Characteristics, clinical presentation and treatment in older patients with cardiac sarcoidosis

Abstract

Abstract Background Patients with cardiac sarcoidosis have high risks of heart failure and lethal arrhythmic events, and often require comprehensive therapies including medications for heart failure, anti-arrhythmic drugs, and immunosuppressive therapy in addition to implantable device therapies. However, controversy exist whether these treatments should be applied to the elderly patients. Purpose The aim of this study was to investigate whether older age affects treatment strategy in patients with cardiac sarcoidosis. Methods A total of 4,566 patients with hospitalized cardiac sarcoidosis were identified from the Japanese diagnosis procedure combination database from 2012 to 2020. Among them, we analyzed 1,946 patients who were initiated corticosteroid therapy during the hospitalization. Patients’ characteristics and treatment including starting dose of corticosteroid therapy were compared between patients aged ≧ 70 years and those with < 70 years. Results A mean age was 63±11 years, and 1,256 patients (64.5 %) were female. Older patients (age ≧ 70 years , n = 599 [30.8%]) had lower BMIs (22.4±3.7 vs 23.1±4.1 kg/m2, p = 0.001), and higher prescription rates of diuretics (268 [44.7 %] vs 488 [36.2%], p<0.001) , calcium channel broker (162 [27.1%] vs 195 [14.5%], p<0.001), anti-diabetes drugs (204 [34.1%] vs 344 [25.5%], p<0.001), statin (252 [42.1%] vs 461 [34.2%], p = 0.001), anti-coagulant therapy (322 [53.8%] vs 658 [48.9%], p = 0.050), and anti-platelet therapy (119 [19.9%] vs 106 [7.9%], p<0.001). There were no significant differences regarding beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers, mineralocorticoid receptor antagonists, SGLT-2 inhibitors, amiodarone, and immunosuppressive therapies except for corticosteroids. The starting dose of corticosteroids were significantly lower in the older group (37 vs 46 mg/day, p<0.001). In addition, older patients were associated with a higher risk of hospitalization due to acute decompensated heart failure (53 [8.9%] vs 78 [5.8%], p = 0.014), while patients with age <70 years had a higher risk of fatal ventricular arrhythmia (11 [1.8%] vs 49 [3.6 %], p = 0.033). Thirty days mortality and the prevalence of cardiac resynchronization therapy were similar between both groups (5 vs 3, p = 0.064; 2 [2.4%] vs 71 [3.8%], p = 0.768, respectively). Conclusion Older patients with cardiac sarcoidosis tended to be treated with lower doses of corticosteroids, and were more likely to admit due to heart failure exacerbation, while the risks of arrhythmic events were higher in the younger group.