Comparative Prognosis of Chagas and Other Cardiomyopathies

BACKGROUND:Chagas disease, caused by Trypanosoma cruzi parasites, is a common cause of heart failure (HF) in Latin America and has recently been declared endemic in the United States. The authors compared outcomes in Chagasic HF vs ischemic and other nonischemic etiologies of HF with reduced ejection fraction (HFrEF). OBJECTIVES:The aim of this study was to compare clinical outcomes of Chagasic HFrEF vs ischemic and other nonischemic etiologies. METHODS:Investigator-reported etiology of HFrEF in the ATMOSPHERE, PARADIGM-HF, and GALACTIC-HF trials was categorized as ischemic, valvular, alcoholic, hypertensive, idiopathic, viral, Chagasic, or "other." Time to the composite of first HF hospitalization or cardiovascular death, its components, all-cause death, and stroke was analyzed using Cox models adjusted for baseline characteristics, patient setting, trial, and other potential confounders. RESULTS:Among 23,647 patients (13,381 ischemic, 4,344 idiopathic, 2,559 hypertensive, 1,923 others, 423 alcoholic, 412 valvular, 297 viral, and 308 Chagasic), Chagasic HF had the highest incidence rates of all clinical outcomes compared with other etiologies. Compared with patients with ischemic etiology, the adjusted HRs in Chagasic HF were significantly higher for the composite outcome (HR: 1.65; 95% CI: 1.36-2.02), HF hospitalization (HR: 1.75; 95% CI: 1.36-2.25), cardiovascular death (HR: 1.86; 95% CI: 1.47-2.35), all-cause death (HR: 1.82; 95% CI: 1.47-2.25), and stroke (HR: 2.16; 95% CI: 1.20-3.88). CONCLUSIONS:Patients with Chagasic HFrEF have a distinct clinical course associated not only with excess mortality but also with an increased risk for stroke compared with other etiologies except for valvular and "other" etiologies. (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE], NCT00853658; Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ACEI [Angiotensin-Converting-Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial [PARADIGM-HF], NCT01035255; Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure [GALACTIC-HF], NCT02929329).