CVDPREVENT · National Audit · Quarterly Extraction

England, to March 2026

The March 2026 extraction is the first full quarter to show what happens when a fifth of QOF is torn up and re-aimed at cardiovascular prevention: the incentivised indicators jumped, the de-incentivised one is sliding, and seven new metrics set the baseline for the next frontier — SGLT2 inhibitors.

By Dr Yogasakaran Arjuna · 25 August 2026 · 39 indicators · ~6,070 practices · aggregated practice-level data

01Blood pressure: the March spike finally broke its ceiling

Treated-to-target indicators always peak in March — the QOF year-end effect — then give half of it back by June. What is different this year is the height of the peak: control in under-80s reached 71.4%, clearing every previous March by three to four points, in the first year that BP control carried re-weighted QOF incentives with raised upper thresholds.

The same year-end surge appears in every treated-to-target measure: BP control in coronary heart disease rose 4.7 points on the quarter to 83.7%, and in stroke/TIA 5.1 points to 81.3% — both clear record highs, not just seasonal peaks. Whether these hold through the usual June dip is the question the next extraction answers.

02Lipids: four years of compounding, now accelerating

Cholesterol management is the quietest success in the dataset — a near-monotonic climb with barely any QOF seasonality until this year. Treatment of the QRISK ≥10% group is up more than eleven points since March 2022; treating CVD patients to target (the hard part) added +4.7 points this year alone after lipid targets entered QOF.

03The trade: smoking support paid for it

The 2025/26 contract retired 32 QOF indicators — including offering cessation support to smokers with chronic disease — and redistributed roughly £198m across nine CVD prevention indicators. The audit shows the cost side of that trade with unusual clarity: the indicator's March spike, visible in 2023, 2024 and 2025, has simply vanished.

04Quiet climbers: kidney monitoring keeps compounding

Two monitoring indicators improve every single quarter with almost no seasonality — the signature of embedded workflow change rather than year-end effort. ACR testing in hypertension has risen from 28.6% to 35.3% in two years; in diagnosed CKD from 39% to 54.5% in under three.

05Seven new indicators set the SGLT2i baseline

The March 2026 release is the largest expansion of the audit since 2024, and it points at one drug class. The headline: only about one in three patients with CKD, heart failure or type 2 diabetes who are eligible for an SGLT2 inhibitor is on one — a gap covering roughly 2.7 million people.

The composite indicators frame the prize: 81% of CVD patients are at BP target, but only 46% are at both BP and cholesterol target — the joint measure is where the remaining premature-mortality reduction lives.

06Case-finding: the registers keep growing, the gaps keep shrinking

The prevalence side of the audit continues its long, steady improvement. The AF register has grown 25% since March 2022 (0.92m → 1.15m anticoagulation-eligible patients); the monitored hypertension population is up 27% to 9.5m. Meanwhile every "possible undiagnosed" flag is falling: patients with a high BP reading but no hypertension code are down to 1.86% of the registered population (~940,000 people, from ~1.03m a year ago), and unresolved possible pre-diabetes fell from 1.12% to 0.99%. Detection is genuinely improving — these gaps are closing by diagnosis, not deletion, because the disease registers grow as the flags fall.

07Every indicator, year on year

March 2026 against March 2025, sorted by change. Indicators marked lower = better are case-finding or overtreatment gaps, where a fall is an improvement — their deltas are coloured accordingly.