The global burden of heart failure: a systematic analysis for the Global Burden of Disease Study 2021

Abstract Background Heart failure is a common reason for hospitalization and is associated with high health care costs and high symptom burden. Updated estimates of global and regional prevalence and underlying causes of HF may be helpful in guiding health policy and investment priorities. Purpose To provide comparable and consistent estimates of heart failure burden as part of the Global Burden of Disease (GBD) 2021. Methods We identified all available data on prevalence, incidence, and mortality for heart failure in the general population. Sources included published scientific literature, administrative records from national health systems, and vital registration data. We generated estimates of heart failure prevalence using DisMod-MR 2.1, a geospatial modelling software program. We then estimated the proportion of prevalent heart failure due to each of 27 underlying aetiologies to produce age-, sex-, location-, year-, and aetiology-specific estimates of heart failure burden. Results In 2021, there were 56.5 million (95% Uncertainty Interval (UI): 49.7 million to 63.7 million) prevalent cases of heart failure globally. There were 27.3 million (24.0 to 30.8) prevalent cases in females and 29.2 million (25.6 to 33.0) cases among males. Age-standardized prevalence increased from 647.9 (556.3 to 739.9) per 100,000 in 1990 to 682.7 (602.8 to 766.8) per 100,000 in 2021. The North Africa and Middle East super region had the highest age-standardized prevalence in 2021 (780.5 per 100,000 (658.7 to 907.6)) and South Asia had the lowest age-standardized prevalence (600.1 per 100,000 (526.5 to 671.4)). In 2021, Ischaemic heart disease, hypertensive heart disease, and other cardiomyopathy were responsible for the majority of prevalent heart failure cases worldwide, at 33.8% (28.4% to 38.3%), 22.6% (19.0% to 27.1%), and 8.2% (7.0% to 9.6%), respectively. Country specific estimates for both sexes combined in 2021 are shown in the map. Conclusion Heart failure is a highly prevalent condition, particularly in older age groups. As populations age and risk profiles change around the world, knowledge of the global epidemiology of heart failure will be critical in preventing or treating its underlying aetiologies in order to decrease its overall burden.Heart failure prevalence, 2021