Epidemiology and Risk Factors for Constrictive Pericarditis in a Statewide Australian Cohort of Patients With Pericardial Disease.

BACKGROUND: Constrictive pericarditis is a rare but serious complication of pericardial disease, with limited longitudinal studies assessing its risk factors. In this study we evaluated the epidemiology and predictors of constrictive pericarditis in a large population-based cohort.

METHODS: We conducted a retrospective cohort study of all hospitalized patients with pericardial disease from 2004 to 2021 using the Australian New South Wales Admitted Patient Data Collection database. Multivariable logistic regression identified risk factors for constrictive pericarditis at index admission with pericardial disease, whereas time-dependent Cox regression and the Fine-Gray method were used to assess risk factors during follow-up.

RESULTS: Among 45,445 patients with pericardial disease, 763 (1.7%) developed constrictive pericarditis (median age 64.3 years; 63.4% men). The median time from cardiac surgery to diagnosis of constriction was 6 months and from autoimmune disease diagnosis it was 2 years. Of these patients, 530 (1.2%) had constriction at index presentation of pericardial disease and 233 (0.5%) developed constriction during follow-up. Constriction at index presentation was associated with older age, malignancy (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2-1.8), tuberculosis (OR 3.9, 95% CI 1.4-8.9), liver disease (OR 1.7, 95% CI 1.3-2.2), and heart failure (OR 2.7 95% CI 2.2-3.3). Constriction identified during follow-up was more common after hospitalization for heart failure (hazard ratio [HR] 5.3, 95% CI 3.4-8.2), nonconstrictive recurrent pericardial disease requiring hospitalization (HR 3.7, 95% CI 2.3-6.2), or pericardiocentesis (HR 3.6, 95% CI 2.7-4.8).

CONCLUSIONS: In this large, contemporary cohort, constrictive pericarditis was rare but occurred more commonly after a diagnosis of tuberculosis, malignancy, liver disease, heart failure, recurrent pericardial disease, and pericardiocentesis. These findings highlight the importance of long-term vigilance when considering constriction in at-risk populations.