Figure 1
Ideal patient pathway for Chagas disease. Reproduced from the WHF IASC Roadmap on Chagas disease with permission (2).
Figure 2
WHF roadmap recommendations for cardiovascular evaluation in patients with positive serology for ChD. Reproduced from the WHF IASC Roadmap on Chagas disease with permission (2).
Table 1
Description of types of care typically provided at primary, secondary, and tertiary facilities.
| LEVEL OF CARE | STRUCTURE | PROCESS | OUTCOMES |
|---|---|---|---|
| All levels | Training materials for ChD management. | Regular training of healthcare teams on ChD detection, evaluation, and management. | Proportion of trained healthcare professionals. |
| All levels | Electronic medical records. | Systematic documentation of ChD cases in EMRs. | Accuracy of EMRs identification of ChD cases. |
| Primary | Serological tests for ChD detection. | Guideline-based screening for ChD in endemic and non-endemic settings. | Rate of confirmed diagnoses with two positive serological tests. |
| Primary Secondary | ECG and chest X-ray. | Annual assessment for early detection and risk stratification of cardiac complications. | Incidence of new cardiac abnormalities. |
| Secondary | Echocardiography. | Guideline-based echocardiographic follow-up. | Incidence of new echocardiographic abnormalities |
| Primary Secondary | Guideline-directed medical therapy for specific organ complications. | Assessment of organ involvement to guide initiation of GDMT. | Proportion receiving GDMT when indicated. |
| Primary Secondary | Antiparasitic treatment. | Guideline-based prescription and monitoring of antiparasitic therapy. | Antiparasitic treatment completion rate. |
| Secondary | Specialists for antiparasitic treatment follow-up. | Follow-up of adverse drug reactions requiring specialist care. | Rate of adverse reactions to antiparasitic treatment requiring specialist care. |
| Secondary Tertiary | Specialized cardiac studies (24-hour Holter monitoring, stress test, advanced cardiovascular imaging). | Specialist cardiac evaluation and follow-up in patients with moderate-to-severe CCM. | Completion rate of indicated advanced cardiac studies. |
| Secondary Tertiary | Specialized gastroenterological studies (barium enema and barium swallow). | Specialist evaluation and follow-up of gastrointestinal involvement. | Proportion undergoing specialized GI evaluation when indicated. |
| Secondary Tertiary | Advanced cardiac therapies/interventions (pacemaker, ICD, ventricular tachycardia ablation, LVAD, heart transplantation). | Delivery of advanced cardiac therapies/interventions for moderate-to-severe CCM. | Utilization rate of advanced cardiac therapies/interventions when indicated. |
| Secondary Tertiary | Resources and trained personnel for cardiac rehabilitation. | Guideline-based referral to cardiac rehabilitation programs. | Proportion of patients completing indicated cardiac rehabilitation. |
| Secondary Tertiary | Quantitative PCR devices and trained personnel knowledgeable in ChD treatment and severity criteria. | Early detection and management of ChD reactivation in immunosuppressed patients. | Treatment rate for confirmed disease reactivation. |
[i] ChD: Chagas disease; EMR: Electronic medical record; ECG: electrocardiogram; GDMT: Guideline-directed medical therapy; CCM: Chronic Chagas cardiomyopathy; ICD: implantable cardioverter-defibrillator; LVAD: left ventricular assist device.