January 27, 2014Open Access
View Full PaperElectrocardiographic Abnormalities in Elderly Chagas Disease Patients: 10‐Year Follow‐Up of the Bambuí Cohort Study of Aging
Key Result
The presence of any major ECG abnormalities doubled the risk of death in elderly Chagas disease patients (HR 2.18; 95% CI 1.35 to 3.53) and also increased mortality risk in non-infected subjects.
Study Design
Type
Cohort (n=1,462)
Multicenter
No
Structured PICO
Do electrocardiographic abnormalities predict mortality in elderly patients with and without Chagas disease?
P
Population
1462 older adults (mean age 69 years, 60.9% women) from Bambuí City, Brazil, including 557 (38.1%) with Trypanosoma cruzi infection (Chagas disease).
I
Intervention
Presence of major electrocardiographic (ECG) abnormalities classified by the Minnesota Code
C
Comparator
Absence of major ECG abnormalities
O
Outcome
Mortality over 10 yearshard clinical
Major ECG abnormalities are highly prevalent in elderly patients with Chagas disease and strongly predict long-term mortality.
Main Result
Effect estimate: HR 2.18 (95% CI 1.35 to 3.53)
Abstract
BACKGROUND: Electrocardiography has been considered an important tool in the management of Chagas disease (ChD) patients, although its value in elderly infected patients is unknown. This study was designed to investigate the prevalence and prognostic value of electrocardiographic abnormalities in Trypanosoma cruzi infected and noninfected older adults. METHODS AND RESULTS: We studied 1462 participants in Bambuí City, Brazil, with electrocardiogram (ECG) records classified by the Minnesota Code. Follow-up time was 10 years; the endpoint was mortality. Adjustment for potential confounding variables included age, gender, conventional risk factors, and B-type natriuretic peptide (BNP). The mean age was 69 years (60.9% women). The prevalence of ChD was 38.1% (n=557). ECG abnormalities were more frequent in ChD patients (87.6% versus 77.7%, P<0.001). Right bundle branch block (RBBB) with left anterior hemiblock (LAH) was strongly related to ChD (OR: 11.99 5.60 to 25.69). During the mean follow-up time of 8.7 years, 556 participants died (253 with ChD), and only 89 were lost to follow-up. ECG variables of independent prognostic value for death in ChD included absence of sinus rhythm, frequent ventricular and supraventricular premature beats, atrial fibrillation, RBBB, old and possible old myocardial infarction, and left ventricular hypertrophy. The presence of any major ECG abnormalities doubled the risk of death in ChD patients (HR: 2.18 1.35 to 3.53), but it also increased the risk in non-ChD subjects (HR: 1.50 1.07 to 2.10); the risk of death increased with the number of major abnormalities in the same patient. CONCLUSION: ECG abnormalities are more common among elderly Chagas disease patients and strongly predict adverse outcomes.