The global prevalence of heart failure (HF) more than doubled in recent decades, from around 24 million cases in 1990 to 56 million in 2023, according to new estimates from the Global Burden of Disease (GBD) study.

Much of the increase is driven by growing and aging populations, but the analysis published in JAMA Cardiology also identified several common causes that tend to differ regionally and by age.

HF is a significant public health issue around the world that is likely to get worse as populations age, but it is challenging to get a good picture of its global epidemiology because the sources and quality of data can differ wildly in different parts of the world.

The GBD team integrated multiple information sources on HF incidence, prevalence, and related mortality from 204 countries and territories and used statistical models to fill in the gaps. They found that the crude prevalence of HF rose by 124% during the study period, with the largest relative changes in East Asia, high-income Asia-Pacific, Europe, and Australasia. But age-standardized prevalence changed only modestly.

“These comprehensive estimates highlight the increase in heart failure burden due to population growth and aging and the need for prevention and treatment strategies specific to common etiologies of heart failure,” the authors wrote.

The two most common causes of heart disease among older adults around the world, and particularly in North America, are ischemic heart disease (IHD) and hypertension. Congenital heart anomalies and rheumatic heart disease were common among children and young adults, while alcohol use was a large factor in central and eastern Europe, Australasia, and the Caribbean.

“Etiology- and location-specific estimates can provide necessary information for public health officials to determine how best to prioritize interventions to reduce HF disease burden,” the authors wrote.

In an accompanying editorial, Philip Joseph, MD, from McMaster University in Hamilton, Ontario, Canada, and Isabelle Bartolini, PhD, from the Karolinska Institute in Stockholm, Sweden, highlighted the importance of these more accurate estimates, though more data from underrepresented regions is still needed.

“Good epidemiology drives healthcare decisions,” they wrote.

But because IHD and hypertension remain poorly managed globally, they wrote, it is likely that the burden of HF will continue to increase in most of the world.

“While there is the potential for significant gains to be made, it will require changes to our current approaches of preventing and managing HF,” they wrote. Cardiovascular polypills and task-sharing among physicians and other healthcare workers are two low-cost strategies that have been shown to improve the management of IHD and hypertension, which should be relatively easy to implement, they suggest.

Joseph and Bartolini reported having no relevant financial relationships.

Brian Owens is a freelance journalist based in New Brunswick, Canada.