Temporal trends in the contribution of Chagas cardiomyopathy to mortality among patients with heart failure

Author(s):Show less -

Nadruz, Wilson ^[1] ; Gioli-Pereira, Luciana ^[2] ; Bernardez-Pereira, Sabrina ^[2] ; Marcondes-Braga, Fabiana G. ^[2] ; Fernandes-Silva, Miguel M. ^{[3, 4]} ; Silvestre, Odilson M. ^[5] ; Sposito, Andrei C. ^[1] ; Ribeiro, Antonio L. ^[6] ; Bacal, Fernando ^[2] ; Fernandes, Fabio ^[2] ; Krieger, Jose E. ^[2] ; Mansur, Alfredo J. ^[2] ; Pereira, Alexandre C. ^[2]

Affiliation

^[1] Univ Estadual Campinas, Dept Internal Med, BR-13083970 Campinas, SP - Brazil

^[2] Univ Sao Paulo, Heart Inst InCor, Med Sch, Sao Paulo - Brazil

^[3] Pontificia Univ Catolica Parana, Med Dept, Curitiba, Parana - Brazil

^[4] Quanta Diagnost & Terapia, Res Dept, Curitiba, Parana - Brazil

^[5] Univ Fed Acre, Dept Internal Med, Rio Branco - Brazil

^[6] Univ Fed Minas Gerais, Dept Internal Med, Belo Horizonte, MG - Brazil

• Document type: Journal article
• Source: HEART; v. 104, n. 18, p. 1522+, SEP 2018.
• Web of Science Citations: 4

Abstract

Background Chagas cardiomyopathy (ChC) prevalence is decreasing in Brazil and medical therapies for heart failure (HF) have improved in the last decade. Whether these changes modified the prognosis of ChC relative to non-Chagas cardiomyopathies (NChC) remains unknown. This study evaluated the temporal trends in population attributable risk (PAR) of ChC for 2-year mortality among patients with HF enrolled at years 2002-2004 (era 1) and 2012-2014 (era 2) in a Brazilian university hospital. Methods We prospectively studied 362 (15% with ChC) and 582 (18% with ChC) HF patients with ejection fraction <= 50% in eras 1 and 2, respectively and estimated the PAR of ChC for 2-year mortality. Results There were 145 deaths (29 in ChC) in era 1 and 85 deaths (26 in ChC) in era 2. In multivariable Cox-regression analysis adjusted for age, sex, ejection fraction, heart rate, body mass index, hypertension, diabetes mellitus, systolic blood pressure and ischaemic/valvar aetiology, ChC was associated with higher risk of death in era 1 (HR (95% CI)=1.92 (1.00 to 3.71), p=0.05) and era 2 (HR (95% CI)=3.51 (1.94 to 6.36), p<0.001). In fully adjusted analysis, the PAR of ChC for mortality increased twofold from era 1 (PAR (95% CI)=11.0 (2.8 to 18.5)%) to era 2 (PAR (95% CI)=21.9 (16.5 to 26.9)%; p=0.023 versus era 1). Conclusion Although the absolute death rates decreased over time in the ChC and NChC groups, the PAR of ChC for mortality increased among patients with HF, driven by increases in the HR associated with ChC. Our results highlight the need for additional efforts aiming to prevent and treat ChC. (AU)

• FAPESP's process: 13/17368-0 - Cardiovascular genomics: mechanisms & novel therapeutics - CVGen mech2ther
• Grantee: José Eduardo Krieger
• Support Opportunities: Research Projects - Thematic Grants