Chagas disease associated with higher in-hospital mortality in adults hospitalized with heart failure

Background: Chagas cardiomyopathy remains a major cause of heart failure (HF) in endemic regions and is increasingly recognized globally, yet data on in-hospital outcomes are limited. Objective: To assess whether Chagas disease is associated with higher in-hospital mortality among patients hospitalized with HF. Methods: We analyzed a nationwide administrative database from the Brazilian Unified Health System (DATASUS/SIHSUS), including adults hospitalized with HF between April 2017 and August 2021. HF was identified using ICD10 code I50.x and Chagas disease using B57.x. The primary outcome was in hospital mortality, evaluated using multivariable Cox models. Results: Among 910,128 HF hospitalizations, 1,082 (0.12%) were associated with Chagas disease. Patients with Chagas were younger but had a more complex clinical profile and higher resource use. In-hospital mortality was higher in the Chagas group (25% vs 12%; p<0.001). After adjustment, Chagas disease remained independently associated with mortality (HR 1.54; 95% CI 1.35, 1.75; p<0.001). Conclusions: In this large real world cohort, Chagas disease was associated with higher in-hospital mortality and greater healthcare utilization. These findings reinforce the high risk nature of Chagas cardiomyopathy and point to the need for more targeted treatment strategies.