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
Objective: To explore the association between giant cell arteritis(GCA) and subsequent cardiovascular disease in older adults. Design: Population based retrospective cohort study. Selling: The entire province of Ontar...Objective: To explore the association between giant cell arteritis(GCA) and subsequent cardiovascular disease in older adults. Design: Population based retrospective cohort study. Selling: The entire province of Ontario, Canada. Participants: Patients aged 66 years and older with newly diagnosed GCA(n=1141), osteoarthritis(n=172 953), or neither(n=200 000). Patients with neither were randomly selected from the general population and formed the control group. Main outcome measures: The primary composite outcome was based on a subsequent diagnosis or surgical treatment for coronary artery disease, stroke, peripheral arterial disease, or aneurysm or dissection of the aorta. Results: The composite end point was more common in seniors with GCA(12.1/1000 person-years) than in patients with osteoarthritis(7.3/1000 person-years) or neither condition(5.3/1000 person-years). The adjusted hazard ratio for cardiovascular disease was 1.6(95%confidence interval(CI) 1.1 to 2.2) in patients with GCA versus patients with osteoarthritis, and 2.1(95%CI 1.5 to 3.0) in patients with GCA versus unaffected controls. Conclusions: Older adults with GCA appear to be at increased risk for developing cardiovascular disease. Whether an aggressive approach to cardiovascular risk factor modification is particularly beneficial in these patients remains to be determined.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.
文摘Objective: To explore the association between giant cell arteritis(GCA) and subsequent cardiovascular disease in older adults. Design: Population based retrospective cohort study. Selling: The entire province of Ontario, Canada. Participants: Patients aged 66 years and older with newly diagnosed GCA(n=1141), osteoarthritis(n=172 953), or neither(n=200 000). Patients with neither were randomly selected from the general population and formed the control group. Main outcome measures: The primary composite outcome was based on a subsequent diagnosis or surgical treatment for coronary artery disease, stroke, peripheral arterial disease, or aneurysm or dissection of the aorta. Results: The composite end point was more common in seniors with GCA(12.1/1000 person-years) than in patients with osteoarthritis(7.3/1000 person-years) or neither condition(5.3/1000 person-years). The adjusted hazard ratio for cardiovascular disease was 1.6(95%confidence interval(CI) 1.1 to 2.2) in patients with GCA versus patients with osteoarthritis, and 2.1(95%CI 1.5 to 3.0) in patients with GCA versus unaffected controls. Conclusions: Older adults with GCA appear to be at increased risk for developing cardiovascular disease. Whether an aggressive approach to cardiovascular risk factor modification is particularly beneficial in these patients remains to be determined.
