Novel “CHASER” Pathway for the Management of Pericardial Disease

Abstract

The diagnosis and management of pericardial disease are very challenging for clinicians. The evidence base in this field is relatively scarce compared with other disease entities in cardiology. In this article, we outline a unified, stepwise pathway-based approach for the management of pericardial disease. We used the "CHASER" acronym to define the entry points into the pathway. These include chest pain, hypotension or arrest, shortness of breath, echocardiographic or other imaging finding of pericardial effusion, and right-predominant heart failure. We propose a score for the assessment of pericardial effusion that is composed of the following 3 parameters: the etiology of the effusion, the size of the effusion, and the echocardiographic assessment of hemodynamic parameters. The score is applied to clinically stable patients with pericardial effusion to quantify the necessity of pericardial effusion drainage. A stepwise, pathway-based approach to the management of pericardial disease is intended to provide guidance for clinicians in decision-making and a patient-tailored evidence-based approach to medical and surgical therapy for pericardial disease. The pathway for the management of pericardial disease is the ninth project to be incorporated into the "Advanced Cardiac Admission Program" at Saint Luke's Roosevelt Hospital Center of Columbia University in New York. Further studies should focus on the validation of the feasibility, efficacy, and reliability of this pathway.

Spectrum of Pericardial Tamponade

“…Similarly, a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases suggested a model that is, in essence, a 3-step algorithm based on etiology, clinical presentation, and imaging findings ( 6 ). Although these approaches lack robust clinical validation, they provide a framework for future studies in this field ( 10 ).…”

Development and validation of a novel prediction score for cardiac tamponade in emergency department patients with pericardial effusion

“…A previously proposed scoring system by Halpern et al . 10 , 11 incorporated a combination of echocardiographic measurements including right atrial collapse, right ventricular collapse, respiratory flow variation across the mitral valve and size of effusion as well as clinical variables including malignant aetiology, immunocompromise aetiology, effusion due to an unidentified cause, effusion failing medical treatment and recurrent effusion in order to identify patients who require pericardial drainage. However, this prediction score was not statistically generated and has not been independently validated.…”