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Concord, Australia

Chwan Ng A.C.,University of Sydney | Chung T.,University of Sydney | Yong A.S.C.,University of Sydney | Wong H.S.P.,Concord Hospital Concord | And 2 more authors.
Circulation: Cardiovascular Quality and Outcomes | Year: 2011

Background-There are currently no guidelines advising long-term surveillance of patients following an acute pulmonary embolism (PE), because long-term outcome studies are rare. We investigated the long-term cardiovascular and all-cause mortality of a large patient cohort with confirmed PE in relation to baseline cardiovascular disease (CVD). Methods and Results-Clinical details of all patients presenting with acute PE to a tertiary hospital were retrieved from medical records, and their survival tracked from a statewide death registry. There were 1023 (45% males) patients admitted with confirmed PE from 2000 to 2007. During a mean follow-up of 3.8±2.6 years, 363 patients died (35.5%), of whom only 31 (3.0%) died in-hospital during the index PE admission. The 3-month, 6-month, 1-year, 3-year, and 5-year cumulative mortality rates were 8.3%, 11.1%, 16.3%, 26.7%, and 31.6% respectively. Annual mortality did not improve over the 7-year period. The postdischarge mortality of 8.5%/patient-year was 2.5-fold that of an age- and sex-matched general population, being 12.6-fold in the youngest quintile (-55 years) and 1.9-fold in the oldest quintile (-83 years). Patients with known CVD at baseline had 2.2-fold greater all-cause mortality than those without CVD, and this effect, although at a lower level of risk, remained significant after multivariate analysis. Of the 332 deaths occurring postdischarge, 40% were attributed to cardiovascular causes. Conclusions-In a contemporary adult population, PE is associated with a substantially increased long-term mortality, of which nearly half is cardiovascular. Our study highlights the urgent need to develop long-term surveillance strategies in this population. (Circ Cardiovasc Qual Outcomes. 2011;4:122-128.) thrombosis. © 2011 American Heart Association, Inc..

Riminton D.S.,Concord Hospital Concord | Hartung H.-P.,Heinrich Heine University Dusseldorf | Reddel S.W.,Concord Hospital
Current Opinion in Neurology | Year: 2011

Purpose of Review: New immunomodulating approaches to neuroinflammatory diseases present new challenges in clinical risk management. We review recent data on immunosuppression in diverse settings to guide the assessment and prevention of adverse effects from these therapies with the aim of improving the benefit to risk equation. Recent Findings: Although individual immunomodulatory agents affect the immune system in different ways, there are common themes in patient risk. Impairment of immunity is primarily responsible for an increased risk of a characteristic spectrum of infection-related cancers in immunocompromised patients. Additional themes include the reactivation of existing infections such as herpes viruses, mycobacterial and JC virus infections, vaccine preventable disease, cardiovascular and metabolic risk and immune dysregulation resulting in autoimmune and immune reconstitution inflammatory syndromes. An online immunosuppression screening tool may help reduce omissions in individual patient-specific risk assessment. Summary: Systematic patient-tailored risk management protocols will be required to ensure reduction in preventable adverse outcomes with new immunomodifying approaches to neuroinflammatory disease and thereby optimize the benefits to patients from these treatments. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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