Clinical and therapeutics aspects of heart failure due to chagas disease

Abstract

OBJECTIVE Describe the clinical and therapeutic characteristics of patients with heart failure (HF) secondary to chronic chagasic cardiomyopathy and evaluate if these characteristics are different from those found in other etiologies. METHODS A prospective analysis of the patients treated between August 2003 and June 2004 at a HF referral outpatient clinic was conducted. RESULTS Three hundred and fi fty six patients diagnosed with HF were included in the study. Chagasic cardiomyopathy was the most common etiology (48% of the cases). Other etiologies included hypertensive cardiomyopathy in 19% of the patients, idiopathic dilated in 11% and ischemic in 9%. Patients with HF secondary to chagasic cardiomyopathy were more frequently from non-white ethnic groups (88 vs. 75%; p = 0.002), had a family history of Chagas disease (57 vs. 21%; p = 0.001), had the disease for a longer length of time (71 vs. 56 months; p = 0.034), had lower levels of education (4.4 ± 4.1 vs. 5.7 ± 4.2 years of study; p = 0.004), had a lower heart rate (69 ± 12 vs. 73 ± 13; p = 0.03) and a lower systolic blood pressure (121 ± 25 vs. 129 ± 28 mmHg; p = 0.006). There was also a higher incidence of the use of amiodarone (22 vs. 13%; p = 0.036) and artifi cial pacemakers (15 vs. 1%; p = 0.001). There was a lower usage of beta-blockers (39 vs. 59%; p = 0.001). CONCLUSION In this sample of HF outpatients, in a state with a high prevalence of Chagas disease, chagasic cardiomyopathy was the most common etiology and they presented some unique clinical and therapeutic characteristics in comparison to other heart failure patients.