Introduction:
Clinician perspectives, and high-quality clinical practice guidelines, are concordant in how best to manage Chronic Venous Disease (CVD); but there are concerns that the implementation of best practice is failing. To improve venous service provision, an evaluation of current management practices is needed, alongside epidemiological studies which help to understand trends in disease frequency, causation, and natural history.
Methods:
National datasets composed of electronic healthcare records (EHR) were used to evaluate the epidemiology and management of CVD. Datasets included Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES), UK Biobank (UKB) and Whole Systems Integrated Care (WSIC). Analytics were performed using statistical methods and unsupervised machine learning methods.
Results:
CVD has an annual period prevalence of 5-6%; this is 2% for symptomatic Varicose Veins (C2), and 0.65% for Venous ulceration (C6). Between 2008-2018, the incidence of C2 has remained consistent (300 per 100,000 person years) whilst the incidence of C6 has decreased from 106 to 90 per 100,000 person years. There are seasonal and regional variations in these trends. Primary care management of CVD appears to have improved during this time, whilst secondary care treatment has deteriorated. Clinical progression of CVD occurs in approximately 12% of individuals with 28% of C6 patients experiencing ulcer recurrence. CVD is associated with advanced age, obesity, deprivation, frailty, and female gender; although progression to ulceration is more likely to occur in males and in white ethnic groups. CVD patients require more healthcare resources, and C6 is associated with a poorer quality and quantity of life.
Conclusion:
EHRs assist in understanding CVD epidemiology and identifying areas for improving service provision. EHRs can be hypothesis generating when evaluating factors associated with CVD, but the causal inference is difficult to ascertain. There is scope to optimise the efficiency and usability of EHRs.