Hyperendemic Chagas Disease and the Unmet Need for Pacemakers in the Bolivian Chaco

Abstract

Morbidity and mortality from Chagas cardiomyopathy have declined over the last three decades because of disruption of domestic vector-borne transmission, improved Trypanosoma cruzi infection treatment programs, and increasing availability of advanced cardiac care. However, the Gran Chaco, an ecological zone that includes parts of Argentina, Bolivia, and Paraguay, continues to struggle with extremely high rates of vector infestation and T. cruzi infection. In addition, this region is one of the poorest in the world, with most individuals living on less than US$2 per day. We estimate that thousands of patients are in need of pacemakers secondary to advanced Chagas cardiomyopathy. However, the vast majority of these individuals lack the resources to obtain these life-saving devices. A collaborative effort must be made by pacemaker donation programs, local implantation hospitals, and the governments of countries affected by Chagas disease to address this unmet need. With the necessary cooperation and infrastructure, pacemaker reuse programs have the potential to offer thousands of low-cost devices to impoverished patients with advancing Chagas cardiomyopathy.