Vancouver IM LMR

In this noon report, Nancy went over practice changing guidelines from numerous specialties that were released in 2023.

Slide deck can be found here.

Key learning points:

• Cardiology:
  • CCS released new Antiplatelet guidelines in 2023.
    • The major update is DAPT duration after PCI (elective or post-ACS) in patients at high bleeding risk (HBR); CCS now says these patients can be de-escalated to SAPT (preferably clopidogrel) after just 1-3 months.
    • Clearer guidance is now provided for who is considered “high bleeding risk”.
  • CCS released new Fitness to Drive guidelines in 2023.
  • CCS released a Clinical Practice Update for patients with HFrEF in 2023.
• Respirology:
  • CTS released new Stable COPD guidelines in 2023.
    • The major update is recommended maintenance pharmacotherapy for stable COPD patients; now a LAMA or LABA (not PRN SABA) is recommended for all COPD patients, and anyone with more than mild symptoms is recommended combination LAMA/ LABA (not just LAMA alone).
  • BTS released new Pleural Disease guidelines in 2023.
    • For suspected parapneumonic effusion without frankly purulent fluid, the key feature to inform decision for intercostal drain insertion is fluid pH. If pH not available, fluid glucose can be used.
    • For primary spontaneous pneumothorax, conservative management can be considered if patient is minimally symptomatic regardless of pneumothorax size.
• Gastroenterology
  • AASLD released new guidelines on risk stratification and management of portal hypertension and varices in cirrhosis in 2023.
    • Liver stiffness measurement (LSM) by transient elastography (e.g. FibroScan) + PLT count is now recommended to diagnose clinically significant portal hypertension and guide decision on non-selective beta-blocker (preferably carvedilol) start instead of endoscopy.
  • AASLD also released new guidelines on HCC screening in 2023.
    • Screening should be done in select populations every 6 months with both abdominal ultrasound AND AFP testing.
• Endocrinology
  • Covered by Alex here.
• Infectious Diseases
  • Updated Modified Duke Criteria for the diagnosis of infective endocarditis were released in 2023, with updated major microbiological criteria and major imaging criteria as well as new major domain of surgical criteria, among others.