Health-related quality of life in patients with Chagas disease: a review of the evidence

Abstract

Chagas disease (ChD), a neglected tropical disease caused by infection with the parasite Trypanosoma cruzi (T. cruzi), remains a serious p ublic health issue in Latin America and is an emerging disease in several non-endemic countries, where knowledge of the condition and experience with its clinical management are limited. Regionally, the disease is the major cause of disability secondary to tropical diseases in young adults. Health-related quality of life (HRQoL) impairment is common in patients with ChD, especially in those with Chagas dilated cardiomyopathy, the most severe manifestation of the disease, which frequently leads to heart failure. The aim of this review was to conduct a literature search for studies that have evaluated the determining factors of HRQoL in ChD patients. We included cross-sectional, case-control, cohort, and experimental studies, as well as clinical trials that evaluated the HRQoL in ChD patients aged 18 to 60 years and are presenting an explicit description of statistical analysis. Using a combination of keywords based on Descriptors in Health Sciences (DeCS) and Medical Subject Headings (MeSH) for searches in PubMed and the Scientifi c Electronic Library Online (SciELO), 148 studies were found. After exclusions, 12 studies were selected for analysis. Three main fi ndings were extracted from these studies: 1) cardiac involvement is associated with a worse HRQoL in ChD patients; 2) HRQoL is associated with the patients' functional capacity; and 3) simple and inexpensive therapeutic measures are effective for improving HRQoL in ChD patients. Hence, ChD patients' functional capacity, the effectiveness of non-surgical conservative treatment, and cardiac involvement are important determining factors for the HRQoL in ChD patients.

Cost-effectiveness of Chagas disease screening in Latin American migrants at primary health-care centres in Europe: a Markov model analysis

“…32 Little knowledge is available about the quality of life of patients with Chagas disease from endemic areas 43 and no knowledge from non-endemic areas. The measurement of quality of life of patients with Chagas disease in non-endemic areas should be set as a priority in the research agenda.…”

Challenges for improving quality of life in Chagas disease

“…Although this is a difficult approach, it is nonetheless possible, provided that appropriate integrated multidisciplinary attention may be available by an adequate and efficient healthcare system. Existing examples of this appropriate condition include the praiseworthy and successful initiatives of actions in global healthcare services for patients with Chagas disease in conjunction with the great personal efforts of those engaged towards the bigger picture (1) (2) (3) (4) (6) (7) (8) (10) .…”

“…Regarding the complex biopsychosocial context of Chagas disease, which encompasses several aspects that can affect quality of life of patients, multidisciplinary attention and actions are warranted to improve it (1) (4) (6) (7) (10) . For attaining this, it is firstly critical to deconstruct and dispel the personal, cultural, and social stigma of the disease, which will serve as a starting point for additional actions.…”

“…However, despite of this issue to be considered relevant in last 30 years, only in recent years that has it gained greater prominence in the literature and attracted more attention from researchers and those professionals dealing with control and treatment of Chagas disease (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) . Quality of life in any particular disease including Chagas disease is a difficult issue to address owing to its complexity.…”

“…Within this complex conceptual framework, factors related to the demand for adequate healthcare are very important, and these are also factors that constitute the basis for the attainment of quality of life requirements in other domains, representing critical markers of individual good health and welfare. A review published in the Journal of the Brazilian Society of Tropical Medicine addressed the question of health-related quality of life regarding to some clinical, functional, and therapeutic factors in patients with Chagas disease (10) . This question about Chagas disease has sparsely been discussed in the literature and thus has great and broad interest.…”