I’m Aware That I’m Rare: Victor F. Tapson, MD
Victor F. Tapson, MD discusses the pulmonary embolism response team [PERT], a network of multidisciplinary pulmonary embolism response teams working to improve the care of patients with severe PE. The PERT Consortium intends to guide and influence pulmonary embolism (PE) care and research in institutions across the U.S. and will be the driving force behind increased survival rates and the future of PE treatment.
I’m Vic Tapson. I’m at Cedar Sinai Medical Center in Los Angeles. I’m in pulmonary critical care medicine and my main clinical and research interests are pulmonary hypertension and pulmonary embolism.
Today I want to talk about the concept of the pulmonary embolism response team [PERT] and how it interfaces with CTEPH.
We think of this as a concept of a patient coming in the hospital with acute pulmonary embolism and a team of people trying to decide how to best handle things. And that’s really what a PERT is. We also follow patients long term. When we see someone in the hospital with acute pulmonary embolism, they have our contact information, we see them back in the clinic, usually within two weeks. We see them again at three months, and we follow them forever. And I think that’s very important. You get your CTEPH population referrals often as full blown CTEPH patients with bad pulmonary hypertension. They’re seen by a pulmonologist or cardiologist, who figure out they’ve got PH and they may figure out they have CTEPH. Either way, they’re sent to you and you diagnose them with CTEPH and try to get them treated.
The other pathway that’s very important is of course to realize everyone with CTEPH had pulmonary embolism at one point. So when those patients come to our clinic, we’re following them not only to see how they’re doing acutely, but to keep in mind there are certain risk factors for CTEPH. Splenectomy, perhaps the size of the PE. Again, certain things that may put patients at higher risk for CTEPH. But either way, we follow them along, we follow their symptoms. In certain cases we repeat imaging. We always make sure the echocardiogram goes back to normal. But this is a great way with a big pulmonary embolism clinic like we have at Cedars, if you’re following hundreds and hundreds of acute PE patients, you’re going to get CTEPH eventually and you’re not going to miss them if they’re in a clinic like that.
So I’d certainly encourage patients with acute pulmonary embolism to be seen in a PE clinic, if you have one like we have at Cedars. If you don’t, the family practitioner, internist, whoever might follow that patient, probably ought to refer them to an expert once a year. Have them talk to them about their breathing, consider duration of anticoagulation. Understand that we have new data now with Amplify Extend and Einstein Choice for longer therapy of anticoagulation with lower doses of either 10 milligrams of rivaroxaban or 2.5 twice daily of apixaban. Bottom line is we’ve got a lot of new things going on and people need to know about that, so consider after your PERT patients are seen in the hospital, make sure they get long term follow up, you may pick up some CTEPH that way.
I’m President right now of the PE Response Team Consortium. This is a 501(c)(3), organized initially at Mass General Hospital with the help of individuals like Ken Rosenfield, and the concept’s really evolved and caught on. Having a PE response team in your hospital and also getting that PE response team to join our national consortium, which actually is international. We’ve had folks from Brazil and Shaoping Lee from China, some great organizations from South America. So we’re becoming international. And this PERT concept involves several things. One is making sure you have a fully operational PERT at your hospital, but also getting involved with and getting the word out about acute pulmonary embolism, PE research, clinical trials. With the PERT Consortium, we’re organizing clinical trials, endorsing certain trials, coming up with ideas. We have a number of just fantastic committees. We have an amazing education committee, protocol committee, governance committee, communications committee, research committee.
We have a great database that’s finally getting off the ground. We’ve moved our database from Mass General to the Boston Clinical Research Institute with Mike Gibson. We’re very excited about that. This REDCap database is going to help us get quality assurance data from around the country as well as a lot of research data. So we’re going to make some big moves in the next year or so with all the data we’re gathering, and try to determine, based on a lot of PERT data, what the best studies are to do next, where we stand and what the major problems in pulmonary embolism are.
This disease continues to kill 100,000 people per year in the United States. Probably affects 800,000 to 900,000 per year in the United States. It’s a bad disease that not only leads to death in some cases, but can lead to CTEPH and other complications. So the PERT Consortium is really trying to work hard to get a multidisciplinary group of individuals from cardiology, pulmonary, radiology, interventional radiology, ED, vascular surgery, vascular medicine, multidisciplinary groups, CT surgery, so that we can work together to come up with the best solutions for pulmonary embolism.
I’m Vic Tapson, and I’m aware that I’m rare.
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