Abstract
Chagas disease (CD) is a neglected tropical disease and its main consequence is chronic chagasic cardiomyopathy (CCC). The clinical manifestations of CD can cause functional limitation and impact on the perception of quality of life (QoL). We evaluated the QoL profile of patients with CD living in remote regions, and their association with socio-demographic, behavioral, and clinical characteristics.A cross-sectional study, using the baseline of a cohort study (SaMi-Trop) was conducted in the state of Minas Gerais, Brazil, an endemic region for CD. The cohort is composed of 1959 patients with CD. The patients were interviewed, and blood collection and electrocardiogram (ECG) were performed. The WHOQOL-BREF scale was used to assess QoL. Descriptive statistics were performed and, for the QoL scale, measures of central tendency and dispersion were calculated. Inflated beta regression models constructed using the gamlss framework were used, and fitted using R software. A significance level of 5% for all analyzes was adopted.QoL was evaluated in 625 participants. The Environment (57.66) and Social Relationships (73.17) domains presented the lowest and highest QoL score respectively. There was no statistically significant difference between QoL domains in the presence of CCC. In the multivariate analysis, the factors associated with a lower QoL were in the Physical domain age increase (OR: 0.95, CI: 0.91–0.99) and using an angiotensin converting enzyme inhibitor (OR 0.89; CI: 0.80–0.99); in the Social Relations domain a history of acute myocardial infarction (OR: 0.75; CI: 0.61–0.92); and in the Environment domain age increase (OR 0.94, CI 0.91–0.97). The factor associated with higher QoL was the use of angiotensin receptor blockers (OR: 1.15; CI 1.04–1.26).The findings of this study reinforce the importance of QoL indicators for planning care and clinical management of patients from remote regions with CD.Trial registrationNCT02646943.
Highlights
Chagas disease (CD) is a neglected tropical disease with approximately 6 to 7 million affected individuals worldwide, most in Latin America [1,2]
There is a gap in the literature regarding the evaluation of quality of life (QoL) in patients living with chronic CD, in remote regions assisted by primary health care in their territory of residence
Low QoL scores have been associated with clinical aspects such as use of angiotensin converting enzyme inhibitor (ACEI), and history of acute myocardial infarction, and socio-demographic aspects such as increasing age
Summary
Chagas disease (CD) is a neglected tropical disease with approximately 6 to 7 million affected individuals worldwide, most in Latin America [1,2] It is an infectious condition with acute and chronic phase. Severe manifestations, including arrhythmia, heart failure, thromboembolism, and sudden death [1,5,6] may occur in CCC. These manifestations are associated with increased myocardial impairment and can cause functional limitations with social, economic, and psychological impacts, among them, on the individual perception of quality of life (QoL) [7,8,9]. The improvement of QoL is one of the therapeutic objectives and its indicators are relevant to guide decisions and behaviors of health teams in order to improve patient care, contributing to a better diagnosis and clinical management, and to the planning of public policies and the allocation of resources [13,14]
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