Large-Scale Study Reinforces the Importance of Detecting, Preventing Heart Disease in Sarcoidosis
The number of hospitalizations of sarcoidosis’ patients in the U.S. has increased over the past decade with more than one-third showing heart-related disorders, according to a study published in the Journal of the American Heart Association. Moreover, sarcoidosis hospitalizations are more frequent in urban as compared with rural hospitals, blacks as compared with other races, and in the southern U.S. as compared with other regions.
Cardiac sarcoidosis was believed to be rare, as it is clinically apparent in only about 5 percent of all patients. However, autopsy studies have shown the condition is undiagnosed in up to 50-60 percent of those patients and may account for 13-25 percent of sarcoidosis deaths. Due to the probability of sudden cardiac death, early diagnosis and treatment is critical and may be lifesaving. The placement of implantable cardioverter-defibrillators — a device placed under the skin that controls and corrects heart rates — is recommended to any patient with cardiac sarcoidosis.
The retrospective study “Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States” investigated the trends of hospitalizations and in-hospital mortality associated with sarcoidosis. The study also examined the prevalence of cardiovascular manifestations and the rates of implantable cardioverter‐defibrillator implantation in hospitalizations with sarcoidosis in a population cohort from 2005 to 2014.
Researchers analyzed data from the National Inpatient Sample (NIS), the largest available database in the U.S. of patient hospitalizations. A total of 609,051 cases of sarcoidosis hospitalizations were included in the study, after excluding patients with prior or present heart diseases. Patients had a mean age of 55 years.
From 2005 to 2014, there was an increase of 26 percent in the number of sarcoidosis hospitalizations. However, the authors believe that the development of a more organized method of diagnosis and advances in imaging techniques has served to enhance the early detection of sarcoidosis, increasing the apparent incidence of this disease.
In-hospital mortality decreased about 26 percent, suggesting that patients with longstanding sarcoidosis now live longer and are potentially experiencing more complications from sarcoidosis that require admission to hospital settings.
Cardiovascular manifestations were found in about 31 percent of sarcoidosis patients, with heart failure (16 percent) and arrhythmias (15 percent) accounting for the most frequent conditions.
Placement of implantable cardioverter-defibrillators’ rate was low and did not show an increase during that time period, suggesting that this preventive measure of sudden cardiac death in patients with sarcoidosis may be underutilized.
The study also showed that sarcoidosis hospitalizations were more frequent in black people (49.5 percent), independent of cardiac involvement. Black race also was associated with a 21 percent increased risk of in-hospital mortality, compared with white people.
The authors pointed out that “aggressive screening of patients with sarcoidosis for cardiovascular manifestations should be considered for prevention of cardiac arrest in sarcoidosis”. They hope this study stimulates clinical groups to achieve such prevention through greater clinical collaboration by forming specialist sarcoidosis with cardiovascular manifestations clinics and/or specialist centers.