Abstract
How the Coronavirus Disease 2019 (COVID-19) pandemic has affected prevention and management of cardiovascular disease (CVD) is not fully understood. In this study, we used medication data as a proxy for CVD management using routinely collected, de-identified, individual-level data comprising 1.32 billion records of community-dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. Here we describe monthly counts of prevalent and incident medications dispensed, as well as percentage changes compared to the previous year, for several CVD-related indications, focusing on hypertension, hypercholesterolemia and diabetes. We observed a decline in the dispensing of antihypertensive medications between March 2020 and July 2021, with 491,306 fewer individuals initiating treatment than expected. This decline was predicted to result in 13,662 additional CVD events, including 2,281 cases of myocardial infarction and 3,474 cases of stroke, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medications decreased by 16,744 patients per month during the first half of 2021 as compared to 2019. By contrast, incident use of medications to treat type 2 diabetes mellitus, other than insulin, increased by approximately 623 patients per month for the same time period. In light of these results, methods to identify and treat individuals who have missed treatment for CVD risk factors and remain undiagnosed are urgently required to avoid large numbers of excess future CVD events, an indirect impact of the COVID-19 pandemic.
| Original language | English |
|---|---|
| Pages (from-to) | 219–225 |
| Number of pages | 7 |
| Journal | Nature Medicine |
| Volume | 29 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 19 Jan 2023 |
Bibliographical note
Funding Information:A.B. has received grant funding from AstraZeneca, the National Institute for Health and Care Research, UK Research and Innovation, the European Union and the British Medical Association. All other authors declare no competing interests.
Funding Information:
This work is carried out with the support of the BHF DSC led by HDR UK (BHF grant no. SP/19/3/34678) and makes use of de-identified data held in NHS Digital’s Trusted Research Environment for England, the SAIL Databank and the Scottish National Data Safe Haven, made available via the HDR UK BHF Data Science Centre’s CVD-COVID-UK/COVID-IMPACT consortium. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make health-relevant data available for research. This study makes use of anonymized data held in the Scottish National Safe Haven. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland) for their involvement in obtaining approvals, provisioning and linking data and the use of the secure analytical platform within the National Safe Haven. This study makes use of anonymized data held in the SAIL Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We would like to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University HDR UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Wales Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP), project number 0911. The project was approved by the BHF DSC Approvals & Oversight Board, which included patient and public partners, who were also consulted as results were produced and provided input into the final manuscript. The BHF DSC (grant no. SP/19/3/34678, awarded to HDR UK) funded co-development (with NHS Digital) of the TRE, provision of linked datasets, data access, user software licenses, computational usage and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government’s Chief Scientific Adviser’s National Core Studies program to coordinate national COVID-19 priority research. Consortium partner organizations funded the time of contributing data analysts, biostatisticians, epidemiologists and clinicians. This work was supported by the Con-COV team funded by the UK Medical Research Council (grant no. MR/V028367/1). This work was supported by HDR UK, which receives its funding from HDR UK (HDR-9006) funded by the UK Medical Research Council, the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the Department of Health and Social Care (England), the Chief Scientist Office of the Scottish Government Health and Social Care Directorates, the Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), BHF and the Wellcome Trust. This work was supported by the ADR Wales program of work. The ADR Wales program of work is aligned to the priority themes 410 as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence that supports Prosperity for All by using the SAIL Databank at Swansea University to link and analyze anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) and funded by ADR UK (grant no. ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. All three national TREs receive support from the Data and Connectivity National Core Study, led by HDR UK in partnership with the Office of National Statistics and funded by UK Research and Innovation (grant no. MC_PC_20029). Additional funding was provided by the Longitudinal Health and Wellbeing COVID-19 National Core Study (UK Research and Innovation (UKRI) Medical Research Council (MRC) MC_PC_20030 and MC_PC_20059), Asthma UK, National Institute for Health Research (NIHR) grant MR/V015737/1 and the NIHR Bristol Biomedical Research Centre.
Funding Information:
This work is carried out with the support of the BHF DSC led by HDR UK (BHF grant no. SP/19/3/34678) and makes use of de-identified data held in NHS Digital’s Trusted Research Environment for England, the SAIL Databank and the Scottish National Data Safe Haven, made available via the HDR UK BHF Data Science Centre’s CVD-COVID-UK/COVID-IMPACT consortium. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make health-relevant data available for research. This study makes use of anonymized data held in the Scottish National Safe Haven. The authors would like to acknowledge the support of the eDRIS Team (Public Health Scotland) for their involvement in obtaining approvals, provisioning and linking data and the use of the secure analytical platform within the National Safe Haven. This study makes use of anonymized data held in the SAIL Databank. This work uses data provided by patients and collected by the NHS as part of their care and support. We would also like to acknowledge all data providers who make anonymized data available for research. We would like to acknowledge the collaborative partnership that enabled acquisition and access to the de-identified data, which led to this output. The collaboration was led by the Swansea University HDR UK team under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organizations: the SAIL Databank, Administrative Data Research (ADR) Wales, Digital Health and Care Wales (DHCW), Public Health Wales, NHS Wales Shared Services Partnership (NWSSP) and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP), project number 0911. The project was approved by the BHF DSC Approvals & Oversight Board, which included patient and public partners, who were also consulted as results were produced and provided input into the final manuscript. The BHF DSC (grant no. SP/19/3/34678, awarded to HDR UK) funded co-development (with NHS Digital) of the TRE, provision of linked datasets, data access, user software licenses, computational usage and data management and wrangling support, with additional contributions from the HDR UK Data and Connectivity component of the UK Government’s Chief Scientific Adviser’s National Core Studies program to coordinate national COVID-19 priority research. Consortium partner organizations funded the time of contributing data analysts, biostatisticians, epidemiologists and clinicians. This work was supported by the Con-COV team funded by the UK Medical Research Council (grant no. MR/V028367/1). This work was supported by HDR UK, which receives its funding from HDR UK (HDR-9006) funded by the UK Medical Research Council, the Engineering and Physical Sciences Research Council, the Economic and Social Research Council, the Department of Health and Social Care (England), the Chief Scientist Office of the Scottish Government Health and Social Care Directorates, the Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), BHF and the Wellcome Trust. This work was supported by the ADR Wales program of work. The ADR Wales program of work is aligned to the priority themes 410 as identified in the Welsh Government’s national strategy: Prosperity for All. ADR Wales brings together data science experts at Swansea University Medical School, staff from the Wales Institute of Social and Economic Research, Data and Methods (WISERD) at Cardiff University and specialist teams within the Welsh Government to develop new evidence that supports Prosperity for All by using the SAIL Databank at Swansea University to link and analyze anonymized data. ADR Wales is part of the Economic and Social Research Council (part of UK Research and Innovation) and funded by ADR UK (grant no. ES/S007393/1). This work was supported by the Wales COVID-19 Evidence Centre, funded by Health and Care Research Wales. All three national TREs receive support from the Data and Connectivity National Core Study, led by HDR UK in partnership with the Office of National Statistics and funded by UK Research and Innovation (grant no. MC_PC_20029). Additional funding was provided by the Longitudinal Health and Wellbeing COVID-19 National Core Study (UK Research and Innovation (UKRI) Medical Research Council (MRC) MC_PC_20030 and MC_PC_20059), Asthma UK, National Institute for Health Research (NIHR) grant MR/V015737/1 and the NIHR Bristol Biomedical Research Centre.
Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Nature America, Inc.
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