Management and Prognosis of Patients With Acute Pericarditis in the Emergency Department: A Retrospective,
Lisa Caldera1, Chiara Lovati2, Alessandra Vecchié3
1Emergency Medicine Residency Program, University of Milan-Bicocca, Monza, Italy.
Insights
Acute pericarditis management in the Emergency Department (ED) shows suboptimal adherence to guidelines. Many patients experience long-term complications, highlighting the need for improved treatment strategies for this common condition.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- Acute pericarditis is a frequent cause for Emergency Department (ED) visits.
- Limited data exists on the effective management of acute pericarditis within the ED setting.
Purpose of the Study:
- To evaluate the management and 12-month outcomes of acute pericarditis patients admitted to the ED.
- To identify risk factors associated with adverse outcomes in acute pericarditis.
Main Methods:
- Retrospective study of 169 acute pericarditis patients from 2019-2023 in an Italian ED.
- Primary endpoint: 12-month composite outcome including treatment failure, recurrence, tamponade, constrictive pericarditis, or death.
- Analysis of medication use, adherence to guidelines, and risk factors for complications.
Main Results:
- The 12-month composite outcome occurred in 20.1% of patients, primarily due to recurrences and treatment failure.
- Suboptimal adherence to guideline-recommended drug doses was common, particularly on admission.
- Independent risk factors for adverse outcomes included diabetes, COPD, recent cardiac procedures, and SARS-CoV-2 vaccination.
Conclusions:
- A significant percentage of acute pericarditis patients face long-term complications.
- Improved adherence to guideline-recommended anti-inflammatory drug dosing is crucial for better patient outcomes.
- ED management of acute pericarditis requires optimization to reduce long-term morbidity.
Background:
Despite being a common reason for Emergency Department (ED) admission, information about the management of acute pericarditis is limited in this setting.
Methods:
In this retrospective study conducted at the ED of Ospedale di Circolo in Varese (Italy) from 2019 to 2023, patients with acute pericarditis were included. The primary endpoint was the occurrence of the 12-month composite outcome (treatment failure, recurrent pericarditis, cardiac tamponade, constrictive pericarditis or death).
Results:
One-hundred and sixty-nine patients were included (median age 54 years, 65.1% males). Chest pain was the main symptom (96.4%). On admission, aspirin was more frequently given over non-steroidal anti-inflammatory drugs (NSAIDs), and colchicine was prescribed in 40% of patients. At discharge, more patients were prescribed ibuprofen, and colchicine prescription significantly increased to 71%. Drug doses were compliant with guidelines in a limited number of patients at admission and increased at discharge. The composite outcome occurred in 20.1% of patients (n = 34), mainly driven by recurrences (n = 18) and treatment failure. Patients with a complicated course were older, of female sex, with a larger proportion of comorbidities and higher CRP levels. Diabetes (HR 3.9, 95% CI 1.7-9.1), COPD (HR 6.2, 95% CI 2.3-17.1), recent percutaneous cardiac procedures (HR 6.5, 95% CI 2.1-19.6), and recent SARS-CoV-2 vaccination (HR 3.0, 95% CI 1.1-8.2) were independent risk factors for the composite outcome.
Conclusion:
A significant proportion of patients with acute pericarditis experience long-term complications. Sub-optimal adherence to guideline-recommended doses of anti-inflammatory drugs was commonly observed, suggesting an area for improvement in the management of these patients.
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