Impact of pharmaceutical care on the quality of life of patients with heart failure due to chronic Chagas disease: Randomized clinical trial

19 February 2020

Chagas disease (ChD) is a neglected tropical disease caused by infec- tion with Trypanosoma cruzi that still affects 6–7 million people world- wide, mainly in Latin America,but also in nonendemic countries due to the migratory flow from endemic countries. Estimates indicate that more than 300 000 people are chronically infected by T. cruzi in USA and ChD prevalence among Latin American migrants in Europe was estimated in 4.2%.


Around 30% of the subjects chronically infected by T. cruzi present the cardiac form of the disease. Chronic chagasic cardiomyopathy (CCC) is responsible for high morbidity and mortality with great social and medical‐labour impact. One of the hallmarks of the CCC is heart fail- ure (HF) and the consequent decrease in survival, functional capacity and quality of life of the affected individuals. Furthermore, HF due to ChD has higher mortality than HF due to other aetiologies both in patients hospitalized for acute decompensated HF and in outpatients with HF. Quality of life is also worse in patients with HF due to ChD than other aetiologies. Functional class and ChD clinical presentation are independently associated with quality of life in patients with ChD.

HF in ChD patients is treated following international HF guidelines as there are few studies testing pharmacological agents in ChD. Beyond pharmacological treatment, the control of reversible precipitat- ing factors are important to reverse HF symptoms and improve quality of life. These factors include nonadherence to therapy and inadequate use of drugs that may aggravate HF, as well as other factors. In this area, pharmaceutical care (PC) has proven to be useful in HF as PC can improve patients' symptoms, improve their quality of life,  and reduce the risk of hospitalization and mortality. PC is a pharmacy practice where the pharmacist works in concert with the patient and the patient's other healthcare providers to promote health, prevent disease, and to assure that drug therapy regimens are safe and effective. PC goals are the improvement of patients adherence to therapy and the decrease in drug‐related problems (DRPs) with consequent optimiza- tion of the patient's quality of life and improve in clinical outcomes.

A DRP is an event or circumstance involving drug therapy that actually or potentially interferes with desired health outcomes.

To date, there are no studies demonstrating the benefits of PC in patients with ChD complicated by HF. Therefore, this study aimed to investigate if PC can improve the quality of life of ChD patients with HF. Our hypothesis was that PC would improve quality of life by improving patients' adherence to their treatment and reducing the frequency of DRPs.


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