Prognostic value of the New York Heart Association classification for cardiovascular events and mortality in Chagas cardiomyopathy: a systematic review and meta-analysis with GRADE recommendations

Chagas cardiomyopathy is associated with a higher risk of severe cardiovascular events and increased mortality. Among the factors associated with Chagas cardiomyopathy, impairment in functional capacity-commonly assessed using the New York Heart Association (NYHA) functional classification-is notable and may contribute to risk stratification. In this review, we assessed the prognostic value of the NYHA classification on cardiovascular events and mortality in patients with Chagas cardiomyopathy. The search was performed across EMBASE, LILACS, MEDLINE, and Web of Science databases. Prospective and retrospective cohort studies in which the prognostic value of the NYHA classification was assessed were eligible. Risk of bias was assessed using the Quality in Prognostic Studies tool. Evidence was classified using the adapted GRADE system. Eighteen studies were included in the systematic review. The meta-analysis results indicate that the NYHA classification is an important prognostic factor for mortality. Patients with NYHA class III and IV showed a higher risk of death than those with class I and II (hazard ratio, 2.63; 95% confidence interval: 2.00-3.45; moderate GRADE evidence). Patients with NYHA class IV had a higher risk of death than those with class I, II, and III (hazard ratio, 2.80; 95% confidence interval: 1.06-7.43; low GRADE evidence). Very low evidence suggests that the NYHA classification does not predict heart transplantation or stroke, but may predict cardiac pacemaker implantation. Overall, the NYHA classification is a key prognostic indicator of mortality in Chagas cardiomyopathy, although its ability to predict stroke, heart transplantation, and pacemaker implantation is inconsistent.

Keywords:
Chagas cardiomyopathy; Chagas disease; NYHA; Prognoses; Prognostic factor; Systematic review