News in brief: Pendulum swings away from aspirin for primary CVD prevention; Antibiotic prescribing halved during pandemic; Online program improves well-being of stroke survivors

Wednesday, 27 Apr 2022

Pendulum swings away from aspirin for primary CVD prevention

The US Preventive Services Task Force (USPSTF) has tightened its recommendations on the use of aspirin to prevent cardiovascular disease.

It concludes that aspirin use has a small net benefit in the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk, based on a CVD risk calculator.

However aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit given the increasing risk of bleeding with older age.

It said for people who have initiated aspirin use, the net benefits continue to accrue overtime in the absence of a bleeding event.

“The net benefits, however, generally become progressively smaller with advancing age because of an increased risk for bleeding, and modeling data suggest that it may be reasonable to consider stopping aspirin use around age 75 years.”

Read more in JAMA

Antibiotic prescribing halved during pandemic

The number of antibiotics prescribed in Australia fell by as much as 50% during the COVID-19 pandemic, a study has shown.

An analysis of outpatient antibiotic prescriptions issued from January 2014 to April 2021 showed that the number of prescriptions dropped sharply as national restrictions were implemented at the start of the pandemic in March 2020 and remained lower than usual during the period studied.

In winter 2020, there were 1,432,000 prescriptions per month compared to 2,313,000 the same month in 2019, a 38% reduction. Summer 2021 showed a 23% reduction in prescriptions compared to the summers of 2018 , according to Dr Jack Skeggs of Monash Infectious Diseases, Monash Health.

The reductions were predominantly in antibiotics such as amoxicillin used to treat community-acquired respiratory infections which showed a 52% reduction in prescribing the winter of 2020 compared to pre-pandemic levels. Prescription of antibiotics such as trimethoprim commonly used for other indications, remained stable.

Some of the reduction is likely to be due to the social distancing measures introduced to curb COVID-19 also reducing the spread of other respiratory infections, Dr Skeggs suggested.

He said it was notable that reductions occurred in all states and territories despite significant differences in COVID-19 case numbers and duration of lockdowns

“This is particularly promising as it suggests that the reductions were not dependent on high case numbers or the most onerous social distancing measures like lockdowns and it may therefore be possible to maintain some of the decreases after the pandemic,” he said.

“Our finding that certain broad-spectrum antibiotics like amoxicillin-clavulanate appear to be being prescribed for community-acquired respiratory infections suggests that antibiotic prescribing for respiratory illness remains a valuable target for future anti-microbial stewardship programs,” he added.

The findings were presented at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal.

Online program improves well-being of stroke survivors

Access to an online program that provides interactive, tailored healthy lifestyle and behaviour change techniques is associated with better health-related quality of life among adult stroke survivors.

An Australian RCT compared outcomes in 399 patients randomised to either the 12-week online program Prevent 2nd Stroke (P2S) or a control arm who were mailed a list of generic health information websites. The group with P2S access also received additional text messages encouraging use of the program.

The P2S online healthy lifestyle program improved stroke survivors’ self-reported global ratings of health-related quality of life (as measured by EQ-VAS) at the 6-month follow-up.

“Additionally, more stroke survivors in the intervention group reported having no problems with personal care and usual activities compared to those in the control group (as measured by EQ-5D) at 6-month follow-up.”

“This indicates that prevention and health risk behaviour change care provision through an online platform is an effective model to engage, support, and improve the lives of stroke survivors.”

Read more in PLOS Medicine

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