Medical Unmet Needs in Latin, Central America and the Caribbean : Chagas Disease with Heart Failure

Chagas cardiomyopathy is a vector-borne parasitic infection caused by the protozoa Trypanosoma cruzi. After the acute infection, 20–30% of individuals will progress after 15–25 years to cardiac complications of the disease with conduction abnormalities, severe heart failure, and a constant threat of thromboembolism, particularly pulmonary embolism, reducing life expectancy of patients to less than 30% at 5 years, with an annual mortality approaching 20 %.

A prospective trial of Latin American immigrants with non-ischemic cardiomyopathy showed that over a 3.6-years follow-up, patients who were positive for Chagas disease had an over fourfold higher mortality or cardiac transplantation rate despite similar baseline characteristics,

World Health Organization estimates that there are between 5 to 8 million people infected with chronic Chagas disease in 21 countries of Latin America. A 2016 epidemiologic study from Sao Paulo confimed that Chagas disease constitutes a major public health problem in Brazil : scientists identified that among the etiologies of heart failure, the most frequent was hypertensive heart disease (42%), followed by Chagas heart disease (26%). Rate and rapidity of rehospitalisation was almost doubled in Chagasic patients. Another recent trial showed that Chagasic heart disease was the most frequent etiology of HF in Salvador, totaling 48% of cases.

But cases of Chagas disease are now found globally; there are more than 400,000 immigrants with this disease living in Europe and the United States, but some are also found in Japan and Australia. A conservative estimate would be that approximately 35,000–50,000 patients live in the USA with advanced cardiomyopathy secondary to Chagas disease. 

Chagas disease is now one of the most important but neglected diseases in the world. Treatment relies on the experience of physicians but a survey of physicians in the USA revealed that a large proportion never consider the risk of Chagas disease in their patient population (29–60 %) and are not confident on their knowledge about Chagas disease (27–68 %). 

Usual heart failure therapies are employed whitout the indispensable learning issued from clinical trials : for example, the chronic use of digoxin has been demonstrated to be an independent predictor of mortality in those patients, but there is still today no evidence base supporting the treatment of patients with Chagas heart failure. Mortality study with clear evaluation of potential treatments benefit remains highly needed.