Health Care Access and Risk Factor Control in US adults with Cardiovascular Disease from 2015 to 2023.

Abstract

Background: The COVID-19 pandemic significantly disrupted multiple dimensions of care for adults with cardiovascular disease (CVD) and its associated risk factors. We investigated the changes in health access, disease awareness, treatment, and control among adults with CVD or CVD risk factors after the pandemic.

Methods: We analyzed National Health and Nutrition Examination Survey (NHANES) data from January 2015 to August 2023 of a civilian adult US population aged ≥20 years. We assessed independent measures of the management of hypertension (HTN), hyperlipidemia (HLD), and diabetes (DM) among participants and health access post-COVID-19. Treatment was defined as a positive response to medical therapy. Control was defined as values that achieved recommended targets of hemoglobin A1C <7.0%, mean systolic blood pressure (BP) <130 mmHg, and total cholesterol <150 mg/dL and/or low-density lipoprotein (LDL) <70 mg/dL.

Results: We analyzed 14,354 adults (unweighted) with CVD or CVD risk factors pre and post COVID-19. Compared to pre-COVID-19, high risk adults had higher diastolic BP (73 vs. 76 mmHg, p<0.001), and greater awareness of high cholesterol (63% vs. 66%, p=0.03) and prediabetes (24% vs. 27%, p=0.01) in post-COVID-19 period. However, fewer reported treatments for HTN (89% vs. 80%, p < 0.001) and HLD (50% vs. 41%, p < 0.001). Among adults with CVD risk factors only, adjusted analyses showed declines in HTN awareness (aOR 0.88, 95% CI 0.79-0.98, p=0.02) and treatment (aOR 0.32, 95% CI 0.25-0.42, p<0.001), with unchanged BP control. Across all high-risk adults, DM treatment increased (aOR 1.68, 95% CI 1.46-1.96, p<0.001), while glycemic control worsened (aOR 0.64, 95% CI 0.44-0.94, p=0.023). Overall health access improved post-pandemic (aOR 1.54, 95% CI 1.10-2.14, p=0.01).

Conclusion and relevance: In this high-risk population, health care access improved post-pandemic, but changes in risk factor control were inconsistent. Despite declines in BP awareness and treatment among individuals with CVD or risk factors, overall BP control improved. In contrast, glycemic control worsened despite increased diabetes treatment. These findings highlight a disconnect between patient reported treatment and effective disease control, raising concern for emerging gaps in CVD risk management in the post-pandemic era.