Heart failure is a chronic and progressive condition where the heart struggles to pump enough blood to meet the body’s demands. This reduced pumping efficiency can lead to various symptoms as organs do not receive adequate oxygen and nutrients. Understanding its global prevalence provides insight into its public health impact.
Global and Regional Scope
Heart failure affects a substantial portion of the global population. In 2021, an estimated 56.5 million cases were reported worldwide, with 27.3 million in females and 29.2 million in males, indicating a slightly higher prevalence in men.
The prevalence varies significantly across regions and economic strata. The North Africa and Middle East super-region reported the highest age-standardized prevalence in 2021, at 780.5 per 100,000 people. South Asia had the lowest, with 600.1 per 100,000 individuals.
The burden of heart failure is also notable in low- and middle-income countries (LMICs). For instance, a study in Haiti, a low-income country, found an age-standardized prevalence of clinical heart failure to be 3.2%. This rate was five times higher than previous LMIC estimates and 50% higher than some high-income settings.
Evolving Landscape of Heart Failure
The prevalence of heart failure has changed over time, reflecting shifts in demographics and medical advancements. Between 1990 and 2019, global cases surged by 106.3%, reaching 56.2 million in 2019. This increase is partly attributed to an aging global population, as heart failure is more common in older age groups.
Improved survival from other cardiovascular conditions, such as heart attacks, also contributes, as survivors may develop heart failure due to heart muscle damage. Enhanced diagnostic capabilities also allow for earlier detection.
Despite the rise in total cases, age-standardized prevalence rates slightly decreased globally from 1990 to 2019. This trend is not uniform, as age-standardized prevalence increased in less-developed countries during the same period. Rising rates of underlying risk factors like obesity and diabetes further influence these trends.
Key Populations and Contributing Factors
Certain demographic groups experience a higher prevalence of heart failure. Age is a primary factor, with prevalence progressively rising across each decade of life. Adults over 65 years old in the U.S. have a fourfold greater heart failure prevalence (8.0%-9.1%) compared to those under 65 years. Racial and ethnic variations are also evident, with non-Hispanic Black adults showing the highest prevalence in the U.S. between 2013 and 2016, followed by non-Hispanic White adults and Mexican American adults.
Major Contributing Factors
Major contributing factors to heart failure include:
Hypertension: High blood pressure forces the heart to work harder, weakening the heart muscle over time.
Coronary Artery Disease: Characterized by fatty deposits narrowing the heart’s arteries, this is the most common cause of heart failure.
Diabetes: Increases the risk of both high blood pressure and coronary artery disease.
Obesity: Increases the risk of heart disease, diabetes, and high blood pressure.
Lifestyle Choices: Smoking, excessive alcohol consumption, unhealthy diet, and lack of physical activity further contribute to its development.
Societal and Healthcare Implications
The widespread prevalence of heart failure places a substantial burden on individuals, healthcare systems, and society. Patients often experience a decreased quality of life, including physical limitations, cognitive decline, and emotional distress. This impact on quality of life is comparable to or worse than many other chronic diseases.
From an economic perspective, heart failure incurs considerable healthcare costs. These include frequent hospitalizations (a leading cause among Medicare patients in the U.S.), ongoing medication, long-term care, and indirect costs like lost productivity. In high-income countries, 1–2% of total healthcare expenditure is spent on heart failure, with costs ranging from $17,000 to $30,000 USD per patient in the U.S.
Heart failure also has high mortality rates. While overall survival has improved, approximately 50% of individuals diagnosed die within five years. Mortality rates vary regionally, with one-year mortality highest in African countries (34%) and India (23%), compared to lower rates in South America (9%) and China (7%). These implications underscore the need for continued focus on prevention and management strategies.