Global, regional, and national burden of heart failure and its underlying causes, 1990-2021: results from the global burden of disease study 2021

Abstract

Background: Heart failure (HF) remains a significant public health challenge globally. This study aims to systematically analyze the global HF disease burden from 1990 to 2021 across temporal, spatial, and demographic dimensions to provide evidence for targeted prevention and control strategies.

Methods: Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the global HF burden through prevalent cases, years lived with disability (YLDs), and age-standardized rates per 100,000 population. Temporal trends were evaluated using estimated annual percentage change (EAPC) and joinpoint regression analysis. The relationship between the Socio-demographic Index (SDI) and disease burden was explored through Pearson correlation analysis, while attribution analysis identified the main causes of HF. When appropriate, analyses were stratified by 5 SDI regions, 21 GBD regions, 204 countries and territories, 20 age groups, and both sexes.

Results: Global HF prevalence and YLDs burden showed substantial increases from 1990 to 2021, with age-standardized prevalence increasing from 641.14 to 676.68 per 100,000 population. Notably, high-SDI regions exhibited a declining burden since 2019, indicating a potential global turning point. High-income North America bears the heaviest burden while South Asia shows the fastest growth rate. The correlation between disease burden and SDI level was negligible. The disease burden in males consistently exceeded that in females, with prevalence and YLDs rates rising sharply after age 60. The main causes and their attributable proportions were: ischemic heart disease (34.53%), hypertensive heart disease (22.53%), other cardiomyopathies (7.61%), chronic obstructive pulmonary disease (6.51%), and congenital heart anomalies (5.69%), with their distribution patterns differing across age groups and regions.

Conclusion: Global burden of HF increased significantly over recent decades, with a potential turning point in 2019 and marked regional disparities. It is essential to prioritize regions with heavy burdens or rapid growth rates, strengthen the management of major causes, and monitor HF burden trends in the post-COVID era.

Keywords: Epidemiology; Global burden of disease; Heart failure; Prevalence; Socio-demographic Index; Years lived with disability.

Fig. 1

The prevalence burden of HF and its temporal trends by regions, 1990–2021 Note: ¹Color intensity represents value magnitude. Red indicates positive values, darker for larger. Blue indicates negative values, darker for more negative. Abbreviations: HF = heart failure; ASPR = age-standardized prevalence (per 100,000 population); HF = heart failure; UI = uncertainty interval; EAPC = estimated annual percentage change; CI = confidence interval; SDI = socio-demographic index

Fig. 2

Temporal trends of HF burdens across different SDI regions from 1990 to 2021 (A) Prevalent cases of HF across different SDI regions from 1990 to 2021, for all ages and both sexes. (B) YLDs of HF across different SDI regions from 1990 to 2021, for all ages and both sexes. (C) ASPR of HF across different SDI regions from 1990 to 2021, for both sexes. (D) ASYR of HF across different SDI regions from 1990 to 2021, for both sexes. Note: Vertical axes use scientific notation (e.g., 5e + 06 = 5,000,000) for large numbers. Abbreviations: HF = heart failure; SDI = socio-demographic index; YLDs = years lived with disability; ASYR = age-standardized YLDs rate (per 100,000 population); ASPR = age-standardized prevalence (per 100,000 population)

Fig. 3

Geographic distributions of HF burdens and their EAPCs across 204 countries and territories (A) ASPR of HF in 2021, for both sexes. Bottom-left small maps display the highest (France) and lowest (Iceland) rates. (B) ASYR of HF in 2021, for both sexes. Bottom-left small maps display the highest (France) and lowest (Iceland) rates. (C) EAPC of ASPR between 1990 and 2021, for both sexes. Bottom-left small maps display the most positive (Germany) and negative (Austria) changes. (D) EAPC of ASYR between 1990 and 2021, for both sexes. Bottom-left small maps display the most positive (Germany) and negative (Austria) changes. Note: Darker shades of red in panels A-B indicate higher burden. In panels C-D, blue shades represent decreases in disease burden, while red shades represent increases over time. Gray areas indicate regions with insufficient data. Abbreviations: ASPR = age-standardized prevalence (per 100,000 population); HF = heart failure; YLDs = years lived with disability; ASYR = age-standardized YLDs rate (per 100,000 population); EAPC = estimated annual percentage change

Fig. 4

Global trends of HF burdens across age groups by sex, 2021 (A) Prevalent cases and prevalence of HF across age groups by sex. (B) YLDs and YLDs rate of HF across different age groups by sex. Note: Bars represent absolute numbers (left y-axis), while lines represent rates (right y-axis). Vertical black lines indicate 95% uncertainty intervals. Abbreviations: HF = heart failure; YLDs = years lived with disability

Fig. 5

The YLDs burden of HF and its temporal trends by regions, 1990–2021 Note: ¹Color intensity represents value magnitude. Red indicates positive values, darker for larger. Blue indicates negative values, darker for more negative. Abbreviations: HF = heart failure; YLDs = years lived with disability; ASYR = age-standardized YLDs rate (per 100,000 population); UI = uncertainty interval; EAPC = estimated annual percentage change; CI = confidence interval; SDI = socio-demographic index

Fig. 6

Proportion of HF prevalent cases and YLDs attributable to major underlying causes globally, 2021. Abbreviations: HF = heart failure; YLDs = years lived with disability

Fig. 7

Proportion of HF prevalent cases attributable to major underlying causes by age groups globally, 2021. Abbreviations: HF = heart failure

Fig. 8

Proportion of HF prevalent cases and YLDs attributable to major causes globally and regionally, 2021. Abbreviations: HF = heart failure; SDI = socio-demographic index; YLDs = years lived with disability