Avaliação clínica de pacientes na forma cardíaca da doença de Chagas após quinze anos de tratamento com Benznidazol

Abstract

The cardiac form of Chagas disease (CD) is a severe complication of the chronic phase of the infection. It leads to Chagas cardiomyopathy, heart failure, arrhythmias, and conduction blocks, increasing the risk of sudden death. These complications not only impact patients' health but also pose a significant challenge to the healthcare system. Treatment is most effective in the acute phase, but in the chronic phase, the focus is on managing cardiac complications and improving patients' quality of life. The disease presents a major public health challenge, requiring continuous monitoring and management. The overall objective is to evaluate the clinical effectiveness of chemotherapy with Benznidazole (BNZ) in patients with the cardiac form of Chagas disease. The methodology was based on a retrospective study assessing patients with the cardiac form of CD who were monitored in a pharmaceutical care service, comparing data collected before and fifteen years after etiological treatment. The results showed that among the patients treated in the service, the majority were male (59.3%), aged between 50 and 79 years (75.58%), with low educational levels, working as farmers or retirees (29.1%), earning up to three minimum wages (62.8%), married (44.2%), and from rural areas of Ceará. Regarding comorbidities, systemic arterial hypertension (SAH) was the most prevalent in groups that underwent follow-up for up to one year or more. The most common morbidities included arrhythmias (55.9%) and angina (13.6%) among patients whose exams were analyzed only before treatment. Among patients whose ECGs were analyzed both before and after treatment, the most frequent finding was right bundle branch block (RBBB) – from 60.9% to 58.5% – with or without associated ventricular repolarization abnormality (VRA) and arrhythmias (from 43.9% to 39%), such as first-degree atrioventricular block and ventricular extrasystoles (VES). The ECG analysis showed that among patients who completed more than 80% of the treatment, 53.8% remained stable, while 33.3% presented new alterations, and 12.8% showed some improvement. Among patients who did not complete the treatment, one remained stable, and the other showed improvement, possibly due to the use of an artificial pacemaker. Thus, the importance of adherence and continuous monitoring of CD patients is evident to ensure treatment effectiveness, prevent future complications, and guarantee a better quality of life for patients.