COVID-19 – Some Positive Outcomes

Published: 10 Sep 2020

With the outbreak of this pandemic, there have been many consequences for the delivery of healthcare in the United Kingdom. It became apparent early on that it was having a negative impact on those with cardiovascular disease.

The National Institute of Cardiovascular Outcomes Research (NICOR) run the national clinical audits in this area and these include:

  • adult cardiac surgery
  • percutaneous coronary intervention
  • myocardial infarction, heart failure
  • cardiac rhythm management
  • congenital cardiac disease.

In addition, NICOR runs the Transcatheter aortic valve implantation (TAVI) registry. It was realised that there would be a requirement for access to real-time information. Permissions were obtained from the Secretary of State to carry out data sharing.

NICOR and NHS Digital, working with professional societies and hospitals, created a cardiovascular data spine. This linked NICOR data, Hospital Episode Statistics (HES), Secondary User Service and Office for National Statistics data. This allowed the creation of a trusted NHS Data Environment for rapid data linkage, analysis and reporting. Arrangements were made with several academic partners to convert these data to useful information with associated analyses and dissemination.

This information has proved invaluable in providing close to real time information at many levels from the service to government. It has led to today’s publication showing:

  1. Across the board reduction in cardiovascular services during the pandemic:
    a) Reduced admissions and delays in the treatment of heart attacks
    b) Reduced numbers of cardiovascular interventions
    c) Reduced admissions with heart failure
  2. Increased cardiovascular mortality in the community
  3. The negative effects of age, comorbidity and ethnicity on access to cardiovascular service

There will be many and appropriate comments on the very important messages from this paper. However, I would like to highlight a different aspect of this work. We can see these very important messages that can be achieved by working with real time data and by linking data. When the pandemic wanes and we return to normal working we must not lose this ability to have quick access to such data and the ability to link data.

The other point that must be drawn out is how to assure such quickly available data. Certainly, at the minute, such quickly available data is likely not to have been assured as it would have been previously. However, as we get used to using near to real time data, we shall learn new ways of quickly validating this data so that we will end up with rapidly available but trusted data. The other point here is there is a point where data “is good enough”. This is in keeping with the theme of using data for quality improvement as opposed to that needed for assurance where reputations and renumeration might depend on the quality of the data. Again, with increasing use we might be able to achieve both. The massive advantage of quickly getting data to those who can use it to improve services cannot be underestimated.

Danny Keenan
Medical Director