|
| Drug groups and interventions | Indication | Recommendation | Evidence |
|
| Renin-angiotensin-aldosterone blockers | ACEi or ARB (for those intolerant to the former) in patients with LV systolic dysfunction, LVEF < 45%, and NYHA I/II/III/IV stages B1 to D | I | C |
| | Spironolactone or eplerenone in patients with LV systolic dysfunction, LVEF < 35% and NYHA III/IV stages B2 to D | I | B |
| Beta blockers | Carvedilol, bisoprolol, and metoprolol succinate in patients with LV systolic dysfunction, LVEF < 45%, and NYHA I/II/III/IV stages B2 to D | IIa | B |
| Diuretics | Patients with signs and symptoms of congestion (NYHA II to IV) | I | C |
| Hydralazine and nitrate | Patients of any ethnicity, with LV systolic dysfunction, LVEF < 45%, and NYHA II–IV stages B2 to D with contraindications or intolerance to ACEI and ARB (e.g., progressive renal failure or hyperkalemia) | I | C |
| | Patients with LV systolic dysfunction, LVEF < 45%, and NYHA III-IV as an addition to the use of optimized therapy stages B2 to D | IIa | C |
| Digitalis | Patients with LV systolic dysfunction, LVEF < 45%, and sinus rhythm or atrial fibrillation, symptomatic despite optimized therapy stages B2 to D | IIa | C |
| | Patients with LV systolic dysfunction, LVEF < 45%, and AF, asymptomatic, to control high heart rate | III | C |
| Oral anticoagulation | Atrial fibrillation, previous embolic events, mural thrombus, IPEC/FIOCRUZ score ≥ 4 | I | C |
| Amiodarone | Patients with ventricular ectopy, asymptomatic NSVT, and left ventricular dysfunction stages B2 to D | I | B |
| | Patients with symptomatic SVT or not, with or without left ventricular dysfunction not treated with ICD stages B1 to D | I | C |
| | To reduce shocks in patients with ICD stages B1 to D | I | C |
| | Patients with symptomatic SVT treated with CDI stages B2 to D | IIa | C |
| ICD | Malignant arrhythmia, or sustained ventricular tachycardia, or those resuscitated from sudden cardiac arrest, especially with a reduced LVEF. Stages B2 to D | I | C |
| Resynchronization | Refractory HF, or functional class III/IV with persistent therapeutic optimization and any evidence of dyssynchrony. Sinus rhythm, QRS duration >120 milliseconds, and LVEF <35%. Stages B2 to D | IIb | C |
| Heart transplantation | Refractory HF, dependent on inotropic drugs and/or circulatory support and/or mechanical ventilation stages C to D | I | C |
| | VO2 peak ≤ 10 mL/kg/min, or if in use of beta blockers with VO2 peak = 12 mL/kg/min stages C to D | I | C |
| | Fibrillation or sustained refractory ventricular tachycardia stages C to D | I | C |
| | Functional class III/IV with persistent therapeutic optimization stages C to D | I | C |
| Ventricular circulatory support | Bridge to heart transplantation, destination therapy, or bridging to recovery. Stages C to D | Few evidence | Few evidence |
| Immunoadsorption (IA) | Based on other cardiomyopathies, without evidence of CCC yet | No evidence | No evidence |
| Aptamers treatment | Studies in progress | No evidence | No evidence |
| Specific treatment | Acute infections, independently of the mechanism of transmission (consensual indication) | I | B |
| | High-risk accidental contaminations (consensual indication) | I | B |
| | Chronic phase in children (consensual indication) | I | B |
| | Reactivated Trypanosoma cruzi infection—AIDS or other immunosuppression (consensual indication) | I | C |
| | Congenital infection (consensual indication) | I | B |
| | Organ transplantation in which either the donor or the recipient has Chagas’ disease (consensual indication) | I | B |
| | Late, chronic phase, including patients with the indeterminate or cardiac forms of Chagas’ disease (not consensual indications) | III | C |
|
