ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Epidemiology and Prevention
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
Gang Xue 1
Yuyan Hou 1
Shuhong Su 1
Weidong Jin 1
Xiao Wu 1
Zhitao Gao 2
Zhifang Wang 1
1. Xinxiang Central Hospital, Xinxiang, China
2. Henan Medical University, Xinxiang, China
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Abstract
Background: 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. Methods: 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. Results: 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. Conclusion: 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.
Summary
Keywords
disease burden, Global Burden of Disease (GBD), health inequality, Hypertensive heart disease, Ischemic Heart Disease, Rheumatic Heart Disease, Severe heart failure
Received
18 June 2025
Accepted
20 February 2026
Copyright
© 2026 Xue, Hou, Su, Jin, Wu, Gao and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Zhitao Gao
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