#60: Knowledge of Diagnosis and Management of Chagas-related Heart Disease Among Pediatric Cardiologists in the United States

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S21-S21
Author(s):  
Sanchi Malhotra ◽  
Imran Masood ◽  
Noberto Giglio ◽  
Jay Pruetz ◽  
Pia Pannaraj
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Heart Disease ◽  
Chagas Disease ◽  
Latin American ◽  
The United States ◽  
Educational Programs ◽  
Childbearing Age ◽  
American Patient ◽  
The Impact

Abstract Background Chagas disease is a highly pathogenic infection with a prevalence of approximately 5.7 million cases worldwide and greater than 300,000 cases in the United States. Up to 40% of immigrants to the United States are from highly endemic Latin American countries. An estimated 40,000 women of childbearing age in the United States are infected, with a 1–5% risk of vertical transmission. The impact of this disease is extensive, often life-long, and difficult to eradicate. The purpose of our study was to better understand current knowledge and experience among pediatric cardiologists in the United States with the cardiac presentations of Chagas disease to determine where to focus educational programs and critical content. Methods We prospectively disseminated a 19-question survey to pediatric cardiologists via the PediHeart, WSOPC, and Pediatric CHF listservs three times between September and November 2019. The survey included demographic, multiple-choice and Likert-scale questions. We used Qualtrics to ensure anonymity. Respondents outside of the United States were excluded. Results Of 140 responses received, 120 cardiologists treated pediatric patients in the United States. Over half (62.5%) of respondents served a >10% Latin American patient population. Most providers (87%) had not seen a case of Chagas disease in their practice; however, most (72%) also had never tested for Chagas. In response to the statement: “I feel comfortable recognizing cardiac presentations of Chagas disease in children”, (85%) of respondents disagreed. Most respondents selected that they would not include Chagas on their differential diagnosis for cardiac presentations that included conduction anomalies, myocarditis, and/or apical aneurysms (Figure 1). However, when considering patients who recently immigrated from Latin American nations, inclusion of Chagas in the differential diagnosis increased. In response to the statement: “If I was offered a lecture on Chagas-related heart disease, I would be likely to attend,” 87% of respondents agreed. Conclusions In our sample of pediatric cardiologists, very few had seen cases of Chagas disease, albeit very few tested for it or included it in their differential diagnosis. However, most individuals agreed that education on Chagas disease would be worth-while. Education could help ensure these cases are not missed in pediatrics. Future analysis should focus on changes in provider knowledge and/or testing as the incidence grows, or as educational programs are implemented.

scholarly journals Current knowledge of Chagas-related heart disease among pediatric cardiologists in the United States

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sanchi Malhotra ◽  
Imran Masood ◽  
Noberto Giglio ◽  
Jay D. Pruetz ◽  
Pia S. Pannaraj
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Heart Disease ◽  
Chagas Disease ◽  
Latin American ◽  
Current Knowledge ◽  
Parasitic Infection ◽  
The United States ◽  
Cardiac Complications ◽  
The U.S

Abstract Background Chagas disease is a pathogenic parasitic infection with approximately 8 million cases worldwide and greater than 300,000 cases in the United States (U.S.). Chagas disease can lead to chronic cardiomyopathy and cardiac complications, with variable cardiac presentations in pediatrics making it difficult to recognize. The purpose of our study is to better understand current knowledge and experience with Chagas related heart disease among pediatric cardiologists in the U.S. Methods We prospectively disseminated a 19-question survey to pediatric cardiologists via 3 pediatric cardiology listservs. The survey included questions about demographics, Chagas disease presentation and experience. Results Of 139 responses, 119 cardiologists treat pediatric patients in the U.S. and were included. Most providers (87%) had not seen a case of Chagas disease in their practice; however, 72% also had never tested for it. The majority of knowledge-based questions about Chagas disease cardiac presentations were answered incorrectly, and 85% of providers expressed discomfort with recognizing cardiac presentations in children. Most respondents selected that they would not include Chagas disease on their differential diagnosis for presentations such as conduction anomalies, myocarditis and/or apical aneurysms, but would be more likely to include it if found in a Latin American immigrant. Of respondents, 87% agreed that they would be likely to attend a Chagas disease-related lecture. Conclusions Pediatric cardiologists in the U.S. have seen very few cases of Chagas disease, albeit most have not sent testing or included it in their differential diagnosis. Most individuals agreed that education on Chagas disease would be worth-while.

scholarly journals Current knowledge of Chagas-related heart disease among pediatric cardiologists in the United States

2020 ◽  
Author(s):  
Sanchi Malhotra ◽  
Imran Masood ◽  
Noberto Giglio ◽  
Jay D. Pruetz ◽  
Pia S. Pannaraj
Keyword(s):  
United States ◽  
Differential Diagnosis ◽  
Heart Disease ◽  
Chagas Disease ◽  
Latin American ◽  
Current Knowledge ◽  
Parasitic Infection ◽  
The United States ◽  
Cardiac Complications ◽  
The U.S

Abstract BackgroundChagas disease is a pathogenic parasitic infection with approximately 8 million cases worldwide and greater than 300,000 cases in the United States (U.S.). Chagas disease can lead to chronic cardiomyopathy and cardiac complications, with variable cardiac presentations in pediatrics making it difficult to recognize. The purpose of our study is to better understand current knowledge and experience with Chagas related heart disease among pediatric cardiologists in the U.S.MethodsWe prospectively disseminated a 19-question survey to pediatric cardiologists via 3 pediatric cardiology listservs. The survey included questions about demographics, Chagas disease presentation and experience.ResultsOf 139 responses, 119 cardiologists treat pediatric patients in the U.S. and were included. Most providers (87%) had not seen a case of Chagas disease in their practice; however, 72% also had never tested for it. The majority of knowledge-based questions about Chagas disease cardiac presentations were answered incorrectly, and 85% of providers expressed discomfort with recognizing cardiac presentations in children. Most respondents selected that they would not include Chagas disease on their differential diagnosis for presentations such as conduction anomalies, myocarditis and/or apical aneurysms, but would be more likely to include it if found in a Latin American immigrant. Of respondents, 87% agreed that they would be likely to attend a Chagas disease-related lecture.ConclusionsPediatric cardiologists in the U.S. have seen very few cases of Chagas disease, albeit most have not sent testing or included it in their differential diagnosis. Most individuals agreed that education on Chagas disease would be worth-while.

scholarly journals The Impact of the Introduction of Clinical Recommendations on Cardiology in the USA and Russia Federetionon Mortality from Ischemic Heart Diseas

2018 ◽  
Vol 17 (4) ◽  
pp. 30-37
Author(s):  
A. A. Gerasimov
Keyword(s):  
United States ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Russian Federation ◽  
Clinical Guidelines ◽  
The United States ◽  
Ischemic Heart ◽  
The Russian Federation ◽  
The Impact

1 million 824 thousand people died in the Russian Federation in 2017, including 457 thousand from ischemic heart disease (IHD). IHD caused more than a quarter of deaths in Russia. Goal. The article analyzes the impact of implementation of clinical guidelines in cardiology in medical practice in the United States and the Russian Federation on the dynamics of mortality from ischemic heart disease and its outcomes in different age groups. Results. The results showed that the implementation of clinical guidelines (CG) increased the rate of mortality reduction from coronary heart diseases in Russia and the United States, which may indicate a positive impact CG on the quality of medical care. Conclusions. A higher level of mortality from coronary heart disease in Russia compared to the United States may be due to less commitment of doctors to the principles of therapy and diagnosis of various forms of coronary heart disease, set out in clinical guidelines.

Difficulties Experienced by Women in Prison

1982 ◽  
Vol 7 (2) ◽  
pp. 107-118 ◽  
Author(s):  
Suzanne B. Sobel
Keyword(s):  
Mental Health ◽  
United States ◽  
Health Services ◽  
The United States ◽  
Educational Programs ◽  
Her Family ◽  
Women's Prisons ◽  
Women In Prison ◽  
The Impact ◽  
Separation Problems

This article assembles data that identify some problems experienced by women incarcerated in prisons in the United States. Inequalities in occupational and educational programs offered in women's prisons in comparison with those offered in prisons for men are discussed. The impact of inadequate health and mental health services on the lives of these women is explored, and separation problems encountered by the woman prisoner and her family are examined. Some recommendations for change are suggested.

The Latin Tinge: The Impact of Latin American Music on the United States

Notes ◽  
1980 ◽  
Vol 36 (4) ◽  
pp. 899
Author(s):  
Susan T. Sommer ◽  
John Storm Roberts
Keyword(s):  
United States ◽  
Latin American ◽  
The United States ◽  
American Music ◽  
Latin American Music ◽  
The Impact

scholarly journals The Impact of the Aging Population on Coronary Heart Disease in the United States

2011 ◽  
Vol 124 (9) ◽  
pp. 827-833.e5 ◽  
Author(s):  
Michelle C. Odden ◽  
Pamela G. Coxson ◽  
Andrew Moran ◽  
James M. Lightwood ◽  
Lee Goldman ◽  
...  
Keyword(s):  
United States ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Aging Population ◽  
The United States ◽  
The Impact

scholarly journals 1165. Seroprevalence of Chagas Disease among Latin American Children Living in New York

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S674-S674
Author(s):  
Andrew S Handel ◽  
Harriet Hellman ◽  
Egar Flores ◽  
Christy Beneri
Keyword(s):  
United States ◽  
Risk Factors ◽  
New York ◽  
Latin America ◽  
Chagas Disease ◽  
Latin American ◽  
Rapid Test ◽  
The United States ◽  
Suffolk County ◽  
The Us

Abstract Background Approximately 300,00 individuals in the United States are estimated to have Chagas disease. To date, only one seroprevalence study in the US has included children. Diagnosis during childhood prevents irreversible sequelae and is better tolerated than during adulthood. Seropositive children may be difficult to identify, as those infected vertically may have never visited an endemic region. We sought to identify children with Chagas disease through a pilot study of serology and risk factors. Methods Participants were recruited from Stony Brook University Hospital (SBUH) or an ambulatory pediatric office, both in Suffolk County, New York (population: 1,476,000; 20.2% Hispanic or Latino). Study participants were 1 - 25 years old, resided in Suffolk County, and either the child and/or the child’s mother was born in or had long-term residence (≥ 3 years) in Latin America. T. cruzi serum IgG was determined with a Chagatest ELISA (Weiner Lab) or a Chagas Detect Plus Rapid Test (InBios). Positive screens were confirmed with a second serologic test at the CDC. Participants completed a survey of demographics and Chagas disease knowledge and risk factors, in English or Spanish. Descriptive statistics were applied. SBUH IRB provided study approval. Results We enrolled 93 children (Table 1). Three (3.2%) had a positive IgG screen, of which only one had a confirmed infection (1.1%). This was a 17-year-old who had lived in a rural adobe home and moved to the US at 8 years old. No children or their mothers recalled being bitten by or seeing triatomine insects in their Latin American homes. Of 27 children whose mothers had been screened for infection, 13 were born to 3 mothers with confirmed Chagas disease; all 13 children were seronegative. Of 8 participants reporting other family members with Chagas disease, all were seronegative. Demographics of 93 participants screened for Chagas disease SD standard deviation; US: United States Conclusion Without reliable tools for identifying those at greatest risk of Chagas disease, universal screening of children born in high-risk Latin American regions remains a reasonable strategy. In addition, screening mothers born in Latin America is likely a more cost-efficient means to evaluate second-generation children. A tremendous knowledge gap of pediatric Chagas disease in the US remains. Disclosures All Authors: No reported disclosures

scholarly journals 1210. Recommendations for Screening and Diagnosis of Chagas Disease in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S695-S695
Author(s):  
Colin Forsyth ◽  
Jen Manne-Goehler ◽  
Jen Manne-Goehler ◽  
Caryn Bern ◽  
Jeffrey Whitman ◽  
...  
Keyword(s):  
United States ◽  
South America ◽  
Central America ◽  
Chagas Disease ◽  
Healthcare Providers ◽  
The United States ◽  
Cardiac Complications ◽  
Childbearing Age ◽  
Serological Tests ◽  
Screening And Diagnosis

Abstract Background Over 300,000 people in the United States are infected with Trypanosoma cruzi, the protozoan parasite that causes Chagas disease (CD). Only about 1% of estimated U.S. cases have been identified, usually through blood donor screening, and most people are unaware they have the infection. Screening is critical for increasing case detection and ensuring patients receive appropriate and timely care, but awareness of CD management strategies among healthcare providers is low. Diagnostic guidelines for CD in the United States are needed to increase provider-directed screening and diagnosis. Methods Screening recommendations were prepared by the U.S. Chagas Diagnostic Working Group, which consists of clinicians, researchers, and public health experts involved in CD programs. The group agreed on six main questions based on the PICO method (Population, Intervention, Comparison, and Outcome). Subgroups discussed each and proposed initial recommendations, which were then shared and validated within the larger group. The recommendations used the GRADE methodology, assigning two sets of ratings: 1) strength of the recommendation, and 2) quality of the evidence. Results The group recommended screening anyone who was born or lived for >6 months in South America, Central America and Mexico (Figure 1). Recent community-based studies found a prevalence of 1-3.8% in this population. Within this population, having a family member with CD, or having clinical conditions suggestive of CD, including electrocardiographic abnormalities, suggest an elevated risk. Screening women of childbearing age and infants born to seropositive women is important for preventing congenital transmission. Test performance may vary depending on several factors, including whether patients are from South America, Central America or Mexico. Confirmation therefore requires positive results on at least two serological tests based on different antigens or formats, in line with Pan American Health Organization (PAHO) recommendations. Once CD is confirmed, patients should receive an electrocardiogram and echocardiogram to monitor for development of cardiac complications. Conclusion These CD screening recommendations are meant to be a resource for U.S. healthcare providers to simplify testing of at-risk patients. Disclosures Jen Manne-Goehler, MD, DSc, Regeneron (Individual(s) Involved: Self): Scientific Research Study Investigator Caryn Bern, MD, MPH, UpToDate (Wolters Kluwer) (Other Financial or Material Support, Author Royalties)

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