Burden and etiology of heart failure in mainland China from 1990 to 2021: Results from the GBD 2021 study

Heart failure (HF) represents a major global public health challenge. This study aims to report the HF prevalence and disability in mainland China from 1990 to 2021, as well as the underlying etiology. Data on HF-related prevalence and years lived with disability (YLDs) were obtained from Global Burden of Disease 2021 study for mainland China. Analyses were conducted by age and sex, with the burden rates expressed per 100,000 population. Age-period-cohort models were used to describe the trajectory of HF during 1990-2021. We analyzed the potential etiologies of HF, and performed decomposition analysis to quantify the main drivers of changes in the burden. In 2021, the prevalence and YLDs rates of HF in mainland China were 920.7 per 100,000 population (95% uncertainty interval [UI]: 795.7–1080.8) and 90.7 per 100,000 population (95% UI: 60.9–124.8), respectively. Both the prevalence and YLDs rates were higher in males than in females. From 1990 to 2021, the crude prevalence rate and crude YLDs rate of HF consistently increased, while the age-standardized prevalence rate and age-standardized rate of YLDs exhibited an double-peak trend. By 2021, ischemic heart disease had surpassed hypertensive heart disease as the leading cause of HF prevalence. Population aging was the largest contributor to changes in HF burden. Our analysis of the GBD 2021 study indicated that the burden of HF is projected to increase substantially with an aging population. Strengthened societal efforts are urgently needed to prevent and manage HF from its causes, with particular attention to older adults. • Between 1990 and 2021, the crude prevalence and years lived with disability (YLDs) rates of HF in mainland China showed a consistent increase. • By 2021, ischemic heart disease had surpassed hypertensive heart disease as the leading cause of HF prevalence in mainland China. • Population aging emerged as the largest contributor to the increasing HF burden in mainland China, emphasizing the need for targeted prevention and management strategies, particularly for older adults.