Hospitalizations For Chagas Heart Disease Show Temporal Increase in United States

The prevalence of chagas heart disease in the United States has affected mainly immigrants from regions in Central and South America, places where the disease is known to be endemic.

Consequently, a cross-sectional study aimed to describe patient characteristics and outcomes of patients hospitalized for Chagas cardiomyopathy in the US, as well as trends in the percentage of hospital discharges.

Led by Neiberg de Alcantara Lima, MD, Department of Internal Medicine, Division of Cardiology, Wayne State University, investigators observed hospitalizations for CHD increased each year of study, showing prevalence in the Western and Southern regions of the US, where migration from South America was higher.

What was the process?

The study included patients who were discharged with a diagnosis of Chagas heart disease (CHD) in the US from 2002 - 2017, excluding 2015. Data was collected from the Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS).

Further, survey procedures using discharge weights from the HCUP-NIS database were used to create national estimates. The database contains data on approximately 482 million inpatient discharges for the study period.

Lima and colleagues noted that since CHD is endemic in South and Central America, previous texts have proven racial and ethnic disparities in the incidence in the US.

They additionally evaluated coded commonly related concurrent conditions in patients with CHD, including node dysfunction.

Prevalence of CHD was assessed through a 95% confidence interval of the observed proportion. Additionally, investigators assessed trends of the frequency of CHD over time using Cochran-Armitage trend tests. The data was analyzed in January 2020.

What were the findings?

Investigators observed CHD was coded as a primary or coexisting diagnosis in a total of 2037 estimated discharges, including a mean age of 51.84 years, with 50.5% men (n = 1028).

Data show in 1774 estimated discharges where a hospital region had been indicated, 35.9% (n = 625) were diagnosed in the West and 32.3% (n = 564) were from the South.

Moreover, investigators observed Hispanic patients represented 12.8% of overall hospital discharges in the US, but 74.2% (n = 1433) of discharges for CHD were patients of Hispanic ethnicity.

Additional data from the study show sinoatrial node dysfunction had been coded in 97 discharges (4.8%; 95% CI, 2.7 - 6.8), atrial tachyarrhythmias were coded in 553 discharges (27.1%; 95% CI, 21.8 - 32.5), and ventricular arrhythmias coded in 509 discharges (25.0%; 95% CI, 20.6 - 29.4).

Other observations included atrioventricular and intraventricular conduction anomalies in patients with Chagas heart disease (553 discharges, 14.5%) and 1316 discharges (64.6%) also including a diagnostic code for heart failure.

Within the discharges, pacemaker implant codes (2.5%), implantable defibrillator procedure codes (10.7%), and cardiac resynchronization procedure codes (2.9%) were reported.

Lastly, Cochran-Armitage test showed the proportion of hospital discharges with Chagas heart disease increased from 2002 - 2017 (P <.001).

What are the takeaways?

“Recognition of this condition, particularly in individuals who emigrated from areas with endemic Chagas, may assist and early diagnosis and avoidance of long-term complications from Chagas heart disease,” investigators wrote.

The study, “Hospitalization for Chagas Heart Disease in the United States From 2002 to 2017,” was published in JAMA Network Open.