Contributor: Elise Vo

A young Latin American female patient walks into clinic with signs and symptoms of HF, a right bundle branch block on 12-lead EKG, and reduced EF on echo. She has Chagas disease and HFrEF, but what is her prognosis?

Despite its high prevalence in South America, reports of morbidity and mortality of this disease have been variant. Using post-hoc analysis, McMurray et al evaluated outcomes in 2552 Latin American patients from the PARADIGM-HF and ATMOSPHERE trials where 195 (7.6%) had Chagasic HFrEF. The authors discovered that despite younger age and fewer comorbidities, the Chagasic HFrEF cohort had higher CV death and hospitalization when compared to ischemic and non-ischemic groups. Chagasic HFrEF patients had worse quality of life compared to the non-ischemic group, measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ).

Chagasic HFrEF patients had higher rates of thromboembolic events and higher prevalence of renal failure, yet similar NT-proBNP levels.

No study is perfect. The study was post-hoc, it included a relatively small number of Chagasic HFrEF patients, and selection bias created by the PARADIGM-HF and ATMOSPHERE trial inclusion criteria was present.

In a heartbeat… In the setting of guideline-based pharmacologic therapy, patients with Chagasic-HFrEF have worse QoL, higher hospitalization rates, and higher incidence of CV death.

Study Link: Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy