The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis

Alejandra Castanon; Katja Grasic; Simon Chen; Florence Ma; Godspower Oboli; Benjamin D Bray; Andrew Hughes; Martin White; Shahed Ahmad; Jonathan Pearson-Stuttard

doi:10.1186/s12889-023-17282-3

The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis

BMC Public Health. 2023 Dec 7;23(1):2443. doi: 10.1186/s12889-023-17282-3.

Affiliations

¹ Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK. alex.castanon@lcp.uk.com.
² Health Analytics, Lane Clark & Peacock LLP, 95 Wigmore Street, London, W1U 1DQ, UK.
³ Office for Health Improvement and Disparities (OHID), Department of Health and Social Care, 39 Victoria Street, London, SW1H 0EU, UK.
⁴ NHS England, 133-155 Waterloo Rd, London, SE1 8UG, UK.

Abstract

Background: There has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications for future mortality and morbidity. We aimed to estimate the change in diagnosed prevalence, treatment and prescription indicators for AF and hypertension and assess corresponding geographical inequalities.

Methods: Using the Quality and Outcomes Framework (2016/17 to 2021/22) and the English Prescribing Datasets (2018 to 2022), we described age standardised prevalence, treatment and prescription item rates for hypertension and AF by geography and over time. Using an interrupted time-series (ITS) analysis, we estimated the impact of the pandemic (from April 2020) on missed diagnoses and on the percentage change in medicines prescribed for these conditions. Finally, we described changes in treatment indicators against Public Health England 2029 cardiovascular risk targets.

Results: We observed 143,822 fewer (-143,822, 95%CI:-226,144, -61,500, p = 0.001) diagnoses of hypertension, 60,330 fewer (-60,330, 95%CI: -83,216, -37,444, p = 0.001) diagnoses of AF and 1.79% fewer (-1.79%, 95%CI: -2.37%, -1.22%), p < 0.0001) prescriptions for these conditions over the COVID-19 impact period. There was substantial variation across geography in England in terms of the indirect impact of the COVID-19 pandemic on the diagnosis, prescription, and treatment rates of hypertension and AF. 20% of Sub Integrated Care Boards account for approximately 62% of all missed diagnoses of hypertension. The percentage of individuals who had their hypertension controlled fell from 75.8% in 2019/20 to 64.1% in 2021/22 and the percentage of individuals with AF who were risk assessed fell from 97.2% to 90.7%.

Conclusions: Hypertension and AF detection and management were disrupted during the COVID-19 pandemic. The disruption varied considerably across diseases and geography. This highlights the utility of administrative and geographically granular datasets to inform targeted efforts to mitigate the indirect impacts of the pandemic through applied secondary prevention measures.

Keywords: Atrial fibrillation; COVID-19 impact; Cardiovascular disease; Health inequalities; Hypertension.

MeSH terms

Atrial Fibrillation* / diagnosis
COVID-19* / epidemiology
Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / prevention & control
England / epidemiology
Humans
Hypertension* / epidemiology
Interrupted Time Series Analysis
Pandemics / prevention & control