25 Management of acute pericarditis and myocarditis - are our patients missing out on esc guideline based practice?. (6th June 2022) - Church, Matt
Abstract : Introduction: Recognising and treating myocarditis and pericarditis is often challenging and there is widespread variation in clinical practice. Delayed diagnosis and treatment can lead to poorer patient outcomes including higher pericarditis recurrence, poor symptom control and a risk of developing arrhythmias or heart failure in myocarditis. Purpose: To assess trends in the assessment and management of myocarditis and pericarditis in patients from a district general hospital. Methods: Retrospective single centre analysis was performed on patients with a coded diagnosis of 'pericarditis' and 'myocarditis' between 2019 and 2021. Results: Out of 116 patients identified, 61 were diagnosed with pericarditis with a mean age of 45.2 years (range 18–88). NSAIDs were given as monotherapy in 44.3% patients despite European society of cardiology (ESC) recommendations to include colchicine as an anti-inflammatory adjunct (class Ia recommendation) with only 16.7% of these receiving adequate dosing (Figure 1). Furthermore, if colchicine was given (40.3%), only 52% were prescribed with the correct duration. The recurrence rate was 9.8%.The remainder of patients who had myocarditis were in a younger cohort (mean age of 33.7 years, range 18–69) with a significantly elevated troponin I assayed (mean troponin of 3260.5, range 76 - >50, 000). A subset of patients with atypical presentation underwent angiography initially and had a diagnosis of myocarditis given in retrospect when they had unobstructed coronary arteries. This demonstrated the diagnostic challenge associated with myocarditis. Despite clear diagnostic benefit of performing a cardiac magnetic resonance scan (CMR) (class Ic recommendation), only 78.2% of patients had this imaging modality. Only 40.8% were informed of exercise restriction requirements, which is essential to reduce the arrhythmic risk in these individuals. Conclusion: Only a minority of patients had received adequate diagnostic workup and anti-inflammatory medication for myocarditis and pericarditis. Patients who have unobstructed coronary arteries on angiogram should also be given empirical anti-inflammatory medication (aspirin included) pending further definitive CMR imaging in clinically suspected cases. Education of admitting medical teams and the development of myocarditis and pericarditis pathways should be considered to improve care of such patients. References: 1. Ammirati, E. et al. Clinical presentation and outcome in a contemporary cohort of patients with acute myocarditis. Circulation 138, 1088–1099 (2018). 2. Adler, Y. et.al. ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, 36(42), pp.2921–2964 (2015). Conflict of Interest: Nil.