From late 2019 onwards, the spread of the novel corona virus SARS-CoV-2 reached pandemic proportions. While the resulting infectious disorder Covid-19 showed a mild disease course in most patients, a small proportion of patients developed critical illness, necessitating oxygen admission or ICU admission with mechanical ventilation, and sometimes leading to death. Early studies showed a clear association of Covid-19 with cardiovascular disease. From an epidemiological aspect, there were clear observations showing an overrepresentation of patients with a history of cardiovascular disease and metabolic risk factors (e.g. diabetes and obesity) in those entering hospital care. Pathophysiological explanations for these observations might involve endothelial involvement, vascular leakage, hypercoagulability and thrombosis in Covid-19 patients with critical illness.
The large population of Covid-19 patients treated in primary care, however, is less well studied, although in this setting timely targeting cardiovascular involvement in Covid-19 might prevent deterioration. This study aims to estimate the incidence of cardiac and thrombo-vascular complications in patients with Covid-19 seen in primary care. Incidence rates will be presented as number of events per 90 person days of follow-up since point of first contact with primary care. Next, we aim to develop a prognostic prediction model in these patients to quantify absolute risks of cardiac and thrombo-vascular complications. Multivariable logistic regression will be performed to obtain adjusted odds ratios with corresponding confidence margins of the relevant predictors of cardiac and thrombo-vascular complications. Last, this study aims to estimate the relative effectiveness of antithrombotic treatment in patients with Covid-19 for preventing these aforementioned adverse outcomes. Potential confounding by indication will be addressed using propensity scoring methods.
Ultimately, this study helps general practitioners to identify patients at high risk of critical illness, monitor them more closely, timely refer them to a hospital, or prescribe preventive cardiovascular medication earlier.
For this study, the main outcome consists of cardiac and thrombo-vascular complications, including:
• Transient ischaemic attack (TIA)
• Ischaemic stroke
• Atrial fibrillation (AF)
• Peripheral artery disease (PAD)
• Acute coronary syndrome (ACS), consisting of acute myocardial infarction (AMI) and unstable angina
• Venous thromboembolism (VTE), consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE);
Olaf Klungel - Chief Investigator - Utrecht University
Patrick Souverein - Corresponding Applicant - Utrecht University
Geert-Jan Geersing - Collaborator - University Medical Centre Utrecht
Hendrika van den Ham - Collaborator - Utrecht University
Sander van Doorn - Collaborator - University Medical Centre Utrecht
HES Admitted Patient Care