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

Background and aims Heart failure (HF) presents a significant global health challenge due to its rising prevalence and impact on disability. This study aims to comprehensively analyse the global burden of HF and its underlying causes.Methods and results Using data from the Global Burden of Disease Study 2021, we analysed the prevalence and years lived with disability (YLD) of HF, examining its implications across diverse demographics and geographic regions. In 2021, approximately 55.5 million [95% uncertainty interval (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% confidence interval (CI) 2.7-8.5] and 5.9% (95% CI 2.9-9.0) during this period. Ischaemic 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.Conclusion HF emerges as a significant and growing public health challenge globally, influenced by distinct socioeconomic gradients.