Impact of COVID-19 on recorded blood pressure screening and hypertension management in England: an analysis of monthly changes in the quality and outcomes framework indicators in OpenSAFELY
Richard J McManus,
Ben Goldacre,
David Evans,
Alex J Walker,
Christopher Wood,
Jessica Morley,
Brian MacKenna,
Christopher T Rentsch,
Seb Bacon,
Chris Bates,
Helen J Curtis,
Amir Mehrkar,
Peter Inglesby,
Jonathan Cockburn,
Laurie Tomlinson,
John Parry,
Frank Hester,
Amelia Green,
Miriam Samuel,
Rose Higgins,
Andrew D Brown,
Viyaasan Mahalingasivam,
Caroline Morton,
Rebecca M Smith,
Louis Fisher,
Lisa Hopcroft,
Jon Massey,
Iain Dillingham,
Steven Maude,
Milan Wiedemann,
Colm Andrews,
Christine Cunningham,
Victoria Speed,
Caroline Walters
Affiliations
Richard J McManus
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Ben Goldacre
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
David Evans
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Alex J Walker
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Christopher Wood
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jessica Morley
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Brian MacKenna
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Christopher T Rentsch
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
Seb Bacon
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Chris Bates
TPP, Leeds, UK
Helen J Curtis
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Amir Mehrkar
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Peter Inglesby
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jonathan Cockburn
TPP, Leeds, UK
Laurie Tomlinson
Epidemiology and Population Health, London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
John Parry
TPP, Leeds, UK
Frank Hester
TPP, Leeds, UK
Amelia Green
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Miriam Samuel
Wolfson Institute of Population Health, Queen Mary University of London, London, UK
Rose Higgins
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Andrew D Brown
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Viyaasan Mahalingasivam
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
Caroline Morton
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Rebecca M Smith
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Louis Fisher
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Lisa Hopcroft
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Jon Massey
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Iain Dillingham
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Steven Maude
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Milan Wiedemann
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Colm Andrews
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Christine Cunningham
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Victoria Speed
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Caroline Walters
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Background The COVID-19 pandemic disrupted cardiovascular disease management in primary care in England.Objective 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.Methods 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.Results 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.Conclusions 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.
