University of East Anglia

TUESDAY, July 16, 2024 -- A considerable proportion of older adults without known valvular heart disease (VHD) have asymptomatic VHD, with age the only parameter associated with significant VHD, according to a study published online June 26 in the European Heart Journal: Cardiovascular Imaging . Vasiliki Tsampasian, M.D., from Norwich Medical School at the University of East Anglia in the United Kingdom, and colleagues conducted a prospective cohort study between 2007 and 2016 to examine the prevalence and associated factors of asymptomatic VHD in individuals aged 60 years and older. Data were included for 4,237 participants. The researchers found that VHD was diagnosed in 28.2 percent of patients. The most common types of VHD were regurgitation of the tricuspid, mitral, and aortic valves (13.8, 12.8, and 8.3 percent, respectively). The rate of prevalence of clinically significant VHD was 2.4 percent, with 2.2 and 0.2 percent moderate and severe, respectively. Mitral and aortic regurgitation were the most common. Age was the only parameter associated with significant VHD (odds ratio, 1.07 per one-year increment). To diagnose one clinically significant case of VHD, the number needed to scan was 42 and 15 for individuals aged 60 years and older and 75 years and older, respectively. "These valuable data can lay the foundation for further epidemiological studies evaluating the burden of VHD in the community and the potential role of echocardiographic screening in the elderly population," the authors write. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Taxing certain antibiotics could help efforts to tackle the escalating threat of antibiotic resistance in humans, according to a new study. Taxing certain antibiotics could help efforts to tackle the escalating threat of antibiotic resistance in humans, according to a new study by the University of East Anglia's Centre for Competition Policy, Loughborough University and E.CA Economics. Antimicrobial resistance (AMR) poses a significant global risk, causing an estimated 700,000 deaths annually. A key AMR report previously warned that if unchecked, it could endanger 10 million lives a year and result in $100 trillion in lost economic output by 2050. Human use of antibiotics is the primary driver of AMR, with the majority in the UK prescribed via GPs. Classified as narrow or broad-spectrum, narrow-spectrum drugs target specific bacteria, helping slow AMR but require knowing the organism causing the infection. Broad-spectrum antibiotics are used more generally when the organism is unknown, exacerbating AMR. The UK government report, published in 2016, recommended testing for pathogens before prescribing and using narrow-spectrum drugs when appropriate, with costly or time-consuming testing leading to overprescribing of broad-spectrum antibiotics and contributing to AMR levels. In this new study, economists examined the feasibility of 'taxing' GP surgeries for using particular broad-spectrum drugs -- the idea being that when they prescribe them, the amount charged to their drug budget would be higher by the amount of the tax. Writing in the International Journal of Industrial Organization, they argue that because GPs can choose which drug to prescribe this could encourage greater use of narrow-spectrum drugs as well as aim to reduce testing time and costs. It could also potentially help manage the demand for antibiotics by adjusting the relative pricing of the drugs. Co-author Prof Farasat Bokhari, previously of UEA's School of Economics and now at Loughborough University, said: "Antibiotic resistance is an important issue and a priority for UK health policy. It's possibly the next ticking time bomb in the healthcare system. "In our analysis, the financial burden of the tax is not on the patients but rather on the GP practices who may be overprescribing in some cases. Our findings show that switching from broad to narrow-spectrum is possible via changes in relative prices brought about via taxation, but it has implications -- in terms of the total cost to society. "While the alternative tax regimes we consider differ in how much demand will shift, our estimates suggest that these policies can be highly effective in managing that demand." The researchers stress that such tax policies should not be implemented without allowing for exemptions based on the severity of the disease, which the physicians could certify. They also acknowledge that if decisions are time-critical and it is not an option to wait for a precise diagnostic test to know which narrow-spectrum antibiotic to prescribe, this may slow the switch from broad to narrow-spectrum. The study draws on 10 years of monthly sales data for antibiotics dispensed in UK pharmacies and uses economic models to assess substitution patterns between different antibiotics, together with the impact of prices, seasonality, spectrum, and other characteristics of a drug on its demand. It looked at the impact of two types of taxes on different groups of drugs. Firstly, a percentage tax (5% or 20%) on all antibiotics, all broad-spectrum antibiotics, and specific broad-spectrum antibiotics known to contribute most to antibiotic resistance (co-amoxiclav, quinolones, and cephalosporins). Secondly, a fixed amount of tax per unit of the drug. A 20% tax on all antibiotics reduces total antibiotic use by 12.7%. However, it only reduces the use of the most problematic broad-spectrum antibiotics by 29.4%. This tax results in a consumer welfare loss, that is, the difference between what an individual is willing to pay and what they actually pay, of £322 per 1000 people, which amounts to about £19.9 million a year in the UK. However, if the same 20% tax is applied only to the broad-spectrum antibiotics that contribute most to antibiotic resistance, their use drops by 37.7%, and the overall antibiotic use drops by only 2.38% because most patients switch to narrow-spectrum drugs. This more targeted tax results in a smaller consumer welfare loss of £78.2 per 1000 people, or £4.8 million a year. Lead author Dr Weijie Yan, at E.CA Economics, said: "The consumer welfare loss and overall welfare loss from taxing these antibiotics are significant, however they are relatively small compared to the predicted societal costs of antibiotic resistance in terms of deaths and economic losses. "While our simulations show how much demand is shifted from broad to narrow-spectrum, and at what cost, it does not calculate the long-term benefits of switching to drugs with a lower AMR footprint. "It is also clear that the estimated loss in welfare is much smaller than previous estimates of worldwide costs, and so it may be well worth considering such remedies to shift demand to narrow-spectrum drugs."

FRIDAY, June 28, 2024 -- Heart valve disease is much more common in aging adults that has been thought, a new study warns. More than a quarter of healthy and symptom-free people aged 60 and older had previously undetected heart valve disease, researchers report. “Our findings showed that more than 28% of these adults had some form of heart valve disease, although reassuringly it was only mild in the majority of the cases,” said lead researcher Vassilios Vassiliou , a clinical professor of cardiac medicine with the University of East Anglia’s Norwich Medical School in the U.K. “The data also indicated that age was the main factor associated with these heart valve problems, meaning that the older a person is, the higher their chance of having a significant valve issue,” Vassiliou said in a university news release. Blood is meant to flow through the heart in one direction. Valves inside the heart keep blood from flowing back between beats, ensuring optimal function. Heart valve disease occurs when one or more of the heart valves malfunction, either by not opening fully to let enough blood through or by not closing properly, which allows blood to leak back in the wrong direction. “These problems can put extra strain on the heart and make the heart work harder,” said co-lead researcher Michael Frenneaux , of the Royal Brompton Hospital in the U.K. “Over time, it can increase the risk of having a heart attack , stroke and other heart conditions.” Symptoms of heart valve disease can include breathlessness, chest pain, weakness, dizziness, fatigue, swollen ankles and feet, or chest or neck palpitations, researchers said. For the new study, researchers evaluated more than 4,200 UK residents aged 60 and older who had not been diagnosed with heart valve disease. The participants filled out a health questionnaire, then underwent a clinical exam and an ultrasound reading of their hearts. Heart valve disease was found in 28% of them, although moderate to severe disease was found in only 2.4%, results show. One in every 42 of those 60 and older had undiagnosed valve disease, researchers estimated. That goes up to one in 15 for those 75 and older. The diagnosis of valve disease relies heavily on heart ultrasound exams, but those are “normally only carried out if symptoms are reported or if an unusual murmur is heard during a physical examination,” Vassiliou said. “This can be challenging in the elderly because mild symptoms may be masked by reduced physical activity and impaired mobility,” Vassiliou added. “This study reveals that many older adults have heart valve issues, even if they don't show any symptoms, and we would suggest that if people do develop any new symptoms or signs that could indicate heart disease to discuss this with their doctor,” Vassiliou said. Further studies are needed to figure out the exact prevalence of heart valve disease in the elderly, as well as better screening methods to accurately identify and manage the disease. The new study was published June 26 in the European Heart Journal-Cardiovascular Imaging . Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.