Vaal Double Strike, technically. You'd have to find another rare jewel too, since Double Strike doesn't have a threshold jewel of its own. If you want to save a lot of money on VDS, a 19/19 gem is like 1/4 the price of a 19/20 and 1/10 the price of a 20/20. All you lose is 0.5% attack speed (and you have to level it to 20).
You can't really change too much more at a fundamental level without spending so many regrets that you'd be better off just rerolling. It's always going to be a bleed-based build, etc.
And I don't think you have much choice other than to dump into life. You're right next to the big life wheel already, and your current life total is extremely low.
Edit: Also Double Strike is a mainhand-only attack, so you could consider replacing Brutality with, say, Ruthless and swapping out the offhand Ichimonji for a shaper stat stick. No idea what effect that would have on your survivability, but even a fairly crappy stat stick is a large dps boost in PoB.