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Clinical Practice Patterns in Constrictive Pericarditis Patients With Heart Failure: A Retrospective Cohort Study
Toshiaki Isogai1,2, Hideo Yasunaga1, Hiroki Matsui1
1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Insights
Constrictive pericarditis patients with more comorbidities and older age are less likely to undergo surgery. Conservative medical therapy may be suitable for high-risk patients with constrictive pericarditis.
Area of Science:
- Cardiology
- Thoracic Surgery
Background:
- Constrictive pericarditis (CP) studies often focus on surgical pericardiectomy.
- Perioperative mortality for CP patients remains high.
- Limited data exists on medically treated CP patients.
Purpose of the Study:
- To investigate factors influencing the decision for pericardiectomy in constrictive pericarditis (CP) patients.
- To compare characteristics of CP patients with and without pericardiectomy.
- To identify predictors of undergoing pericardiectomy.
Main Methods:
- Retrospective analysis of 855 CP patients (NYHA class II-IV) from 2007-2013.
- Comparison of clinical characteristics between surgery and no-surgery groups.
- Multivariable logistic regression to identify factors associated with pericardiectomy likelihood.
Main Results:
- 19.2% of patients underwent pericardiectomy.
- Surgery group was younger and more male; no difference in NYHA class or Barthel Index.
- Older age, female sex, and higher Charlson Comorbidity Index (CCI) were associated with lower likelihood of surgery.
- Higher 30-day mortality in surgery patients who underwent cardiopulmonary bypass (11.3% vs 2.9%).
Conclusions:
- Patient background factors significantly influence the likelihood of undergoing pericardiectomy for constrictive pericarditis.
- Conservative medical management may be a viable option for high-risk CP patients.
- Careful consideration of comorbidities and surgical risk is crucial in CP management.
Background:
Previous studies on constrictive pericarditis (CP) mainly concerned patients undergoing pericardiectomy. The reported perioperative mortality of CP patients remained high. Data on medically treated CP patients without pericardiectomy have been scarce.
Hypothesis:
Constrictive pericarditis patients with more comorbidities are less likely to undergo pericardiectomy.
Methods:
Using the Diagnosis Procedure Combination database from 2007 to 2013, we retrospectively identified CP patients admitted with heart failure of New York Heart Association (NYHA) class II to IV. We compared clinical characteristics between patients treated with and without pericardiectomy. A multivariable logistic regression analysis was performed to assess the factors associated with likelihood of undergoing pericardiectomy.
Results:
Of 855 eligible patients, 164 (19.2%) underwent pericardiectomy (surgery group) and 691 (80.8%) did not (no-surgery group). The surgery group was younger (mean age, 65.0 years vs 70.3 years; P < 0.001) and more often male (81.7% vs 72.2%; P = 0.013) than the no-surgery group. No significant difference was seen in NYHA class and Barthel Index between the groups, whereas the surgery group had a lower Charlson Comorbidity Index (CCI). Older age, female sex, and higher CCI were significantly associated with a lower likelihood of undergoing pericardiectomy. In the surgery group, 30-day postoperative mortality was significantly higher in patients who underwent cardiopulmonary bypass than in those who did not (11.3% vs 2.9%; P = 0.030).
Conclusions:
Patients' backgrounds were associated with the likelihood of undergoing pericardiectomy. Conservative medical therapy may be acceptable in CP patients with severe background and high preoperative need for cardiopulmonary bypass.
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