The adverse impact of COVID-19 pandemic on cardiovascular disease prevention and management in England, Scotland and Wales: A population-scale analysis of trends in medication data

  1. Caroline E Dale
  2. Rohan Takhar
  3. Ray Carragher
  4. Fatemeh Torabi
  5. Michalis Katsoulis
  6. Stephen Duffield
  7. Seamus Kent
  8. Tanja Mueller
  9. Amanj Kurdi
  10. Stuart McTaggart
  11. Hoda Abbasizanjani
  12. Sam Hollings
  13. Andrew Scourfield
  14. Ronan Lyons
  15. Rowena Griffiths
  16. Jane Lyons
  17. Gareth Davies
  18. Dan Harris
  19. Alex Handy
  20. Mehrdad Alizadeh Mizani
  21. Chris Tomlinson
  22. Mark Ashworth
  23. Spiros Denaxas
  24. Amitava Banerjee
  25. Jonathan Sterne
  26. Kate Lovibond
  27. Paul Brown
  28. Ian Bullard
  29. Rouven Priedon
  30. Mamas A Mamas
  31. Ann Slee
  32. Paula Lorgelly
  33. Munir Pirmohamed
  34. Kamlesh Khunti
  35. Naveed Sattar
  36. Andrew Morris
  37. Cathie Sudlow
  38. Ashley Akbari
  39. Marion Bennie
  40. Reecha Sofat
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Abstract

Objectives

To estimate the impact of the COVID-19 pandemic on cardiovascular disease (CVD) and CVD management using routinely collected medication data as a proxy.

Design

Descriptive and interrupted time series analysis using anonymised individual-level population-scale data for 1.32 billion records of dispensed CVD medications across 15.8 million individuals in England, Scotland and Wales.

Setting

Community dispensed CVD medications with 100% coverage from England, Scotland and Wales, plus primary care prescribed CVD medications from England (including 98% English general practices).

Participants

15.8 million individuals aged 18+ years alive on 1stApril 2018 dispensed at least one CVD medicine in a year from England, Scotland and Wales.

Main outcome measures

Monthly counts, percent annual change (1stApril 2018 to 31stJuly 2021) and annual rates (1stMarch 2018 to 28thFebruary 2021) of medicines dispensed by CVD/ CVD risk factor; prevalent and incident use.

Results

Year-on-year change in dispensed CVD medicines by month were observed, with notable uplifts ahead of the first (11.8% higher in March 2020) but not subsequent national lockdowns. Using hypertension as one example of the indirect impact of the pandemic, we observed 491,203 fewer individuals initiated antihypertensive treatment across England, Scotland and Wales during the period March 2020 to end May 2021 than would have been expected compared to 2019. We estimated that this missed antihypertension treatment could result in 13,659 additional CVD events should individuals remain untreated, including 2,281 additional myocardial infarctions (MIs) and 3,474 additional strokes. Incident use of lipid-lowering medicines decreased by an average 14,793 per month in early 2021 compared with the equivalent months prior to the pandemic in 2019. In contrast, the use of incident medicines to treat type-2 diabetes (T2DM) increased by approximately 1,642 patients per month.

Conclusions

Management of key CVD risk factors as proxied by incident use of CVD medicines has not returned to pre-pandemic levels in the UK. Novel methods to identify and treat individuals who have missed treatment are urgently required to avoid large numbers of additional future CVD events, further adding indirect cost of the COVID-19 pandemic.

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