Global, Regional, and National Burden of Heart Failure, 1990-2023: A Systematic Analysis for the Global Burden of Disease Study 2023.

Importance: Heart failure (HF) is a common condition with substantial geographical variation in its prevalence and underlying etiologies. Consistent and comparable data on the burden of HF within populations are needed to inform health system priorities. Objective: To estimate the global burden of HF. Design, Setting, and Participants: This cross-sectional study estimates disease burden using Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodologies to integrate multiple information sources. Data come from 204 countries and territories from 1990 to 2023 representing the global population with prevalent HF. Exposure: HF and underlying etiologies. Main Outcomes and Measures: Estimates with 95% uncertainty intervals (UIs) for the prevalence and years lived with disability (YLDs) for HF by age, sex, location, year, and underlying etiology. Results: Globally, there were 56.0 million (95% UI, 49.9-62.2 million) estimated cases of HF in 2023. The estimated prevalence of HF generally increased with age for all locations. While ischemic heart disease and hypertensive heart disease were the 2 most common etiologies globally among older adults, there was substantial variation in etiological pattern by location and age. Congenital heart anomalies and rheumatic heart disease (RHD) were common etiologies in children and young adults, while the proportion of HF due to alcohol use peaked in middle adulthood. Location-specific estimates highlighted regions with higher burden of HF due to specific etiologies, including RHD (south Asia, east Asia, Oceania, southeast Asia, central sub-Saharan Africa, eastern sub-Saharan Africa, southern sub-Saharan Africa, and western sub-Saharan Africa), alcohol use (eastern Europe, Australasia, the Caribbean, and central Europe), and Chagas disease (southern, Andean, tropical, and central Latin America). Conclusions and Relevance: Heart failure is a significant global public health burden, and the impact is likely to increase as populations age. However, most HF etiologies can be prevented by interventions that reduce exposure to modifiable risk factors, such as elevated blood pressure, excessive alcohol consumption, and tobacco use. Etiology- and location-specific estimates can provide necessary information for public health officials to determine how best to prioritize interventions to reduce HF disease burden.