Burden of Recurrent Pericarditis on Health-Related Quality of Life.

The extent to which recurrences of pericarditis episodes impact patients' health-related quality of life (HRQOL) remains poorly understood. This study aimed to evaluate HRQOL and work productivity in patients with recurrent pericarditis (RP). Adult patients from a centralized recruitment database for the rilonacept Phase 2/3 clinical trials were invited to participate in a survey. Inclusion criteria were confirmed RP diagnosis and ≥1 recurrence within the previous 12 months. The 11-Point Pain Numeric Rating Scale, Patient Global Impression of Pericarditis Severity, Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health v1.2, PROMIS Short Form Sleep Disturbance 8b, Work Productivity and Activity Impairment v2.0, and customized questions about fear and economic impact were used. In total, 83 patients (55% female, average age = 49.3 years) completed the survey. The median time since pericarditis diagnosis was 3.0 years at the time of survey completion; 49% experienced ≥3 recurrences in the previous 12 months. Forty percent had an emergency room visit, and 25% were hospitalized for their most recent recurrence. Sixty-six percent of participants rated the symptoms of their last recurrence as severe. The mean value for worst pericarditis pain (0 to 10 scale) during the most recent recurrence was 6.1. The average T-scores for PROMIS physical and mental health were 37.6 and 42.8, respectively, compared with 50 in the general population. Participants reported 50% of overall work impairment and 62% of activity impairment due to RP. In conclusion, patients with RP experienced a high number of recurrences with severe symptoms that substantially reduced their HRQOL and work productivity.

Sales performance and athletic outcome in young Thoroughbreds with pericarditis.

BACKGROUND: Pericarditis is a sporadic, but important cause of critical illness in horses of all ages. There is limited information on whether Thoroughbred horses that survive pericarditis are able to reach athletic potential. OBJECTIVES: To determine how pericarditis affected horses that had the disease as young animals with regard to selling price in public sales and the ability to race successfully. STUDY DESIGN: Retrospective case series. METHODS: Medical records were searched to identify pericarditis cases. Signalment and month of diagnosis were noted and Thoroughbreds with ultrasonographically confirmed pericarditis that presented from 2 months to 3 years old were identified. For this subgroup data on sales and racing performed were obtained from publicly available databases to determine long-term survival and post-treatment outcomes from these horses and their unaffected half-siblings. RESULTS: Horses that survived pericarditis as young animals may recover growth and maturation rates quickly enough to reach expected sales prices at public sales for horses of racing age and recovered horses can have successful racing careers. MAIN LIMITATIONS: The number of horses in this case series was not sufficient to enable statistical comparisons between affected horses and unaffected half-siblings, but description of sales prices and race earnings nevertheless yields information about the chances for affected young horses to achieve their intended purposes. CONCLUSIONS: Young Thoroughbreds with pericarditis warrant treatment and can sell and have successful racing careers.

Economics of cardiac adverse events after smallpox vaccination: lessons from the 2003 US Vaccination Program.

Of >39,000 civilian public health responders vaccinated against smallpox in 2003, 203 reported cardiovascular adverse events (CAEs). An association exists between the US vaccinia strain and myocarditis and/or pericarditis ("myo/pericarditis" [MP]). Other associations are inconclusive. We used surveillance and follow-up survey data of CAE case patients to estimate the resources used during the 2003 smallpox vaccination program and used a probabilistic model to estimate the potential costs of CAEs in a mass vaccination campaign. For every million adult vaccinees, 3001 CAEs (including 351 MP cases) would occur, with >92% in revaccinees. CAEs would require a median of 5934 outpatient visits, 1786 emergency department visits, 533 days in general wards, 132 days in intensive care units, 5484 cardiac enzymes tests, 3504 electrocardiograms, 3049 chemistry tests, 2828 complete blood counts, and 1444 transthoracic echocardiograms, among other procedures. CAEs would reduce productivity (15,969 work days lost) and cost $11 per vaccinee. In a mass vaccination campaign, the care of a sizable number of CAEs would be resource intensive.

Asymptomatic ST segment elevation.

Asymptomatic ST segment elevation in a life insurance applicant's ECG raises several prognostically important possibilities such as myocardial infarction, pericarditis, Brugada syndrome and early repolarization. This ECG case study discusses the ECG features involved in the differential diagnosis.

Day-hospital treatment of acute pericarditis: a management program for outpatient therapy.

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.