The global epidemiology of heart failure: a comprehensive and contemporary review

Heart failure (HF) is a complex and progressive syndrome associated with high morbidity, mortality, impaired quality of life, and substantial healthcare costs. Globally, more than 55 million people live with HF, and prevalence is steadily rising, largely driven by population ageing, improved survival after cardiovascular events, and the increasing burden of comorbidities. While the prevalence of HF with reduced EF (HFrEF) appears to be stable or declining, most likely due to improved treatment of ischaemic heart disease, HF with preserved EF (HFpEF) is steadily increasing and may become the most common form of HF in the future. Overall HF incidence has remained stable or even declined in many Western countries, although rising trends have been reported in younger populations and in specific regions. However, incidence of HFpEF is rising rapidly and has nearly doubled over two decades due to ageing and increased prevalence of comorbidities, whereas HFrEF incidence has declined slightly. Considerable geographic variation exists in HF epidemiology, with data from low- and middle-income countries being still limited, although HF in these settings often differs in terms of causes, age at onset, and outcomes. Despite substantial advances in life-saving, evidence-based therapies, prognosis remains poor: depending on the population and care setting 1-year mortality ranges from 5% to 34%, 1-year rehospitalization is ∼30%, and non-cardiovascular mortality is rising, particularly among patients with HFpEF. In this review, we provide an updated and comprehensive overview of HF epidemiology, summarizing recent evidence on prevalence, incidence, aetiologies, outcomes, and costs across diverse populations and regions worldwide.