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Acute lower respiratory tract infection in primary care: improving prognosis by considering the interplay between the lung and the heart

Lower respiratory tract infections (LRTIs) may lead to serious complications, including hospitalisation, mortality and acute cardiovascular events. Early identification of patients at increased risk is therefore important in general practice. 

Aim

This project investigated the prognosis of lower respiratory tract infections in primary care. 

Approach

Using routinely collected electronic health record data linked to hospital admission and mortality data, we developed and externally validated a prediction model for hospitalisation or death within 30 days after an LRTI. We also investigated the risk of acute cardiovascular events during and shortly after an LRTI and evaluated the use of natural language processing of free-text electronic health records for prognostic research.

Results

  • The developed prediction model is promising to support general practitioners in estimating the prognosis of patients with an LRTI. 
  • In addition, the risk of acute cardiovascular events—including myocardial infarction, stroke, transient ischaemic attack, pulmonary embolism, deep venous thrombosis and atrial fibrillation—was highest during the first week after an LRTI and remained increased for 1 to 3 months. 
  • The project also demonstrated that language models can be used to retrieve information from free-text electronic health records for scientific research.

Recommendations

  • Currently available prediction models for hospitalisation or mortality after LRTI are not suitable for implementation in everyday general practice and should be further evaluated and improved.
  • Future research should evaluate whether the newly developed and externally validated prediction model improves patient outcomes in routine primary care.
  • Develop interventions, together with patients and general practitioners, aimed at early detection and/or prevention of acute cardiovascular events following LRTI, while promoting uptake of seasonal vaccination against important respiratory pathogens.

Products

Title: Estimated causal effects of common respiratory infections on cardiovascular risk: a meta-analysis.
Author: la Roi-Teeuw HM, van Smeden M, Bos M, de Wilde SM, Yang B, Rutten FH, Geersing GJ.
Magazine: Open Heart
Title: Incomplete and possibly selective recording of signs, symptoms, and measurements in free text fields of primary care electronic health records of adults with lower respiratory tract infections
Author: Rijk MH, Platteel TN, Mulder MMM, Geersing GJ, Rutten FH, van Smeden M, Venekamp RP, Leeuwenberg TM
Magazine: J Clin Epidemiol. 2024 Feb;166:111240
Title: Neutrophil and Eosinophil Responses Remain Abnormal for Several Months in Primary Care Patients With COVID-19 Disease.
Author: Jukema BN, Smit K, Hopman MTE, Bongers CCWG, Pelgrim TC, Rijk MH, Platteel TN, Venekamp RP, Zwart DLM, Rutten FH, Koenderman L
Magazine: Frontiers in Allergy.
Link: https://www.frontiersin.org/articles/10.3389/falgy.2022.942699/full
Title: . Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study.
Author: la Roi-Teeuw HM, van Smeden M, Geersing GJ, Klungel OH, Rutten FH, Souverein PC, van Doorn S.
Magazine: Eur Heart J Open
Title: Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study.
Author: la Roi-Teeuw HM, van Smeden M, Geersing GJ, Klungel OH, Rutten FH, Souverein PC, van Doorn S
Magazine: Eur Heart J Open. 2023 Sep 28;3(6):oead101
Title: Incomplete and possibly selective recording of signs, symptoms, and measurements in free text fields of primary care electronic health records of adults with lower respiratory tract infections.
Author: Rijk MH, Platteel TN, Mulder MMM, Geersing GJ, Rutten FH, van Smeden M, Venekamp RP, Leeuwenberg TM
Magazine: J Clin Epidemiol. 2024 Feb;166:111240
Title: Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study.
Author: la Roi-Teeuw HM, van Smeden M, Geersing GJ, Klungel OH, Rutten FH, Souverein PC, van Doorn S.
Magazine: Eur Heart J Open. 2023
Title: Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes.
Author: Rijk MH, Platteel TN, Geersing GJ, Hollander M, Dalmolen BLGP, Little P, Rutten FH, van Smeden M, Venekamp RP.
Magazine: Diagn Progn Res. 2023 Dec 7;7(1):23
Title: Incidence and individual risk prediction of post-COVID-19 cardiovascular disease in the general population: a multivariable prediction model development and validation study.
Author: la Roi-Teeuw HM, van Smeden M, Geersing GJ, Klungel OH, Rutten FH, Souverein PC, van Doorn S
Magazine: EHJ Open
Title: Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review.
Author: Rijk MH, Platteel TN, van den Berg TMC, et al
Magazine: BMJ open
Title: Estimated causal effects of common respiratory infections on cardiovascular risk: a meta-analysis.
Author: la Roi-Teeuw HM, van Smeden M, Bos M, de Wilde SM, Yang B, Rutten FH, Geersing GJ
Magazine: Open Heart. 2023 Nov 28;10(2):e002501
Title: Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
Author: Rijk MH, Platteel TN, Geersing GJ, Hollander M, Dalmolen BLGP, Little P, Rutten FH, van Smeden M, Venekamp RP
Magazine: Diagn Progn Res.
Title: Neutrophil and Eosinophil Responses Remain Abnormal for Several Months in Primary Care Patients With COVID-19 Disease.
Author: Jukema BN, Smit K, Hopman MTE, Bongers CCWG, Pelgrim TC, Rijk MH, Platteel TN, Venekamp RP, Zwart DLM, Rutten FH, Koenderman L.
Magazine: Frontiers in Allergy

Quick links

  • General practitioner care
  • COVID-19
  • Data and technology
  • Primary care
  • Cardiovascular diseases
  • Lungs
  • Training, learning and professionalisation

    • Features

    • Project number:
      08391052110003
    • Duration: 100%
      2022
      2026
    • Part of programme:
    • Related funding round:
      Huisartsgeneeskunde ronde 2021
    • Project lead and secretary:
      prof. dr. T.N. Platteel MD PhD
    • Responsible organisation:
      Universitair Medisch Centrum Utrecht

    General Practitioner care research

    We need more knowledge from research into general practice, and we need to disseminate this knowledge among GPs in order to maintain the current high standards of research and care. We therefore support academicization by funding PhD research projects for GPs training to become clinical researchers.

    More projects

    Other ZonMw-projects in which projectleader Tamara Platteel and/or applicant Roderick Venekamp is/are invvolved: