Global Burden of Stroke-related Heart Failure in GBD 2021 from 1990 to 2021

Background Stroke-related Heart Failure (HF) is a modeled cause–impairment outcome in the Global Burden of Disease (GBD) study. Its population distribution should be distinguished from all HF occurring among people with a history of stroke. We examined temporal patterns, demographic contributions, and socioeconomic disparities in this GBD-defined outcome. Methods We analyzed GBD 2021 prevalence and years lived with disability (YLDs) estimates for 1990–2021 across global, regional, and national settings. Full-period estimated annual percentage change (EAPC) and segmented regression described trends. Age- and sex-specific rates supplemented absolute counts. Spearman correlations, explicitly defined inequality indices, and demographic decomposition characterized differences in burden. Bayesian age-period-cohort projections were evaluated using two held-out time windows and a last-observed-rate benchmark. Results Global prevalent cases increased from 900,446 in 1990 to 1,983,544 in 2021, while age-standardized prevalence and YLD rates declined modestly over the full period. The middle-SDI group had high aggregate burden, but this does not imply uniform country-level patterns. Male age-specific rates remained higher at ages 80–89 despite a crossover in absolute counts at age 80. Ischemic stroke and intracerebral hemorrhage accounted for 47.46% and 46.64% of prevalent cases in the subtype estimates. Population aging and growth contributed 55.95% and 49.81% of the net increase in cases. Inequality estimates depended on weighting and the selected estimator; a robust widening was not established. Forecasts performed worse than the simple benchmark in both validation windows. Conclusion Increasing absolute burden despite modest declines in standardized rates supports planning for the needs of ageing populations. Country-specific estimates and local assessments of access to care should guide priorities. Count-based sex differences, ecological associations, inequality trends, and exploratory forecasts require cautious interpretation.