Dataset Information

Database Analysis of Eplerenone Use in Japanese Hypertensive Patients in Clinical Practice.

ABSTRACT: Eplerenone, a mineralocorticoid receptor antagonist (MRA), is available in Japan, but details of its use in clinical settings have not been thoroughly investigated. Thus, this study was aimed at examining the characteristics of eplerenone-prescribed hypertensive patients in Japan, describing the combination patterns of antihypertensive medications, and comparing eplerenone's mean doses with respect to concomitant diseases. Data of 160,992 hypertensive patients who used the same drugs for six months or more were collected from an insurance database from January 1, 2009, to December 31, 2013. The number of MRA-receiving patients among the extracted population was 3,274 (2%). Compared to patients on eplerenone or spironolactone, patients on neither drug had fewer comorbidities. Eplerenone was administered in combination with calcium channel blockers and angiotensin II receptor blockers in 23.1% and as monotherapy in 6.6% of cases. The most frequent initial daily dose of eplerenone was 50 mg/day followed by 25 mg/day irrespective of the presence of a comorbidity. MRA use was as low as 2%, but its use was more frequent in patients with comorbidities compared to that of other antihypertensives. Despite studies showing eplerenone's efficacy and safety in high-risk hypertensive patients with albuminuria, the drug is not widely used.

SUBMITTER: Takahashi S

PROVIDER: S-EPMC6420997 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Database Analysis of Eplerenone Use in Japanese Hypertensive Patients in Clinical Practice.

Takahashi Shoko S Ii Yoichi Y Yamamoto Yuji Y Ikeda Aya A Fujimoto Yoko Y

International journal of hypertension 20190303

Eplerenone, a mineralocorticoid receptor antagonist (MRA), is available in Japan, but details of its use in clinical settings have not been thoroughly investigated. Thus, this study was aimed at examining the characteristics of eplerenone-prescribed hypertensive patients in Japan, describing the combination patterns of antihypertensive medications, and comparing eplerenone's mean doses with respect to concomitant diseases. Data of 160,992 hypertensive patients who used the same drugs for six mon ...[more]

PMID: 30941208

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Project description:ObjectivesDelirium commonly occurs during hospitalisation and is associated with increased mortality, especially in elderly patients. This study aimed to determine the demographic and clinical characteristics of patients with delirium in the Japanese real-world clinical setting using a nationwide database comprising claims and discharge abstract data.DesignThis was an observational, cross-sectional, retrospective study in hospitalised patients with an incident delirium identified by a diagnosis based on International Classification of Diseases, 10th Revision codes or initiating antipsychotics recommended for delirium treatment in Japan during their hospitalisation.SettingPatients from the Medical Data Vision database including more than 400 acute care hospitals in Japan were evaluated from admission to discharge.ParticipantsOf the 32 910 227 patients who were included in the database between April 2012 and September 2020, a total of 145 219 patients met the criteria for delirium.Primary and secondary outcome measuresDemographic and baseline characteristics, comorbidities, clinical profiles and pharmacological treatments were evaluated in patients with delirium.ResultsThe mean (SD) patient age was 76.5 (13.8) years. More than half of the patients (n=82 159; 56.6%) were male. The most frequent comorbidities were circulatory system diseases, observed in 81 954 (56.4%) patients. Potentially inappropriate medications (PIMs) with risk of delirium including benzodiazepines and opioids were prescribed to 76 798 (52.9%) patients. Approximately three-fourths of these patients (56 949; 74.2%) were prescribed ≥4 PIMs. The most prescribed treatment for delirium was injectable haloperidol (n=82 490; 56.8%). Mean (SD) length of hospitalisation was 16.0 (12.1) days.ConclusionsThe study results provide comprehensive details of the clinical characteristics of patients with delirium and treatment patterns with antipsychotics in the Japanese acute care setting. In this patient population, the prescription rate of injectable haloperidol and PIMs was high, suggesting the need for improved understanding among healthcare providers about the appropriate management of delirium, which may benefit patients.

Project description:Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.

Dataset Information

Database Analysis of Eplerenone Use in Japanese Hypertensive Patients in Clinical Practice.

Publications

Database Analysis of Eplerenone Use in Japanese Hypertensive Patients in Clinical Practice.

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