Global Heart Failure Cases More Than Doubled to 56 Million Since 1990

The number of people living with heart failure (HF) worldwide more than doubled between 1990 and 2023, reaching an estimated 56.0 million, though population growth and aging, rather than a rising age-standardized rate, drove most of the increase, according to a Global Burden of Disease (GBD) 2023 analysis published in JAMA Cardiology.¹

The GBD 2023 Heart Failure Collaborators estimated HF prevalence and years lived with disability (YLDs) across 204 countries and territories, attributing each case to a single underlying cause from among 32 GBD etiologies. The estimates capture symptomatic HF, corresponding to American College of Cardiology/American Heart Association stage C and D disease, and exclude stage B.

Case Counts Climbed While Age-Standardized Rates Held Nearly Flat

Global HF cases rose from 24.9 million (95% uncertainty interval [UI], 22.5-27.5 million) in 1990 to 56.0 million (95% UI, 49.9-62.2 million) in 2023, a 124.6% increase. Over the same period, age-standardized prevalence moved from 624.2 to 641.3 per 100,000, a 2.7% change with an uncertainty interval that crossed zero (95% UI, −0.6% to 5.8%). HF accounted for an estimated 5.33 million YLDs in 2023.

Cases were split fairly evenly by sex, with 28.9 million among males and 27.1 million among females, although age-standardized prevalence was higher in males (718.6 vs 573.0 per 100,000). Prevalence rose sharply beginning around age 60 years, and the absolute number of cases peaked in the 70- to 74-year age group.

Regional rates varied about 2-fold, though uncertainty intervals overlapped substantially. High-income North America had the highest age-standardized prevalence (868.3 per 100,000), followed by central Europe and Australasia, while high-income Asia Pacific, Oceania, and South Asia had the lowest. Prevalence also differed 1.4- to 1.7-fold between subnational locations within several countries, including the US.

Domestic figures point the same direction. The Heart Failure Society of America's HF Stats 2026 report puts the number of US adults with HF at about 7.7 million, based on 2023 National Health and Nutrition Examination Survey data, and projects 8.7 million by 2030 and 11.4 million by 2050. The report also estimates that direct and indirect HF-related costs of about $46 billion in 2020 will reach $142 billion by 2050.²

Ischemic and Hypertensive Heart Disease Lead, but Cause Shifts With Age

Across all ages, ischemic heart disease (IHD) accounted for 33.7% of prevalent HF cases, hypertensive heart disease (HHD) for 23.8%, other cardiomyopathy for 7.9%, and chronic obstructive pulmonary disease (COPD) for 5.7%—together more than two-thirds of cases.¹ Among adults 70 years and older, IHD underlay 11.8 million cases, HHD 8.35 million, and COPD 2.35 million.

Younger populations showed a different pattern. Congenital heart anomalies were the predominant cause of HF in childhood, with 2.70 million cases among those younger than 15 years, and rheumatic heart disease caused roughly 1 in 5 cases among adults aged 20 to 29 years. Alcohol use accounted for 3% to 4% of cases among people aged 35 to 54 years. Region-specific drivers included rheumatic heart disease in parts of Asia, Oceania, and sub-Saharan Africa; alcohol use in eastern and central Europe, Australasia, and the Caribbean; and Chagas disease in Latin America.

The authors noted that many HF etiologies stem from modifiable risks such as elevated blood pressure, tobacco, and alcohol, and that blood pressure lowering acts across several leading causes, including IHD, HHD, and stroke. They also acknowledged limitations: GBD does not yet estimate HF by ejection fraction, and etiology-specific excess mortality inputs came from linked data in a single location in Italy, which could bias estimates toward patterns seen in high-income settings.

References

1. GBD 2023 Heart Failure Collaborators. Global, regional, and national burden of heart failure, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023. JAMA Cardiol. Published online September 30, 2026. doi:10.1001/jamacardio.2026.4068
2. HF Stats 2026: an updated report on heart failure epidemiology and outcomes from the Heart Failure Society of America. Heart Failure Society of America. Accessed October 8, 2026. https://hfstats.org