What is the epidemiology of heart failure (HF)?

From the Guidelines

Heart failure affects approximately 64 million people worldwide, with increasing prevalence due to aging populations and improved survival from cardiovascular diseases. The condition is more common in older adults, with prevalence rising from 1-2% in the general population to over 10% in those above 70 years 1. Men typically develop heart failure at younger ages than women, though women represent about half of all cases due to their longer life expectancy. Risk factors include hypertension, coronary artery disease, diabetes, obesity, and smoking. Hypertension contributes to approximately 75% of heart failure cases, while coronary artery disease accounts for about 60-70% of cases in developed countries. Geographic variations exist, with higher rates in North America and Europe compared to developing regions. Socioeconomic factors also play a role, as lower income is associated with higher heart failure incidence due to limited healthcare access and higher prevalence of risk factors. Despite advances in treatment, heart failure carries a poor prognosis with 5-year survival rates of approximately 50%, comparable to some cancers. The economic burden is substantial, accounting for 1-2% of healthcare expenditures in developed countries, primarily due to hospitalizations.

Some key points to consider in the epidemiology of heart failure include:

• The global burden of heart failure is significant, with 64.3 million people estimated to suffer from HF worldwide in 2017 1.
• The prevalence of HF is expected to raise due to the improved survival following a HF diagnosis associated with the availability of life-saving evidence-based treatments and the overall longer life-expectancy of the general population.
• Heart failure is primarily a condition of the elderly, thus the widely recognized “aging of the population” also contributes to the increasing incidence of HF.
• The incidence of HF approaches 10 per 1000 population after age 65, and approximately 80% of patients hospitalized with HF are more than 65 years old 1.
• The total estimated direct and indirect costs for HF in 2005 were approximately $27.9 billion, with projections suggesting an increase in costs by 127% to $69.8 billion in 2030 1.

The most recent and highest quality study, published in 2023, provides the most comprehensive and updated review of the epidemiology of heart failure 1. This study highlights the importance of considering the global burden of heart failure, providing updated estimates on prevalence, incidence, outcomes, and costs worldwide. The study also acknowledges the availability of limited data in specific geographical areas, such as Africa, South America, and to some extent Asia.

In terms of classification, heart failure can be categorized into four stages: Stage A (patients with risk factors that clearly predispose toward the development of HF), Stage B (patients who are asymptomatic but demonstrate LV hypertrophy and/or impaired LV function), Stage C (patients with current or past symptoms of HF associated with underlying structural heart disease), and Stage D (patients with truly refractory HF who might be eligible for specialized, advanced treatment strategies) 1. This classification system is intended to complement but in no way to replace the New York Heart Association (NYHA) functional classification, which primarily gauges the severity of symptoms in patients who are in Stage C or Stage D.

From the Research

Epidemiology of Heart Failure

The epidemiology of heart failure (HF) is a complex and rapidly evolving field, with various studies providing insights into its prevalence, incidence, mortality, and morbidity.

• The estimated global prevalence of HF is approximately 64 million people, with a significant burden on the healthcare system 2.
• The incidence of HF has stabilized or declined in developed countries, but the prevalence continues to increase due to an aging population, improved survival after myocardial infarction, and improved treatment and survival of patients with HF 3, 2, 4.
• HF is associated with high mortality and morbidity, poor quality of life, and functional capacity, with significant geographical variations in prevalence, incidence, mortality, and morbidity rates 2, 5, 4.

Global Burden of Heart Failure

The global burden of HF is substantial, with significant economic and social implications.

• The total medical costs for patients with HF are expected to rise from $20.9 billion in 2012 to $53.1 billion by 2030 in the USA 3.
• HF is a leading cause of hospitalization among adults and the elderly, with a significant impact on healthcare systems worldwide 3, 6.
• The epidemiology of HF varies across different regions, with disparities in access to healthcare, treatment, and outcomes 5, 4.

Trends and Variations in Heart Failure

There are various trends and variations in HF, including:

• An increasing proportion of cases with preserved ejection fraction, for which established effective treatments are mostly lacking 5, 4.
• Major disparities in the occurrence, presentation, and outcome of HF, particularly among younger Black men and women 5.
• Emerging risk factors, including omics science, which offer the promise of discovering new mechanistic pathways that lead to HF 5.
• A shift towards HF with preserved ejection fraction, particularly among younger adults 4.