# Evaluation of Quality of Care in Chagas Disease Cardiomyopathy

## TL;DR

This paper evaluates how to improve care for Chagas disease cardiomyopathy by defining quality components at different healthcare levels.

## Contribution

The study introduces a structured framework for quality care in Chagas disease cardiomyopathy using the Donabedian model and case studies.

## Key findings

- Primary care is crucial for early diagnosis and treatment of Chagas disease cardiomyopathy.
- Secondary and tertiary care levels provide specialized interventions and rehabilitation.
- Systematic processes and defined outcomes are key to improving care quality and equity.

## Abstract

Chagas disease (ChD), a neglected tropical disease caused by Trypanosoma cruzi, affects around 7.5 to 10 million people globally, primarily in Latin America. Chronic Chagas cardiomyopathy (CCM) is the most severe clinical form, leading to substantial cardiovascular morbidity and mortality. Despite existing guidelines, fragmented health systems, low provider awareness, and limited access to care hinder effective disease management.

We aimed to define the key components of the CCM quality of care (structure, process, and outcomes) for main clinical activities at the three levels of care.

We applied the Donabedian model to define essential components of ChD care at primary, secondary, and tertiary levels. Key recommendations from the World Heart Federation (WHF) roadmap and evidence-based guidelines were used to identify core services at each level. We also examined two case studies that demonstrate successful implementation of innovative screening and management models.

Essential components of ChD care were identified at all levels. Primary care plays a central role in early diagnosis and timely treatment. Secondary care addresses complications through imaging and targeted therapy, while tertiary care provides advanced interventions and rehabilitation. Although structural gaps persist, the implementation of systematic processes and clearly defined outcomes is key to strengthening the quality, continuity, and equity of care.

A comprehensive, structured approach to ChD care is essential to improving outcomes. Successful models illustrate that scalable, resource-appropriate interventions can enhance diagnosis and treatment. Integration into routine health systems, supported by universal health coverage, improved data systems, and implementation research, is critical to closing the care gap and advancing equity in cardiovascular health.