Less than 1 in 4 eligible patients with HFrEF are receiving Quadruple GDMT
Optimal implementation of GDMT could save an estimated 1.19 million lives a year globally
Download the Full Report in Journal of Cardiac Failure now!
Key Points By Category
- Approximately 6.7 million Americans over 20 years of age have HF, and the prevalence is expected to rise to 8.7 million Americans in 2030, 10.3 million in 2040, and 11.4 million Americans by 2050.
- The lifetime risk of HF has increased to 24%; approximately 1 in 4 people will develop HF in their lifetime.
- The prevalence of HF among U.S. adults is approximately 1.9% to 2.8% for the overall population and is higher among older individuals. The prevalence is expected to increase to 8.5% among individuals aged 65 to 70 years.
- The trend for HF with preserved ejection fraction (HFpEF) across populations is increasing with significant differences by race and ethnicity. Women experience a higher lifetime risk of HFpEF than HFrEF, though this risk differs among race and ethnic groups.
- Approximately 33% of the U.S. adult population without known symptomatic HF is at risk for HF (Stage A) and 24-34% have pre-HF (Stage B).
- The age-adjusted incidence and prevalence of HF are higher among Black individuals compared to other racial and ethnic groups. The prevalence of HF has increased among Black and Hispanic/Latino individuals over time.
- The prevalence of HF is higher among young and middle-aged Black adults compared with young and middle-aged White adults.
- In the overall population, HF is most prevalent among adults older than 60 years old.
- HF prevalence estimates around the world range from 1 to 3% of the population, with varying etiology profiles in different regions.
- HF prevalence has increased globally, from an estimated 25.4 million in 1990 to 55.5 million in 2021, although with a possible downtrend in higher socio-demographic index countries from 2019 to 2021.
- Globally, hypertensive and ischemic heart disease are the leading HF etiologies.
- Non-traditional risk factors, including socioeconomic status and access to healthcare, and environmental risks such as air pollution, play important roles globally.
- HF was a contributing cause in 425,147 deaths in the U.S. in 2022.
- HF mortality rates have increased since 2012.
- The age-adjusted mortality rate (AAMR) from HF was higher in 2021 than in 1999.
- Among ambulatory adults with chronic HF, the 1-year mortality rate is estimated at 13.5%.
- Among U.S. patients 65 and older hospitalized for HF, the 1-year post-discharge mortality rate is estimated at 35%.
- Compared with the general U.S. population, HF is associated with a loss of 7 to 15 years of median survival for adults 65-85 years of age.
- HF-related mortality in the U.S. increases significantly with age, particularly after age 74 years, but a greater relative annual increase in HF-related mortality rates has been observed in younger (35-64 years) compared to older (65-84 years) adults.
- HF hospitalizations declined from 2010 to 2014 but increased between 2014 and 2020, after which the COVID-19 pandemic temporarily reduced the hospitalization rate.
- HF hospitalizations during the COVID-19 pandemic had higher inpatient mortality rates.
- Increasing rates of hospitalization are noted across age groups, sex, race, and ethnic minority populations, with the highest rates among Black Americans.
- HF hospitalizations have increased among young adults aged 18-45 since 2013, and Black patients accounted for 50% of these hospitalizations.
- HF hospitalizations among the elderly >80 years old have increased since 2014, with a greater risk among those with more comorbid chronic conditions.
- The implementation of quadruple GDMT in patients with HFrEF is suboptimal, with significant gaps, variations, and disparities in use among eligible patients. In the U.S. and globally less than one in four eligible patients with HFrEF are receiving quadruple GDMT.
- In some settings, there have been improvements in use and dosing of quadruple GDMT in recent years, but further opportunities remain to improve implementation.
- Based on recent data, the use of GDMT improved in Black and Hispanic adults, but significant sex disparities persist.
- Fewer than 25% of eligible Black adults with HFrEF are prescribed a combination of hydralazine and isosorbide dinitrate, despite its Class I recommendation.
- Counseling for or placement of device therapies prior to discharge in hospitalized HF patients remains low, with cardiac resynchronization therapy (CRT) being prescribed or placed in only 36.7% of eligible patients.
- In the U.S., significant geographic disparities exist in the density of cardiac rehabilitation programs which correlate with utilization rates.
- Heart transplant volumes have increased from 2014 to 2024. The contributing factors to the higher volumes include more donor availability due to the opioid epidemic, hepatitis C-positive donation, and donation after circulatory death (DCD).
- Durable LVAD volumes decreased after the 2018 U.S. heart allocation policy change, but LVAD remains an important treatment modality for advanced HF patients.
- In 2020, HF accounted for an estimated $32 billion in direct medical costs and $14 billion in indirect costs in the United States. The total direct costs for individuals with HF are estimated at $227 billion.
- Globally, 2021 HF direct medical costs were estimated at $136 billion, with indirect costs of $147 billion illustrating the proportion of consumer health expenditures attributable to HF.
- HF-related costs are projected to grow significantly: overall HF-related direct medical costs may reach $142 billion by 2050, while total direct medical costs for individuals with HF could rise to $858 billion.
- Hospitalizations account for nearly 40% of the total direct medical costs for individuals with HF.
- All four pillars of GDMT for HFrEF are cost-effective at $100,000 per quality-adjusted life year (QALY).
Featured Figures
This content is for HFSA members. Please click here to log in to view this content and to learn more about membership benefits.
Download the Report
Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America
Journal of Cardiac Failure
Published September 22, 2025
