Rethinking Chagas disease for 21st-century health systems.

Chagas disease is a neglected tropical disease that disproportionately affects underserved populations and is associated with substantial health and socioeconomic burden. Although age-standardised prevalence and mortality have declined since 1990, approximately 10.5 million people remain infected globally. As infected populations age, Chagas disease is increasingly concentrated among older adults and is transitioning from a predominantly acute infection of younger populations into a chronic cardiomyopathy affecting ageing adults in both endemic and non-endemic regions. Migration has further redistributed the disease burden to Western countries where clinical awareness, routine screening, and timely diagnosis of Chagas disease remain limited. We highlight three priorities to address this evolving burden: reframing Chagas disease from a neglected tropical infection to a neglected chronic cardiomyopathy, expanding responsibility of screening and clinical care beyond endemic countries, and strengthening surveillance and epidemiological data systems. Recognizing Chagas disease as a chronic cardiovascular condition will be essential for health systems to address its evolving global burden.