Epidemiology and aetiology of heart failure

Abstract

Heart failure (HF) is a rapidly growing public health issue with an estimated prevalence of >37.7 million individuals globally. HF is a shared chronic phase of cardiac functional impairment secondary to many aetiologies, and patients with HF experience numerous symptoms that affect their quality of life, including dyspnoea, fatigue, poor exercise tolerance, and fluid retention. Although the underlying causes of HF vary according to sex, age, ethnicity, comorbidities, and environment, the majority of cases remain preventable. HF is associated with increased morbidity and mortality, and confers a substantial burden to the health-care system. HF is a leading cause of hospitalization among adults and the elderly. In the USA, the total medical costs for patients with HF are expected to rise from US$20.9 billion in 2012 to $53.1 billion by 2030. Improvements in the medical management of risk factors and HF have stabilized the incidence of this disease in many countries. In this Review, we provide an overview of the latest epidemiological data on HF, and propose future directions for reducing the ever-increasing HF burden.

Figure 1. Incidence of heart failure in Olmsted County between 2000 and 2010

A decrease in the age-adjusted rate of HF for both men and women was observed between 2000 and 2010. This decrease is most notable for HRrEF. HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction. Modified from Gerber, Y. et al. A contemporary appraisal of the heart failure epidemic in Olmsted County, Minnesota, 2000 to 2010. JAMA Intern. Med. 175, 996–1004 (2015), with permission from the American Medical Association.

Figure 2. Global cost of HF per capita in 2012

The map shows the estimated per capita cost of HF based on reported national health-care expenditures and expected HF burden. HF, heart failure. Modified from Cook, C. et al. The annual global economic burden of heart failure. Int. J. Cardiol. 171, 368–376 (2014), with permission from Elsevier.