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Original research article
Temporal trends in the contribution of Chagas cardiomyopathy to mortality among patients with heart failure
  1. Wilson Nadruz Jr1,
  2. Luciana Gioli-Pereira2,
  3. Sabrina Bernardez-Pereira2,
  4. Fabiana G Marcondes-Braga2,
  5. Miguel M Fernandes-Silva3,4,
  6. Odilson M Silvestre5,
  7. Andrei C Sposito1,
  8. Antonio L Ribeiro6,
  9. Fernando Bacal2,
  10. Fabio Fernandes2,
  11. Jose E Krieger2,
  12. Alfredo J Mansur2,
  13. Alexandre C Pereira2
  1. 1 Department of Internal Medicine, University of Campinas, Campinas, Brazil
  2. 2 Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
  3. 3 Medicine Department, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
  4. 4 Research Department, Quanta Diagnósticos e Terapia, Curitiba, Brazil
  5. 5 Department of Internal Medicine, Federal University of Acre, Rio Branco, Brazil
  6. 6 Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
  1. Correspondence to Professor Wilson Nadruz Jr, Department of Internal Medicine, University of Campinas, Campinas, SP, 13083-970, Brazil; wilnj{at}


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.

  • chagas disease
  • heart failure

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  • Contributors WN, ACP, MMF-S and OMS contributed to the design of the work and to the analysis and interpretation of data. LG-P, SB-P, FGM-B, ACS, ALR, FB, FF, JEK and AJM contributed to the acquisition, analysis and/or interpretation of data. WN and ACP drafted the work and MMF-S, OMS, LG-P, SB-P, FGM-B, ACS, ALR, FB, FF, JEK and AJM revised it critically for important intellectual content. All authors approved the version published and are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The study was supported by CNPq (grant 304245/2013-5) for WN and by NIH (grants R01HL133165, U19 AI098461-07) and FAPESP (grant 2013/17368-0) for ACP.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the Human Research Ethics Committee of the University of São Paulo (Protocol number 0398/04—SDC 2368/03/162).

  • Provenance and peer review Not commissioned; externally peer reviewed.