Hospitalization rates, prevalence of cardiovascular manifestations, and outcomes associated with sarcoidosis in the United States

Nirav Patel, Rajat Kalra, Rajkumar Doshi, Harpreet Arora, Navkaranbir S. Bajaj, Garima Arora, Pankaj Arora

Research output: Contribution to journalArticlepeer-review

18 Scopus citations

Abstract

Background--Recent trends of hospitalizations and in-hospital mortality are not well defined in sarcoidosis. We examined aforementioned trends and prevalence of cardiovascular manifestations and explored rates of implantable cardioverter-defibrillator implantation in hospitalizations with sarcoidosis. Methods and Results--Using data from the National Inpatient Sample, a retrospective population cohort from 2005 to 2014 was studied. To identify sarcoidosis, an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code was used. We excluded hospitalizations with myocardial infarction, coronary artery disease, and ischemic cardiomyopathy. Cardiovascular manifestations were defined by the presence of diagnosis codes for conduction disorders, arrhythmias, heart failure, nonischemic cardiomyopathy, and pulmonary hypertension. A total of 609 051 sarcoidosis hospitalizations were identified, with an age of 55±14 years, 67% women, and 50% black. The number of sarcoidosis hospitalizations increased from 2005 through 2014 (138 versus 175 per 100 000, Ptrend < 0.001). We observed declining trends of unadjusted in-hospital mortality (6.5 to 4.9 per 100 sarcoidosis hospitalizations, Ptrend < 0.001). Overall ≈31% (n=188 438) of sarcoidosis hospitalizations had coexistent cardiovascular manifestations of one or more type. Heart failure (≈16%) and arrhythmias (≈15%) were the most prevalent cardiovascular manifestations. Rates of implantable cardioverter-defibrillator placement were ≈7.5 per 1000 sarcoidosis hospitalizations (Ptrend=0.95) during the study period. Black race was associated with 21% increased risk of in-hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.16-1.27 [P < 0.001]). Conclusions--Sarcoidosis hospitalizations have increased over the past decade with a myriad of coexistent cardiovascular manifestations. Black race is a significant predictor of in-hospital mortality, which is declining. Further efforts are needed to improve care in view of low implantable cardioverter-defibrillator rates in sarcoidosis.

Original languageEnglish (US)
Article numbere007844
JournalJournal of the American Heart Association
Volume7
Issue number2
DOIs
StatePublished - Jan 1 2018

Bibliographical note

Funding Information:
This work was supported in part by the Walter B. Frommeyer, Junior Fellowship in Investigative Medicine, which was awarded to Dr Arora by the University of Alabama at Birmingham. Dr Patel is supported by National Institutes of Health grant number 1T32HL129948-01A1. Dr Bajaj is supported by National Institutes of Health grant number 5T32HL094301-07.

Publisher Copyright:
© 2018 The Authors.

Keywords

  • Cardiovascular outcomes
  • Implantable cardioverter-defibrillator
  • Sarcoidosis

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