In-Hospital Mortality in Chagas vs Non-Chagas Heart Failure: A Nationwide Real-World Analysis From the Brazilian Public Health System

Abstract 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 ICD-10 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. ⍰ What is the clinical question being addressed? Chagas cardiomyopathy is a major cause of heart failure in endemic regions and an emerging global health problem, yet real-world data on in-hospital outcomes remain limited. Is Chagas disease associated with higher in-hospital mortality? ⍰ What is the main finding? Chagas disease was independently associated with a 54% higher risk of in-hospital mortality in a large real-world cohort.