Treat pneumonia as a cardiovascular sentinel event: expert

An expert has urged respiratory physicians to change their approach to the way they manage pneumonia, especially post-pneumonia care.

Dr Grant Waterer from the University of Western Australia told TSANZSRS16 delegates here in Perth that cardiovascular events were “much more common” in acute pneumonia and one year after recovery than had previously been recognised.

“I don’t think we can ignore it any longer… twenty percent are going to have a cardiovascular event and if they do, they are running at a four to five times risk of dying over the next three to four years,” he told delegates.

There was a need to move away from the current paradigm of care, which was to treat the patient and discharge once they were better.

“Too many of us are happy that the patient is going out… we feel that we’ve done a good job but we don’t know that they’ve dropped dead 45 days later from an MI or they have a devastating stroke and are in a nursing home,” Dr Waterer said.

He said there was an immediate need for clinicians to change their perspective on their role and treat pneumonia as a cardiovascular sentinel event.

“We have an obligation to look at cardiovascular risk factors at discharge and at least have a communication with the patient and the GP around the need to manage those much more aggressively than we have done in the past,” he said.

While there was a lack of data around how to mitigate the risk Dr Waterer advised delegates to prescribe aspirin, unless contraindicated, initially at a dose of 300mg for the first month post discharge before potentially reducing to 100mg.

The role of statins in these patients was also uncertain but two RCTs on the use of statins in post pneumonia settings were currently underway, he said.

Exercise was also a really important and under-recognised intervention for this group of patients, he added.

Dr Waterer is currently co-Chair of the American Thoracic Society and Infectious Disease Society of North America statement on community-acquired pneumonia.

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