Abstract 4146444: Higher total physical activity levels are associated with decreased all-cause mortality in patients with Chagas disease

Introduction: Higher levels of physical activity (PA) are associated with lower mortality in different populations. However, no previous study evaluated this association among patients with Chagas disease (CD), a neglected tropical disease that affects approximately 7 million people worldwide associated with high mortality rates in its more advanced stages. Aim: This study aimed to assess the association between PA level and all-cause mortality in patients with CD. Methods: This was an observational study including CD patients (confirmed by two serological methods) followed-up at the National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz). Baseline assessment was conducted from March 2014 to March 2017. PA level was assessed using International Physical Activity Questionnaire short version (IPAQ). Deaths were assessed using patients' medical records and the regional death registry system. The association between PA levels (tertiles and as continuous variable) and mortality was determined by log-rank test and Cox regression models. Adjusted analyses were conducted for potential confounding variables including age, sex, hypertension, diabetes mellitus, dyslipidemia, obesity, clinical form of CD, ejection fraction, and prior use of benznidazole. Results: Of the 361 participants included, 56.2% were women (mean age 60.7±10.7 years). During a median follow-up of 7.2 years (IQR 25-75% 5.4 to 8.0 years), there were 90 deaths (24.9%), of those 39 (32.2%) in the lowest PA tertile, 32 (26.7%) in the intermediate PA tertile, and 19 (15.8%) in the highest PA tertile (p=0.006, Log-Rank test). In adjusted Cox regression analysis, the risk of death was lower in the highest PA tertile compared to those in the lowest PA tertile (HR 0.55; 95% CI 0.31 to 0.96; p<0.001; Table). Furthermore, each increase of 100 MET.minutes/week was associated with a 2% lower risk of all-cause mortality. Similar results were observed after excluding deaths within the first 2 years. Conclusion: A linear dose-response association was observed between increased levels of PA and reduced mortality, demonstrating the importance of encouraging PA in this population.