Accuracy of health-related quality of life in identifying systolic dysfunction in patients with Chagas cardiomyopathy.

OBJECTIVE: Systolic dysfunction is a well-established marker of mortality in patients with Chagas cardiomyopathy (CC). However, its diagnosis is expensive and useful tools for screening these patients are required. The evaluation of the health-related quality of life (HRQoL) detects the patient's perception of the disease's impact. However, its accuracy in identifying patients with CC and systolic dysfunction is unknown. The study aimed to verify the sensitivity, specificity and predictive values of the physical and mental components related to HRQoL in identifying patients with CC and systolic dysfunction. METHODS: 75 patients with CC, aged 49 (95% confidence interval: 47-51) years, were evaluated by echocardiography and Short-Form of Health Survey (SF-36) questionnaire. Systolic dysfunction was defined by left ventricular ejection fraction <52% for men and <54% for women and left ventricular diastolic diameter >55 mm. RESULTS: Most patients (73%) had systolic dysfunction, with lower HRQoL values in the physical functioning, physical role functioning and general health perceptions domains and in the physical component summary. The accuracy of identifying patients with systolic dysfunction by the scores of physical components was 73% and 62% of mental components. The optimal cut-off point was 46 for physical and 54 for mental components, with respective positive predictive values of 91% and 80%. CONCLUSION: The evaluation of the HRQoL by the SF-36, a low-cost instrument, can be useful in identifying patients with systolic dysfunction, assisting in the screening and risk stratification of patients.

The prognostic value of health-related quality of life in patients with Chagas heart disease.

PURPOSE: To verify the prognostic value of health-related quality of life (HRQoL) and the differences in HRQoL and clinical variables between groups of Chagas heart disease (CHD) patients with and without cardiovascular adverse events. METHODS: Seventy-five CHD patients were evaluated by echocardiography, maximal exercise testing, and Short-form of Health Survey (SF-36) Questionnaire. Patients were followed during 6 years. In the statistical analysis, uni- and multivariate Cox regression were performed to verify the accuracy of the HRQoL in predicting cardiovascular events. RESULTS: After the follow-up period (41 ± 12 months), 20 patients (27%) had adverse events. Those with poor outcome had lower left ventricular ejection fraction (LVEF) (p = 0.002), higher left ventricular end-diastolic diameter (LVDd) (p = 0.019), and worse scores in general health perceptions (p = 0.047), social role functioning (p = 0.026), and mental component summary (p = 0.043) of SF-36. Patients with lower LVEF (p = 0.003), higher LVDd (p = 0.022), worse HRQoL in the general heath perceptions domain (p = 0.022), and mental component summary (p = 0.031) were associated with worse prognosis. In the multivariate Cox regression, LVEF (HR 0.94, 95% CI from 0.90 to 0.98, p = 0.007) and mental component summary (HR 0.98, 95% CI from 0.94 to 1.00, p = 0.047) remained as independent predictors of adverse events in CHD patients. CONCLUSION: The assessment of HRQoL, especially the mental component, should be taken into account to provide an accurate prognosis in addition to other well-established predictors of poor outcomes in CHD patients.

Reassessment of quality of life domains in patients with compensated Chagas heart failure after participating in a cardiac rehabilitation program.

INTRODUCTION:: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS: This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS:: The program promoted improved physical functioning (ß= +5.7; p=0.003), role-physical (ß= +1.9; p=0.03), and bodily pain (ß= +3.5; p=0.02) scores. Moreover, the summary physical health score (ß= +1.4; p=0.001) improved. CONCLUSION:: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.

Reassessment of quality of life domains in patients with compensated Chagas heart failure after participating in a cardiac rehabilitation program

Abstract INTRODUCTION: We evaluated the effects of a cardiac rehabilitation program on quality of life. METHODS This secondary analysis of a single-arm study included 12 patients with Chagas heart failure. The cardiac rehabilitation program comprised exercise training and nutritional and pharmaceutical counseling. Quality of life was assessed using the SF-36 questionnaire. RESULTS: The program promoted improved physical functioning (β= +5.7; p=0.003), role-physical (β= +1.9; p=0.03), and bodily pain (β= +3.5; p=0.02) scores. Moreover, the summary physical health score (β= +1.4; p=0.001) improved. CONCLUSION: The cardiac rehabilitation program significantly improved the physical quality of life of patients with Chagas heart failure.

Respiratory muscle strength, the six-minute walk test and quality of life in Chagas cardiomyopathy.

BACKGROUND AND PURPOSE: Patients with heart failure disease develop respiratory and functional limitations and suffer from the negative influence on their quality of life. This study was designed to evaluate respiratory muscle strength and its relationship to functional capacity, quality of life and rate of perceived exertion in patients with Chagas cardiomyopathy. METHODS: We evaluated 32 patients divided into groups with and without Chagas heart disease. We measured the Minnesota Living with Heart Failure Questionnaire, the maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), distance walked during the 6-minute walk test, rating of perceived exertion (RPE), heart rate, blood pressure, respiratory rate, oxygen saturation and ejection fraction (EF). RESULTS: The group with Chagas heart disease showed decreased quality of life (overall score: p = 0.001; physical domain: p = 0.002; role-emotional domain: p = 0.031 and general health domain: p < 0.001) and MIP (p < 0.001) when compared with the control group. There was no difference between the distance walked in both groups. The RPE was greater in the group with Chagas heart disease (p = 0.001). The MIP correlated with MEP (r = 0.631, p = 0.009) and EF (r = 0.524, p = 0.037). CONCLUSION: The inspiratory muscle strength is reduced, and the decreased quality of life has a negative influence on the physical and emotional aspects of the patients with Chagas cardiomyopathy. No correlation was found between perceived exertion and the reduction of respiratory muscle strength.

Impact of pharmaceutical care on the quality of life of patients with Chagas disease and heart failure: randomized clinical trial.

BACKGROUND: Pharmaceutical care is the direct interaction between pharmacist and patient, in order to improve therapeutic compliance, promote adequate pharmacotherapeutic follow-up, and improve quality of life. Pharmaceutical care may be effective in reducing complications and in improving the quality of life of patients with chronic diseases, like Chagas heart disease, while bringing a positive impact on health system costs. The morbidity and mortality indexes for patients with Chagas heart disease are high, especially if this heart disease is complicated by heart failure. In this setting, we hypothesize that pharmaceutical care might be an important tool for the clinical management of these patients by improving their quality of life, as a better compliance to their treatment and the avoidance and prompt correction of drug-related problems will minimize their symptoms, improve their functional class, and decrease the number of hospital admissions. Therefore, the aim of this trial is to evaluate the contribution of pharmaceutical care to clinical treatment of patients with Chagas heart disease complicated by heart failure. METHODS/DESIGN: A prospective, single-center randomized clinical trial will be conducted in patients with Chagas heart disease complicated by heart failure. A total of 88 patients will be randomly assigned into two parallel groups: an intervention group will receive standard care and pharmaceutical care, and a control group will receive only standard care. Both groups will be subjected to a follow-up period of 12 months. The primary outcome of this trial is the evaluation of quality of life, measured by the 36-item short-form and the Minnesota Living with Heart Failure Questionnaire. Secondary outcomes include drug-related problems, exercise tolerance as measured by the standard six-minute-walk test, and compliance. DISCUSSION: Patients with Chagas heart disease complicated by heart failure under pharmaceutical care are expected to improve their quality of life, present with a lower incidence of drug-related problems, improve their functional capacity, and improve in their compliance to treatment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01566617.

Health-related quality of life in Brazilian outpatients with Chagas and non-Chagas cardiomyopathy.

PURPOSE: To examine differences in demographic, clinical, and health-related characteristics of quality of life in heart failure patients with Chagas and non-Chagas cardiomyopathy in Brazil. METHODS: This observational study was carried out with 43 Brazilian out-patients with Chagas and 59 non-Chagas cardiomyopathy. RESULTS: No differences were evident between the 2 groups regarding age, sex, mean left-ventricular ejection fraction, and duration of follow-up. Compared with the non-Chagas group, patients with Chagas cardiomyopathy had a higher percentage of participants using artificial pacemakers (P < .001), more symptoms of heart failure as measured by New York Heart Association classes III and IV (P = .02), higher intakes of aspirin and warfarin, a higher use of artificial pacemakers because of bradycardia, and lower health-related quality of life in the Physical Functioning (P = .01) and Role Physical (P = .002) domains of the Medical Outcomes Study Short Form 36-Item Health Status Survey. CONCLUSION: Our study population was limited to one region endemic for Chagas disease in Brazil, and therefore findings need to be confirmed and should not be generalized to other populations without further research.

A randomized trial of the effects of exercise training in Chagas cardiomyopathy.

AIMS: The effects of exercise training in chronic heart failure are well established, however, they have not been evaluated in Chagas cardiomyopathy (ChC). We sought to determine the effects of exercise training on functional capacity, health-related quality of life (HQoL), and brain natriuretic peptide (BNP) levels in patients with ChC. METHODS AND RESULTS: This randomized, controlled, single-blind trial included 40 patients with ChC (age 49.5 +/- 7.8 years, 57.5% male) who did not practice regular exercise. All patients were assessed, at baseline and at the end of the study, by exercise test (VO(2) and exercise time), six-minute walk test (6MWT), Goldman Specific Activity Scale (SAS), HQoL, and BNP levels. Patients were randomized to inactive control group (ICG = 19) or exercise training group (ETG = 21). Exercise training group patients underwent 12 weeks of exercise training: walking for up to 30 min (intensity 50-70% HR reserve + HR at rest) and warm-up and cooling-down exercising, three times a week. The data were analysed for delta values (Delta= end - baseline). After intervention, compared with the ICG, the ETG had significant increases in functional parameters including, DeltaVO(2) (6.5 vs. 2.8 mL/kg/min, P = 0.001), Delta exercise time (2.9 vs.1.1 min, P < 0.001), Delta6MWT distance (83.5 vs. 2.0 m, P = 0.001) improved DeltaSAS (8 vs. 1 patient, P = 0.008), and HQoL: Delta domains vitality (7.5 vs. 0 points, P = 0.013), Delta emotional aspects (16.7 vs. 0 points, P = 0.012), and Delta mental health (16.1 vs. 0 points, P = 0.031). There was no difference in BNP levels. CONCLUSION: In patients with ChC, exercise training was associated with a major improvement in functional capacity and HQoL without any adverse effects.

[Heart transplantation: the experience of patients with Chagas disease]. / Transplante cardíaco (TC): a experiência do portador da Doença de Chagas.

Successful heart transplantation in patients with Chagas disease depends on special care to be provided during all phases of the transplantation process, and requires specific and rigorous follow-up by the health care team. Recipients must be aware of the permanence of the trypanosome in their organisms as well as of the possibility of infection reactivation after transplantation. Therefore, the patient's knowledge regarding this condition and his active participation in his own treatment are of utmost importance. This study aimed at investigating heart transplantation as experienced by patients with Chagas disease, seeking to understand the meanings that they attribute to such an experience. The methodological procedures included: patient selection; interviews; data analysis, indication of the meaning units and individual analysis; search for discourse convergence; and hermeneutic analysis of convergences. From the data analysis, the following themes emerged: the time lived by recipients with Chagas Disease; the conception of heart transplantation presented by patients with Chagas Disease; and care in the course of heart transplantation.

Transplante cardíaco (TC): a experiência do portador da doença de Chagas / Trasplante cardíaco (TC): la experiencia del portador de la enfermedad de Chagas / Heart transplantation: the experience of patients with Chagas disease

O sucesso do transplante cardíaco com portadores da doença de Chagas está condicionado a cuidados especiais durante todas as fases do transplante, com necessidade de acompanhamento específico e rigoroso pela equipe de saúde. Os receptores devem estar conscientes da permanência do Trypanossoma no organismo, e das possibilidades de reativação da infecção após o transplante. Portanto, seu conhecimento dessa condição, e a sua participação ativa no próprio tratamento, têm importância fundamental. O objetivo do estudo foi investigar a experiência do transplante cardíaco vivenciada por pacientes portadores da doença de Chagas, para buscar compreender os significados que eles atribuem a esta experiência. Os procedimentos metodológicos abrangeram: a seleção dos pacientes; as entrevistas; a análise dos dados, indicando as unidades de significado e a análise individual; a busca de convergências dos discursos; e análise hermenêutica das convergências. Da análise dos dados emergiram os seguintes temas: o tempo vivido pelo receptor, portador da Doença de Chagas; a concepção do TC apresentado pelo portador de Chagas; o cuidado na trajetória do TC.

Successful heart transplantation in patients with Chagas disease depends on special care to be provided during all phases of the transplantation process, and requires specific and rigorous follow-up by the health care team. Recipients must be aware of the permanence of the trypanosome in their organisms as well as of the possibility of infection reactivation after transplantation. Therefore, the patient's knowledge regarding this condition and his active participation in his own treatment are of utmost importance. This study aimed at investigating heart transplantation as experienced by patients with Chagas disease, seeking to understand the meanings that they attribute to such an experience. The methodological procedures included: patient selection; interviews; data analysis, indication of the meaning units and individual analysis; search for discourse convergence; and hermeneutic analysis of convergences. From the data analysis, the following themes emerged: the time lived by recipients with Chagas Disease; the conception of heart transplantation presented by patients with Chagas Disease; and care in the course of heart transplantation.

El éxito del trasplante cardíaco con portadores de la enfermedad de Chagas está condicionado a cuidados especiales durante todas las fases del trasplante, con necesidad de acompañamiento específico y riguroso por el equipo de salud. Los receptores deben estar conscientes de la permanencia del Tripanosoma en el organismo y de las posibilidades de reactivación de la infección después del trasplante. Por lo tanto, su conocimiento sobre esa condición y su participación activa en el propio tratamiento es de fundamental importancia. El objetivo del estudio fue investigar la experiencia del trasplante cardíaco experimentada por pacientes portadores de la enfermedad de Chagas, para comprender los significados que ellos atribuyen a esta experiencia. Los procedimientos metodológicos abarcaron: la selección de los pacientes; las entrevistas; el análisis de los datos, indicando las unidades de significado y el análisis individual; la búsqueda de convergencias de los discursos; el análisis hermenéutico de las convergencias. Del análisis de los datos emergieron los siguientes temas: el tiempo vivido por el receptor, portador de la Enfermedad de Chagas; la concepción del TC que tiene el portador de Chagas; el cuidado en la trayectoria del TC.

Chagas disease as a mechanistic model for testing a novel hypothesis.

The association between depression and cardiovascular disease is well documented. Nevertheless, the process through which they are linked remains unknown, as does the direction of this relationship. Studies have suggested both that depression is a risk factor for heart disease and that heart disease is a risk factor for depression. A number of studies have established that a relationship exists between depression and inflammation, with alterations in the levels of inflammatory markers (IL-1, IL-6, TNF-alpha and others). Depressive symptoms have also been identified in many diseases characterized by inflammatory processes e.g. rheumatoid arthritis, bronchial asthma, diabetes, tuberculosis and cardiovascular diseases. In this brief viewpoint, we explain and propose how to use Chagas disease, a disorder characterized by inflammatory processes and leading to cardiovascular and autonomic problems, as a model for studying the directionality of the relationship between heart disease and depression.

Chagas disease as a mechanistic model for testing a novel hypothesis

The association between depression and cardiovascular disease is well documented. Nevertheless, the process through which they are linked remains unknown, as does the direction of this relationship. Studies have suggested both that depression is a risk factor for heart disease and that heart disease is a risk factor for depression. A number of studies have established that a relationship exists between depression and inflammation, with alterations in the levels of inflammatory markers (IL-1, IL-6, TNF-alpha and others). Depressive symptoms have also been identified in many diseases characterized by inflammatory processes e.g. rheumatoid arthritis, bronchial asthma, diabetes, tuberculosis and cardiovascular diseases. In this brief viewpoint, we explain and propose how to use Chagas disease, a disorder characterized by inflammatory processes and leading to cardiovascular and autonomic problems, as a model for studying the directionality of the relationship between heart disease and depression.

A associação entre depressão e doença cardiovascular está bem documentada. Não obstante, o processo pelo qual está associada permanece desconhecido, assim como o sentido desta associação. Estudos têm sugerido que tanto a depressão é um fator de risco para a doença cardiovascular quanto esta o é para a depressão. Uma série de trabalhos tem estabelecido que uma relação existe entre depressão e inflamação, com alterações evidenciadas por marcadores de inflamação (IL-1, IL-6, TNF alfa e outros). Sintomas de depressão também têm sido identificados em diversas doenças caracterizadas por processos inflamatórios, tais como artrite reumatoide, asma brônquica, diabete, tuberculose e doenças cardiovasculares. Nesta breve opinião é explicitado e proposto como empregar a doença de Chagas, um agravo caracterizado por processos inflamatórios e indutor de problemas cardiovasculares e autonômicos, como um modelo de estudo da direcionalidade da relação entre doença cardíaca e depressão.

Representações, mitos e comportamentos do paciente submetido ao implante de marcapasso na doença de Chagas / Representations, myths, and behaviors among Chagas disease patients with pacemakers

Estudo antropológico sobre o modo de incorporação e as repercussões do implante do marcapasso na vida do indivíduo portador da doença de Chagas. Foi realizada uma pesquisa etnográfica baseada no instrumento de entrevista aberta, buscando identificar a percepção do estado de saúde de um grupo de 15 pacientes portadores de cardiopatia Chagásica crônica que necessitaram de implante de marcapasso, atendidos no Ambulatório de Marcapasso do Hospital das Clínicas da Universidade Federal de Minas Gerais, em Belo Horizonte, Minas Gerais, Brasil. Utilizou-se o referencial da qualidade de vida para observar os recursos culturais, físicos e psicológicos que os pacientes utilizam para enfrentar, explicar e aceitar o processo de adoecimento, incluindo as representações mentais que constroem o sentido cultural da doença e definem as relações sociais. O estudo pretende contribuir para que os profissionais de saúde atendam seus pacientes em sua integralidade. A orientação decodificada e integrada no âmbito cultural assume um papel importante para evitar que a desinformação perpetue a difusão de mitos populares, que, por vezes, se tornam preconceitos e elementos sociais ativos de estigma do indivíduo portador de cardiopatia.

This anthropological study aimed to evaluate the incorporation of pacemakers into the lives of individuals with Chagas disease. An ethnographic methodology was used, based on an open interview focusing on the personal perceptions of 15 patients with chronic Chagas cardiopathy who had required pacemaker implants at the Federal University Hospital in Belo Horizonte, Minas Gerais State, Brazil. As part of a broader quality of life analysis, the study investigated the cultural, physical, and psychological resources used by patients to confront, explain, and accept the disease process, including mental representations on the cultural perception of the illness and definition of social relations. The study was intended to contribute to comprehensive patient care by health professionals, including psychosocial aspects. Decoded and integrated orientation in the cultural sphere assumes an important role in order to prevent disinformation from perpetuating the dissemination of popular myths as active elements in patient stigmatization.

[Representations, myths, and behaviors among Chagas disease patients with pacemakers]. / Representações, mitos e comportamentos do paciente submetido ao implante de marcapasso na doença de Chagas.

This anthropological study aimed to evaluate the incorporation of pacemakers into the lives of individuals with Chagas disease. An ethnographic methodology was used, based on an open interview focusing on the personal perceptions of 15 patients with chronic Chagas cardiopathy who had required pacemaker implants at the Federal University Hospital in Belo Horizonte, Minas Gerais State, Brazil. As part of a broader quality of life analysis, the study investigated the cultural, physical, and psychological resources used by patients to confront, explain, and accept the disease process, including mental representations on the cultural perception of the illness and definition of social relations. The study was intended to contribute to comprehensive patient care by health professionals, including psychosocial aspects. Decoded and integrated orientation in the cultural sphere assumes an important role in order to prevent disinformation from perpetuating the dissemination of popular myths as active elements in patient stigmatization.