Longitudinal study of patients with chronic Chagas cardiomyopathy in Brazil (SaMi-Trop project): a cohort profile

• Published in: BMJ open Vol. 6; no. 5; p. e011181
• Main Authors: Cardoso, Clareci Silva, Sabino, Ester Cerdeira, Oliveira, Claudia Di Lorenzo, de Oliveira, Lea Campos, Ferreira, Ariela Mota, Cunha-Neto, Edécio, Bierrenbach, Ana Luiza, Ferreira, João Eduardo, Haikal, Desirée Sant'Ana, Reingold, Arthur L, Ribeiro, Antonio Luiz P
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 04-05-2016; BMJ Publishing Group
• Subjects: Aged; Biomarkers; Biomarkers - blood; Brazil - epidemiology; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular Medicine; Chagas Cardiomyopathy - blood; Chagas Cardiomyopathy - drug therapy; Chagas Cardiomyopathy - epidemiology; Chagas Cardiomyopathy - physiopathology; Chagas disease; Chronic Disease - drug therapy; Chronic Disease - epidemiology; Disease Progression; Female; Follow-Up Studies; Health education; Health literacy; Health services; Heart failure; Heart Failure - epidemiology; Heart Failure - physiopathology; Heart Failure - prevention & control; Humans; Immunoassay; Immunosuppressive Agents - therapeutic use; Longitudinal Studies; Male; Medical prognosis; Medicine; Middle Aged; Mortality; Natriuretic Peptide, Brain - blood; Nitroimidazoles - therapeutic use; Peptide Fragments - blood; Population Surveillance; Predictive Value of Tests; Primary care; Prognosis; Prospective Studies; Quality of Life; Questionnaires; Research centers; Sociodemographics; Socioeconomic Factors; Telemedicine; Brazil; Biomarkers; Chagas disease; CHEMICAL PATHOLOGY; Cohort Studies
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2016-011181

PurposeWe have established a prospective cohort of 1959 patients with chronic Chagas cardiomyopathy to evaluate if a clinical prediction rule based on ECG, brain natriuretic peptide (BNP) levels, and other biomarkers can be useful in clinical practice. This paper outlines the study and baseline characteristics of the participants.ParticipantsThe study is being conducted in 21 municipalities of the northern part of Minas Gerais State in Brazil, and includes a follow-up of 2 years. The baseline evaluation included collection of sociodemographic information, social determinants of health, health-related behaviours, comorbidities, medicines in use, history of previous treatment for Chagas disease, functional class, quality of life, blood sample collection, and ECG. Patients were mostly female, aged 50–74 years, with low family income and educational level, with known Chagas disease for >10 years; 46% presented with functional class >II. Previous use of benznidazole was reported by 25.2% and permanent use of pacemaker by 6.2%. Almost half of the patients presented with high blood cholesterol and hypertension, and one-third of them had diabetes mellitus. N-terminal of the prohormone BNP (NT-ProBNP) level was >300 pg/mL in 30% of the sample.Findings to dateClinical and laboratory markers predictive of severe and progressive Chagas disease were identified as high NT-ProBNP levels, as well as symptoms of advanced heart failure. These results confirm the important residual morbidity of Chagas disease in the remote areas, thus supporting political decisions that should prioritise in addition to epidemiological surveillance the medical treatment of chronic Chagas cardiomyopathy in the coming years. The São Paulo-Minas Gerais Tropical Medicine Research Center (SaMi-Trop) represents a major challenge for focused research in neglected diseases, with knowledge that can be applied in primary healthcare.Future plansWe will continue following this patients’ cohort to provide relevant information about the development and progression of Chagas disease in remotes areas, with social and economic inequalities.Trial registration numberNCT02646943; Pre-results.