This section of the scientific article provides a comprehensive overview of the global burden of heart failure, including its prevalence, incidence, and mortality across different geographic regions and populations.This section of the scientific article provides a comprehensive overview of the global burden of heart failure, including its prevalence, incidence, and mortality across different geographic regions and populations. Prevalence: – Heart failure is a common condition, affecting approximately 56.2 million people worldwide in 2019. – North America, Eastern Europe, and Western Europe have the highest prevalence. – Heart failure with preserved ejection fraction is more prevalent in the United States, while heart failure with reduced ejection fraction is more prevalent in Europe. – Women and older adults have a higher prevalence of heart failure. Incidence: – The global incidence of heart failure has declined over the past decade. – The decline is more pronounced in older adults and in certain regions, such as the United States. – However, the incidence remains high in some populations, such as those with lower socioeconomic status. – Women and non-Hispanic black adults have a higher incidence of heart failure. Mortality: – Heart failure is a serious condition with high mortality rates. – The 1-year, 2-year, 5-year, and 10-year survival rates from heart failure are 87%, 73%, 57%, and 35%, respectively. – Mortality is higher in black adults and young adults. These findings emphasize the importance of understanding the geographic and demographic variations in heart failure epidemiology for improving disease prevention, management, and outcomes.
In a review article published in the journal Nature Reviews CardiologyIn this article, the 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 in different geographic regions and populations.
Review article: Global epidemiology of heart failure. Image credits: Vector_Leart / Shutterstock
Background
Heart failure is a multifactorial clinical syndrome caused by structural and functional abnormalities of the heart. The main symptoms are shortness of breath, ankle swelling, fatigue, and clinical signs such as increased carotid venous pressure, pulmonary crackles, and peripheral edema.
There are three types of heart failure, depending on the ejection fraction of the left ventricle, 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-related risk factors for heart failure include smoking and alcohol consumption, unhealthy diet, lack of exercise, stress and socioeconomic disadvantage.
Prevalence of heart failure in North America and Europe
The prevalence of heart failure is gradually increasing worldwide, which can be attributed to the aging of the population, an increase in risk factors, better treatment outcomes and improved survival. Between 2010 and 2019, there was a 29% increase in the global prevalence of heart failure.
It is estimated that 56.2 million people worldwide experienced heart failure in 2019. The highest prevalence was 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, estimates of the prevalence of heart failure range from 2.6% to 6.8% depending on the population studied and the healthcare setting.
In the US, heart failure with preserved ejection fraction has been observed in approximately 50% of all heart failure patients over the past decade. In contrast, a relatively 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, a decrease and an induction in the prevalence of heart failure have been observed in the past decade among older adults and young adults, respectively. With regard to gender-related variations, a higher global prevalence of heart failure has been observed among women (35 million) than among men (29 million).
In terms of race- and ethnicity-related variations, 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 inhabitants, with East Asia having the highest prevalence and South Asia having the lowest prevalence in 2019. Notably, 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 heart failure 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 show that 53.7% of patients have heart failure with reduced ejection fraction, 30.1% have heart failure with a slightly reduced ejection fraction and 16.2% have heart failure with a 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 demographics. In the United States, heart failure patients aged 65 years and older experienced a decline from 36 cases per 1,000 persons in 2011 to 26 cases per 1,000 persons in 2016. A similar decline has been noted 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 United Kingdom, a 7% reduction in the incidence of heart failure was observed between 2002 and 2014.
A higher incidence of heart failure has been noted 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 Britain, a 61% higher risk of incident heart failure has been observed in those with the lowest socio-economic status.
In Australia, the annual incidence of heart failure between 2013 and 2018 was 0.348%. In China, the age-standardized incidence rate in 2017 was 275 per 100,000 person-years.
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.
Death rate
Variation in heart failure-related mortality has been observed across geographic regions and populations, which could be due to differences in access to healthcare, economic resources, population health profiles, and clinical management practices.
A systematic review involving 1.5 million patients with heart failure found that the 1-year, 2-year, 5-year, and 10-year survival rates from heart failure were 87%, 73%, 57%, and 35%, respectively amounts. A systematic review involving 1.5 million patients with heart failure found that the 1-year, 2-year, 5-year, and 10-year survival rates from heart failure were 87%, 73%, 57%, and 35%, respectively amounts.
Relatively higher mortality has been observed in black adults compared to that in other races and ethnicities. In the US, age-adjusted mortality among young adults increased from 2.36 in 1999 to 3.16 in 2019, a more significant increase than that among older adults.
