An update on global epidemiology in heart failure

Heart failure (HF) is a heterogenous and life-threatening syndrome that affects more than 60 million individuals globally and is characterised by severe morbidity and mortality, poor quality of life, and a high burden on the healthcare systems in terms of resource use and expenditures.1 \n \nThe 2019 Heart Failure Association (HFA) ATLAS provided estimates concerning important aspects of HF epidemiology in Europe and reported a HF prevalence ranging from ≤12 in Spain and Greece to over >30 per 1000 persons in Lithuania and Germany.2 The prevalence of HF in the United States was estimated at 2.4% in 2012.1 Prevalence estimates in Asia range between 1.3% and 6.7%.1 Notably, the prevalence of HF is further projected to increase worldwide due to the aging of populations, improved treatments for ischaemic heart disease, and the availibility of effective evidence-based therapies prolonging life in patients with established HF, most notably HF with reduced ejection fraction (HFrEF).1 Data on the prevalence of the different HF phenotypes stratified by EF [HFrEF, HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] are limited due to the lack of an ejection fraction (EF) assessment in numerous large-scale registries and administrative datasets. Epidemiological data across the EF spectrum are mostly derived from registries in Western countries, where HFrEF (EF <40%) seems to affect ∼50% of HF patients, whereas ∼20–25% each might have HFmrEF or HFpEF.1 More specifically, in the Get With The Guidelines-HF registry from the United States, estimates were 39% for HFrEF (EF <40%), 14% for HFmrEF (EF 40–50%), and 47% for HFpEF (EF >50%).3 In the Swedish HF registry, 56% had HFrEF, 21% HFmrEF, and 23% HFpEF.4 In Asia, the prevalence of HFpEF seems to be higher compared with Western countries (35–45%).1 Notably, the prevalence of HF has been observed to be increasing for HFpEF, but to be stable or even declining for HFrEF, likely due to enhanced treatment and prevention of ischaemic heart disease (Figure 1). There is lack of evidence on HF prevalence in Africa and South America. Current data suggest that HFpEF may become the most common HF phenotype in the near future.