RAISE study provides new evidence for action against Chagas disease worldwide

World Heart Federation and Novartis presented conclusions from the RAISE study, a project conducted in collaboration with the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, and led by the Federal University of Minas Gerais.

RAISE compiles updated information on the prevalence and mortality of Chagas disease, refining global estimates with a comprehensive and multidimensional approach (global, regional, and national). By combining systematic reviews, disease models, and real-world mortality reclassification, the study represents the most detailed global analysis of the disease to date.

The goal is to assess a realistic global health burden (for both endemic and non-endemic countries) and also the economic burden, to provide a foundation future public policies and evidence-based research.

According to the results obtained, the global prevalence exceeds previous estimates, rising from approximately 6 to 10.5 million of affected people. It is now decreasing in endemic regions of Latin America while increasing in non-endemic regions. According to new estimates, Chagas disease is affecting an increasingly older population (from 30 to 49 years old in 1990 to 45 to 64 years old in 2023), with a rise in cases of cardiomyopathy caused by Trypanosoma cruzi among adults.

However, a shift in the prevalence of cardiac and digestive sequelae in older age groups over time may be due to reduced vector-borne transmission (via the triatomine bug) and improved survival individuals living with these sequelae.

But despite the decrease in rates, there is an enormous burden of mortality related to Chagas disease, and thousands of cases go undetected. Indeed, the true burden of chronic Chagas disease remains unclear due to outdated diagnostic models and insufficient official data.

Heart failure stands out as the main driver of the economic burden of Chagas disease, and along with atrial fibrillation, it is the leading cause of disability among older adults (while digestive disorders predominate among younger patients).

One of the main objectives of RAISE has been precisely to determine the costs associated with the treatment of Congenital Chagas Cardiomyopathy (CCC) for endemic and non-endemic countries. Cardiomyopathy is the most significant clinical complication caused by the disease, and it is estimated that 30% of affected individuals will develop chronic cardiomyopathy, which determines with high rates of hospitalization. Alos, the high costs associated with the treatment of cardiomyopathies is a challenge for low and middle-income countries, highlighting the urgent need to provide early intervention.

To this end, the following needs can be deduced from the RAISE study:

• Raising public awareness (70% of those affected are unaware of their condition, and less than 10% receive timely diagnosis and treatment).
• Training health personnel and improving health systems to enhance detection and care for those affected by Chagas disease.
• Supporting with continued funding research and innovation.

“With the RAISE project, we now have the evidence to act, and the responsibility to do so“ (Dr. Antonio Luiz Pinto Ribeiro, lead investigator of the RAISE study)

The RAISE study improves our understanding of the burden of Chagas disease and identifies a series of needs to, firstly, improve these new estimates and, secondly, to address the disease early, reducing costs and preventing the most serious complications that this Neglected Tropical Disease causes in adults in its chronic phase. It also sheds light on the situation in non-endemic countries, where prevalence has risen due to migration, but also due to the growing interest of experts in studying the extent of Chagas disease beyond the 21 countries where it is endemic, in North America, and countries in Europe and the western Pacific.