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

Cardiovascular disease (CVD) remains the most common cause of mortality and morbidity worldwide, yet the impact of the COVID-19 pandemic on CVD and its risk factors remains unstudied. We use medication data to proxy CVD management using routinely collected anonymised individual-level data comprising 1.32 billion records of linked community dispensed CVD medications from England, Scotland and Wales between April 2018 and July 2021. We describe monthly prevalent and incident counts, annual monthly percentage change of medicines dispensed by CVD indications, focusing on hypertension, hypercholesterolaemia, diabetes, and use interrupted time-series analysis to model the impact of the pandemic. A decline in medicines used for CVD prevention was observed with 733,586 (95%CI 516,763 to 950,409) fewer individuals initiating antihypertensive treatment than expected. This could result in 20,399 additional CVD events, including 3,406 myocardial infarctions (MIs) and 5,188 strokes, should individuals remain untreated over their lifecourse. Incident use of lipid-lowering medicines decreased by 41,456 (95%CI 31,106 to 51,805) patients per month compared to the predicted pre-pandemic trend. Use of incident medicines to treat type-2 diabetes (T2DM) decreased by approximately 12,287 (95%CI 7,686 to 16,887) patients per month. Methods to identify and treat individuals who have missed treatment and remain undiagnosed are urgently required to avoid large numbers of additional future CVD events, further adding to the indirect impacts of the COVID-19 pandemic