With this proposal, we aim to test the hypothesis that cardiovascular involvement with Covid-19 should be targeted early in primary care in order to be successful in mitigating cardiovascular risk and complications in these patients. As part of this consortium, this study specifically aims to develop a tool that helps to identify cardiovascular high-risk patients with Covid-19 already in primary care, before critical illness has developed. General practitioners can use this tool to ‘flag’ high-risk patients, monitor them more closely, timely refer them to a hospital, or prescribe preventive cardiovascular medication earlier (‘moon shot’).
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.
• 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 - UMC Utrecht
Hendrika van den Ham - Collaborator - Utrecht University
Sander van Doorn - Collaborator - UMC Utrecht