Introduction: Guidelines recommend electrocardiogram (ECG) at initial sarcoidosis diagnosis as one screening tool for cardiac involvement. ECG is inexpensive and widely available, yet frequency of its use and whether screening rates differ by sex have not been characterized at scale.

Objectives: To measure ECG screening rates within six months of sarcoidosis diagnosis and evaluate sex-based disparities over time.

Materials and Methods: We conducted a retrospective review of 7,468 adults (age ≥18) diagnosed with sarcoidosis at a quaternary care center and regional sites between 2020 and 2024, identified by ICD-10 codes. Patients with pre-existing cardiac sarcoidosis based on ICD-10 coding (n=356) were excluded. ECG screening was defined as an ECG within ±180 days of diagnosis at our institution; externally performed ECGs were not captured, so true screening rates may be higher. Multivariable logistic regression adjusted for sex, age, race, and diagnosis year.

Results: The cohort was 55.4% female with median age 58.7 years. Overall, 55.1% received an ECG within 180 days before or after first ICD-10 code of sarcoidosis, Men were screened more than women (59.7% vs 51.4%; p<0.001). ECG rates did not differ significantly across race groups except Black patients were screened more than White (60.2% vs 55.3%; p<0.001). Post-ICD-10 code diagnosis ECG showed the starkest disparity: female rates remained flat at ~40% while male rates rose from 41% to 53% (sex×year interaction p=0.003). On multivariable analysis, male sex was the strongest predictor (OR 1.45; 95% CI 1.32–1.60; p<0.001), with screening rates improving over time (OR 1.10 per year; p<0.001).

Conclusions: ECG screening at sarcoidosis diagnosis remains suboptimal, with a significant and widening sex disparity persisting after adjustment for race and not explained by potential undercapture of external ECGs. This could be an area to improve intervention and increase ECG screening.