Chagas Disease in Northern California: Observed Prevalence, Clinical Characteristics, and Outcomes Within an Integrated Health Care Delivery System.

INTRODUCTION

Chagas disease (CD) is caused by the protozoan parasite Trypanosoma cruzi and can remain clinically silent for decades. The objectives of this study were to quantify the prevalence of CD within the membership of Kaiser Permanente Northern California, to describe the demographic and clinical characteristics of patients with CD, and to report their adverse cardiovascular outcomes.

METHODS

In this cohort study from 2006 to 2022, the authors identified patients with CD by screening the electronic medical record for International Classification of Diseases, 9th Revision and 10th Revision codes. The authors obtained demographic, medical history, electrocardiographic, echocardiographic, and pharmacy data. Adverse outcomes, including all-cause mortality, heart failure hospitalization, and heart transplantation, were identified by database programming and confirmed by manual chart review.

RESULTS

There were 53 cases of CD in total, and 75% of patients self-identified as Hispanic. The mean age was 49 years old, and 45% were female. Dyslipidemia (45%) and hypertension (32%) were common comorbidities. A total of 7 patients (13%) had a left ventricular ejection fraction < 45%. During the follow-up period, adverse outcomes included 4 cardiovascular deaths, 5 heart failure hospitalizations, and 4 heart transplantations. The prevalence of diagnosed CD in the Kaiser Permanente Northern California population has risen from 0.22 per 100,000 persons from 2006 to 2010 to 0.70 per 100,000 persons from 2018 to 2022.

DISCUSSION: The prevalence of diagnosed CD in Kaiser Permanente Northern California increased during the study period, and patients with CD frequently had poor cardiovascular outcomes, likely due to the patients presenting with advanced disease.

CONCLUSION

Systematic screening and awareness are likely to facilitate early diagnosis and improve treatment to avoid chronic complications of CD.