Clinical and Epidemiological Profile of Elderly Patients With Chagas Disease Followed Between 2005-2013 by Pharmaceutical Care Service in Ceará State, Northeastern Brazil

Abstract

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Epidemiological features, echocardiographic findings, and parasite load in patients with Chagas disease

“…As this cohort was derived mostly from an outpatient clinic, the predominance of females might be related to a greater demand for medical services by women, as determined by Bozelli et al 14 , Vizzoni et al 15 , and Martins-Melo et al in a recent meta-analysis 1 . The age of our participants was similar to those reported by Bozelli et al 14 and Araújo et al 16 , but differed from those described by Vizzoni et al 15 , Alves et al 17 and Pereira et al 18 , who reported a more advanced group. We consider that this difference was due to the types of patients who use the HUB service.…”

“…However, these depend on the type of study and the predominant clinical forms. Other studies have generated different results; Pereira et al 18 and Andrade et al 35 respectively detected electrocardiographic abnormalities and changes in 48% and 10.8% of patients.…”

The detection of Trypanosoma cruzi by nested-PCR in elderly patients: relationship to the clinical and epidemiological profile

“…In addition, the cardiac form was the main clinical form in another study done in the northeastern Brazilian state of Ceará. 9 Aging is known to cause histopathological changes in the heart and to contribute to cardiovascular pathologies such as arterial hypertension and coronary and valvular pathologies that are common in elderly patients. 22 However, in elderly Chagas disease subjects, electrocardiographic abnormalities and cardiac lesions may be caused by a combination of Chagas cardiomyopathy and other conditions often seen in elderly persons without Chagas disease, e.g.…”

“…7,8 Elderly patients with Chagas disease show a greater number of diseases associated with old age and have overuse of medicines beyond those that are normally used for digestive and heart disorders. 9 The fact that Chagas disease is one of the leading causes of death among the elderly in Brazil indicates that early acquired infection is still a major problem. 10 Most of the human infections with T. cruzi are only detected in the chronic phase, which is characterized by subpatent parasitemia and limited tissue parasitism.…”

Using a Chagas disease hospital database: a clinical and epidemiological patient profile

“…Only in 2006 Brazil received the international certificate of elimination of CD transmission by this vector, which was awarded by the Pan American Health Organization. Studies on the prevalence rate of chronic CD cases are not abundant in Brazil and the few available have mainly focused on a single clinical form 7 or associated with patient characteristics 8 . Current information on the distribution of the disease in a country, the characteristics of individuals affected, and the clinical form and mode of transmission are of utmost importance to facilitate research, disease detection, and to provide data to increase disease control and prevention.…”