Heart Failure in the United States: Rising Burden and Unmet Needs

Heart failure (HF) affects nearly 1 in 4 Americans over their lifetime, and its growing prevalence, rising mortality, widening disparities, and persistent undertreatment have made it an increasingly urgent public health crisis. About one-third of U.S. adults without symptomatic HF are already at risk (Stage A), while another 24–34% have pre-HF (Stage B); approximately 3% of adults—7.7 million people—currently have HF, a number projected to reach 11.4 million by 2050, driven largely by population aging, obesity, high blood pressure, and other cardiometabolic risk factors, with HF with preserved ejection fraction expected to become increasingly prominent. HF is also shifting toward younger populations: hospitalization rates have risen among adults younger than 65 years, while HF mortality from 2001 to 2020 increased by 121% among those aged 25–44 years and 96% among those aged 45–64 years. In 2023, HF contributed to 452,573 U.S. deaths, and age-adjusted mortality increased by approximately 37% from 2010 to 2023. Major racial, geographic, and rural–urban disparities persist, with Black Americans experiencing substantially higher HF incidence, hospitalization, and mortality and the highest burden concentrated in parts of the South, Appalachia, and Midwest. Despite strong evidence that guideline-directed medical therapy (GDMT) improves survival in HF with reduced ejection fraction, the four foundational therapies—beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and SGLT2 inhibitors—remain profoundly underused, with only about 18% of eligible patients receiving quadruple therapy and fewer than 1% reaching target doses. HF imposes enormous and rapidly increasing economic costs, while comprehensive GDMT is now highly cost-effective. At the same time, important forms of cardiomyopathy—including transthyretin amyloid cardiomyopathy, hypertrophic cardiomyopathy, and genetic dilated cardiomyopathy—remain underdiagnosed, and vulnerable populations such as older adults, cancer survivors, pregnant women, and patients with malnutrition or frailty face particularly high risks. Advanced HF and cardiogenic shock represent the highest-acuity end of the spectrum, with substantial mortality and unmet therapeutic needs. Overall, the findings highlight the urgent need for earlier prevention, equitable access to evidence-based therapy, improved diagnosis of specific cardiomyopathies, stronger multidisciplinary care, and greater investment in advanced HF and cardiogenic shock research. Source: https://onlinejcf.com/