Burden of cardiovascular diseases in England (2020-24): a national cohort using electronic health records data

The COVID-19 pandemic led to substantial health services disruption in England. Health-care policy makers need reliable national-level information on disease burden to plan services. Whole-population individual-level data, which are routinely collected and linked across multiple sources, provide comprehensive estimates that can be regularly updated at low cost. We aimed to measure the burden of cardiovascular diseases in the whole population of England from 2020 to 2024.

Using linked National Health Service England hospital, primary care, death, and specialist registers between Jan 1, 2020, and May 31, 2024, we defined 79 common and rare cardiovascular diseases, and estimated incidence, prevalence, 30-day case fatality, and post-diagnosis rates of myocardial infarction and ischaemic stroke, focusing on five common conditions (myocardial infarction, ischaemic stroke, heart failure, atrial fibrillation, and peripheral vascular disease), as well as pulmonary embolism, myocarditis, and intracranial venous thrombosis. We conducted subgroup analyses based on and adjusted for age, sex, ethnicity, long-term conditions, deprivation, and geographical area.

Analysis of data for 57 406 990 people in England between 2020 and 2024 revealed changes in cardiovascular disease burden. Although incidences after the pandemic were generally stable for the five common diagnoses, myocardial infarction (events per 100 000 person-years: 245·2 vs 216·9; -12%, 95% CI -17 to -6; p=0·0003) and peripheral vascular disease (97·9 vs 86·5; -12%, -21 to -1; p=0·032) showed decreases compared with January to February, 2020. Prevalence increased for ischaemic stroke (1·5% vs 1·8%; +16%, 10 to 21; p<0·0001), heart failure (0·9% vs 1·2%; +25%, 17 to 34; p<0·0001), and atrial fibrillation (2·8% vs 2·9%; +3%; 2 to 5; p=0·0001). There was little change in 30-day case fatality for most common diagnoses before and after the pandemic. Post-diagnosis myocardial infarction and stroke rates from 30 days to 1 year increased for myocardial infarction (events per 100 000 person-years: 18 850 vs 21 289; +13%, 5 to 22; p=0·0023), ischaemic stroke (11 849 vs 13 574; +15%, 7 to 23; p=0·0008), and heart failure (5821 vs 6393; +10%, 1 to 19; p=0·031) after the pandemic. Subgroup analyses indicated higher burdens among older adults, males, deprived populations, people with multiple long-term conditions, and Asian or Black ethnicities. There were clear regional variations in the incidence of stroke, myocardial infarction, heart failure, atrial fibrillation, and peripheral vascular disease.

Our study offers new insights into recent cardiovascular disease patterns and reveals important health inequalities at a whole-population scale for multiple cardiovascular diseases, during and after the COVID-19 pandemic. These inequalities are targets for the improvement of cardiovascular health.

British Heart Foundation Data Science Centre (Health Data Research UK).