University of Cambridge

3

CCU092

Many public health policies (i.e. decisions relating to healthcare for the whole population) could be altered to improve health outcomes, value for money, or both. For example, in heart disease we could change the timing or frequency of risk assessments. In England, statin medicine to help lower cholesterol is offered if the risk of heart disease is high, but for some people it could be better to do this earlier. There are many possibilities and it is not ethical or practical to conduct multiple clinical trials to find the best strategy. Instead, computer modelling can be used to simulate what might happen given different decisions for assessment and treatment. In the light of the impact of COVID19 on both cardiovascular disease risk and overall service burden, it is particularly important that cardiovascular risk assessment and intervention strategy is re-evaluated and optimised, including consideration of the impact of COVID19-related inequalities on outcomes. We will develop a computer model for the progression of heart disease risk, using information from the CVD-COVID-UK database to estimate rates of significant health issues such as diabetes. We will include information about age, sex, ethnicity and risk factors such as smoking and blood pressure. We will check how our model performs against real data, and if successful, use it to evaluate the health outcomes and costs of different public health policies, including: (1) the current England policy offering treatment to people at high risk of heart disease, (2) varying the definition of high risk according to age, and (3) treating people based on their age. We will further conduct a range of analyses relating to inequalities, including (1) exploring whether pre-existing inequalities in assessment and management of heart disease have been exacerbated post-COVID19, and (2) exploring the impact of policy changes on inequalities.

This work will benefit the public and patients through: • Identifying policies that reduce heart disease by improving early detection and treatment. • Encouraging policy change by providing the cost estimates needed by decision-makers. Visit the BHF Data Science Centre website for more detailed information about project outputs. https://bhfdatasciencecentre.org/projects/ccu092/ • Identifying the extent to which COVID19 has impacted inequalities in assessment and management of cardiovascular disease. • Enabling policies to be identified that reduce differences in health outcomes according to factors associated with inequalities such as sex, ethnicity and region. • Enabling future advances in genetics and other measurements to be rapidly tested and put into practice.

This project accessed the following datasets within the Trusted Research Environment(s) for CVD-COVID-UK / COVID-IMPACT: - ENGLAND: - Civil Registration - Deaths - COVID-19 SARI-Watch (formerly CHESS) - Covid-19 Second Generation Surveillance System - Covid-19 UK Non-hospital Antibody Testing Results - Covid-19 UK Non-hospital Antigen Testing Results - COVID-19 Vaccination Adverse Reaction - COVID-19 Vaccination Status - Emergency Care Data Set (ECDS) - GPES Data for Pandemic Planning and Research (COVID-19) - Hospital Episode Statistics Accident and Emergency - Hospital Episode Statistics Admitted Patient Care - Hospital Episode Statistics Critical Care - Hospital Episode Statistics Outpatients - ICNARC: Intensive Care National Audit and Research Centre - Improving Access to Psychological Therapies Data Set - Medicines dispensed in Primary Care (NHSBSA data) - Mental Health Services Data Set - MSDS (Maternity Services Data Set) - NICOR – MINAP: Myocardial Ischaemia National Audit Project - NICOR – NACRM: National Audit of Cardiac Rhythm Management - NICOR – NACSA: National Adult Cardiac Surgery Audit - NICOR – NCHDA: National Congenital Heart Disease Audit - NICOR – NHFA: National Heart Failure Audit - NICOR – PCI: Percutaneous Coronary Interventions - NICOR – TAVI: Transcatheter Aortic Valve Implantation - Secondary Care Prescribed Medicines (EPMA) - Secondary Uses Services Payment By Results - Sentinel Stroke National Audit Programme Clinical Dataset - Uncurated Low Latency Hospital Data (Admitted Patient Care, Outpatients, Critical Care)

03/09/2024

02/09/2025

20/12/2024

De-Personalised

20/12/2024

TRE