Estimates based on National Health and Nutrition Examination Survey (NHANES) data from 2017-2020 suggest that around 6.7 million adults ≥20 years of age had heart failure (HF) in the US.[9]Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Feb 20;149(8):e347-913.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001209
http://www.ncbi.nlm.nih.gov/pubmed/38264914?tool=bestpractice.com
Prevalence is increasing in the US, and is projected to rise from 2.4% of the total US population in 2012 to 3.0% in 2030.[9]Martin SS, Aday AW, Almarzooq ZI, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024 Feb 20;149(8):e347-913.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001209
http://www.ncbi.nlm.nih.gov/pubmed/38264914?tool=bestpractice.com
The CaReMe study, which uses data from healthcare registries in Belgium, Canada, Germany, Israel, Italy, Norway, Portugal, Spain, Sweden, Switzerland, and the UK, reported the prevalence of HF in the adult population to be 1% to 2%, depending on whether a broad or strict definition was used.[10]Norhammar A, Bodegard J, Vanderheyden M, et al. Prevalence, outcomes and costs of a contemporary, multinational population with heart failure. Heart. 2023 Mar 10;109(7):548-56.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10086499
http://www.ncbi.nlm.nih.gov/pubmed/36781285?tool=bestpractice.com
The incidence and prevalence of HFpEF specifically are increasing, and are increasing relative to heart failure with reduced ejection fraction (HFrEF).[11]Borlaug BA, Sharma K, Shah SJ, et al. Heart failure with preserved ejection fraction: JACC scientific statement. J Am Coll Cardiol. 2023 May 9;81(18):1810-34.
http://www.ncbi.nlm.nih.gov/pubmed/37137592?tool=bestpractice.com
Studies suggest that approximately 50% of heart failure patients have HFpEF; however, HFpEF is expected to become the most prevalent HF subtype in the future.[11]Borlaug BA, Sharma K, Shah SJ, et al. Heart failure with preserved ejection fraction: JACC scientific statement. J Am Coll Cardiol. 2023 May 9;81(18):1810-34.
http://www.ncbi.nlm.nih.gov/pubmed/37137592?tool=bestpractice.com
[12]Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006 Jul 20;355(3):251-9.
https://www.nejm.org/doi/10.1056/NEJMoa052256
http://www.ncbi.nlm.nih.gov/pubmed/16855265?tool=bestpractice.com
[13]Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017 Oct;14(10):591-602.
https://www.doi.org/10.1038/nrcardio.2017.65
http://www.ncbi.nlm.nih.gov/pubmed/28492288?tool=bestpractice.com
Risk of HFpEF increases with age and additional strong risk factors include hypertension, obesity, diabetes mellitus, atrial fibrillation (AF), and coronary artery disease (CAD).[12]Owan TE, Hodge DO, Herges RM, et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006 Jul 20;355(3):251-9.
https://www.nejm.org/doi/10.1056/NEJMoa052256
http://www.ncbi.nlm.nih.gov/pubmed/16855265?tool=bestpractice.com
[13]Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2017 Oct;14(10):591-602.
https://www.doi.org/10.1038/nrcardio.2017.65
http://www.ncbi.nlm.nih.gov/pubmed/28492288?tool=bestpractice.com
[14]Bhatia RS, Tu JV, Lee DS, et al. Outcome of heart failure with preserved ejection fraction in a population-based study. N Engl J Med. 2006 Jul 20;355(3):260-9.
https://www.nejm.org/doi/10.1056/NEJMoa051530
http://www.ncbi.nlm.nih.gov/pubmed/16855266?tool=bestpractice.com
[15]Lenzen MJ, Scholte op Reimer WJ, Boersma E, et al. Differences between patients with a preserved and a depressed left ventricular function: a report from the EuroHeart Failure Survey. Eur Heart J. 2004;25:1214-1220.
https://academic.oup.com/eurheartj/article/25/14/1214/509370/Differences-between-patients-with-a-preserved-and
http://www.ncbi.nlm.nih.gov/pubmed/15246639?tool=bestpractice.com
HFpEF is more common in women (79%), whereas HFrEF is equally prevalent in women and men.[16]Tarantini L, Faggiano P, Senni M, et al. Clinical features and prognosis associated with a preserved left ventricular systolic function in a large cohort of congestive heart failure outpatients managed by cardiologists: data from the Italian Network on Congestive Heart Failure. Ital Heart J. 2002 Nov;3(11):656-64.
http://www.ncbi.nlm.nih.gov/pubmed/12506524?tool=bestpractice.com
[17]Masoudi FA, Havranek EP, Smith G, et al. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. 2003 Jan 15;41(2):217-23.
https://www.sciencedirect.com/science/article/pii/S0735109702026967
http://www.ncbi.nlm.nih.gov/pubmed/12535812?tool=bestpractice.com
Comorbidity and multimorbidity is common in patients with HF.[3]Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2022 May 3;145(18):e895-1032.
https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001063
http://www.ncbi.nlm.nih.gov/pubmed/35363499?tool=bestpractice.com
One study looking at twelve common comorbidities (CAD, AF/flutter, hypertension, peripheral artery disease, cerebrovascular disease, anaemia, obesity, hypercholesterolaemia, diabetes mellitus, rheumatoid arthritis, COPD, and chronic kidney disease) found that 98% to 99% of HF patients had at least one comorbidity, and those with HFpEF had a mean comorbidity burden of 4.3.[18]Screever EM, van der Wal MHL, van Veldhuisen DJ, et al. Comorbidities complicating heart failure: changes over the last 15 years. Clin Res Cardiol. 2023 Jan;112(1):123-33.
https://link.springer.com/article/10.1007/s00392-022-02076-1
http://www.ncbi.nlm.nih.gov/pubmed/35976430?tool=bestpractice.com
Non-cardiovascular comorbidities such as anaemia, hypothyroidism, renal impairment, chronic lung disease, and liver disease are more prevalent in the HFpEF population.[19]Lam CS, Donal E, Kraigher-Krainer E, et al. Epidemiology and clinical course of heart failure with preserved ejection fraction. Eur J Heart Fail. 2011 Jan;13(1):18-28.
http://onlinelibrary.wiley.com/doi/10.1093/eurjhf/hfq121/full
http://www.ncbi.nlm.nih.gov/pubmed/20685685?tool=bestpractice.com