Day-hospital treatment of acute pericarditis: a management program for outpatient therapy.
OBJECTIVE
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 degrees 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.
Imazio
Massimo
M
Cardiology Department, Maria Vittoria Hospital, Corso Trapani 195/A, 10141 Turin, Italy. imazio@tin.it
Demichelis
Brunella
B
Parrini
Iris
I
Giuggia
Marco
M
Cecchi
Enrico
E
Gaschino
Gianni
G
Demarie
Daniela
D
Ghisio
Aldo
A
Trinchero
Rita
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000008:administration & dosage; D003631:Day Care, Medical / Q000592:standards* / Q000706:statistics & numerical data; D003663:Decision Trees; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D010493:Pericarditis / Q000000981:diagnostic imaging / Q000191:economics / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence
D001241:Aspirin