BackgroundThe natural history of Chagas disease (ChD) in older ages is largely unknown, and it is a matter of controversy if the disease continues to progress in the elderly.ObjectiveTo investigate the evolution of electrocardiographic abnormalities inT.cruzichronically infected community-dwelling elderly compared to non-infected (NChD) subjects and how it affects this population’s survival in a follow-up of 14 years.Methods and resultsA 12-lead ECG of each individual of the Bambui Cohort Study of Aging was obtained in 1997, 2002, and 2008, and the abnormalities were classified using the Minnesota Code. The influence of ChD on the ECG evolution was assessed by semi-competing risks considering a new ECG abnormality as the primary event and death as the terminal event. A Cox regression model to evaluate the population survival was conducted at a landmark point of 5.5 years. The individuals of both groups were compared according to the following categories: Normal, Maintained, New, and More by the development of ECG major abnormalities between 1997 and 2002. Among the participants, the ChD group had 557 individuals (median age: 68 years) and NChD group had 905 individuals (median age: 67 years). ChD was associated with a higher risk of development of a new ECG abnormality [HR: 2.89 (95% CI 2.28–3.67)]. The development of a new major ECG abnormality increases the risk of death ChD patients compared to those that maintain a normal ECG [HR: 1.93 (95% CI 1.02–3.65)].ConclusionChD is still associated with a higher risk of progression to cardiomyopathy in the elderly. The occurrence of a new major ECG abnormality in ChD patients predicts a higher risk of death.