Pharmacological interventions for treating heart failure in patients with Chagas cardiomyopathy

Prognosis of chronic Chagas heart disease and other pending clinical challenges

“…A meta-analysis of two trials (69 participants) found a lower proportion of all-cause mortality in the carvedilol group than in the placebo group [RR 0.69; 95% confidence interval (CI) (0.12 -3.88)], although the evidence was low quality through the GRADE assessment, and there were no conclusive results between carvedilol and placebo in terms of hospital readmissions and quality of life. (97) In contrast to the lower use of beta-blockers, patients with Chagas-HF more often receive amiodarone due to the higher risk of ventricular malignant arrhythmias. The same phenomenon has been observed with anticoagulants due to a higher frequency of cardioembolic events.…”

Treatment of Chronic Chagasic Patients: Is Killing the Parasite the Only Option?

“…Instead, the drug modulated the pattern of CCL2 and IL-10 mediators. 92 An extensive meta-analysis, however, concluded that there were no conclusive data to support or reject the use of either carvedilol for treating Chagas cardiomyopathy, 93 although individual clinical trials suggest beneficial effects. 94,95 Interestingly, carvedilol alone and in combination with vitamins C and E was effective at attenuating the systemic oxidative stress in patients with Chagas heart disease, especially those less severely affected, thus suggesting the possibility of synergism between these compounds 96 and opening a window for future explorations.…”

Utility of Cardiac Implantable Electronic Devices in Patients with Chagas Disease and Systolic Heart Failure

“…Small studies have shown that neurohormonal inhibition can improve both symptoms and left ventricular function. However, a systematic review of Cochrane found very low-quality evidence for the effects of carvedilol compared with placebo for treating heart failure in people with CD [55]. On the other hand, chagasic The Role of the Clinical Cardiac Electrophysiologist in the Management of Congestive Heart Failure patients frequently have lower blood pressure and a higher incidence of bradyarrhythmias and may not tolerate target doses of angiotensin-converting enzyme inhibitors (ACEI) and beta-blockers.…”