Factors associated with quality of life in patients with Chagas disease: SaMi-Trop project.

TRIAL REGISTRATION: NCT02646943.

Risk Score for Predicting 2-Year Mortality in Patients With Chagas Cardiomyopathy From Endemic Areas: SaMi-Trop Cohort Study.

Background Risk stratification of Chagas disease patients in the limited-resource setting would be helpful in crafting management strategies. We developed a score to predict 2-year mortality in patients with Chagas cardiomyopathy from remote endemic areas. Methods and Results This study enrolled 1551 patients with Chagas cardiomyopathy from Minas Gerais State, Brazil, from the SaMi-Trop cohort (The São Paulo-Minas Gerais Tropical Medicine Research Center). Clinical evaluation, ECG, and NT-proBNP (N-terminal pro-B-type natriuretic peptide) were performed. A Cox proportional hazards model was used to develop a prediction model based on the key predictors. The end point was all-cause mortality. The patients were classified into 3 risk categories at baseline (low, <2%; intermediate, ≥2% to 10%; high, ≥10%). External validation was performed by applying the score to an independent population with Chagas disease. After 2 years of follow-up, 110 patients died, with an overall mortality rate of 3.505 deaths per 100 person-years. Based on the nomogram, the independent predictors of mortality were assigned points: age (10 points per decade), New York Heart Association functional class higher than I (15 points), heart rate ≥80 beats/min (20 points), QRS duration ≥150 ms (15 points), and abnormal NT-proBNP adjusted by age (55 points). The observed mortality rates in the low-, intermediate-, and high-risk groups were 0%, 3.6%, and 32.7%, respectively, in the derivation cohort and 3.2%, 8.7%, and 19.1%, respectively, in the validation cohort. The discrimination of the score was good in the development cohort (C statistic: 0.82), and validation cohort (C statistic: 0.71). Conclusions In a large population of patients with Chagas cardiomyopathy, a combination of risk factors accurately predicted early mortality. This helpful simple score could be used in remote areas with limited technological resources.

Avaliação do conhecimento acerca do manejo clínico de portadores da doença de Chagas em região endêmica no Brasil / Assessment of knowledge about the clinical management of patients with Chagas disease in an endemic region in Brazil

Objetivo: conhecer o manejo de pacientes com Doença de Chagas (DC) por médicos da Atenção Primária à Saúde (APS) de regiões endêmicas. Método: estudo transversal realizado com 104 médicos da APS de 39 municípios das regiões norte de Minas Gerais e Vale do Jequitinhonha. Foram abordados perfil sociodemográfico, formação acadêmica e prática clínica, por meio de questionário autoaplicado. Resultados: os médicos apresentaram idade média de 33(±9,88) anos, 4(±7,26) anos de atuação na APS, 49% relataram que a graduação não ofereceu formação suficiente em DC. Embora quase 90% tivessem experiência com atendimento de pacientes com DC crônica e 57% com DC aguda, apenas 9% relataram sentir-se totalmente seguros para esses atendimentos e 33% relataram não conhecer o Benzonidazol, único antitripanossômico disponível. Contribuindo para esse quadro, após a graduação, somente 13,3% receberam alguma informação ou treinamento relativo à DC e quase metade recebeu esse treinamento há mais de 4 anos. Há insegurança, desconhecimento e carência de capacitações sobre DC entre profissionais médicos da APS de localidades endêmicas.

Objective: to understand the management of patients with Chagas Disease (CD) by Primary Health Care (PHC) doctors in endemic regions. Methods: cross-sectional study with 104 PHC doctors in 39 municipalities in the northern regions of Minas Gerais and Jequitinhonha Valley. Socio-demographic profile, academic training, and clinical practice were covered through a self-administered questionnaire. Results: the physicians had a mean age of 33 (± 9.88) years, 4 (± 7.26) years experience in the PHC system, and 49% reported that their undergraduate studies did not offer enough training on CD. Although almost 90% had experience with the care of patients with chronic CD and 57% with acute CD, only 9% reported feeling completely secure about these services and 33% reported not knowing about benznidazole, the only antitrypanosomal available. Contributing to this situation, after graduation, only 13.3% received any information or training on CD and almost half received this training more than four years ago. There is insecurity, ignorance, and lack of training on CD among PHC medical professionals in endemic locations.