Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States.

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.

• Authors: Nirav Patel, Rajat Kalra, Rajkumar Doshi, Harpreet Arora, Navkaranbir S Bajaj, Garima Arora, Pankaj Arora
• Journal: Journal of the American Heart Association (J Am Heart Assoc) Vol. 7 Issue 2 (01 22 2018) ISSN: 2047-9980 [Electronic] England
• PMID: 29358190 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Topics

• Adult
• Black or African American
• Aged
• Cardiovascular Diseases (diagnosis, epidemiology, mortality, therapy)
• Defibrillators, Implantable (trends)
• Electric Countershock (adverse effects, instrumentation, mortality, trends)
• Female
• Hospital Mortality (trends)
• Hospitalization (trends)
• Humans
• Male
• Middle Aged
• Prevalence
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Sarcoidosis (diagnosis, epidemiology, mortality, therapy)
• Time Factors
• Treatment Outcome
• United States (epidemiology)
• White People