About Recurrent Pericarditis

Revealing the true prevalence of this challenging disease

Recurrent pericarditis can have far-reaching implications for patients and the
healthcare system.1,2 For many individuals, the first acute episode is just the
beginning of their pericarditis journey.

Data on disease recurrence and complication rates
indicate a significant unmet clinical need, as approximately
40,0003,4 patients in the US seek treatment annually for
recurrent pericarditis.3

Recognizing recurrence

Pericarditis, or inflammation of the pericardium, often resolves after 1 episode, but for some individuals it can persist or recur repeatedly. Some patients experience painful symptoms and face complications regardless of treatment. Others will become steroid dependent to manage refractory symptoms.1 For all patients, an improved understanding of pericarditis is required in order to effectively manage their disease.

Acute pericarditis causes

  • Approximately 80% to 90% of cases are considered idiopathic1,7
  • Causes of acute pericarditis7:
    • Infection (viral is most common)
    • Postpericardial injury syndromes/postcardiac injury syndromes, such as postpericardiotomy syndrome, which affects a range of 10% to 40% of patients after cardiac surgery9
    • Autoimmune diseases such as lupus or rheumatoid arthritis
    • Medications (rare)

Recurrent pericarditis causes

  • Inadequate treatment of the first episode1,7,10
    • Rapid tapering of anti-inflammatory therapy
    • Early use of corticosteroids (rapid tapering or use of short courses of high-dose corticosteroids)
  • Incomplete response to anti-inflammatory therapy1,7
  • High levels of C-reactive protein (CRP)1,10
  • Idiopathic etiology, presumed to be the result of an underlying autoinflammatory pathophysiology driven by IL-11,7,10

Symptoms & Signs

Pericarditis can present with chest pain and other symptoms. Diagnosis
is aided by other clinical findings. Following is a list of key symptoms and
signs for recurrent pericarditis (not all-inclusive).

Pericarditis symptoms5,6

  • Sharp, stabbing chest pain
    • Worse with inhalation, swallowing, coughing, or laying flat
    • Improves when the patient sits up or leans forward
  • Back, neck, or shoulder pain
  • Dry cough
  • Dyspnea
  • Anxiety or fatigue
  • Palpitations

Signs of pericarditis6

  • Pericardial friction rub (as heard through a stethoscope)
  • ST-segment elevation and PR elevation on electrocardiogram (ECG)
  • Pericardial effusion that is more than trivial

The increased risk of complications6-8

Individuals with pericarditis that remains uncontrolled
face the risk of considerable clinical and humanistic burden, including
these major complications6-8:

  • Pericardial effusion
  • Cardiac tamponade
  • Constrictive pericarditis

In particular, cardiac tamponade and constrictive pericarditis
(especially effusive-constrictive pericarditis) have a poor prognosis.
Cardiac tamponade is considered life threatening.6

Illustrating Significance

Recurrent pericarditis affects more individuals than many clinicians may realize.
Most cases have been deemed “idiopathic,”1 and the evolving science has 
revealed that autoinflammation is the underlying etiology for these.1,10,11

 

The current snapshot

While exact figures are not available, research estimates describe a convincing 
clinical challenge for those who manage recurrent pericarditis.

80K-90K
Acute Episodes

Approximately 80,000 to 90,000
individuals in the US experience an 
initial episode of viral or idiopathic 
acute pericarditis per year12,13

30%
Recurrence

Rates of recurrence after an
initial acute episode run up to
30% within 18 months1

Sambola et al14 conducted a randomized, multicenter, open-label study that found that among patients with a first episode of acute idiopathic pericarditis:

The Time To First
Recurrence Was
9.1 ± 9.0
months
With an episode
duration of
7.2 ± 4.8
days
Recurrent pericarditis impacts men and women of different ages, ethnicities, and socioeconomic backgrounds.

The evolving picture

Klein et al3 conducted a retrospective claims database* analysis to characterize the
US population affected by complicated and recurrent forms of pericarditis and to
understand the clinical burden of recurrences in these patients. The study found
a higher disease burden in a greater proportion of patients.3

20%

Some 20% of patients with pericarditis had multiple recurrences or developed complications such as pericardial effusion, constrictive pericarditis, or cardiac tamponade.3



In this analysis, observed recurrence rates coincide with prior studies for the first
and second recurrence.1 Yet the proportion of patients experiencing each subsequent
recurrence beyond the second recurrence was higher than previously reported.3



*Source: PharMetrics Plus database from IQVIA, which contains longitudinally linked patient claims records from approximately 90 million insured patients in the US, with dates of service from January 1, 2013 to March 31, 2018.3

Estimate of disease persistence (3-year cohort)

Of the newly diagnosed patients, 23% experienced a recurrence in the first calendar year. Of those with at least 1 recurrence, 41% experienced recurrence in the second calendar year and 53% in the third calendar year.3
 

23%
23%
11%
41%
6%
53%
Percent recurring
Portion with recurrence

Estimate of disease persistence (4-year cohort)

Lin et al15 conducted a separate cohort design claims database study that found that nearly 10% of patients with recurrent pericarditis will experience 4 or more recurrences within 4 years.

A later retrospective study, also by Lin et al,16 of US claims from January 2007 to March 2017 found that among patients with recurrent pericarditis, the median disease duration was:
~6 months for those with 1 recurrence • ~3 years for those with 2 recurrences

Summary

Approximately 40,000 
patients in the US seek treatment 
annually for recurrent pericarditis.3,4

Patients with unresolved 
recurrent pericarditis may face a 
significant burden of disease.1

The risk for additional recurrence 
increases after each episode of 
recurrent pericarditis.3

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References:

  1. Cremer PC, Kumar A, Kontzias A, et al. Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment. J Am Coll Cardiol. 2016;68(21):2311-2328.
  2. Mody P, Bikdeli B, Wang Y, Imazio M, Krumholz HM. Trends in acute pericarditis hospitalizations and outcomes among the elderly in the USA, 1999-2012. Eur Heart J Qual Care Clin Outcomes. 2018;4(2):98-105.
  3. Klein A, Cremer P, Kontzias A, et al. Recurrent pericarditis epidemiology in the United States (2013-2018). Poster presented at: American College of Epidemiology (ACE) 2019 Annual Meeting; September 7-10, 2019; Pasadena, CA. Poster P13.
  4. IQVIA PharMetrics Plus Claims Data January 1, 2013-March 31, 2018; ClearView Analysis.
  5. Pericarditis. Cleveland Clinic website. March 12, 2020. Accessed April 14, 2020. https://my.clevelandclinic.org/health/diseases/17353-pericarditis
  6. Chiabrando JG, Bonaventura A, Vecchie A, et al. Management of acute and recurrent pericarditis. J Am Coll Cardiol. 2020;75(1):76-92.
  7. Adler Y, Charron P, Imazio M, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2015;36(42):2921-2964.
  8. Imazio M, Battaglia A, Gaido L, Gaita F. Recurrent pericarditis. Rev Med Interne. 2017;38(5):307-311.
  9. Imazio M, Hoit BD. Post-cardiac injury syndromes: an emerging cause of pericardial diseases. Int J Cardiol. 2013;168(2):648-652.
  10. Brucato A, Imazio M, Cremer PC, et al. Recurrent pericarditis: still idiopathic? The pros and cons of a well-honoured term. Intern Emerg Med. 2018;13(6):839-844.
  11. Dinarello CA, van der Meer JW. Treating inflammation by blocking interleukin-1 in humans. Semin Immunol. 2013;25(6):469-484.
  12. Imazio M, Cecchi E, Demichelis B, et al. Myopericarditis versus viral or idiopathic acute pericarditis. Heart. 2008;94(4):498-501.
  13. US Census Bureau. Current US Population. April 15, 2020. Accessed May 28, 2020. https://www.census.gov/popclock
  14. Sambola A, Roca Luque I, Mercé J, et al. Colchicine administered in the first episode of acute idiopathic pericarditis: a randomized multicenter open-label study. Rev Esp Cardiol (Engl Ed). 2019;72(9):709-716.
  15. Lin D, Majeski C, DerSarkissian M, et al. Real-world clinical characteristics and recurrence burden of patients diagnosed with recurrent pericarditis in the United States. Poster presented at: American Heart Association 2019 Scientific Sessions; November 16-18, 2019. Poster Su3090.
  16. Lin D, Laliberte F, Magestro M, et al. Recurrence burden in recurrent pericarditis: a US-based retrospective study of administrative healthcare claims. Poster presented at: American Heart Association Quality of Care and Outcomes Research 2020 Scientific Sessions; Virtual Meeting; May 15-16, 2020. Poster 248.

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