CLINICAL CHARACTERISTICS AND OUTCOMES OF HOSPITALIZED PATIENTS WITH HEART FAILURE AND SARCOIDOSIS: ANALYSIS OF THE NATIONWIDE READMISSIONS DATABASE 2010-2019
Authors: Ahmed Raheel , Sawatari Hiroyuki , Amanullah Khadija , Okafor Joseph , Irfan Wafa Syed Emir , Deshpande Saurabh , Ramphul Kamleshun , Ali Isma , Khanji Mohammed , Wells Athol , Ezzeddin Omar , Kouranos Vasilis , Sharma Rakesh , Somers Virend K. , Mohammed Selma F. , Chahal C. Anwar A. 
Published: August 2023

BACKGROUND

Sarcoidosis is a multi-systemic granulomatous inflammatory disorder. In the setting of cardiac involvement, clinical manifestations include ventricular arrhythmias, high-grade atrioventricular block (AVB) and heart failure (HF). The impact of HF in patients with sarcoidosis has not been established from real-world data.

METHODS

Patients admitted with sarcoidosis from 2010-2019 were identified from the Nationwide Readmissions Database. Those with ischemic heart disease were excluded. Sarcoidosis patients without HF were propensity matched for age, gender and Charlson comorbidity index and compared to patients with HF. Clinical characteristics, length of stay (LOS), adjusted healthcare-associated costs (HAC), 90-day readmission and 90-day mortality was observed.

RESULTS

During the 10-year study period, 97,961 patients (median age 63 [54-71] years, 37.9% male) with a diagnosis of sarcoidosis were hospitalized (35.9% with HF and 64.1% without HF). On index admission, HF patients had a higher prevalence of AVB (3.3% vs 1.4%, p<0.0001), ventricular tachycardia (6.5% vs 1.3%, p<0.0001), ventricular fibrillation (0.4% vs 0.1%, p<0.0001) and atrial fibrillation (22.1% vs 7.5%, p<0.0001). The median LOS (4 [3-7] vs. 4[2-6] days, p<0.0001) was similar but median HAC (US$ 9,954.5 [5,934.7-18,128.8] vs. 8,828.3 [5,303.1-15,384.9], p<0.0001) during the index admission were higher in HF patients.

The LOS and HAC were greater in HF patients on 90-day readmission. HF patients were significantly more likely to be re-admitted within 90 days [adjusted all-cause readmissions (HR [95% CI: 1.28 [1.25 – 1.31], p<0.0001), atrial fibrillation (HR 1.35 [1.05-1.75], p=0.02), acute HF (HR 10.77 [9.45 – 12.16], p<0.0001) and ventricular tachycardia/ventricular fibrillation (HR 2.55 [1.69 – 3.85], p<0.0001)]. Adjusted inpatient mortality at readmission was also higher in HF patients (5.1% vs. 3.8%, p<0.0001).

CONCLUSION

The presence of HF in hospitalized sarcoidosis patients is associated with an increased prevalence of conduction disorders, ventricular arrhythmias and atrial fibrillation. HF patients had greater costs, readmissions and mortality at 90-days.

What is known?

1)

Cardiac involvement in sarcoidosis is associated with ventricular arrhythmias, high-grade atrioventricular block and heart failure

2)

Retrospective small, single-center studies have reported relatively poor long-term survival outcomes for symptomatic cardiac sarcoidosis patients with reduced left ventricular ejection fraction

What the study adds?

1)

Using a large real-world database, this study has demonstrated that heart failure in hospitalized sarcoidosis patients is associated with increased prevalence of arrythmia, conduction disorders, cardiac implanted electronic devices, catheter ablations and cardiac transplantation.

2)

Heart failure in hospitalized sarcoidosis patients leads to a significantly higher length of stay, healthcare-adjusted costs, 90-days readmissions and mortality following readmission.