Association Between Heart Failure Medications and Outcomes in Patients With Cardiac Sarcoidosis and Left Ventricular Systolic Dysfunction: Insights From ILLUMINATE-CS.

BACKGROUND

Heart failure associated with cardiac sarcoidosis (CS) is typically managed using conventional heart failure medications (HFMs). However, their effectiveness in this specific population remains unclear. We aimed to evaluate the association between HFMs and clinical outcomes in patients with CS and left ventricular systolic dysfunction.

METHODS

This post hoc observational analysis used data from the ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients With Cardiac Sarcoidosis), a retrospective registry of patients diagnosed with CS between 2001 and 2017. Patients with left ventricular ejection fraction <50% were included. Characteristics and outcomes of patients treated with HFMs (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists) at diagnosis were assessed. The primary end point was a composite of all-cause death, hospitalization for heart failure, and documented fatal ventricular arrhythmia events. Propensity score-based overlap weighting analysis was used to balance covariates across the study groups.

RESULTS

Of 242 eligible patients with CS, 199 (82%) received at least 1 HFM. The HFM group had significantly lower left ventricular ejection fraction (36% versus 40%) and higher brain natriuretic peptide levels (215 versus 152 pg/mL) than the non-HFM group. In the unadjusted analysis, the incidence of the primary end point did not differ significantly between the groups (38% versus 37%; hazard ratio [HR]=1.12 [95% CI=0.65-1.92]). Overlap weighting analysis showed no significant association between HFM use and the primary end point (HR=0.63 [95% CI=0.32-1.23]).

CONCLUSIONS

Although HFM was commonly used in patients with CS and impaired left ventricular ejection fraction, HFM use at diagnosis was not significantly associated with improved clinical outcomes.