Inpatient cases of acute idiopathic pericarditis (AIP) in the United States are associated with significant use of healthcare resources, disparities, morbidity, and mortality, according to authors of a large US cohort study published in Heart and Lung.
Given the lack of outcomes-based data on the management of patients hospitalized with AIP in the United States, this historical cohort study sought to examine the clinical and economic outcomes associated with inpatient AIP care. The authors, from the University of Oklahoma Health Sciences Center College of Pharmacy and Oklahoma Heart Hospital, both in Oklahoma City, evaluated inpatient discharge data from 2001 to 2014 from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project Nationwide Inpatient Sample, which is designed to capture more than 95% of hospital discharges to facilitate findings generalizable to a national level.
Out of a total 85,673 patients with AIP, 56.8% were men, 71.7% were White, 47.0% were commercially insured, and 68.0% presented within large-bed facilities. The median length of stay was 3 days, and the median charges were $24,264 (range, $14,037-$44,497). Medical or surgical complications occurred in 11.5% of cases and were in turn associated with a 1.955-times higher odds of inpatient mortality (95% CI, 1.099-3.477; P =.023). Requiring pericardiocentesis or pericardiotomy was associated with an approximately 50% higher odds of inpatient mortality (odds ratio [OR] for pericardiocentesis, 1.540; 95% CI, 1.01-2.348; OR for pericardiotomy, 1.485; 95% CI, 1.009-2.187; P <.05) and an approximately 70% higher odds of surgical or medical complications (OR for pericardiocentesis, 1.672; 95% CI, 1.342-2.083; OR for pericardiotomy, 2.161; 95% CI, 1.761-2.652; P <.001). Pericardiectomy was associated with a 2.699-times higher odds of complications (95% CI, 7.602-4.548; P <.001) but was not significantly associated with inpatient mortality (OR, 0.213; 95% CI, 0.024-1.864; P =.162).
Inpatient mortality was associated with rural or micropolitan patient residence vs urban residence (OR, 1.677; P =.037), as well as Medicaid vs Medicare coverage (OR, 2.139; P =.006). Black patients faced higher odds of inpatient mortality (OR, 1.709; P =.010) but lower odds of surgical and/or medical complications (OR, 0.712; P =.019). Women (compared with men) and black, Hispanic, and Asian/Pacific Islander patients (compared with White patients) were significantly associated with higher odds of longer hospital stays (+11.4%, + 14.5%, +18.5%, and 27.4%, respectively; P <.001). Longer stays, in turn, were associated with requiring pericardiocentesis (+31.2%), pericardiectomy (+52.3%), and pericardiotomy (+81.5%; all P <.001); with corresponding increases in charges: +34.3%, +53.1%, and +92.3%, respectively (P <.001); and with several comorbidities (P <.05). Compared with White patients, charges were also significantly higher for black (+8.3%; P <.05), Hispanic (+31.7%; P <.001), and Asian/Pacific Islander patients (+51.3%; P <.001).
The investigators concluded, “US cases of AIP are associated with significant use of healthcare resources, morbidity, and mortality in the inpatient setting. Specifically, length of stay, charges, inpatient mortality, surgical or medical care complications, as well as use of procedures for treatment of AIP. In certain case populations with discharge diagnosis for AIP, including cases with specific comorbidities, requirement of pericardiocentesis, pericardiectomy, pericardiotomy, and surgical complications, are associated with relatively poor morbidity, mortality, and healthcare burden. Additionally, in specific populations of AIP cases, disparities in outcomes associated with certain races/ethnicities, hospital characteristics, and cases of female sex exist.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Schwier NC, Tran NT, Skrepnek GH. Clinical and economic outcomes associated with hospitalizations for acute idiopathic pericarditis in the United States. Published online July 23, 2021. Heart Lung. doi:10.1016/j.hrtlng.2021.06.009