Trends and future projections of the disease burden of pulmonary arterial Hypertension–related heart failure in China and G20 countries: Based on the global burden of disease 2023 database

Objectives: While the Global Burden of Disease (GBD) study has extensively assessed various cardiovascular conditions, the epidemiological profile of pulmonary arterial hypertension-related heart failure (PAH-HF) across the G20 remains uncharacterized. Study design: This study assessed the burden trends and distribution of the disease in China and G20 countries, analyzed the key drivers, projected future burden changes. Methods: Using the GBD 2023 database, we assessed the burden of PAH-HF in China and G20 countries (1990-2023) by integrating trend, age-period-cohort (APC), decomposition, and ARIMA forecasting analyses. Results: In 2023, the age-standardized prevalence rate (ASPR) was 2.35 per 100,000 in the G20, with a higher burden in females. China's increase (EAPC = 0.31%, 95% CI 0.24-0.39) was 5.17 times greater than the G20 average (0.06%, 0.04-0.09). Decomposition attributed 59.7% of China's rise to population aging versus 52.2% to population growth in the G20. Projections indicate stable age-standardized rates (ASR) in China and a declining disability burden in the G20 by 2050. Conclusion: The burden of PAH-HF is characterized by stable rates but rising absolute numbers, predominantly driven by demographic shifts and exhibiting significant heterogeneity. Targeted risk interventions, precision diagnostics, and strengthened multinational collaboration are needed to mitigate the future disease burden.