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Acute Pericarditis: should I stay or should I go?
Session:
Sessão de Comunicações Orais - Doenças do Miocárdio
Speaker:
João André Ferreira
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
18. Pericardial Disease
Subtheme:
18.2 Pericardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João André Ferreira; Mariana Luís; Rui Baptista; Sílvia Monteiro; Lino Gonçalves
Abstract
<p>Introduction: 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 according to their presence. We aim to evaluate the adequacy of hospitalization criteria in a cohort of patients presenting to the emergency department (ED) with acute pericarditis.</p> <p>Methods: Retrospective analysis of patients admitted in ED with acute pericarditis, from 2009 to 2019. All patients were evaluated by a cardiologist during ED stay 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 need for pericardiocentesis and/or cardiac surgery, pericarditis recurrence and all-cause death. The clinical decision was then counterpoised with ESC guidelines.</p> <p>Results: A total of 192 patients were included in the analysis (mean age 46 ± 18.5 years-old and 83.3% male) of which 87 (45.5%) were hospitalized. Clinico-demographic features are presented in Table 1. A total of 25% (n=48) registered the primary outcome, mainly due to acute pericarditis recurrence, occurring in 21.9% (n=42). No death was registered during ED stay or hospitalization. Having at least 1 major risk criteria (OR=3.14, 95% CI 1.59-6.19, p=0.001), but not a minor one (OR=1.47, 95% CI 0.69-3.14, p=0.315), was predictive of recurrence. Predictors of recurrence were: glucocorticoid therapy (OR=11.93, 95% 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 the hospitalization/discharge decision, the ESC guidelines were respected in 72.9% (n=140) of the cases. However, no significant difference in the primary outcome was noted whether the ESC guidelines were respected or not (27.5% <em>vs.</em> 24.3%, p=0.707). Acute pericarditis recurrence was also similar between the groups (25.5% <em>vs.</em> 21.4%, p=0.561).</p> <p>Conclusions: Discrepancy between current guidelines and clinical reasoning did not translate into different outcomes. Although guidelines should always guide clinical decision-making, local factors have to be taken into account when it comes to the decision to hospitalize or discharge a patient with acute pericarditis.</p>
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