ondon’s over-70s may have to wait longer for their Covid-19 jab because of the slow start made in the capital to the vaccinations rollout, it was revealed today.
The Government announced on Sunday that jabs will be offered to nearly five million over 70s and clinically “extremely vulnerable” people from this week.
But, on Monday morning, Nadhim Zahawi, the Vaccine Deployment Minister, clarified that letters to over-70s and clinically vulnerable people would only begin in areas where “the majority of the over-80s” have been successfully vaccinated.
That appeared to exclude London, where only 29.5 per cent of over-80s had been treated according to the first regional statistics published last week. By contrast the North East and Yorkshire had hit 44 per cent, and the North West was at 36 per cent.
Asked on Sky News to confirm that letters would only go out in places that had vaccinated over half of their over-80s, Mr Zahawi said: “Correct. Absolutely right.”
He said some “amazing” areas had vaccinated 90 per cent of over-80s, while Darlington had completed all their care homes residents. Other areas would get more vaccine supplies and more help “to make sure that they're able to vaccinate the majority of the over-80s and finish their care homes, and then move to the over-70s as well”. By
National Institute for Health and Care Excellence (NICE)draft guidancerecommendsdapagliflozin(Forxiga, AstraZeneca) as an add-on option to optimised standard care for patients who haveheart failurewith reduced ejection fraction (HFrEF).
The regulator citesDAPA-HFclinical trial evidence that adding dapagliflozin to standardACE inhibitor, ARB, or sacubitrilvalsartantreatment reduced mortality and hospitalisation risk compared with standard care alone.
An indirect comparison has also shown dapagliflozin is likely to be as effective as sacubitril valsartan at reducing the risk of death from heart disease.
The annual treatment list price before any NHS discounts is £476.98. NICE estimates that around 260,000 people could be eligible for dapagliflozin treatment.
Dapagliflozin should only be started on the advice of a heart failure specialist, and should be monitored once commenced.
Dapagliflozin is approved separately for glucose management in type 1 andtype 2 diabetes, but it is not suitable for patients withtype 1 diabetesat the dose used for HFrEF.
Reaction: Does Not Go Far Enough
Mamas Mamas, professor of cardiology, Keele University whocomments on cardiology issuesforMedscape UKtold us: "The NICE draft guidance around the recommendation of adding dapagliflozin to medically optimised chronic heart failure patients with the SGLT-2 is a step in the right direction for utilising this new class of drugs in patients with heart failure. Nevertheless, I believe that the guideline does not go far enough in its recommendations.
"There are two large randomised controlled trials that have shown the benefits of this class of drugs in symptomatic patients with chronic heart failure and reduced LV function - DAPA-HF andEMPEROR Reduced- using dapagliflozin andempagliflozin. It is therefore surprising that the draft guidelines only focus on dapagliflozin rather than both agents as a class.
"Secondly, patients with HF have significant event rates, and in the real world achieving optimal HF medical treatment takes time. I cannot see any pathophysiological reason why the guidelines recommend waiting until patients with HF are on optimal HF therapies before starting dapagliflozin given that in the real world, optimising patients on triple therapy often takes many months.
"In my view, the guidelines should have advocated a more state-of-the-art approach of rapid initiation/uptitration of quarternary therapy within a month, to reduce the risk of HF events, rather than the more conservative approach that was practised a decade ago.
"Nevertheless, challenges to overcome in the implementation of these guidelines will be around a workforce not used to prescribing/using these drugs that have been the remit of diabetologists to date." By Nicky Broyd, UK Medical News
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