Epidemiology

The prevalence of known heart failure (HF) in high-income countries has been estimated at 1% to 3%, and the incidence is estimated at 1 to 20 per 1000 person-years, depending on study population.​[2][3][4]​​​​​​​​ 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.[5]​ Of those with a recorded ejection fraction (EF), about 39% had HF with reduced EF and 18% had HF with mildly reduced EF.[5]

In the US, among people ages 40-59 years, the prevalence of HF is about 2.3% in men and 1.2% in women, and in people ages ≥80 years, the prevalence of HF is about 7.1% in men and 10.9% in women.[6] Estimates based on National Health and Nutrition Examination Survey (NHANES) data from 2017 to 2020 suggest that around 6.7 million adults ages ≥20 years had HF in the US.[6]​​ 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.[6]​​​

Worldwide the absolute numbers of people living with HF are also increasing.[2] The rising prevalence of HF is not necessarily linked with an increase in HF incidence, as the incidence appears to be stable or decreasing in some countries, in part due to better treatment and reduced mortality of patients with acute myocardial infarctions earlier in life.​[2][3]​​​​​ HF is primarily a condition of older people, and thus the widely recognized "aging of the population" contributes to its increasing prevalence.[2]

Comorbidity and multimorbidity is common in patients with HF.[7] One study looking at 12 common comorbidities (coronary artery disease, atrial fibrillation/flutter, hypertension, peripheral artery disease, cerebrovascular disease, anemia, obesity, hypercholesterolemia, 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 HFrEF had a mean of 3.7 comorbidities.[8] Comorbidity burden increases with age; in patients ages <40 years, none had more than four comorbidities, but more than four comorbidities were present in 39% to 40% of those ages ≥80 years.[8]​​

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