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Increased Mortality and Morbidity in Patients With Heart Failure With Sarcoidosis Compared With Other Causes: A
Entela Bollano1,2, Michael Fu2,3, Aldina Pivodic4
1Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden.
Insights
Heart failure (HF) associated with sarcoidosis has worse outcomes than HF from dilated cardiomyopathy (DCM) or ischemic heart disease (IHD). Sarcoidosis-HF patients face higher mortality and morbidity, requiring specialized care.
Area of Science:
- Cardiology
- Immunology
- Internal Medicine
Background:
- Heart failure (HF) prognosis varies by underlying cause, with ischemic heart disease (IHD) generally having worse outcomes than dilated cardiomyopathy (DCM).
- The prognostic impact of sarcoidosis as a cause of HF remains largely uncharacterized.
- This study investigates the outcomes of sarcoidosis-associated HF (SC-HF) compared to IHD-HF and DCM-HF.
Purpose of the Study:
- To evaluate the prognostic impact of sarcoidosis in patients with heart failure.
- To compare all-cause mortality, cardiovascular death, and hospital readmission rates in SC-HF versus DCM-HF and IHD-HF.
- To identify potential differences in comorbidities among these HF etiologies.
Main Methods:
- Utilized the Swedish Heart Failure Registry (SwedeHF) database (2003-2020).
- Identified patients with sarcoidosis before HF diagnosis (SC-HF) and propensity-matched them to DCM-HF and IHD-HF cohorts.
- Primary outcome was all-cause mortality; secondary outcomes included cardiovascular death and hospital readmission.
Main Results:
- After propensity matching, SC-HF patients (n=365-418) were compared to DCM-HF (n=730) and IHD-HF (n=836) cohorts.
- SC-HF patients exhibited higher 1-year all-cause mortality than both DCM-HF (12.9% vs 8.6%; HR 1.51) and IHD-HF (14.8% vs 9.7%; HR 1.58).
- Higher hospital readmission rates were observed in SC-HF compared to DCM-HF; similar relative risks persisted throughout follow-up.
Conclusions:
- Sarcoidosis-associated heart failure is associated with significantly higher mortality compared to both DCM and IHD.
- SC-HF also demonstrates higher morbidity than DCM-HF, indicating a more complex clinical picture.
- These findings highlight the need for increased clinical vigilance and potentially tailored management strategies for SC-HF patients.
Background:
The prognosis of heart failure (HF) from ischemic heart disease (IHD) is generally worse than from dilated cardiomyopathy (DCM). The impact of prior sarcoidosis on HF outcomes is unknown. We evaluated the prognostic impact of sarcoidosis in HF compared with IHD-HF and DCM-HF using SwedeHF (Swedish Heart Failure Registry).
Methods:
We identified patients with sarcoidosis before HF diagnosis (SC-HF) and propensity-matched them to patients with DCM-HF or IHD-HF between 2003 and 2020. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular death and hospital readmission.
Results:
A total of 422 patients with SC-HF, 6913 with DCM-HF, and 47 164 with IHD-HF were eligible. After 1:2 matching, 365 patients with SC-HF (median follow-up 2.9 years) were compared with 730 with DCM-HF (3.6 years), and 418 with SC-HF (2.8 years) with 836 with IHD-HF (3.6 years). Baseline characteristics were well balanced. Patients with SC-HF had more comorbidities than DCM-HF but fewer than IHD-HF. One-year all-cause mortality was higher in patients with SC-HF than DCM-HF (12.9% versus 8.6%; hazard ratio [HR, 1.51] [95% CI, 1.04-2.21]; P=0.031), along with higher readmission rates. Compared patients with IHD-HF, those with SC-HF also showed higher 1-year mortality (14.8% versus 9.7%; HR, 1.58 [95% CI, 1.14-2.20]; P=0.006). Similar relative risks were observed across full follow-up.
Conclusions:
Sarcoidosis-associated HF is linked to significantly higher mortality than both DCM and IHD and to higher morbidity than DCM. These findings underscore the need for heightened clinical attention and may warrant tailored management strategies for this high-risk group.
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