Global trends and projections in cardiovascular disease-related heart failure, 1990-2050: an analysis of the Global Burden of Disease 2021 data.

Heart failure (HF) is a major endpoint of cardiovascular disease (CVD) and a growing global public health challenge. This study assessed the global burden of CVD-related HF from 1990 to 2021 and projected trends to 2050. Utilizing data from the Global Burden of Disease (GBD) 2021 study, we analyzed years lived with disability (YLD) and prevalence for CVD-related HF, stratified by sex, age, socio-demographic index (SDI), region, and specific CVD etiology. In 2021, CVD-related HF affected approximately 45.56 million individuals globally, causing 4.32 million YLD. The global age-standardized prevalence and YLD rates were 548.81 and 52.00 per 100,000 population, respectively, with higher rates in males. Hypertensive and ischemic heart disease were predominant causes, except in the under-20 age group where cardiomyopathy/myocarditis and rheumatic heart disease prevailed. From 1990 to 2021, global age-standardized prevalence and YLD rates increased, with the sharpest rise in the 20-54 age group, males and middle to high-middle SDI countries. Age-standardized prevalence and YLD rates declined for rheumatic heart disease, stroke, and non-rheumatic valvular heart disease-related HF, whereas most other etiologies exhibited upward trends, most notably atrial fibrillation/flutter and endocarditis. There were significant disparities in various CVD-related HF across sex, age, SDI country, and region in 2021 and from 1990 to 2021. By 2050, projections indicate that CVD-related HF will increase to varying degrees across sex, age, and specific CVD types. The global burden of CVD-related HF is substantial, escalating, and characterized by significant disparities across sex, age, SDI country, region, and CVD type. Urgent and targeted public health strategies are essential to mitigate this rising burden.