Document resource
Introduction Patients with cardiac sarcoidosis (CS) can suffer complications such as advanced heart failure, life-threatening arrhythmias and sudden cardiac death. Multi-faceted clinical management is therefore required to provide comprehensive care to CS patients. The new regional Sussex Cardiac Sarcoidosis service focuses on the prevention and treatment of CS complications, such as heart failure, cardiac arrhythmias and myocardial inflammation. The care model hinges on a multi-disciplinary team (MDT) approach, including input from a heart failure specialist with CS expertise, in collaboration with respiratory and rheumatology specialists. The service has wider support from other cardiology domains such as electrophysiology and intervention. This study sought to assess the clinical effectiveness of the CS service.Methods We assessed the treatments received by the first 20 new CS patients diagnosed between January and November 2025 and their clinical outcomes. The clinical outcomes recorded included all-cause mortality, sustained ventricular tachycardia (VT; >30 seconds in duration) and decompensated heart failure hospitalisations.Results Of the 20 patients diagnosed with CS, 6 (30%) had active myocardial inflammation on FDG-PET-CT. Three patients received IV methylprednisolone due to evidence of intense myocardial FDG-uptake (SUVmax >6), which completely resolved on repeat FDG-PET-CT. The remaining patients received oral prednisolone and/or methotrexate therapy. Of the 20 CS patients, 8 (40%) had left ventricular (LV) systolic dysfunction as defined by LV ejection fraction (LVEF) <50% on cardiovascular MRI. Seven of the 8 patients with LV dysfunction (88%) were treated with optimal guideline directed heart failure medical therapy (GDMT); the remaining 1 patient could not have GMDT due to concurrent severe aortic stenosis (awaited aortic valve replacement surgery). Of the 20 CS patients, 7 (35%) underwent implantable cardioverter defibrillator (ICD) implantation. Two patients developed further sustained VT episodes after ICD implantation despite medical therapy and with no active myocardial inflammation; these patients are awaiting VT ablations. One patient developed sarcoidosis-associated pulmonary hypertension and received specialist care. Possible obstructive coronary disease was found in one patient on cardiac CT, who was referred for a functional ischaemia test. No death or decompensated heart failure hospitalisations were reported.Conclusions The Sussex cardiac sarcoidosis service provided multi-faceted specialist care to newly diagnosed regional CS patients, with no adverse outcomes (death/HF hospitalisation) in the first year. This service model may be replicable. Long-term follow up will inform on future outcomes in the service.