The impact of the COVID-19 pandemic on cardiovascular disease prevention and management : a population-scale analysis of trends in medication data

Dale, Caroline E and Takhar, Rohan and Carragher, Ray and Katsoulis, Michail and Torabi, Fatemeh and Duffield, Stephen and Kent, Seamus and Mueller, Tanja and Kurdi, Amanj and McTaggart, Stuart and Abbasizanjani, Hoda and Hollings, Sam and Scourfield, Andrew and Lyons, Ronan and Griffiths, Rowena and Lyons, Jane and Davies, Gareth and Harris, Dan and Handy, Alex and Mizani, Mehrdad Alizadeh and Tomlinson, Chris and Thygesen, Johan H and Ashworth, Mark and Denaxas, Spiros and Banerjee, Amitava and Sterne, Jonathan and Brown, Paul and Bullard, Ian and Priedon, Rouven and Mamas, Mamas A and Slee, Ann and Lorgelly, Paula and Pirmohamed, Munir and Khunti, Kamlesh and Morris, Andrew and Sudlow, Cathie and Akbari, Ashley and Bennie, Marion and Sattar, Naveed A. and Sofat, Reecha, CVD-COVID-UK Consortium (2023) The impact of the COVID-19 pandemic on cardiovascular disease prevention and management : a population-scale analysis of trends in medication data. Nature Medicine, 29 (1). 219–225. ISSN 1078-8956 (https://doi.org/10.1038/s41591-022-02158-7)

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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.

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