Increased risk for major cardiac electrical events in patients with sarcoidosis: a nationwide cohort study
M Murninkas, T Sonin, U Shani, Y Patt, Y Elizur, A Cohen, H Amital, N Ben ShabatAbstract
Background
Cardiac sarcoidosis is associated with clinically important conduction disease and ventricular arrhythmias, yet longitudinal outcome data remain limited. A key evidence gap concerns electrical risk in sarcoidosis patients who lack overt cardiac involvement, in whom the burden of major electrical events is less well defined.
Objectives
To quantify the long-term risk of major cardiac electrical outcomes among patients with sarcoidosis compared with the general population (matched controls), and to identify predictors of adverse electrical outcomes within the sarcoidosis cohort.
Methods
We performed a retrospective, nationwide, population-based matched cohort study using Clalit Health Services electronic records. Adults with sarcoidosis (2000–2022) were matched 1:1 to controls by age, sex, and residence; propensity score matching was then applied to balance cardiometabolic and cardiac comorbidities. The primary outcome was a composite of cardiac implantable electronic device (CIED) implantation, sudden cardiac death, or cardiac arrest. Follow-up continued through December 31, 2024; risk estimates were derived using Cox regression models.
Results
The initial cohort included 6,038 sarcoidosis patients and 6,038 matched controls; after propensity matching, 5,246 pairs remained. Cardiac involvement was documented in 2.5% of sarcoidosis patients. Over a median follow-up of 11.1 years (IQR 5.6–17.8), the composite outcome incidence was 2.31 vs 1.93 per 1,000 person-years (sarcoidosis vs controls), corresponding to a higher adjusted risk (aHR 1.40, 95% CI 1.12–1.75). Associations were stronger among women (aHR 1.60) and patients <56 years (aHR 2.07), and persisted among those without baseline ischemic heartdisease or congestive heart failure (aHR 1.37). In sarcoidosis, baseline conduction disorders (aHR 4.88) and congestive heart failure (aHR 5.13) were the strongest independent predictors.
Conclusions
Sarcoidosis is associated with increased long-term risk of major cardiac electrical outcomes versus the general population, particularly among women and patients younger than 56 years.SurvivalRisks