Hospitalizations for Chagas Heart Disease Increasing in the US

By Brandon May

October 29, 2021

NEW YORK (Reuters Health) - Hospitalizations for Chagas heart disease have been increasing in the United States over the past two decades, according to a new study.

Most of the patients are immigrants from Central and South America, suggesting that trends in hospitalizations for the condition may reflect patterns of immigration from those regions, Dr. Neiberg de Alcantara Lima of Wayne State University, in Detroit, and colleagues suggest in JAMA Network Open paper.

To characterize recent hospitalization trends and patient characteristics in U.S. hospitalizations for Chagas cardiomyopathy, Dr. Lima and colleagues conducted a cross-sectional study of patient data from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS).

They focused on patients who were discharged with a Chagas heart disease diagnosis from 2002 through 2017. The year 2015 was excluded from the study as this was a period of transition between ICD-9 and ICD-10 diagnosis codes, which the researchers indicated could have led to inconsistences in reported diagnoses.

Over the 12-year study period, Chagas heart disease was listed as a primary or coexisting diagnosis in 2,037 of 482 million inpatient discharges, and the proportion of discharges with the condition rose from just over 0.0001to almost 0.001 (P<0.001).

The patients' mean age was 52 years, and half were men; 36% were diagnosed in the West and 32% in the South.

The researchers noted that while Hispanic patients represent only 12.8% of overall U.S. hospital discharges, this ethnicity accounted for 74% of the estimated hospital discharges for Chagas cardiomyopathy in the study.

Several disorders were coded in discharges, including sinoatrial node dysfunction (4.8%), atrial tachyarrhythmias (27.1%), and ventricular arrhythmias (25.0%). Up to 14.5% of patients with Chagas heart disease had atrioventricular and intraventricular conduction anomalies. Nearly two-thirds also had a heart-failure diagnostic code.

Among the discharges, 2.5% had codes for pacemaker implantation,10.7% for implantable-defibrillator procedures and 2.9% for cardiac resynchronization procedures.

The team notest that relying on diagnostic codes in the NIS-HCUP database rather than individual patient-level information may have led to underrepresentation of Chagas heart disease. Despite this limitation, they conclude that the recognition of the disease, particularly in people who have emigrated from endemic areas, may facilitate the "early diagnosis and avoidance of long-term complications from Chagas heart disease."

Dr. Jessica Harris Huston, a cardiologist at the University of Pittsburgh Medical Center, told Reuters Health by email that while Chagas heart disease is still relatively uncommon in the United States, physicians should be cognizant of the increasing incidence.

"Early diagnosis and treatment may help delay or avoid lasting complications in these patients," said Dr. Huston, who wasn't involved in the study. "Recognition is especially important in the field of cardiac transplantation as failure to diagnose Chagas heart disease prior to cardiac transplantation and implementation of immunosuppressive medications can lead to reactivation and ultimately graft failure."

"The regional distributions of hospitalizations are important to note," she added. "Additionally, while Chagas disease is generally thought to primarily affect those from South and Central America, approximately 25% of the patients here were non-Hispanic. These findings display the globalization of disease, specifically that in heart failure, arrhythmia, and conduction disease in the U.S., the diagnosis should be considered regardless of ethnicity."

Dr. de Alcantara Lima did not respond to a request for comment.

SOURCE: https://bit.ly/3Gf5PmE JAMA Network Open, online October 19, 2021.

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