OC 13.4 - Cardio-embolic vulnerability predicts hospitalisation in primary care clinically suspected and confirmed COVID-19 patients: a model development and validation study

Sunday, July 10, 2022

11:30 AM – 11:45 AM

Location: ExCel Center, S11B

Presentation Format: In-Person

Presenting Author(s)

Florien van Royen, MD

PhD student
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
Utrecht, Utrecht, Netherlands

Co-Author(s)

Linda P.T Joosten, MD

PhD-student
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands
Mv

Maarten van Smeden

PhD
Julius Center for HealthSciences and Primary Care, University Medical Center Utrecht, Utrecht University
Utrecht, Utrecht, Netherlands
PS

Pauline Slottje

Research associate
Dept. General Practice, Academic network of general practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
Amsterdam, Noord-Holland, Netherlands
FR

Frans Rutten

Prof, MD, PhD
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands
Geert-Jan Geersing, MD, PhD

Associate Professor
Department General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Utrecht, Utrecht, Netherlands
Sander van Doorn, MD, PhD

MD, PhD
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Utrecht, Utrecht, Netherlands

Background: Cardio-embolic 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.

Aims: The aim of this study was to determine the incremental prognostic value of cardio-embolic vulnerability in predicting the risk of hospital referral in primary care COVID-19 outpatients.

Methods: Data were retrospectively collected from three large Dutch primary care registries. 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) were included. 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. Age, sex, the interaction between age and sex, and the number of cardiovascular and thrombo-embolic 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’.

Results: There were 5,475 patients included for model development and 16,693 for external validation. The full model performed better than the simple model (likelihood ratio test p< 0.001). Older male patients with multiple cardio-embolic 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.

Conclusion(s): For patients with COVID-19 symptoms managed in primary care, the risk of hospital referral was on average 5.1%. Older, male and cardio-embolic vulnerable COVID-19 patients are more at risk for hospital referral.