Comprehensive care for patients with Chagas cardiomyopathy during the coronavirus disease pandemic

Abstract

Chagas disease is a neglected tropical disease according to the World Health Organization 1. The most common clinical complication of Chagas disease is Chagas cardiomyopathy, that represents the main cause of non-ischemic cardiomyopathy in Latin America, affecting 20% to 40% of infected people 2. The chronic form, with a slow and persistent course, results from the destruction of the myocardial fibers, caused by a chronic inflammatory process. It is associated with intense reparative fibrosis and progressive ventricular remodeling and manifests as heart failure and/or arrhythmic and thromboembolic syndromes 3. 14. Chambela MDC, Mediano MFF, Carneiro FM, Ferreira RR, Waghabi MC, MendesVG, et al. Impact of pharmaceutical care on the quality of life of patients with heart failure due to chronic Chagas disease:

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

“…É importante ressaltar que essas comorbidades também refletem a idade mais avançada das populações que são especialmente impactadas pela DC e pela COVID-19. 71 , 100 - 102 Embora mais de 80% dos casos de COVID-19 sejam leves ou assintomáticos, casos graves têm sido mais frequentes entre pessoas idosas e com comorbidades, enquanto que, para a DC, pessoas idosas com cardiomiopatia crônica apresentam maior risco de morte, justificado, em parte, pela associação com idade ou outras condições crônicas, mas também pela condição de pobreza social. 71 , 100 …”

“…The concomitance of CD is particularly worrisome because it can cause cardiac, gastrointestinal, neurological and other complications, increasing susceptibility to COVID-19. 71 , 100 - 102 The highest prevalence of comorbidities seems to be related to a worse prognosis in coinfection. 102 Since the appearance of the pandemic caused by SARS-CoV-2, the cardiovascular involvement has been identified as a frequent complication of COVID-19.…”

“… 102 Since the appearance of the pandemic caused by SARS-CoV-2, the cardiovascular involvement has been identified as a frequent complication of COVID-19. 96 , 100 However, there is little evidence on the effects of COVID-19 on individuals with CD. 100 , 102 - 104 Some studies have reported that COVID-19 may add new challenges in guaranteeing access to total healthcare (diagnosis and treatment, as well as throughout the full disease cycle) to those individuals and in the necessary development of new research analyzing the implications of SARS-CoV-2 coinfection.…”

“…It is important to emphasize that those comorbidities reflect the more advanced ages of the populations that are specially impacted by CD and COVID-19. 71 , 100 - 102 Although more than 80% of the cases of COVID-19 are mild or asymptomatic, severe cases have been more frequent among elderly and individuals with comorbidities, while, for CD, elderly with chronic cardiomyopathy are at a higher risk of death, which is partially justified by its association with age or other chronic conditions and by social poverty. 71 , 100 …”

SECCION II. Definiciones operativas de casos de infección por SARS-CoV-2/COVID-19

“…Consideramos entonces que la enfermedad de Chagas puede ser un riesgo importante y subestimado para desarrollar infección por SARS-CoV-2/COVID-19 severa, especialmente en aquellos pacientes con forma crónica asociada a miocardiopatía, que los hace propensos a tener un peor desenlace, especialmente en áreas endémicas con evidencia de coinfección por Chagas y SARS-CoV-2/COVID-19 [135][136][137][145][146][147][148] .…”