Clinical and economic outcomes associated with hospitalizations for acute idiopathic pericarditis in the United States.

BACKGROUND: Outcomes-based data regarding the management of hospitalized U.S. patients with acute idiopathic pericarditis (AIP) are lacking. OBJECTIVES: This study sought to elucidate the clinical and economic outcomes associated with the inpatient care of AIP. METHODS: Cohort study of adults with AIP; multivariable analyses of clinical and economic outcomes (inpatient mortality, surgical or medical complications, length of stay, and medical charges). RESULTS: Surgical or medical complications, pericardiocentesis, and pericardiotomy were each independently associated with a significantly higher odds of inpatient mortality (p<0.05). Pericardiocentesis, pericardiotomy, and pericardiectomy were also independently associated with significantly higher odds for complications (p<0.001) and, overall, surgical or medical complications were associated with longer lengths of stay and higher charges (p < 0.001). A higher odds of inpatient mortality was associated with micropolitan or rural patient residence, Medicaid payor, and African American race (p<0.05). CONCLUSIONS: U.S. inpatient cases of AIP are associated with significant use of healthcare resources, disparities, morbidity, and mortality.

Lone atrial fibrillation is associated with pectus excavatum.

BACKGROUND: Pectus excavatum is a skeletal abnormality that may have cardiac manifestations. OBJECTIVE: To determine whether pectus excavatum is associated with lone atrial fibrillation (AF). METHODS: The pectus severity index (PSI) is the ratio of the lateral diameter of the chest to the distance between the sternum and the spine on computed tomography scan. A normal PSI is ≤2.5 whereas patients with severe pectus excavatum have a PSI >3.25. We calculated the PSI of 220 consecutive patients with AF who underwent radiofrequency catheter ablation from September 2008 to 2012 and compared this to the PSI of 225 controls without a history of AF undergoing chest computed tomography. RESULTS: Mean PSI was higher in patients with lone AF (2.72 ± 0.07) compared to patients with nonlone AF (2.25 ± 0.03) or controls (2.26 ± 0.03) (P < .001). The likelihood of mild, moderate, or severe pectus excavatum was higher in patients with lone AF compared to patients with nonlone AF and controls (P < .001). Patients with lone AF were more than 5 times as likely to have severe pectus excavatum compared to patients with nonlone AF or controls (P < .001) even after adjustment for potential confounders. CONCLUSIONS: Nearly two-thirds of the patients with lone AF have at least mild pectus excavatum and 17% have severe pectus, which is significantly higher than in patients with nonlone AF or controls. This association suggests a potential genetic or mechanical abnormality may be common to the 2 disorders. Our study may provide insight into the pathogenesis of lone AF.