Increased Mortality and Morbidity in Patients With Heart Failure With Sarcoidosis Compared With Other Causes: A Propensity-Matched Nationwide Cohort Study

Abstract

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.

Keywords: all‐cause mortality; cardiac sarcoidosis; heart failure; inflammatory cardiomyopathy; myocarditis.