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. 2022 Apr 25:9:856689.
doi: 10.3389/fcvm.2022.856689. eCollection 2022.

Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope?

Amélie Gabet  1 , Clémence Grave  1 , Philippe Tuppin  2 , Thomas Lesuffleur  2 , Charles Guenancia  3 , Viêt Nguyen-Thanh  1 , Romain Guignard  1 , Jacques Blacher  4 , Valérie Olié  1
Affiliations

Nationwide Initiation of Cardiovascular Risk Treatments During the COVID-19 Pandemic in France: Women on a Slippery Slope?

Amélie Gabet et al. Front Cardiovasc Med. .

Abstract

Objectives: This study examines the initiation of prescribed medication treatments for cardiovascular risk (antihypertensives, lipid-lowering drugs, oral anticoagulants in atrial fibrillation, and smoking cessation medications) during the COVID-19 pandemic in the French population.

Methods: For each year between 2017 and 2021, we used the French National Insurance Database to identify the number of people with at least one reimbursement for these medications but no reimbursement in the previous 12 months. We computed incidence rate ratios (IRRs) between 2017-2019 and, respectively 2020 and 2021 using Poisson regression adjusted for age and 2017-2019 time trends. We recorded the number of lipid profile blood tests, Holter electrocardiograms, and consultations with family physicians or cardiologists.

Results: In 2020, IRR significantly decreased for initiations of antihypertensives (-11.1%[CI95%, -11.4%;-10.8%]), lipid-lowering drugs (-5.2%[CI95%, -5.5%;-4.8%]), oral anticoagulants in atrial fibrillation (-8.6%[CI95%, -9.1%;-8.0%]), and smoking cessation medications (-50.9%[CI95%, -51.1%;-50.7%]) compared to 2017-2019. Larger decreases were found in women compared to men except for smoking cessation medications, with the sex difference increasing with age. Similar analyses comparing 2021 to 2017-2019 showed an increase in the initiation of lipid-lowering drugs (+ 11.6%[CI95%, 10.7%;12.5%]) but even lower rates for the other medications, particularly in women. In addition, the 2020 number of people visiting a family physician or cardiologist decreased by 8.4 and 7.4%. A higher decrease in these visits was observed in those over 65 years of age compared to those under 65 years of age. A greater use of teleconsultation was found in women.

Conclusion: The COVID-19 pandemic heavily impacted the initiation of medication treatments for cardiovascular risk in France, particularly in women and people over 65 years.

Keywords: COVID-19 pandemic; cardiovascular; cardiovascular risk; initiation; medication.

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Conflict of interest statement

CGu reported, outside the submitted work, grants from Microport CRM, consulting fees from Boston Scientific and Microport CRM, and honoraria from Medtronic. JB reports, outside the submitted work, personal fees from Abbott, Bayer, Bottu, Ferring, Steripharma, Kantar, Teriak, personal fees and non-financial support from Pfizer, Quantum Genomics, personal fees from Sanofi and Servier. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Incidence rate ratio (IRR)a and 95% confidence intervals (95% CI) between the rates of treatment initiation, respectively in 2020 and 2021 compared to the rates of initiation in 2017–2019 according to lockdown/curfew time-periods. Gray: lockdown period; light gray: curfew period. aadjusted for age and 2017–2019 time trends; W: weeks.
FIGURE 2
FIGURE 2
Incidence rate ratio (IRR)a and 95% confidence intervals (95% CI) between rates of initiation of treatments, respectively in 2020 and 2021 compared to the rates of initiation in 2017–2019 according to sex by age group. aadjusted for age and 2017–2019 time trends; IRRs: Incidence rate ratios; Blue: men; Orange: women.
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