The spectrum of heart failure: prevalence and years lived with disability of heart failure across 2 severity levels and implications for health systems: a population-based comparative study

BACKGROUND: Heart failure (HF) is a global health challenge with rising burden. OBJECTIVE: Understanding the spectrum of HF across severity levels is essential to inform service delivery and health system responses. METHODS: Using Global Burden of Disease (GBD) Study 2021 data, we analyzed age-standardized rates of prevalence and years lived with disability (YLDs) for HF, stratified into four levels based on symptom severity: treated, mild, moderate, and severe. Estimates were stratified by sex, region, and underlying causes. Spearman's rank correlation tests were used to assess the relationships between burden and sociodemographic index (SDI) and universal health coverage (UHC). Temporal trends and contributions were evaluated using estimated annual percentage changes and decomposition analyses. RESULTS: The overall prevalence of HF was 55.5 million (M) and using GBD symptom severity categories there were 20.5 M treated HF globally in 2021, resulting in 1.3 M YLDs. Mild HF was 10.3 M (0.4 M YLDs), moderate HF was 6.7 M (0.5 M YLDs), and severe HF was 18.0 M (3.1 M YLDs). Ischemic heart disease remained the leading underlying cause of HF. Males experienced 25% higher burden than females. Geographic variation was observed, with higher YLDs due to treated HF correlating with lower SDI and UHC levels, while no significant association for mild, moderate, or severe HF. During 1990-2021, prevalence and YLDs increased across all groups with an increase of 0.2%, predominantly driven by population growth and aging. CONCLUSIONS: The burden of HF is projected to rise significantly. Advancing strategies to strengthen health systems particularly in low- and middle-income countries is an important focus.