Global burden of heart failure in older adults: trends, socioeconomic inequalities, and future projections from 1990 to 2035

Jianhua Gu; Zhaolei Zheng; Jiqing Li; Shuo Wu; Heming Sun; Jiaojiao Pang; Yuguo Chen

doi:10.1093/ehjqcco/qcaf047

Global burden of heart failure in older adults: trends, socioeconomic inequalities, and future projections from 1990 to 2035

Eur Heart J Qual Care Clin Outcomes. 2025 Jun 20:qcaf047. doi: 10.1093/ehjqcco/qcaf047. Online ahead of print.

Authors

Jianhua Gu^{1

2

3}, Zhaolei Zheng^{1

2

3}, Jiqing Li^{1

2

3}, Shuo Wu^{1

2

3}, Heming Sun⁴, Jiaojiao Pang^{1

2

3}, Yuguo Chen^{1

2

3}

Affiliations

¹ Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China.
² Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
³ Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Shandong Key Laboratory: Magnetic Field-free Medicine & Functional Imaging, Qilu Hospital of Shandong University, Jinan, China.
⁴ University of Florida, Department of Computer and Information Science and Engineering.

PMID: 40578836
DOI: 10.1093/ehjqcco/qcaf047

Abstract

Background: Heart failure (HF) is a major global public health concern, particularly in older adults (aged ≥65 years). Despite its growing prevalence, comprehensive analyses of HF burden in this population, including trends, causes, and socioeconomic disparities, remain limited.

Methods: Using data from the Global Burden of Disease (GBD) Study 2021, we analyzed the burden of HF among older adults from 1990 to 2021, including prevalence, years lived with disability (YLDs), and underlying causes. We conducted a decomposition analysis to quantify the contributions of population growth, aging, and epidemiological changes and projected future trends to 2035 using Bayesian Age-Period-Cohort modeling.

Results: From 1990 to 2021, global HF cases among older adults increased from 14.1 million to 36.2 million, whereas YLDs rose from 1.34 million to 3.45 million. Population growth accounted for 89.0% of the increase in both prevalence and YLDs, while the aging effect varied by Sociodemographic Index (SDI) quintiles, , showing negative contributions (-39.4%) in high-SDI regions and positive contributions (+28.7%) in middle-SDI regions. Globally, ischemic heart disease was the leading cause of death (37.6%) across all SDI quintiles, followed by hypertensive heart disease (24.1%). The low-to-middle SDI regions experienced the fastest growth in HF burden (EAPC=0.22), with socioeconomic inequality widening over time. Projections suggest that age-standardized prevalence and YLDs will rise to 4,935 cases and 473 years lived with disability per 100,000 population, respectively, by 2035.

Conclusions: Global heart failure burden in older adults is escalating fastest in low-middle SDI regions due to population growth and healthcare inequities. Mitigating this crisis requires prioritizing equitable access to evidence-based therapies and addressing socioeconomic disparities in aging populations.

Keywords: Etiology; Global Burden of Disease; Heart failure; Older adults; Prevalence; Socioeconomic disparities; Years lived with disability.

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