Clinical and Epidemiological Profile of Heart Failure Patients With Chagas Disease: Insights From the SEPE-HF Registry

Chagas cardiomyopathy (Ch-CMP) represents a unique and understudied phenotype of heart failure (HF) in endemic regions, with distinct clinical, electrocardiographic, and therapeutic characteristics compared to non-Chagas HF. In this retrospective cohort of 417 patients hospitalized for decompensated HF at a tertiary center in Brazil, 155 (37.1%) had confirmed Ch-CMP. Chagas patients were younger (mean age 67.5 vs 67.7 years, p = 0.86), had lower BMI (28.65 vs 25.40, p < 0.001), and a higher proportion of males (50.9% vs 47.7%, p = 0.56). Comorbidities were less frequent in the Chagas group, including hypertension (49.6% vs 70.1%, p = 0.001) and ischemic heart disease (3.2% vs 16.6%, p = 0.001). Electrocardiographic abnormalities were more prevalent among Chagas patients, such as right bundle branch block (17.6% vs 9%, p = 0.015), atrial fibrillation (37.9% vs 23%, p = 0.001), and pacemaker rhythms (22.2% vs 3.7%, p = 0.001). Systolic dysfunction (LVEF < 40%) was more common in Chagas (59.4% vs 27.1%, p = 0.001). Despite these differences, cardiovascular inhospital mortality did not significantly differ (8.4% vs 5.2%, p = 0.279). The use of guideline-directed medical therapy at discharge was suboptimal in both groups, but even lower in Chagas patients, particularly for beta-blockers (52% vs 64%, p = 0.02) and ACEi/ARB/ARNi (54% vs 68%, p = 0.01). Loop diuretics were used in only 64% of the entire cohort; among those not requiring diuretics, arrhythmias and infections were the leading causes of admission, atrial fibrillation in 22 patients, and infection in 21. In conclusion, Chagas cardiomyopathy remains a major contributor to HF hospitalizations in endemic regions, with a unique arrhythmogenic and vasodilated profile, lower prevalence of traditional risk factors, and concerning therapeutic gaps at discharge that merit targeted intervention.