The ACC's newest Concise Clinical Guidance (CCG) expert consensus statement focuses on diagnostic and therapeutic advances in evaluating and managing pericarditis, with the goal of helping to close the educational gaps surrounding this condition for providers, payers and patients.

The CCG, published in JACC, focuses primarily on three parts: 1) Clinical Evaluation; 2) Multi-Modality Imaging; and 3) Management. It also addresses complications of pericarditis, including pericardial effusion, cardiac tamponade and pericardiocentesis, constrictive pericarditis, and pericarditis in oncologic patients.

On the evaluation front, the CCG includes novel diagnostic criteria consisting of pleuritic chest pain or equivalent suggestive presentation, plus at least one additional clinical finding such as pericardial friction rub, changes in ECG, elevated inflammatory biomarkers, and/or new or worsening pericardial effusion or evidence of pericardial inflammation as observed by cardiac imaging.

The statement also provides a multimodality imaging-guided therapeutic approach with echocardiography remaining the first-line modality to evaluate pericarditis, pericardial effusion/cardiac tamponade and constrictive pericarditis, according to Writing Committee Chair Tom Kai Ming Wang, MBCHB, MD, FACC, and Vice Chair Allan L. Klein, MD, CM, FACC. Cardiac magnetic resonance is recommended if indicated to "assess and grade pericardial thickness, inflammation, effusion and constrictive physiology," while cardiac computed tomography is recommended, if indicated, to assess pericardial thickness, calcification, constrictive physiology and aid in preoperative planning.

In terms of management, colchicine and NSAIDs (or aspirin) are recommended as first-line for acute and first recurrence of pericarditis, along with exercise restriction. If patients are not responding to first-line treatment, the CCG recommends use of anti-IL1 agents (rilonacept, anakinra) for an inflammatory phenotype and steroids for managing non-inflammatory phenotype and systemic autoimmune diseases. Radical pericardiectomy is recommended for managing medically refractory pericarditis or constrictive pericarditis. Treating the underlying etiology, as well as referring patients with complicated cases to a pericardial diseases center (PDC) are also options.

"A [PDC] offers a structured solution to managing the complexity of pericardial disorders, which can otherwise strain health care systems," write the authors. "These centers are particularly effective in improving care and outcomes for patients with recurrent or refractory pericarditis, as well as those requiring frequent follow-ups, while reducing emergency visits and hospitalizations."

Wang and Klein note that there is a large educational gap for providers, payers and patients in the diagnosis and management of pericarditis, which remains a challenging and heterogenous condition. "This CCG aims to guide clinicians to optimize evaluation and management of patients with pericarditis, with the goal of improving clinical outcomes," they write.