Changes in cardiovascular disease monitoring in English primary care during the COVID-19 pandemic: an observational cohort study
medRxiv (Cold Spring Harbor Laboratory)(2020)
Abstract
Objective To quantify the impact and recovery in cardiovascular disease monitoring in primary care associated with the first COVID-19 lockdown.
Design Retrospective nationwide primary care cohort study, utilising data from 1st January 2018 to 27th September 2020.
Setting We extracted primary care electronic health records data from 514 primary care practices in England contributing to the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID). These practices were representative of English primary care across urban and non-urban practices.
Participants The ORCHID database included 6,157,327 active patients during the study period, and 13,938,390 patient years of observation (final date of follow-up 27th September 2020). The mean (SD) age was 38±24 years, 49.4% were male and the majority were of white ethnicity (65% [21.9% had unknown ethnicity])
Exposure The primary exposure was the first national lockdown in the UK, starting on 23rd March 2020.
Main outcome measures Records of cholesterol, blood pressure, HbA1c and International Normalised Ratio (INR) measurement derived from coded entries in the primary care electronic health record.
Results Rates of cholesterol, blood pressure, HbA1c and INR recording dropped by 23-87% in the week following the first UK national lockdown, compared with the previous week. The largest decline was seen in cholesterol (IRR 0.13, 95% CI 0.11 to 0.15) and smallest for INR (IRR 0.77, 95% CI 0.72 to 0.81).
Following the immediate drop, rates of recorded tests increased on average by 5-9% per week until 27th September 2020. However, the number of recorded measures remained below that expected for the time of year, reaching 51.8% (95% CI 51.8 to 51.9%) for blood pressure, 63.7%, (95% CI 63.7% to 63.8%) for cholesterol measurement and 70.3% (95% CI 70.2% to 70.4%) for HbA1c. Rates of INR recording declined throughout the previous two years, a trend that continued after lockdown. There were no differences in the times series trends based on sex, age, ethnicity or deprivation.
Conclusions Cardiovascular disease monitoring in English primary care declined substantially from the time of the first UK lockdown. Despite a consistent recovery in activity, there is still a substantial shortfall in the numbers of recorded measurements to those expected. Strategies are required to ensure cardiovascular disease monitoring is maintained during the COVID-19 pandemic.
### Competing Interest Statement
Prof. Gale reports personal fees from Amgen, personal fees from AstraZeneca, personal fees from Bayer, personal fees from Daiichi Sankyo, personal fees from Vifor Pharma, grants from Abbot, grants from BMS, outside the submitted work. All other authors have None to declare
### Funding Statement
This work was not specifically funded but used data from the ORCHID database, which is partially supported by the University of Oxford Medical Sciences Division Urgent COVID Fund and a discretionary award from the Primary Care Research Trust. All COVID-19 research conducted within ORCHID is supported by Public Health England, the National institute for Health Research (NIHR) Oxford and Thames Valley Applied Research Collaboration. JPS is supported by the Wellcome Trust/Royal Society via a Sir Henry Dale Fellowship (ref: 211182/Z/18/Z) and the NIHR Oxford Biomedical Research Centre. FDRH acknowledges part-funding from the NIHR School for Primary Care Research, the NIHR Collaboration for Leadership in Health Research and Care (CLARHC) Oxford, the NIHR Oxford Biomedical Research Centre (BRC, UHT), and the NIHR Oxford Medtech and In-Vitro Diagnostics Co-operative (MIC). CRB and RP are supported by the NIHR Oxford Biomedical Research Centre and the NIHR Thames Valley Applied Research Collaborative. BDN is supported by an NIHR Academic Clinical Lectureship. MS and CWD are supported by the NIHR Oxford Biomedical Research Centre.
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
University of Oxford Medical Sciences Interdivisional Research Ethics Committee (ref: R69874/RE001).
All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.
Yes
Data were obtained from ORCHID
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Key words
english primary care,cardiovascular disease monitoring,primary care,cohort study
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