Clinical and Epidemiological Profile of Heart Failure Patients With Chagas Disease: Insights From the SEPE-HF Registry
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Published on: January 27, 2019
Juliana Giorgi1, Roberto Cristodulo2, Carlos Vaca2
1Hospital Sirio Libanes, São Paulo, São Paulo, Brazil; Hospital Albert Einstein, São Paulo, São Paulo, Brazil.
Insights
Chagas cardiomyopathy (Ch-CMP) presents unique heart failure characteristics, including distinct ECG findings and lower traditional risk factors. However, Ch-CMP patients show suboptimal guideline-directed medical therapy at discharge, highlighting a critical need for intervention.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Chagas cardiomyopathy (Ch-CMP) is a distinct heart failure (HF) phenotype in endemic areas, differing from non-Chagas HF.
- Understanding Ch-CMP's unique clinical, electrocardiographic, and therapeutic profiles is crucial for effective management.
- HF management in Chagas-endemic regions requires specific considerations due to disease-specific characteristics.
Purpose of the Study:
- To compare the clinical characteristics, comorbidities, and in-hospital outcomes of patients with Chagas cardiomyopathy (Ch-CMP) versus non-Chagas heart failure (HF).
- To evaluate the prevalence of specific electrocardiographic abnormalities and systolic dysfunction in Ch-CMP.
- To assess the utilization of guideline-directed medical therapy (GDMT) at discharge for Ch-CMP patients compared to non-Chagas HF.
Main Methods:
- Retrospective cohort study of 417 patients hospitalized for decompensated HF at a tertiary center in Brazil.
- Patients were divided into confirmed Chagas cardiomyopathy (Ch-CMP) and non-Chagas HF groups.
- Data collected included demographics, comorbidities, electrocardiographic findings, left ventricular ejection fraction (LVEF), in-hospital mortality, and discharge medications.
Main Results:
- Chagas patients (37.1%) were younger, had lower BMI, and fewer comorbidities (hypertension, ischemic heart disease) than non-Chagas HF patients.
- Ch-CMP patients exhibited higher rates of right bundle branch block, atrial fibrillation, pacemaker rhythms, and systolic dysfunction (LVEF < 40%).
- In-hospital mortality was similar, but GDMT use (beta-blockers, ACEi/ARB/ARNi) was significantly lower in Ch-CMP patients at discharge.
Conclusions:
- Chagas cardiomyopathy is a significant cause of HF hospitalizations, characterized by an arrhythmogenic profile and fewer traditional risk factors.
- Despite similar mortality, Ch-CMP patients face significant therapeutic gaps in GDMT at discharge, necessitating targeted interventions.
- The unique profile of Ch-CMP warrants specialized management strategies to improve long-term outcomes and address treatment disparities.
Abstract:
Chagas cardiomyopathy (Ch-CMP) represents a unique and understudied phenotype of heart failure (HF) in endemic regions, with distinct clinical, electrocardiographic, and therapeutic characteristics compared to non-Chagas HF. In this retrospective cohort of 417 patients hospitalized for decompensated HF at a tertiary center in Brazil, 155 (37.1%) had confirmed Ch-CMP. Chagas patients were younger (mean age 67.5 vs 67.7 years, p = 0.86), had lower BMI (28.65 vs 25.40, p < 0.001), and a higher proportion of males (50.9% vs 47.7%, p = 0.56). Comorbidities were less frequent in the Chagas group, including hypertension (49.6% vs 70.1%, p = 0.001) and ischemic heart disease (3.2% vs 16.6%, p = 0.001). Electrocardiographic abnormalities were more prevalent among Chagas patients, such as right bundle branch block (17.6% vs 9%, p = 0.015), atrial fibrillation (37.9% vs 23%, p = 0.001), and pacemaker rhythms (22.2% vs 3.7%, p = 0.001). Systolic dysfunction (LVEF < 40%) was more common in Chagas (59.4% vs 27.1%, p = 0.001). Despite these differences, cardiovascular inhospital mortality did not significantly differ (8.4% vs 5.2%, p = 0.279). The use of guideline-directed medical therapy at discharge was suboptimal in both groups, but even lower in Chagas patients, particularly for beta-blockers (52% vs 64%, p = 0.02) and ACEi/ARB/ARNi (54% vs 68%, p = 0.01). Loop diuretics were used in only 64% of the entire cohort; among those not requiring diuretics, arrhythmias and infections were the leading causes of admission, atrial fibrillation in 22 patients, and infection in 21. In conclusion, Chagas cardiomyopathy remains a major contributor to HF hospitalizations in endemic regions, with a unique arrhythmogenic and vasodilated profile, lower prevalence of traditional risk factors, and concerning therapeutic gaps at discharge that merit targeted intervention.
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