Chagasic HFrEF was associated with a higher risk of first HF hospitalization or cardiovascular death compared to ischemic etiology (HR 1.65; 95% CI 1.36-2.02).
Cohort (n=23,647)
Yes
Does Chagasic etiology increase the risk of cardiovascular death or heart failure hospitalization in patients with HFrEF compared to ischemic and other etiologies?
Chagasic HFrEF is associated with a significantly worse prognosis, including higher risks of mortality, heart failure hospitalization, and stroke, compared to ischemic and most other non-ischemic etiologies.
Hazard Ratio: 1.65 (95% CI 1.36–2.02)
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 USA. We compared outcomes in Chagasic HF to ischemic and other non-ischemic etiologies of HF with reduced ejection fraction (HFrEF). OBJECTIVES To compare clinical outcomes of Chagasic HFrEF with ischemic and other non-ischemic 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 were 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 to other etiologies. Compared to patients with ischemic etiology, the adjusted hazard ratios (95% confidence interval) in Chagasic HF were significantly higher for the composite outcome 1.65 (1.36-2.02), HF hospitalization 1.75 (1.36-2.25), cardiovascular death 1.86 (1.47-2.35), all-cause death 1.82 (1.47-2.25) and stroke 2.16 (1.20-3.88), respectively. CONCLUSIONS Patients with Chagasic HFrEF have a distinct clinical course associated not only with excess mortality but also with an increased risk of stroke compared with other etiologies except for valvular and "other" etiologies.".
Ono et al. (Sun,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=23,647). Chagasic etiology vs. Ischemic etiology was evaluated on Composite of first HF hospitalization or cardiovascular death (HR 1.65, 95% CI 1.36-2.02). Chagasic HFrEF was associated with a higher risk of first HF hospitalization or cardiovascular death compared to ischemic etiology (HR 1.65; 95% CI 1.36-2.02).