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

Li Shen, Felix Ramires, Felipe Martinez, Luiz Carlos Bodanese, Luis Eduardo Echeverría, Efraín A Gómez, William T Abraham, Kenneth Dickstein, Lars Køber, Milton Packer, Jean L Rouleau, Scott D Solomon, Karl Swedberg, Michael R Zile, Pardeep S Jhund, Claudio R Gimpelewicz, John J V McMurray, PARADIGM-HF and ATMOSPHERE Investigators and Committees

    57 Citations (Scopus)

    Abstract

    BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies.

    METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher.

    CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies.

    CLINICAL TRIAL REGISTRATION: PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658.

    Original languageEnglish
    JournalCirculation. Heart failure
    Volume10
    Issue number11
    Pages (from-to)e004361
    ISSN1941-3289
    DOIs
    Publication statusPublished - Nov 2017

    Keywords

    • Aged
    • Amides
    • Angiotensin Receptor Antagonists
    • Angiotensin-Converting Enzyme Inhibitors
    • Cardiovascular Agents
    • Chagas Cardiomyopathy
    • Female
    • Fumarates
    • Heart Failure
    • Hospitalization
    • Humans
    • Kaplan-Meier Estimate
    • Latin America
    • Male
    • Middle Aged
    • Multicenter Studies as Topic
    • Quality of Life
    • Randomized Controlled Trials as Topic
    • Risk Factors
    • Stroke Volume
    • Time Factors
    • Treatment Outcome
    • Ventricular Function, Left
    • Journal Article

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