Introduction: Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity, particularly heart failure (HF), is common. Characteristics predicting this important outcome remain largely unknown, largely due to limitations of small case series.
Methods: We used the Healthcare Cost and Utilization Project database, a longitudinal analysis of California residents ≥ 21 years of age who received ambulatory surgery, emergency, or inpatient care from 2005-2011. After excluding those with prevalent HF, we assessed demographic variables and medical diagnoses as predictors of new onset HF.
Results: Among 14,816,596 California residents, we identified 10,622 patients with sarcoidosis. Of these, 640 (7%) developed HF over a median 2.6 (interquartile range 2.8) years. Compared to sarcoid patients who did not develop HF, those that did were more likely to be non-white (53% v 61%, p<0.01), have lower income (30% v 24% in lowest quartile, p<0.01), and have a preceding diagnosis of hypertension (74% v 48%, p<0.01), diabetes (49% v 25%, p<0.01), coronary artery disease (32% v 10%, p<0.01), tobacco use (10% vs. 8%, p=0.02), stroke (6% v 2%, p<0.01), atrial fibrillation (17% v 4%, p<0.01), AV block (3% v 0.5%, p<0.01), and ventricular tachyarrhythmias (6% v 0.7%, p<0.01). After adjusting for covariates, all of the same predictors except for tobacco use remained predictive of incident heart failure, with arrhythmias exhibiting particularly high odds ratios (Figure).
Conclusion: While conventional HF risk factors predicted increased HF risk in sarcoid patients, tachyarrhythmias and AV block, events that suggest cardiac infiltration, were also especially potent predictors of HF in this population. These characteristics may facilitate the early initiation of relevant therapies in sarcoidosis patients, helping to reduce cardiac morbidity in this population.