Prognostic Evaluation of Chagasic and Non-Chagasic Patients Undergoing Pacemaker Implantation and Cardiac
Laís Toledo de Vasconcelos1, Larissa Natany Almeida Martins2, Anna Terra França1
1Programa de Pós-graduação em Ciências Aplicadas à Saúde do Adulto - Departamento de Clínica Médica - Faculdade de Medicina e Serviço de Cardiologia e Cirurgia Cardiovascular do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brasil.
Insights
Chagas cardiomyopathy does not increase mortality risk in patients receiving pacemakers or cardiac resynchronizers. This study suggests improved care for Chagas disease patients may be mitigating adverse outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Chagas cardiomyopathy (ChCC) is a significant cause for pacemaker implantation.
- ChCC has historically been linked to poorer patient prognosis.
Purpose of the Study:
- To compare the prognosis of patients with and without Chagas disease undergoing pacemaker and cardiac resynchronizer implantation.
- To evaluate the impact of Chagas disease on mortality and hospitalization rates in device recipients.
Main Methods:
- Observational, retrospective cohort study (2007-2017) comparing chagasic and non-chagasic patients.
- Kaplan-Meier survival analysis and Cox regression adjusted for sex and age.
- Primary outcome: all-cause mortality; secondary outcomes: hospitalization and combined death/hospitalization.
Main Results:
- 911 patients included; 23.4% had Chagas cardiomyopathy.
- Chagas disease was not associated with increased risk of death (HR: 1.14), hospitalization (HR: 0.79), or combined outcome (HR: 0.90) after adjustment.
- Statistical analysis showed no significant difference in adverse events between groups (p > 0.05).
Conclusions:
- Chagas disease did not elevate the risk of death, hospitalization, or combined adverse events in patients receiving cardiac devices.
- Findings contrast with previous studies, suggesting potential improvements in Chagas cardiomyopathy patient care.
- Further research may explore evolving management strategies for Chagas disease-associated heart conditions.
Background:
Chagas cardiomyopathy (ChCC) is one of the causes of the implantation of pacemakers (PM) in many patients and has been associated with an adverse prognosis.
Objectives:
To compare the prognosis of the chagasic and non-chagasic populations undergoing PM and cardiac resynchronizer implantation.
Methods:
Observational, retrospective study, which analyzed a cohort of patients who underwent implantation of these devices, in a tertiary center, from October 2007 to December 2017, comparing the chagasic group with non-chagasic patients. The non-parametric Kaplan-Meier method was used to calculate patient survival. The significance level adopted in the statistical analysis was 5%. The primary outcome was mortality from any cause, while the secondary outcomes were the occurrence of hospitalization and the combination of hospitalization and death.
Results:
A total of 911 patients were included, of which 23.4% had ChCC. In a Cox analysis adjusted for sex and age, Chagas disease (ChD) was not associated with an increased risk of death (HR: 1.14, CI:95%, 0.86-1.51, p=0.365), hospitalization (HR: 0.79, CI:95%, 0.61-1.04, p=0.09) or combined outcome of death and hospitalization (HR: 0.90, CI:95%, 0.72-1 .12, p=0.49).
Conclusions:
ChD was not associated with an increased risk of death, hospitalization, or combined outcome of death and hospitalization, even after adjustment for sex and age. These results contrast with those of previous studies and suggest changes in the quality of care of patients with cardiomyopathy.
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