world.展开更多
文摘BACKGROUND: The Randomized Aldactone Evaluation Study (RALES) demonstra ted tha t spironolactone significantly improves outcomes in patients with severe heart f ailure. Use of angiotensin-converting-enzyme(ACE)-inhibitors is also indicate d in these patients. However, life-threatening hyperkalemia can occur when thes e drugs are used together. METHODS: We conducted a population-based time-serie s analysis to examine trends in the rate of spironolactone prescriptions and the rate of hospitalization for hyperkalemia in ambulatory patients before and afte r the publication of RALES. We linked prescription-claims data and hospital-ad mission records for more than 1.3 million adults 66 years of age or older in Ont ario, Canada, for the period from 1994 through 2001. RESULTS: Among patients tre ated with ACE inhibitors who had recently been hospitalized for heart failure, t he spironolactone-prescription rate was 34 per 1000 patients in 1994, and it in creased immediately after the publication of RALES, to 149 per 1000 patients by late 2001 (P< 0.001). The rate of hospitalization for hyperkalemia rose from 2.4 per 1000 patients in 1994 to 11.0 per 1000 patients in 2001 (P< 0.001), and the associated mortality rose from 0.3 per 1000 to 2.0 per 1000 patients (P< 0.001) . As compared with expected numbers of events, there were 560(95 percent confide nce interval, 285 to 754) additional hyperkalemia-related hospitalizations and 73 (95 percent conf idence interval, 27 to 120) additional hospital deaths during 2001 among older p atients with heart failure who were treated with ACE inhibitors in Ontario. Publ ication of RALES was not associated with significant decreases in the rates of r eadmission for heart failure or death from all causes. CONCLUSIONS: The publicat ion of RALES was associated with abrupt increases in the rate of prescriptions f or spironolactone and in hyperkalemia- associated morbidity and mortality. Closer laboratory monitoring and more judi cious use of spironolactone may reduce the occurrence of this complication.
基金This study was financed by the National Social Science Foundation of China(No.17ZDA195).
文摘Description Générale de la Chine is an important sinology masterpiece published in France in the late 18^(th) century.Its author Jean-Baptiste Grosier summarized and rearranged a large number of first-hand materials to systematically introduce China’s national traditions and culture.A great part of this book introduced ancient Chinese medicine,which facilitated the unbiased understanding of traditional Chinese medicine(TCM)in Europe and fostered a knowledge dialogue between the Chinese and Western medicine systems.Such content also provided a historical reference for how to promote the further going out of TCM to the world.
