Global trends in heart failure from 1990 to 2019: An age-period-cohort analysis from the Global Burden of Disease study

Abstract

Aims: This study aimed to analyse the global prevalence and disability trends of heart failure (HF) from 1990 to 2019, considering both sexes and country-specific economic strata.

Methods: This study conducted a secondary analysis employing data from the Global Burden of Disease (GBD) study. The analysis is stratified by sex and Socio-demographic Index (SDI) levels. Through age-period-cohort and Joinpoint regression analyses, we investigated the temporal trends in HF prevalence and years lived with disability (YLDs) during this period.

Results: Between 1990 and 2019, the global prevalence of HF surged by 106.3% (95% uncertainty interval: 99.3% to 114.3%), reaching 56.2 million cases in 2019. While all-age prevalence and YLDs increased over the 30 year span, age-standardized rates decreased by 2019. Countries with higher SDI experienced a more pronounced percentage decrease compared with those with lower SDI. Longitudinal analysis revealed an overall improvement in both prevalence and YLDs for HF, albeit with notable disparities between SDI quintiles and sexes. Ischaemic heart disease and hypertensive heart disease emerged as the most rapidly increasing and primarily contributing causes of HF, albeit with variations observed across different countries. The average annual percentage change for prevalence and YLDs over the period was -0.26% and -0.25%, respectively.

Conclusions: This study offers valuable insights into the global burden of HF, considering factors such as population aging, regional disparities, sex differences and aetiological variations. The findings hold significant implications for healthcare planning and resource allocation. Continued assessment of these trends and innovative strategies for HF prevention and management are crucial for addressing this pressing global health concern.

Keywords: Global Burden of Disease study; age‐period‐cohort analysis; heart failure; prevalence; years lived with disability.

Figure 1

Causes and outcomes of global heart failure (HF): (A) temporal trends of contributing causes to the prevalence (n × 1 000 000) of HF in both sexes across 204 countries and territories from 1990 to 2019. The solid lines and shaded areas represent the case numbers and their corresponding 95% uncertainty intervals. During this period, the prevalence of ischaemic heart disease increased by 98.7% and hypertensive heart disease by 137.9%. (B) Composition of contributing causes in 1990 and 2019. In 1990, ischaemic heart disease and hypertensive heart disease accounted for 29.0% and 43.6%, respectively, of all contributing causes of HF. By 2019, these proportions had changed to 33.5% and 41.1%, respectively. (C) Alluvial diagram representing the transformation patterns between contributing causes and outcomes of HF in 2019. Ischaemic heart disease and hypertensive heart disease constituted 37.6% and 29.2% of all contributing causes, respectively, while severe HF accounted for 37.7% and 33.2%, respectively.

Figure 2

Relationship between Socio‐demographic Index levels and sex‐specific age‐standardized rate (ASR) of prevalence and percentage change of ASR of prevalence for heart failure in 204 countries and territories during 1990–2019. Each coloured dot represents a country, with a solid black line depicting the non‐linear fitting trend. (A) ASR of prevalence and (B) percentage change of ASR of prevalence. ASPR, age‐standardized prevalence rate.

Figure 3

Age‐period‐cohort effects of prevalence rate for heart failure during 1990–2019: (A) local drifts; (B) age effects; (C) period effects; and (D) cohort effects.

Figure 4

Joinpoint regression analysis of the age‐standardized rates (ASRs) of prevalence and years lived with disability (YLDs) for heart failure by Socio‐demographic Index (SDI) quintiles in 204 countries and territories during 1990–2019: (A) ASR of prevalence and (B) ASRs of YLDs. AAPC, average annual percentage change; APC, annual percentage change. * indicates statistical significance.

Figure 5

Age‐period‐cohort effects of age‐standardized rates (ASRs) of prevalence for heart failure (HF) from 1990 to 2019 on exemplar countries. Each of the six horizontal graphs represents (1) temporal change in the relative proportion of ASRs of prevalence for HF from 1990 to 2019; (2) temporal change of the prevalence rate for HF from 1990 to 2019; (3) local drifts; (4) age effects; (5) period effects; and (6) cohort effects.