Burden of Cardiovascular Diseases from 2020 to 2024: A National Cohort in NHS England.

Abstract

Background: Healthcare policy-makers need reliable national-level information on disease burden to plan services. Whole-population individual-level-data, that are routinely-collected and linked across multiple sources, provide comprehensive estimates that can be regularly updated at low cost. We aimed to measure the burden of cardiovascular diseases in a whole population from 2020 to 2024, including the COVID-19 pandemic period. Methods: Using linked NHS England hospital, primary care, death and specialist registers between 1 January 2020 and 31 May 2024, we defined 79 common and rare cardiovascular diseases; estimated incidence, prevalence, 30-day case fatality, and post-diagnosis 30-day to one-year rate of myocardial infarction (MI) or ischaemic stroke; and conducted subgroup analyses based on and adjusted for age, sex, ethnicity, long-term conditions, deprivation, and geographic area. Findings: Analysis of 57,484,685 people in England revealed increases in cardiovascular disease burden. For example, myocarditis incidence rose by 26% in 2024 compared with January-February 2020 (95% confidence interval [95%CI] 4-55%; 6.4 vs 5.0/100,000 person-years); heart failure crude prevalence increased by 25% (95%CI 17-34%; 1.2% vs 0.9%). Subgroup analyses indicated higher burdens among older adults, men, deprived populations, people with multiple long-term conditions, and Asian or Black ethnicities. For example, MI incidence was 81% higher in the Bangladeshi vs. White British ethnicity (adjusted relative rates: 1.81; 95%CI 1.65-1.98). There were clear regional variations in the incidence of stroke, MI, heart failure and peripheral vascular disease. Interpretation: We have demonstrated an approach that provides monitoring of fast-evolving disease burdens and trends that shows important health inequalities at whole-population scale across multiple cardiovascular diseases. We recommend this tool for efficient and effective health service and public health planning beyond the COVID-19 pandemic. Copyright © 2025, The Authors. All rights reserved.