In a review article published in the journal Nature Reviews Cardiologythe authors provide a detailed overview of the global burden of heart failure, including the incidence and prevalence of heart failure, disease etiology, risk factors, and disease outcomes across geographic regions and populations.
Article Review: Global epidemiology of heart failure. Image credit: Vector_Leart / Shutterstock
Record
Heart failure is a multifactorial clinical syndrome caused by structural and functional cardiac abnormalities. Key symptoms include shortness of breath, ankle swelling, fatigue, and clinical symptoms such as increased jugular venous pressure, crackles, and peripheral edema.
Heart failure can be of three types depending on the left ventricular ejection fraction, namely, heart failure with preserved ejection fraction, heart failure with mildly reduced ejection fraction, and heart failure with reduced ejection fraction.
Non-modifiable risk factors for heart failure include age, sex, and genetic variants. Medically modifiable risk factors include hypertension, diabetes, obesity, hyperlipidemia, atrial fibrillation, sleep apnea, poor renal function, pregnancy-related hypertension, chronic kidney disease, and chronic obstructive pulmonary disease.
Lifestyle risk factors for heart failure include smoking and alcohol consumption habits, unhealthy diet, lack of physical activity, stress and socioeconomic deprivation.
Prevalence of heart failure in North America and Europe
The prevalence of heart failure is gradually increasing worldwide, which can be attributed to an aging population, an increase in risk factors, better treatment outcomes and improved survival. A 29% increase in the global prevalence of heart failure occurred between 2010 and 2019.
The estimated global prevalence of heart failure was 56.2 million people in 2019, with the highest prevalence observed in East Asia, North America and Western Europe.
In the US, the prevalence of heart failure was estimated at 2.5% among adults, while in Canada it was 3.5% in 2022. In Europe, the estimated prevalence was 1.7% in 13 countries in 2019. The highest prevalence was observed in Germany and Lithuania, and the lowest was observed in Greece, the Netherlands, Spain and the United Kingdom. However, in Spain, HF prevalence estimates ranged from 2.6% to 6.8%, depending on the population studied and the care setting.
In the US, heart failure with preserved ejection fraction has been seen in approximately 50% of all heart failure patients over the past decade. In contrast, a comparatively lower prevalence of heart failure with preserved ejection fraction has been observed in European countries, where heart failure with reduced ejection fraction remains the predominant subtype.
In the US, the last decade has seen a decrease and an induction in the prevalence of heart failure among older and younger adults, respectively. Regarding sex-related variations, a higher global prevalence of heart failure has been observed in women (35 million) than in men (29 million).
Regarding variations related to race and ethnicity, the highest prevalence of heart failure between 2013 and 2016 was observed among non-Hispanic black adults, followed by non-Hispanic white adults and Mexican American adults.
Prevalence of heart failure in Asia and Australia
The estimated prevalence of heart failure in Asia and Oceania is 722 per 100,000 population, with East Asia having the highest prevalence and South Asia the lowest prevalence in 2019. In particular, Japan, South Korea and Thailand have the lowest prevalence in Asia (< 1%).
Considering left ventricular ejection fraction, heart failure with reduced ejection fraction has been observed in 81% of all HF patients in Asia.
Prevalence of heart failure in Africa and South America
The estimated prevalence of heart failure in South America was 1% between 1994 and 2014. Although no population-level estimates are currently available for African countries, data obtained from five African countries indicate that 53.7% of patients have heart failure with a reduced ejection fraction. 30.1% have heart failure with mildly reduced ejection fraction and 16.2% have heart failure with preserved ejection fraction.
Global incidence of heart failure
Over the past decade, the global incidence of heart failure has declined. However, this decline varies significantly by region and demographic. In the US, heart failure patients aged 65 and older saw a decline from 36 cases per 1,000 people in 2011 to 26 cases per 1,000 people in 2016. A similar decline was seen in Cabada.
In Europe, the incidence of heart failure ranges from 1.99 in Italy to 6.55 in Germany per 1000 person-years. In the UK, there was a 7% reduction in the incidence of heart failure between 2002 and 2014.
A higher incidence of heart failure has been observed in women compared to men in the US and Europe. However, the incidence of heart failure with preserved ejection fraction is significantly higher in women than in men in Europe.
In the US, the highest incidence has been observed in non-Hispanic black adults, followed by Hispanic adults, White adults, and Chinese American adults. In the UK, a 61% higher risk of heart failure has been observed among people with the lowest socio-economic status.
In Australia, the annual incidence of heart failure was 0.348% between 2013 and 2018. In China, the age-standardized incidence was 275 per 100,000 person-years in 2017.
In South America, an incidence of 1.99 cases per 1000 person-years and 5.57 cases per 1000 person-years has been reported in Brazil and Argentina, respectively.
Mortality rate
A variation in HF-related mortality has been observed between geographic regions and populations, which could be due to differences in access to health care, financial resources, population health profiles, and clinical management practices.
A systematic review including 1.5 million patients with heart failure showed that the 1-year, 2-year, 5-year, and 10-year survival rates are 87%, 73%, 57%, and 35%, respectively. A systematic review including 1.5 million patients with heart failure showed that the 1-year, 2-year, 5-year, and 10-year survival rates are 87%, 73%, 57%, and 35%, respectively.
Relatively higher mortality has been observed in black adults compared to that in other races and ethnicities. In the US, age-adjusted mortality in young adults increased from 2.36 in 1999 to 3.16 in 2019, which is a more significant increase than that of older adults.
