Among 910,128 heart failure hospitalizations in Brazil's public health system, patients with Chagas disease faced dramatically higher mortality rates—25% versus 12% for non-Chagas cases. After adjusting for clinical variables, Chagas disease independently increased death risk by 54% (HR 1.54), despite affecting younger patients who paradoxically required more intensive healthcare resources. This massive real-world dataset reveals the severe clinical burden of Chagas cardiomyopathy, a parasitic infection affecting millions in Latin America that causes progressive heart muscle damage. The finding challenges assumptions about age-related mortality in heart failure, as younger Chagas patients experienced worse outcomes than typically older non-Chagas cohorts. For global health systems, this underscores the urgent need for specialized Chagas treatment protocols, particularly as migration patterns spread the disease beyond traditional endemic zones. The study's observational design limits causal interpretations, and coding accuracy in administrative databases may affect precision. As a preprint awaiting peer review, these striking mortality differences require validation, but the sheer scale and consistency of this Brazilian data strongly suggest Chagas cardiomyopathy represents a distinct, high-risk heart failure phenotype demanding targeted therapeutic approaches.