Contemporary Management of Patients With Chagas Cardiomyopathy in Bolivia

BACKGROUND: Chagas cardiomyopathy (CCM) is the debilitating result of a parasitic infection that causes structural and electrical abnormalities. Yet, optimal CCM management is challenging in the resource-poor communities where it predominates. OBJECTIVES: The authors sought to investigate current practice patterns and barriers to CCM care through an online survey of cardiologists in Bolivia, the country with the highest CCM prevalence. METHODS: Cardiologists were recruited through the national cardiologist directory. The Qualtrics survey was distributed anonymously. Survey questions were developed by Bolivian and U.S. researchers with extensive Chagas disease experience. RESULTS: Of 194 cardiologists, 67 (35%) completed ≥80% of the survey. Responses were collected from every major Bolivian city. More than 70% of cardiologists cared for CCM patients daily or weekly. More frequent prescription of angiotensin-converting enzyme inhibitors (73%) and mineralocorticoid receptor antagonists (82%) for heart failure was reported compared to β-blockers. Ventricular tachycardia treatment was achieved more often with amiodarone (92%) than implantable cardioverter-defibrillators (46%). Anticoagulation was prescribed if CCM patients had atrial fibrillation (91%) or apical aneurysm with thrombus (86%), yet few cardiologists prescribed anticoagulation in left ventricular systolic dysfunction or CCM diagnosis alone. While pacemaker therapy was generally available to cardiologists (66%), patients received devices only through private insurance or philanthropy, with few physicians (28%) offering implantable cardioverter-defibrillators regularly. CONCLUSIONS: Cardiologists cited lack of device access as the predominant challenge in CCM management rather than insufficient knowledge or experience. These findings suggest that significant health equity gaps remain in CCM care, particularly in the availability of commonly indicated, potentially life-saving devices.