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Usefulness of Beta-Blockers to Control Symptoms in Patients With Pericarditis

Published:February 01, 2021DOI:https://doi.org/10.1016/j.amjcard.2021.01.032

      Highlights

      • Persistence of pericardial pain is one of the most troublesome challenges in the management of pericarditis. Exercise restriction through heart rate control is recommended as a nonpharmacological therapy for pericarditis.
      • In symptomatic patients with pericarditis and heart rate>75 beats/min , the empiric use of beta-blockers on top of anti-inflammatory therapies is associated with improved control of symptoms.
      • Empiric use of beta-blockers could help to control pericardial pain in patients with persistent symptoms and increased rest heart rate.
      Exercise restriction is a nonpharmacological treatment of pericarditis that could reduce symptoms by slowing heart rate (HR). Beta-blockers allow pharmacological control of HR. Aim of this paper is to explore the possible efficacy of beta-blockers to improve control of symptoms in patients with pericarditis. We analyzed consecutive cases with pericarditis referred to our center. Beta-blockers were prescribed on top of standard anti-inflammatory therapy in symptomatic patients (chest pain and palpitations) with rest HR>75 beats/min. The primary end point was the persistence of pericardial pain at 3 weeks. The secondary end point was the occurrence of recurrent pericarditis at 18 months. Propensity score matching was used to generate 2 cohorts of 101 patients with and without beta-blockers with balanced baseline features. A clinical and echocardiographic follow-up was performed at 3 weeks, 1, 3, 6 months and then every 12 months. A total of 347 patients (mean age 53 years, 58% females, 48% with a recurrence, 81% with idiopathic/viral etiology) were included. Among them, 128 patients (36.9%) were treated with beta-blockers. Peak C-reactive protein values were correlated with heart rate on first observation (r=0.48, p<0.001). Using propensity-score matched cohorts, patients treated with beta-blockers had a lower frequency of symptoms persistence at 3 weeks (respectively 4% vs. 14%; p = 0.024) and a trend towards a reduction of recurrences at 18 months (p = 0.069).
      In conclusion the use of beta-blockers on top of standard anti-inflammatory therapies was associated with improved symptom control.
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