The impact of COVID-19 on heart failure epidemiology and outcomes across primary care: a population-based cohort study

Date of Approval
Application Number
Technical Summary

Heart failure (HF) affects approximately 2% of the general population and up to 10% of the elderly. It is associated with high mortality and morbidity and consumes over 2% of the entire NHS budget. The COVID-19 pandemic has had a massive impact on healthcare systems and the delivery of care. These changes led to a reduction of hospitalizations for heart failure, paralleled by increased mortality. The increased HF mortality during the peak of the SARS-CoV2 pandemic necessitates further research to understand its underlying reasons so that they can be mitigated in the future.
We will interrogate complementary, national, linked data sources to ascertain changes the year before, the years during and the year after the SARS-CoV2 pandemic. We will use de-identified individual patient data from key national datasets: The Clinical Practice Research Datalink (CPRD) to obtain information on primary care, the Hospital for Episode Statistics (HES) for hospitalizations, and the Office for National Statistics (ONS) for mortality.
We will link information of approximately 100,000 patients with HF to determine the changes that occurred during the COVID-19 pandemic and compare them to before and after the SARS-CoV2 pandemic to describe the epidemiology of HF during COVID-19 as well as the changes observed in the quality of care and outcomes.
We will use standard descriptive statistics to compare baseline clinical characteristics. Incidence rates of HF hospitalizations will be calculated, and incidence rate ratios (IRR) will be compared using Poisson regression. Cumulative incidence curves for adverse events (i.e. all-cause mortality and HF hospitalization) will be estimated and compared between groups using the Log-rank test. Cox proportional hazard models will be estimated to assess the prognostic significance of the parameter analysed.

Health Outcomes to be Measured

We will measure for each of the time frames:
1. Incidence and prevalence of HF
2. Aetiology of HF
3. Quality of care for both incident and prevalent HF (i.e. the proportion of patients having “essential diagnostic tests” and the average time-to-optimization of medical therapy for those with incident HF).
4. All-cause mortality, cardiovascular mortality, hospitalization rates for both incident and prevalent HF in each of the three time periods. We will also examine the association between the above Quality of Care Indicators, and mortality and readmission rates.


Theresa McDonagh - Chief Investigator - King's College London (KCL)
Antonio Cannata - Corresponding Applicant - King's College London (KCL)
Daniel Bromage - Collaborator - King's College London (KCL)


HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation