{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:47:56Z","timestamp":1787870876575,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Heart Failure"],"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Chagas\u2019 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\u2019 disease, with other etiologies, in the era of modern HF therapies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p>\n              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\u2014adjusted hazard ratio for Chagasic versus other nonischemic: 1.49 (95% confidence interval, 1.15\u20131.94;\n              <jats:italic>P<\/jats:italic>\n              =0.003) and Chagasic versus ischemic: 1.55 (1.18\u20132.04;\n              <jats:italic>P<\/jats:italic>\n              =0.002). The rates of all-cause mortality were also higher.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p>\n              PARADIGM-HF: URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT01035255; ATMOSPHERE: URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/www.clinicaltrials.gov\">http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              . Unique identifier: NCT00853658.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circheartfailure.117.004361","type":"journal-article","created":{"date-parts":[[2017,11,16]],"date-time":"2017-11-16T01:10:49Z","timestamp":1510794649000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":82,"title":["Contemporary Characteristics and Outcomes in Chagasic Heart Failure Compared With Other Nonischemic and Ischemic Cardiomyopathy"],"prefix":"10.1161","volume":"10","author":[{"given":"Li","family":"Shen","sequence":"first","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Ramires","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Martinez","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Carlos","family":"Bodanese","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Eduardo","family":"Echeverr\u00eda","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efra\u00edn A.","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William T.","family":"Abraham","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Dickstein","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"K\u00f8ber","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton","family":"Packer","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean L.","family":"Rouleau","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Solomon","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Zile","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardeep S.","family":"Jhund","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio R.","family":"Gimpelewicz","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"From the BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (L.S., P.S.J., J.J.V.M.); Instituto do Cora\u00e7\u00e3o (InCor) do Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo, Brazil (F.R.); Instituto DAMIC\/Fundacion Rusculleda, Cordoba, Argentina (F.M.); Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Porto Alegre, Brazil (L.C.B.); Grupo de Ciencias Cardiovasculares, Fundaci\u00f3n Cardiovascular de Colombia, Santander (L.E.E.); Clinica Shaio, Bogota,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the PARADIGM-HF and ATMOSPHERE Investigators and Committees","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(01)00497-1"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.109"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.06.013"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.2174\/1573403X11309020007"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1586\/14779072.2015.1103648"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gheart.2015.06.001"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1410150"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.recesp.2016.04.045"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccl.2016.08.013"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024839"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0005033"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn424"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(97)00083-1"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2004.05.025"},{"key":"e_1_3_3_16_2","first-page":"161","article-title":"Major clinical characteristics of patients surviving 24 months or more after hospitalization due to decompensated heart failure.","volume":"84","author":"Oliveira MT","year":"2005","unstructured":"Oliveira MT, Canesin MF, Munhoz RT, del Carlo CH, Scipioni A, Ramires JA, Barretto AC. 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