Abstract
BackgroundThe European Society of Cardiology (ESC) guidelines for the diagnosis and management of pericardial diseases identify predictive factors of poor prognosis and advise either in favor or against hospitalization accordingly. We aim to evaluate the adequacy of hospitalization criteria in a cohort of patients presenting to the emergency department (ED) with acute pericarditis.MethodsRetrospective analysis of patients admitted to ED with acute pericarditis, from 2009 to 2019. During ED stay, all patients were evaluated by a cardiologist who decided if the patient was to be discharged or hospitalized. Hospitalized and discharged patients were compared regarding the primary outcome, defined by a composite of: the need for pericardiocentesis and/or cardiac surgery, pericarditis recurrence, and all-cause death. The clinical decision was then counterpoised with ESC guidelines.ResultsA total of 192 patients were included in the analysis (median age 44.5 years old, 83.3% male) of which 87 (45.5%) were hospitalized. A total of 25% registered the primary outcome, mainly due to acute pericarditis recurrence, occurring in 21.9%. Predictors of recurrence were: glucocorticoid therapy (Odds Ratio [OR]=11.93, 95% Confidence Inirtval [CI] 3.13-45.5, p<0.001), fever at admission (OR=2.67, 95% CI 1.29-5.49, p=0.008), immunosuppression (OR=4.03, 95% CI 1.280-12.659, p=0.017) and increased cardiothoracic index (OR 3.85, CI 95% 1.67-8.86, p=0.002). Regarding hospitalisation/discharge decision, the ESC guidelines were respected in 73.4% of the cases. However, no significant difference in the primary outcome was noted whether the ESC guidelines were respected or not (27.5% vs. 24.3%, p=0.707).ConclusionsDiscrepancy between current guidelines and the clinical decision did not translate into a different outcome.
Highlights
Acute pericarditis is a common cause of non-ischemic chest pain in the emergency department (ED) [1]
Regarding hospitalisation/discharge decision, the European Society of Cardiology (ESC) guidelines were respected in 73.4% of the cases
No significant difference in the primary outcome was noted whether the ESC guidelines were respected or not (27.5% vs. 24.3%, p=0.707)
Summary
Acute pericarditis is a common cause of non-ischemic chest pain in the emergency department (ED) [1] In most cases, it is a benign and self-limited disease in the setting of a recent viral infection, though it can be a life-threatening condition or leave permanent complications [2]. It may be the case that acute pericarditis is only a manifestation of a more severe underlying condition, as a neoplasm or an immunemediated disease [2,3,4] Given this heterogeneity around acute pericarditis prognosis, the European Society of Cardiology (ESC) guidelines for the diagnosis and management of pericardial diseases identify predictive factors of poor prognosis and advise either in favor or against hospitalization of acute pericarditis patients according to their presence [5].
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