BACKGROUND The role of Chagas' etiology of chronic heart failure in predicting patient outcomes while awaiting heart transplantation is unknown. Accordingly, in this study we compare outcomes in Chagas' disease with non-Chagas'-disease-related advanced heart failure among patients on the waiting list for heart transplantation. METHODS We reviewed the clinical outcomes of 103 consecutive patients with chronic heart failure listed for heart transplantation from August 2000 to January 2008 at a single institution. Forty-six (44%) patients were diagnosed with Chagas' disease on the basis of positive serology. A Cox proportional hazards model was used to establish independent predictors of mortality, whereas competing risk analysis was used to estimate time-related prevalence of death and heart transplantation in Chagas' disease and non-Chagas' disease patients. RESULTS In the multivariate model, inotropic support (p < 0.0005; hazard ratio = 5.96; 95% confidence interval [CI] 2.41 to 14.71) and Chagas' disease etiology of heart failure (p = 0.02; hazard ratio = 2.27; 95% CI 1.14 to 4.52) were retained as independent predictors of mortality. Prevalence of death at 100 days after listing was 30% in Chagas' disease and 16% in non-Chagas' disease patients (p = 0.02), despite no difference in the competing rates of transplantation (30% in Chagas' and 37% in non-Chagas' patients, p = 0.5). CONCLUSIONS Chagas' disease etiology serves as an independent predictor of mortality in patients listed for heart transplantation, with a worse outcome when compared with non-Chagas' disease patients.