Chronic cardiac Chagas disease in Primary Health Care: experience report on the compulsory notification process and case classification

Abstract

Objective: to evaluate the feasibility of implementing a flow for diagnosis, notification and classification of cases of chronic cardiac Chagas disease in primary health care in the city of Patos de Minas, Minas Gerais. Experience report: The study participants were followed between September 2023 and June 2024. For compulsory notification of chronic Chagas disease, registration and subsequent release of access by a municipal, state or federal manager is required, which, in this experience, proved to be a bureaucratic, confusing and inefficient process. There was low adherence to confirmatory serological tests (16; 48.5%). There was also no complete adherence of the recruited patients to perform cardiological tests: electrocardiogram (31; 93.9%), chest X-ray (31; 93.9%) followed by echocardiogram (29; 87.9%) and Holter (24; 72.7%). There was one case of self-reported cardiac Chagas disease that had no serological confirmation and that did not have any cardiological damage. Patients' memory bias made it difficult to conduct research on aspects of disease onset, previous diagnosis, and other epidemiological aspects. These findings may be associated with the high mean age of patients (68.9 ± 9.5 years). In view of this, a protocol for diagnosing and monitoring chronic cardiac Chagas disease adapted to the local reality was proposed. Conclusion: The current reporting process may significantly impair estimates of the prevalence of chronic Chagas disease in the country. The low adherence of patients recruited for serological testing, associated with their advanced age, highlights the need for active search by health teams in communities, especially in areas of intense transmission in the past. Cardiological examinations are important for classifying cases in relation to risk of death, cardiac staging, and appropriate referral to different levels of health care.