# Global, regional, and national burden and projections of severe heart failure attributable to hypertensive, ischemic, and rheumatic heart diseases: an analysis from the global burden of disease study 2021

## TL;DR

This study analyzes the global rise in severe heart failure cases caused by three heart diseases and highlights the need for targeted health policies to address growing health inequalities.

## Contribution

The study provides updated global and regional projections of severe heart failure burden from three specific heart diseases using the latest GBD data and modeling techniques.

## Key findings

- In 2021, ischemic heart disease caused the highest number of severe heart failure cases at 6.24 million.
- Projections show continued increases in severe heart failure cases and disability years, with persistent regional disparities.
- Eastern Sub-Saharan Africa had the highest burden of hypertensive heart disease-related heart failure.

## Abstract

Severe heart failure (SHF) caused by hypertensive heart disease (HHD), ischemic heart disease (IHD), and rheumatic heart disease (RHD) remains a significant global public health concern. Accurate assessments of the global and regional burdens, trends, and health inequalities related to these diseases are critical for formulating targeted health policies and interventions.

Data on the prevalence and years lived with disability (YLDs) due to severe heart failure resulting from HHD, IHD, and RHD from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) Study 2021. Trends were analyzed according to age-standardized rates (ASRs) and sociodemographic index (SDI) stratifications. Predictions for 2022–2040 were generated using Nordpred modeling and validated with the Bayesian Age-Period-Cohort (BAPC) model.

In 2021, prevalent cases for severe heart failure attributable to HHD, IHD, and RHD reached 4.07 million, 6.24 million, and 0.74 million, respectively, with corresponding age-standardized prevalence rates (ASPR) of 48.3, 74.4, and 9.2 per 100,000. Compared with 1990, cases increased by 170.3% for HHD, 140.7% for IHD, and 39.0% for RHD. YLDs rose to 700,272 (HHD), 1,075,512 (IHD), and 129,155 (RHD), respectively. The greatest burdens occurred in Eastern Sub-Saharan Africa for HHD (ASPR: 95.0), North Africa and the Middle East for IHD (ASPR: 103.1), and South Asia for RHD (ASPR: 21.0). Projections indicate continued increases in prevalent cases and YLDs for all conditions, with stable or slightly rising standardized rates, highlighting persistent regional and gender inequalities.

Severe heart failure burdens related to HHD, IHD, and RHD are increasing globally, influenced significantly by demographic shifts and socioeconomic disparities. Urgent implementation of context-specific preventive and healthcare strategies is essential to address health inequalities and reduce the future burden of severe heart failure worldwide.