Respiratory CONNECT meeting Dr Julius Cairn

Risk stratification in PE Clinical parameters – shock, JVP, S3 Imaging – CTPA, echo Biomarkers – Troponin, BNP High mortality risk > 15% - shock, RV dysfunction, positive biomarkers – thrombolyse Intermediate risk 3-15% RV dysfunction and positive biomarkers – iv heparin Low risk <1% mortality Early discharge Above knee DVT – high risk for post-thrombotic syndrome and for PE Risk stratification should improve outcome and reduce length of stay

Duration of anticoagulation Number of studies show no benefit of 6 months over 3 months, also ACCP recommendation Risk of recurrence returns after stopping 0.7% per year VTE provoked by surgery 3% per year for all patients 7.4% per year for unprovoked event In order to justify lifelong anticoagulation 5% or greater risk Consider lifelong anticoagulation in idiopathic PE

Respiratory CONNECT meeting Dr Julius Cairn

Late mortality from CAP Leading cause of death from infectious disease in western countries – mortality rate 5-15% On-going risk of mortality in months/years afterwards >25% of deaths within 30 days are not directly related Nearly 50% deaths overall related to comorbidties Evidence of link between acute respiratory infections and increased risk of cardiovascular events Incidence after CAP : 15 days – 10.7%, 90days 13%, 1 year 33% Prior statin or ACEi treatment Influenza/ Pneumococcal vaccination Further define if cause of CV events and pathogenesis

How differences in medical management of CAP might influence outcome Menendes et al multicentre trial of 4,137 pts Adherence to antibiotic guidelines Shorter length of stay in patients without organ failure Delivery of the first dose of antibiotic within 6 hours of presentation Mortality better in the severe sepsis patients Measurement of oxygenation at presentation Doesn’t distinguish between preventable/inevitable mortality BUT medical management influence outcome Challenge – identify bundles of practice that give best outcomes