Abraham Jacob, Spinelli Kateri, Li Hsin-Fang, Pham Tuan, Wang Mansen, Sheikh Farooq H
Center for Cardiovascular Analytics, Research and Data Science (CARDS), Providence Heart Institute, Providence Research Network, Portland, Oregon.
Adventist Health, Portland, Oregon.
Front Cardiovasc Med. 2024 Nov 19;11:1475181. doi: 10.3389/fcvm.2024.1475181. eCollection 2024.
Cardiac sarcoidosis (CS) is an increasingly recognized cause of cardiac disease. Because the clinical presentation of CS is non-specific, the diagnosis is often delayed. Early detection is essential to initiate treatments that reduce the risk of heart failure (HF) and arrhythmic death. We therefore aimed to describe the features of CS hospitalizations during which the initial diagnosis of CS is made.
We performed a retrospective analysis of hospitalizations from 2016 to 2019 in the Nationwide Readmission Database (NRD). Hospitalizations with a primary diagnosis suggestive of CS (HF/cardiomyopathy, cardiac arrest, arrhythmias, or heart block) were categorized into cases with and without CS as a secondary diagnosis (CS+ and CS-, respectively). One-to-one propensity score matching (PSM) was performed.
The CS+ cohort comprised 1,146 hospitalizations and the CS- cohort 3,250,696 hospitalizations. The CS+ cohort included patients who were younger and more often male. PSM resulted in highly matched cohorts (absolute standardized mean difference <0.1). Primary diagnoses of ventricular arrhythmias (VA) or heart block were more frequent in matched CS+ hospitalizations, whereas primary diagnosis of HF/cardiomyopathy was more frequent in matched CS- hospitalizations. The matched CS+ group exhibited higher rates of in-hospital procedures and longer length of stay. In-hospital mortality and 30-day readmission were similar between matched cohorts.
These findings highlight increased rates of CS in younger males with primary diagnoses of VA and heart block, and increased use of diagnostic and therapeutic interventions such as pacemaker and left ventricular assist device implantation, and could aid clinicians in more timely diagnosis and treatment of CS.
心脏结节病（CS）是一种日益被认识到的心脏病病因。由于CS的临床表现不具有特异性，诊断往往会延迟。早期检测对于启动降低心力衰竭（HF）和心律失常性死亡风险的治疗至关重要。因此，我们旨在描述确诊CS的住院病例的特征。
我们对全国再入院数据库（NRD）中2016年至2019年的住院病例进行了回顾性分析。将初步诊断提示CS（HF/心肌病、心脏骤停、心律失常或心脏传导阻滞）的住院病例分为有CS作为次要诊断和无CS作为次要诊断的病例组（分别为CS+和CS-）。进行了一对一倾向评分匹配（PSM）。
CS+队列包括1146例住院病例，CS-队列包括3250696例住院病例。CS+队列中的患者更年轻，男性比例更高。PSM产生了高度匹配的队列（绝对标准化平均差异<0.1）。在匹配的CS+住院病例中，室性心律失常（VA）或心脏传导阻滞的初步诊断更为常见，而在匹配的CS-住院病例中，HF/心肌病的初步诊断更为常见。匹配的CS+组住院期间进行手术的比例更高，住院时间更长。匹配队列之间的住院死亡率和30天再入院率相似。
这些发现突出了在初步诊断为VA和心脏传导阻滞的年轻男性中CS发生率增加，以及起搏器和左心室辅助装置植入等诊断和治疗干预措施的使用增加，这有助于临床医生更及时地诊断和治疗CS。
