Bring a large pot of salted water to a boil (I used 1 tablespoon of salt for 8 cups of water). Cook the macaroni according to the package instructions. Drain and set aside.
In a large pot, melt the butter over medium-high heat. Add the ground beef and onions. Cook for 8 minutes until the beef is no longer pink.
Add the garlic and cook for 1 minute. Add the flour and stir until evenly incorporated.
Stir in the tomato sauce, beef broth, tomato paste, ketchup, Worcestershire sauce, salt, and black pepper. Bring to a gentle simmer and cook for 10 minutes.
Stir in the heavy cream, followed by the cheddar cheese. Finally, stir in the drained macaroni and mix until well combined. If you find the sauce is too thick, add a little bit of water to thin it out. Enjoy!