Prevalence, symptom severity and years lived with the disability of heart failure, and their implications on health systems: a population-based comparative study

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Abstract
Aims: Heart failure (HF) is a global health challenge with increasing burden. This study characterized HF across different severity levels to inform service delivery and health system responses. Methods and results: Using Global Burden of Disease (GBD) Study 2021 data, we analyzed age-standardized rates of prevalence and years lived with disability (YLDs) for HF, stratified into four levels based on symptom severity as determined by the GBD: treated, mild, moderate and severe. Estimates were stratified by sex, region, and underlying causes. Spearman's rank correlation tests were used to assess the relationships between burden and sociodemographic index (SDI) and universal health coverage (UHC). Temporal trends and contributions were evaluated using estimated annual percentage changes and decomposition analyses. The overall prevalence of HF was 55.5 million (M), and using GBD symptom severity categories, there were 20.5 M treated HF globally in 2021, resulting in 1.3 M YLDs. Mild HF was 10.3 M (0.4 M YLDs), moderate HF was 6.7 M (0.5 M YLDs), and severe HF was 18.0 M (3.1 M YLDs). Ischaemic heart disease remained the leading underlying cause of HF. Males experienced a burden 25% higher than females. Geographic variation was observed, with higher YLDs due to treated HF correlating with lower SDI and UHC levels, while no significant association for mild, moderate, or severe HF. During 1990–2021, prevalence and YLDs increased across all groups with an increase of 0.2%, predominantly driven by population growth and ageing. Conclusion: The burden of HF is projected to rise significantly. Advancing strategies to strengthen health systems and address disparities in access to guideline-directed care, particularly in low- and middle-income countries, is an important focus for action.

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