<International Circulation>:  You only used data that was submitted by hospitals which submitted data for at least twelve quarters. If a hospital is not submitting data for at least twelve of the possible sixteen quarters， is that because there are gaps or because they started late?

　　《国际循环》：您只采用了提交至少3年数据的医院所提交的数据。如果一家医院没有提供这种数据，是否因为存在空白或他们开展这项工作较晚？
　　Dr Dodson:  I think it is more because they are starting late and more hospitals are coming online. The reason we did that was that we wanted a stable cohort. If we are looking at changes in outcomes， it is not that more hospitals are coming online and submitting data， it is because hospitals within the cohort are changing. We don’t have all hospitals from year one to year four but including hospitals that have submitted for more than twelve quarters ensures that， over time， the changes are more likely to be due to patterns within hospitals rather than other hospitals that are submitting data doing better.

　　Dr Dodson: 我想更多是因为开展工作较晚，目前更多的医院已经进入这一行列。我们这样做，是希望保持队列的稳定性。如果观察结局的变化，我们希望不是因为更多医院加入这一行列和提交数据，而是因为队列内的医院发生了变化。在第一至第四年，我们没有纳入所有医院，而是选择能够提交至少3年数据的医院，以确保随时间推移的变化主要是归因于医院间治疗模式的改变，而不是因为提交数据的其他医院做得更好。

　　<International Circulation>:  Your definition of optimal medical therapy was ejection fraction <30% and then given an ACE-inhibitor or ARB and a beta-blocker. Why were these parameters chosen?

　　《国际循环》： 您对最佳药物治疗的定义是，对射血分数<30%的患者给予一种ACEI或ARB和一种β受体阻滞剂。为何选择这些指标？

　　Dr Dodson:  There have been multiple randomized trials showing mortality benefit in patients with systolic dysfunction prescribed beta-blocker therapy and ACE-inhibitor therapy dating back to the 1980s. There is very good data that those patients live longer with both an ACE-inhibitor and a beta-blocker. One drug has an incremental benefit over the next. In the guidelines for patients with heart failure and systolic dysfunction， it is a class I indication， meaning that at that level of evidence， unless there is some contraindication that we have excluded from our sample， the patients should absolutely undertake this regimen.

　　Dr Dodson: 1980s以来，已有多项随机化试验显示了收缩功能不全患者服用β受体阻滞剂和ACEI带来的生存获益。有很好的数据表明这些患者采用ACEI和β受体阻滞剂联合治疗可生存更久。一种药物对另一种具有增量获益。在心力衰竭和收缩功能不全患者的管理指南中，这被列为I级适应证，就是说在这一证据水平下，除非存在某种禁忌证（我们的样本中已排除在外），患者绝对应当服用这些药物。
 

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