Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Open Heart. 2024 Aug 30;11(2):e002732. doi: 10.1136/openhrt-2024-002732.
The COVID-19 pandemic disrupted cardiovascular disease management in primary care in England.
To describe the impact of the pandemic on blood pressure screening and hypertension management based on a national quality of care scheme (Quality and Outcomes Framework, QOF) across key demographic, regional and clinical subgroups.
With NHS England approval, a population-based cohort study was conducted using OpenSAFELY-TPP on 25.2 million NHS patients registered at general practices (March 2019 to March 2023). We examined monthly changes in recorded blood pressure screening in the preceding 5 years in patients aged ≥45 years and recorded the hypertension prevalence and the percentage of patients treated to target (≤140/90 mmHg for patients aged ≤79 years and ≤150/90 mmHg for patients aged ≥80 years) in the preceding 12 months.
The percentage of patients aged ≥45 years who had blood pressure screening recorded in the preceding 5 years decreased from 90% (March 2019) to 85% (March 2023). Recorded hypertension prevalence was relatively stable at 15% throughout the study period. The percentage of patients with a record of hypertension treated to target in the preceding 12 months reduced from a maximum of 71% (March 2020) to a minimum of 47% (February 2021) in patients aged ≤79 years and from 85% (March 2020) to a minimum of 58% (February 2021) in patients aged ≥80 years before recovery. Blood pressure screening rates in the preceding 5 years remained stable in older people, patients with recorded learning disability or care home status.
The pandemic substantially disrupted hypertension management QOF indicators, which is likely attributable to general reductions of blood pressure measurement including screening. OpenSAFELY can be used to continuously monitor changes in national quality-of-care schemes to identify changes in key clinical subgroups early and support prioritisation of recovery from care disrupted by COVID-19.
新冠疫情大流行扰乱了英国初级保健中心的心血管疾病管理。
根据全国医疗质量计划（质量和结果框架，QOF）在关键人口统计学、地区和临床亚组中，描述疫情对血压筛查和高血压管理的影响。
在获得 NHS 英格兰批准的情况下，我们利用 OpenSAFELY-TPP 对在普通诊所注册的 2520 万 NHS 患者进行了一项基于人群的队列研究（2019 年 3 月至 2023 年 3 月）。我们检查了过去 5 年中年龄≥45 岁患者的记录血压筛查每月变化情况，并记录了过去 12 个月中高血压患病率和达到目标治疗的患者比例（年龄≤79 岁的患者为≤140/90mmHg，年龄≥80 岁的患者为≤150/90mmHg）。
过去 5 年中，年龄≥45 岁患者中有记录的血压筛查比例从 90%（2019 年 3 月）下降到 85%（2023 年 3 月）。整个研究期间，记录的高血压患病率相对稳定在 15%。过去 12 个月中，记录的高血压治疗比例从 2020 年 3 月的最高 71%（2020 年 3 月）下降到 2021 年 2 月的最低 47%（2021 年 2 月），年龄≤79 岁的患者，从 2020 年 3 月的 85%下降到 2021 年 2 月的最低 58%（2021 年 2 月），≥80 岁的患者。过去 5 年中，年龄较大的患者、有记录的学习障碍或养老院状况的患者的血压筛查率保持稳定。
疫情大流行极大地扰乱了高血压管理 QOF 指标，这可能归因于血压测量（包括筛查）的普遍减少。OpenSAFELY 可用于持续监测国家医疗质量计划的变化，以早期识别关键临床亚组的变化，并支持从 COVID-19 中断的护理中恢复的优先级。
