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Cardiovascular vulnerability predicts hospitalisation in primary care clinically suspected and confirmed COVID-19
Florien S van Royen1, Linda P T Joosten1, Maarten van Smeden2
1Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Insights
Older, male, and cardiovascularly vulnerable patients with COVID-19 symptoms managed in primary care face a higher risk of hospital referral. This study identifies key predictors for hospital admission in these outpatients.
Area of Science:
- Primary Care Research
- Epidemiology
- Cardiovascular Medicine
Background:
- Hospitalized coronavirus disease 2019 (COVID-19) patients with cardiovascular conditions show increased clinical deterioration.
- The predictive value of cardiovascular vulnerability for hospital referral in primary care COVID-19 outpatients remains undetermined.
Purpose of the Study:
- To assess the added value of cardiovascular vulnerability in predicting hospital referral risk among primary care COVID-19 outpatients.
- To identify patient characteristics associated with increased risk of hospital admission.
Main Methods:
- Analysis of anonymized electronic medical records from Dutch primary care registries.
- Development and external validation of a multivariable logistic regression model to predict hospital referral within 90 days.
- Inclusion of patients from the first wave (n=5,475) for model derivation and the second wave (n=16,693) for validation.
Main Results:
- The comprehensive model, including cardiovascular conditions and diabetes, outperformed a simpler age/sex model (p<0.001).
- Older males with multiple cardiovascular conditions and/or diabetes exhibited the highest predicted hospital referral risk (15-20%), compared to the average risk of 5.1%.
- The model demonstrated good calibration and a temporally validated c-statistic of 0.747 (95%CI 0.729-0.764).
Conclusions:
- Cardiovascular vulnerability is a significant predictor of hospital referral in primary care COVID-19 outpatients.
- Older, male, and cardiovascularly compromised individuals with COVID-19 symptoms require closer monitoring in primary care settings.
- The developed model aids in identifying high-risk patients for timely hospital referral.
Objectives:
Cardiovascular conditions were shown to be predictive of clinical deterioration in hospitalised patients with coronavirus disease 2019 (COVID-19). Whether this also holds for outpatients managed in primary care is yet unknown. The aim of this study was to determine the incremental value of cardiovascular vulnerability in predicting the risk of hospital referral in primary care COVID-19 outpatients.
Design:
Analysis of anonymised routine care data extracted from electronic medical records from three large Dutch primary care registries.
Setting:
Primary care.
Participants:
Consecutive adult patients seen in primary care for COVID-19 symptoms in the 'first wave' of COVID-19 infections (March 1 2020 to June 1 2020) and in the 'second wave' (June 1 2020 to April 15 2021) in the Netherlands.
Outcome Measures:
A multivariable logistic regression model was fitted to predict hospital referral within 90 days after first COVID-19 consultation in primary care. Data from the 'first wave' was used for derivation (n = 5,475 patients). Age, sex, the interaction between age and sex, and the number of cardiovascular conditions and/or diabetes (0, 1, or ≥2) were pre-specified as candidate predictors. This full model was (i) compared to a simple model including only age and sex and its interaction, and (ii) externally validated in COVID-19 patients during the 'second wave' (n = 16,693).
Results:
The full model performed better than the simple model (likelihood ratio test p<0.001). Older male patients with multiple cardiovascular conditions and/or diabetes had the highest predicted risk of hospital referral, reaching risks above 15-20%, whereas on average this risk was 5.1%. The temporally validated c-statistic was 0.747 (95%CI 0.729-0.764) and the model showed good calibration upon validation.
Conclusions:
For patients with COVID-19 symptoms managed in primary care, the risk of hospital referral was on average 5.1%. Older, male and cardiovascular vulnerable COVID-19 patients are more at risk for hospital referral.
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