July 19, 2026Journal of the American College of Cardiology236 citations
View Full PaperDay-hospital treatment of acute pericarditis
Key Result
Outpatient triage with high-dose aspirin was efficacious in 87% of low-risk acute pericarditis patients; responders had fewer recurrences than resistant cases (10.4% vs 60.6%, P<0.01).
Key Points
- The aim is to evaluate the safety and effectiveness of outpatient management for low-risk acute pericarditis.
- Evaluated consecutive cases of acute pericarditis in a day-hospital from January 1996 to December 2001.
- Patients with no poor prognostic predictors were treated with high-dose oral aspirin.
- Follow-up included clinical and echocardiographic assessments at set intervals.
- Outpatient treatment was successful in 221 out of 254 (87%) low-risk patients.
- Patients requiring hospitalization due to aspirin failure were 33 out of 254.
- No serious complications occurred in outpatient-treated patients over an average follow-up of 38 months.
Study Design
Type
Cohort (n=300)
PICO
P
Population
300 consecutive patients with acute pericarditis, including 254 low-risk cases managed outpatient, followed for a mean of 38 months.
E
Exposure / Comparator
Outpatient treatment with high-dose oral aspirin vs Aspirin-resistant cases (high-dose)
O
Primary Outcome
recurrences, p=< 0.01
Main Result
Absolute Event Rate: 10.4% vs 60.6%
p-value: p=< 0.01
Abstract
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 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.