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Contemporary Charac...
Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy
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Shen, L. (author)
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Ramires, F. (author)
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Martinez, F. (author)
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Bodanese, L. C. (author)
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Echeverria, L. E. (author)
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Gomez, E. A. (author)
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Abraham, W. T. (author)
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Dickstein, K. (author)
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Kober, L. (author)
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Packer, M. (author)
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Rouleau, J. L. (author)
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Solomon, S. D. (author)
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- Swedberg, Karl, 1944 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Zile, M. R. (author)
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Jhund, P. S. (author)
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Gimpelewicz, C. R. (author)
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McMurray, J. J. V. (author)
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(creator_code:org_t)
- 2017
- 2017
- English.
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In: Circulation. Heart failure. - 1941-3289 .- 1941-3297. ; 10:11
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Abstract
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- BACKGROUND: Chagas' disease is an important cause of cardiomyopathy in Latin America. We aimed to compare clinical characteristics and outcomes in patients with heart failure (HF) with reduced ejection fraction caused by Chagas' disease, with other etiologies, in the era of modern HF therapies. METHODS AND RESULTS: This study included 2552 Latin American patients randomized in the PARADIGM-HF (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients With Heart Failure) trials. The investigator-reported etiology was categorized as Chagasic, other nonischemic, or ischemic cardiomyopathy. The outcomes of interest included the composite of cardiovascular death or HF hospitalization and its components and death from any cause. Unadjusted and adjusted Cox proportional hazards models were performed to compare outcomes by pathogenesis. There were 195 patients with Chagasic HF with reduced ejection fraction, 1300 with other nonischemic cardiomyopathy, and 1057 with ischemic cardiomyopathy. Compared with other etiologies, Chagasic patients were more often female, younger, and had lower prevalence of hypertension, diabetes mellitus, and renal impairment (but had higher prevalence of stroke and pacemaker implantation) and had worse health-related quality of life. The rates of the composite outcome were 17.2, 12.5, and 11.4 per 100 person-years for Chagasic, other nonischemic, and ischemic patients, respectively-adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15-1.94; P=0.003) and Chagasic versus ischemic: 1.55 (1.18-2.04; P=0.002). The rates of all-cause mortality were also higher. CONCLUSIONS: Despite younger age, less comorbidity, and comprehensive use of conventional HF therapies, patients with Chagasic HF with reduced ejection fraction continue to have worse quality of life and higher hospitalization and mortality rates compared with other etiologies. CLINICAL TRIAL REGISTRATION: PARADIGM-HF: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01035255; ATMOSPHERE: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00853658.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Keyword
- Aged
- Amides/therapeutic use
- Angiotensin Receptor Antagonists/therapeutic use
- Angiotensin-Converting Enzyme Inhibitors/therapeutic use
- Cardiovascular Agents/adverse effects/*therapeutic use
- Chagas Cardiomyopathy/*complications/mortality/virology
- Female
- Fumarates/therapeutic use
- Heart Failure/*drug therapy/mortality/physiopathology/virology
- Hospitalization
- Humans
- Kaplan-Meier Estimate
- Latin America
- Male
- Middle Aged
- Multicenter Studies as Topic
- Quality of Life
- Randomized Controlled Trials as Topic
- Risk Factors
- Stroke Volume/drug effects
- Time Factors
- Treatment Outcome
- Ventricular Function
- Left/drug effects
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Shen, L.
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Ramires, F.
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Martinez, F.
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Bodanese, L. C.
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Echeverria, L. E ...
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Gomez, E. A.
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show more...
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Abraham, W. T.
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Dickstein, K.
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Kober, L.
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Packer, M.
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Rouleau, J. L.
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Solomon, S. D.
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Swedberg, Karl, ...
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Zile, M. R.
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Jhund, P. S.
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Gimpelewicz, C. ...
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McMurray, J. J. ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
- Articles in the publication
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Circulation. Hea ...
- By the university
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University of Gothenburg