0036: Management of acute pericarditis in the emergency room. A real-life study in a tertiary care center in France

Abstract

Few data on the management of acute pericarditis (AP) in emergency departments (ED) are available. We sought to describe the characteristics and outcomes of patients diagnosed for acute pericarditis (AP) in our ED in a tertiary care university hospital. We retrospectively retrieved all the patients diagnosed for AP in our ED from 01/2011 to 06/2013. We collected the data from medical files and through a questionnaire sent to general practitioners. We identified 150 patients (age 42±16 years, 66% males). The 2004-ESC guidelines criteria for the diagnosis of AP were met only in 48% of cases. An increased (>5 mg/l) C-reactive protein (CRP) was present in 51.3% of patients, with significantly higher levels when symptoms onset exceeded 24 hours in patients meeting the diagnostic criteria (79.1 vs. 14.9 mg/l in patient with – vs. without ESC diagnostic criteria, p<0.029). In 49% of cases, ECG was compatible with the diagnosis of AP. An echocardiography was performed during the ED stay in 77% of patients, showing a pericardial effusion in 26% of cases. Patients were hospitalized in 27% of cases. Aspirin was the most often prescribed (84%). Colchicine alone or in association with aspirin was proposed in 30% of patients and was significantly associated with a medical history of pericarditis (63% with- vs. 25% without history of AP, p<0.0001). The duration of drug therapy was longer for colchicine than for other anti-inflammatory drugs (respectively 58±31 vs. 26±13 days, p<0.01). Follow-up data were only available in 50 patients: only 52% have consulted their physician within a period of 1 to 120 days after discharge. Treatment side effects were noted in 6% and recurrence in 4% of cases. This study highlights the lack of a systematic guidelinesbased management of patients with acute pericarditis in the emergency room. The assessment of CRP is of diagnostic value in this setting especially after 24 hours of symptoms onset. This marker may be considered in the future guidelines updates. Since a majority of these cases are managed as outpatients, emphasis should also be made for an adequate and systematic follow-up.