Sarcoidosis Hospitalization Increases; In-hospital Mortality Declines, Database Study Shows

Hospitalization due to sarcoidosis has increased in the U.S., but in-hospital mortality has declined, according to a study from the University of Alabama at Birmingham (UAB).

The data also showed that more than 30 percent of the hospitalized sarcoidosis patients had one or more cardiovascular complications.

The research, “Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States,” was published in the Journal of the American Heart Association.

Cardiac complications are common among sarcoidosis patients. Research has shown that up to 25 percent of patients without cardiac symptoms show evidence of cardiac granulomas, which are collections of inflammatory cells that characterize sarcoidosis.

Patients with sarcoidosis and associated cardiovascular manifestations exhibit more disease-related complications and are at greater risk of sudden death. This leads to a great interest among clinicians to determine the prevalence of cardiovascular symptoms in sarcoidosis patients, as well as to evaluate in-hospital mortality and trends in defibrillator (ICD) placement in these patients.

Researchers used the National Inpatient Sample, the largest hospital in-patient database in the U.S., which contains information about more than 7 million hospital stays. The analysis focused on the years 2005-2014.

“In view of the gaps in the existing literature base, a retrospective study was conducted to determine trends of hospitalizations and outcomes in sarcoidosis,” Nirav Patel, MD, the study’s first author, said in a press release.

“We examined rates of ICD [cardiac resynchronization therapy (CRT)], permanent pacemaker placement, and factors associated with in-hospital mortality. We also examined racial disparities in outcomes in sarcoidosis hospitalizations,” Patel said.

Of note, CRT uses a pacemaker to correct arrhythmia (irregular heart rhythm).

The team found that more than 600,000 sarcoidosis patients (average age 55) required hospitalization, of which 67 percent were women and 50 percent were African-American. Importantly, the data indicated an increase in hospitalizations from 2005 through 2014 — 138 versus 175 per 100,000 individuals.

In contrast, results showed a decrease in in-hospital mortality throughout the same study period — 6.5 to 4.9 per 100 sarcoidosis hospitalizations.

Concerning race, researchers reported that “Black race is a significant predictor of in-hospital mortality.” African-American patients had a 21 percent increased risk of in-hospital mortality, as well as increased prevalence of cardiac arrest.

Rates of ICD placement were low — less than 1 percent— and did not show a trend to increase.

Overall, about 31 percent of the patients had coexistent cardiovascular issues of one or more types. The most prevalent cardiovascular complications were heart failure and arrhythmias, followed by pulmonary hypertension, non-ischemic cardiomyopathy (disease of the heart muscle) and conduction disorder, which is the impaired conduction of electrical impulses through the heart.

“On the most basic level, we hope to inform clinicians that the co-occurrence of cardiovascular manifestations in sarcoidosis is devastating and could be a leading cause of death,” said Pankaj Arora, MD, the study’s senior author.

Arora added that the study provides evidence of the importance of preventing cardiovascular and pulmonary conditions in sarcoidosis, “and it serves as a stark reminder of the need to aggressively pursue the preventive measures to improve longstanding cardiovascular racial disparities.”

According to the team, clinicians and investigators alike carry an important responsibility to proactively investigate cardiovascular manifestations in sarcoidosis patients.