CLINICAL RESEARCH: PERICARDITIS
Day-hospital treatment of acute pericarditis
A management program for outpatient therapy
Massimo Imazio, MD*,*,
Brunella Demichelis, MD*,
Iris Parrini, MD*,
Marco Giuggia, MD*,
Enrico Cecchi, MD*,
Gianni Gaschino, MD*,
Daniela Demarie, MD*,
Aldo Ghisio, MD* and
Rita Trinchero, MD*
* Cardiology Department, Maria Vittoria Hospital, Turin, Italy
Manuscript received April 16, 2003;
revised manuscript received August 21, 2003,
accepted September 9, 2003.
* Reprint requests and correspondence: Dr. Massimo Imazio, C.so Trapani 195/A 10141 Torino, Italy.
imazio{at}tin.it
OBJECTIVES: We sought to investigate the safety and efficacy of a protocol for acute pericarditis triage and outpatient management of low-risk cases.
BACKGROUND: Acute pericarditis has generally a brief and benign course after empiric treatment by non-steroidal anti-inflammatory drugs, and routine hospitalization of most patients may be unnecessary.
METHODS: From January 1996 to December 2001, all consecutive cases of acute pericarditis were evaluated on a day-hospital basis. Patients without clinical poor prognostic predictors (fever >38°C, subacute onset, immunodepression, trauma, oral anticoagulant therapy, myopericarditis, severe pericardial effusion, cardiac tamponade) were considered low-risk cases and assigned to outpatient treatment with high-dose oral aspirin. Patients with poor prognostic predictors or aspirin failure were hospitalized for etiology search and treatment. A clinical and echocardiographic follow-up was performed at 48 to 72 h, 7 to 10 days, 1 month, 6 months, and 1 year.
RESULTS: Two hundred fifty-four out of 300 (84.7%) patients were selected as low-risk cases. Outpatient treatment was efficacious in 221 out of 254 (87%) cases. Thirty-three out of 254 patients were hospitalized because of aspirin failure. Patients treated on an out-of-hospital basis had no serious complications after a mean follow-up of 38 months (no cases of cardiac tamponade). A higher frequency of recurrences and constriction was recorded in aspirin-resistant cases than in aspirin responders (60.6% vs. 10.4% for recurrences and 9.1% vs. 0.5% for constriction, respectively; all p < 0.01).
CONCLUSIONS: A protocol for acute pericarditis triage and outpatient therapy of low-risk cases is safe and efficacious and may reduce management costs.
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Abbreviations and Acronyms
| | CK | = creatine kinase | | ECG | = electrocardiogram/electrocardiograph/ electrocardiographic | | NSAIDs | = non-steroidal anti-inflammatory drugs | | RR | = relative risk |
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