Global burden of heart failure and its underlying causes in 204 countries and territories, 1990–2021

Abstract Background Heart failure (HF) presents a significant global health challenge due to its rising prevalence and impact on disability. Aims This study aims to comprehensively analyze the global burden of HF and its underlying causes. Methods Using data from the Global Burden of Disease Study 2021, we analyzed the prevalence and Years Lived with Disability (YLD) of HF, examining its implications across diverse demographics and geographic regions. Results In 2021, approximately 55.5 million (95% UI 49.0–63.8) people worldwide were affected by HF, a significant increase from 25.4 million (95% UI 22.3–29.2) in 1990. The age-standardized prevalence rate per 100 000 people was 676.7 (95% UI 598.7–776.8) overall, with males experiencing a higher rate at 760.8 (95% UI 673.2–874.7) compared to females at 604.0 (95% UI 535.0–692.3). The age-standardized prevalence YLD rates increased by 5.5% (95% CI 2.7–8.5) and 5.9% (95% CI 2.9–9.0) during this period. Ischemic heart disease emerged as the primary cause of HF, with an age-standardized prevalence rate of 228.3 (95% UI 118.2–279.6), followed by hypertensive heart disease at 148.3 (95% UI 117.3–186.3), and cardiomyopathy/myocarditis at 62.0 (95% UI 51.2–73.2). Noteworthy, countries in the high Socio-Demographic Index (SDI) quintile exhibited higher HF prevalence rates but maintained stable trends. In contrast, countries in lower SDI quintiles, while initially experiencing lower prevalence rates, showed increased age-standardized HF prevalence and YLD rates over the same period. Conclusions HF emerges as a significant and growing public health challenge globally, influenced by distinct socioeconomic gradients.