During COVID-19 pandemic, some heart disease risk markers improved, but others worsened
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Key takeaways:
- The pandemic had variable effects on risk factor control for people with ASCVD.
- Risk factors were more likely to go unmonitored during the pandemic.
Data show many people with atherosclerotic CVD did not have risk factors monitored during the COVID-19 pandemic, leading to variable outcomes in BP, lipid and glucose control, researchers reported.
“Our study showed that control of risk factors in patients with stable ASCVD was not optimal both before and during the first year of the pandemic,” Dean G. Karalis, MD, clinical professor of medicine at Thomas Jefferson University Hospital in Philadelphia, and colleagues wrote. “The pandemic led to less BP control; however, in contrast, during the pandemic a modest improvement in guideline-directed medical therapy for lipid management was demonstrated. In addition, more patients quit smoking during the pandemic while the pandemic had no significant effect on glycemic control in patients with diabetes.”
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In a retrospective study, Karalis and colleagues analyzed data from 24,760 patients with ASCVD from Cardiology Consultants of Philadelphia, an independent cardiac care practice with 32 centers across the Philadelphia region. Patients had at least one outpatient encounter before and during the first year of the COVID-19 pandemic. The mean age of patients was 73 years; 67.2% were men; 88.5% were white. Researchers assessed electronic health record data to evaluate control of BP (< 130/80 mm Hg), LDL (< 70 mg/dL), HbA1c (< 7% for people with diabetes) and smoking status.
The findings were published in The American Journal of Preventive Cardiology.
Within the cohort, 74.8% had hypertension and 26.8% had diabetes.
During the pandemic, there was a significant increase in the number of patients whose risk factors were unmonitored. In the first year of the pandemic, 9.2% had no BP recording in the EHR compared with 0.6% in the year before the pandemic (P < .001). During the first year of the pandemic, 54.8% had no LDL measurement vs. 43.8% in the year before the pandemic (P < .001). Among patients with diabetes, HbA1c values were missing from the EHR for 40.9% during the pandemic vs. 33.8% before the pandemic (P < .001).
Compared with the year before the pandemic, BP control worsened during the pandemic period, rising from 64.2% of patients with hypertension to 65.7% of patients (P = .01). Lipid management, however, improved during the pandemic period, with 43.9% of patients prescribed a high-intensity statin vs. 38.9% in the year before the pandemic (P < .001), and more people achieving an LDL of less than 70 mg/dL. Fewer patients also reported smoking during the pandemic vs. the year before (6.7% vs. 7.4%; P < .001), whereas diabetes control was unchanged.
Researchers found that Black patients and younger patients were more likely to have missing or uncontrolled risk factors during compared with before the pandemic.
“Since most patients had returned to in-person visits by the end of the first year of the pandemic, we were unable to determine the impact of telemedicine on risk factor control, nor the effect of socioeconomic factors assessed by ZIP code,” the researchers wrote. “However, telemedicine likely had an impact on risk factor control and may explain the modest improvement in lipid management during the pandemic and may have prevented worsening control of the patients’ other cardiovascular risk factors.”
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