title: Novel "CHASER" pathway for the management of pericardial disease.
abstract: The diagnosis and management of pericardial disease are very challenging for clinicians. The evidence base in this field is relatively scarce compared with other disease entities in cardiology. In this article, we outline a unified, stepwise pathway-based approach for the management of pericardial disease. We used the "CHASER" acronym to define the entry points into the pathway. These include chest pain, hypotension or arrest, shortness of breath, echocardiographic or other imaging finding of pericardial effusion, and right-predominant heart failure. We propose a score for the assessment of pericardial effusion that is composed of the following 3 parameters: the etiology of the effusion, the size of the effusion, and the echocardiographic assessment of hemodynamic parameters. The score is applied to clinically stable patients with pericardial effusion to quantify the necessity of pericardial effusion drainage. A stepwise, pathway-based approach to the management of pericardial disease is intended to provide guidance for clinicians in decision-making and a patient-tailored evidence-based approach to medical and surgical therapy for pericardial disease. The pathway for the management of pericardial disease is the ninth project to be incorporated into the "Advanced Cardiac Admission Program" at Saint Luke's Roosevelt Hospital Center of Columbia University in New York. Further studies should focus on the validation of the feasibility, efficacy, and reliability of this pathway.
authors: Department of Medicine, Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, NY 10025, USA.
authors: Edgar
authors: E
authors: Argulian
authors: Dan G
authors: DG
authors: Halpern
authors: Emad F
authors: EF
authors: Aziz
authors: Seth
authors: S
authors: Uretsky
authors: Farooq
authors: F
authors: Chaudhry
authors: Eyal
authors: E
authors: Herzog
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002637:Chest Pain / Q000188:drug therapy / Q000209:etiology; D002985:Clinical Protocols; D019091:Critical Pathways / Q000592:standards*; D019468:Disease Management; D004452:Echocardiography; D004562:Electrocardiography; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000209:etiology; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D020519:Pericardiocentesis / Q000379:methods*; D010496:Pericardium / Q000000981:diagnostic imaging*; D015397:Program Evaluation; D012720:Severity of Illness Index
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D002317:Cardiovascular Agents