56 million people were living with heart failure in 2023, global GBD analysis finds

Heart failure is the syndrome cardiology arrives at when other things have gone wrong first. It is not a single disease but a common endpoint — the heart no longer pumping well enough to meet the body's needs — and that makes it unusually revealing as a global statistic. Count the heart failure in a population and you are indirectly counting its untreated hypertension, its rheumatic fever, its drinking and, in some places, its parasites. A new Global Burden of Disease analysis does exactly that, estimating heart failure across 204 countries and territories from 1990 to 2023 [s1].

The headline number is 56.0 million people living with heart failure in 2023 [s1]. That sits inside the larger cardiovascular picture the World Health Organization describes: cardiovascular diseases are the leading cause of death globally, with an estimated 19.8 million deaths in 2022, about 32% of all global deaths, of which 85% were due to heart attack and stroke [s2].

A condition of age

The first pattern is demographic. The estimated prevalence of heart failure generally increased with age in all locations [s1]. That single sentence explains why the authors expect the burden to grow: heart failure is a disease of survival, accumulating in populations that live long enough to develop it. As the world ages, the pool of people at risk expands even if the underlying rates hold steady.

Among older adults, the two most common causes globally were ischaemic heart disease and hypertensive heart disease [s1] — the familiar drivers of cardiovascular disease that the WHO ties to tobacco, unhealthy diet, physical inactivity, harmful alcohol use and air pollution [s2]. In the richest and oldest populations, heart failure is largely the long shadow of blocked arteries and uncontrolled blood pressure.

Causes that map the world

The more striking contribution of the analysis is what it finds underneath that global average. There was substantial variation in the etiological pattern by location and age [s1], and the variation is almost a map of each region's other problems.

Congenital heart anomalies and rheumatic heart disease were common causes in children and young adults [s1]. Rheumatic heart disease — valve damage following streptococcal infection, which the WHO lists among the main cardiovascular diseases [s2] — concentrated across south Asia, east Asia, Oceania and the four sub-Saharan African subregions [s1]. These are failures of primary care: a sore throat that is never treated, a rheumatic fever that is never caught.

The proportion of heart failure due to alcohol use peaked in middle adulthood, and clustered in eastern Europe, Australasia, the Caribbean and central Europe [s1]. And Chagas disease — the parasitic infection of the Americas — drove heart failure across southern, Andean, tropical and central Latin America [s1]. Three regions, three different stories, one shared endpoint.

Why the breakdown matters

Grouping these together as "heart failure" is clinically accurate and strategically unhelpful, because the prevention runs through entirely different systems. Alcohol-related heart failure is a problem of alcohol policy. Rheumatic heart disease is a problem of antibiotics and primary care. Chagas cardiomyopathy is a problem of vector control and early treatment of a neglected tropical disease. The only thing a cardiology ward can do about any of them is manage the damage once it has arrived.

That is the authors' own framing. They note that most heart-failure etiologies can be prevented by interventions that reduce exposure to modifiable risk factors such as elevated blood pressure, excessive alcohol consumption and tobacco use [s1] — the same levers the WHO names as the route to preventing most cardiovascular disease [s2]. The value of an etiology- and location-specific estimate is that it tells a health minister which lever is theirs to pull.

The trajectory

The study's conclusion is cautious but directional: heart failure is a significant global public health burden, and the impact is likely to increase as populations age [s1]. That expectation is the part worth holding onto. A prevalence figure of 56.0 million [s1] is a snapshot of a number most demographers expect to rise, because the thing that most reliably produces heart failure — reaching old age with a damaged heart — is exactly what global progress in survival delivers more of each year.

What to watch

The question the next GBD cycle will answer is whether the cause mix shifts. If rheumatic and Chagas heart failure recede while ischaemic and hypertensive heart failure grow, that would signal the low-income causes yielding to primary care even as the ageing-related causes climb. The regional etiology maps in this analysis [s1] are the baseline against which that shift will be read.

Sources

• Global, Regional, and National Burden of Heart Failure, 1990–2023: A Systematic Analysis for the Global Burden of Disease Study 2023, JAMA Cardiology, 30 September 2026
• Cardiovascular diseases (CVDs) (fact sheet), World Health Organization