Health data in England show changing patterns of heart diseases before, during and after the pandemic

A comprehensive study of electronic health records for 57 million people living in England has revealed the evolving burden of cardiovascular diseases before, during and after the COVID-19 pandemic.

The study was led by scientists at the Universities of Edinburgh, UCL, and Cambridge with technical and data support from the BHF Data Science Center at Health Data Research UK. The insights gained into the patterns of multiple heart diseases reveal important health inequalities during and after the COVID-19 pandemic that can be targeted to improve cardiovascular health.

The electronic health record data analyzed in this study is anonymized and never leaves a secure data environment, which is only accessible by approved researchers working on approved projects.

The study is published in The Lancet Public Health.

Co-author Professor William Whiteley, Associate Director at the BHF Data Science Center, said, “Our findings show that during the COVID-19 pandemic there were drops in the incidence of some cardiovascular disease, and that disparities in the burden of these conditions were borne unequally by England’s diverse population.

“But diagnosis rates of many conditions have since returned to pre-pandemic levels, and our insights could provide a foundation to push health care resources fairly to who and where they’re needed most. Detecting cases of cardiovascular disease in a targeted and timely way opens up more windows for us to intervene, saving and improving lives.”

Co-author Professor Angela Wood, University of Cambridge and Associate Director at the BHF Data Science Center, said, “During the pandemic, we saw marked rises in the prevalence of conditions like ischemic stroke and heart failure.

Although our study did not investigate reasons behind these trends, we believe these observations may reflect the direct effects of the COVID-19 virus, as well as the indirect effects of disruption to health care delivery and delayed care.

“Harnessing whole population data in a responsible, trustworthy, and secure manner can help us to pinpoint health inequalities, track changes over time, and influence policy decision-making. Our findings could also inform preparation for future pandemics.”

Cardiovascular diseases remain a major public health challenge. The COVID-19 pandemic coincided with higher risks of cardiovascular complications among those with existing conditions, higher rates of new-onset cardiovascular disease, and disruption to routine care.

To gain a high-resolution and comprehensive picture, the research team used linked health data for more than 57 million people in England to determine the impact of the COVID-19 pandemic on 79 different cardiovascular conditions.

The data from hospital, primary care, death and specialist registries covered 1 January 2020 and 31 May 2024. All personal information that could identify individuals had been stripped away, and approved researchers accessed this data entirely within the NHS England Secure Data Environment (SDE), a secure data and analysis platform.

For each heart condition, they looked at the incidence (the rate of new diagnoses per 100,000 people), the prevalence (the percentage of people with both old and new diagnoses), the percentage of people who died from any cause within 30 days of a diagnosis, and the rate of heart attacks and strokes occurring between 30 days and one year after a diagnosis.

They then estimated the changes in these rates before and after the COVID-19 pandemic, pinpointing whether age, sex, ethnicity, deprivation, area, and the number of long-term conditions people were living with had any effects.

The researchers found that the number of new diagnoses of heart conditions fell during the first COVID-19 lockdown in 2020. However, the people who received these diagnoses were more likely to die than at other times from 2020 to 2024. They believe this decrease is because health care services were under severe pressure and only the most seriously ill people were seeking care.

There was a lot of variation between ethnicities. People of Bangladeshi, Indian, and Pakistani ethnicities were more likely to be diagnosed with coronary vascular disease, while people of African, Caribbean, and other Black ethnicities were more likely to experience conditions related to high blood pressure. But diagnoses of these conditions tended to be less fatal than for the white British population.

Geographical location and deprivation also influenced the rates and numbers of cardiovascular diagnoses. For example, there was higher case fatality for heart attacks and stroke in the North, Midlands and parts of the South, as well as in coastal areas of the East.

Comparing before and after the pandemic, the researchers found that in 2024, the number of new cardiovascular diagnoses was up compared with before the pandemic.

In particular, they saw increases in the incidence (26%, or from 5 to 6.4 per 100,000 people), prevalence (50%, or from 0.03% to 0.04%), and the risk of short-term death (from a rate of 8.5% to 17%) from inflammation of heart tissue, called myocarditis, as well as a 25% increase (from 0.9% to 1.2%) in the prevalence of heart failure.

However, the researchers believe these increases are in part due to health care services catching up in the wake of the pandemic, with more diagnoses now being possible as pressure eases and resources are less stretched, and as health care professionals get better at spotting symptoms.

The researchers have developed a dashboard to help researchers, policymakers, and the public to access and interpret their findings. This will be available on the BHF Data Science Center’s website.

The researchers were able to carry out this study under measures put in place during the pandemic to enable COVID-19-related research. In their paper, they note that the approach could continue to provide detailed readouts of cardiovascular diagnoses and inform policymaking, research, and regional commissioning of care, if access to the linked data was possible for uses beyond COVID-19.

Principal author Dr. Elias Allara at the University of Cambridge said, “This study paints England’s burden of cardiovascular disease in unprecedented detail, and research like this is only possible at low cost by leveraging and linking health data on a whole population scale. By revealing where the biggest gaps are in cardiovascular diagnosis and care, our findings lay the groundwork for action to tackle these important inequalities.”

Provided by
Health Data Research UK