Heart Failure Report: U.S. Headed for Dangerous Territory

In their annual report, heart failure experts pointed to worsening survival and disease trends unless the field is able to change course.

According to this year’s HF STATS report from the Heart Failure Society of America, the estimated prevalence of heart failure among U.S. adults is 3% (7.7 million) and is projected to increase to 3.2% (8.7 million) by 2030, 3.6% (10.3 million) by 2040, and 3.8% (11.4 million) by 2050, driven by an aging population with rising rates of obesity, hypertension, and other cardiometabolic risk factors.

The way things are going, about one in four Americans are now expected to develop heart failure in their lifetimes.

In addition, the mortality burden has increased: age-adjusted mortality rates increased by approximately 37% from 2010 to 2023, and the upward trajectory is continuing, “reversing more than a decade of prior progress,” wrote the authors of the report published in the Journal of Cardiac Failure.

“HF STATS 2026 reports a condition at a critical inflection point: rising mortality, younger age at onset, an expanding at-risk population, and widening gaps between evidence and practice,” noted the group, chaired by Eiran Gorodeski, MD, MPH, of University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University School of Medicine in Cleveland. “The data compiled here are not merely descriptive; they define the dimensions of an urgent and actionable public health challenge.”

“Realizing the potential to reverse these trends will require commitment across disciplines, institutions, payers, policymakers, and communities — and it must begin now,” they urged.

A major issue is how guideline-directed medical therapy (GDMT) remains “profoundly underutilized” despite its clear benefits and relatively low costs. The four pillars of therapy — beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists, and SGLT2 inhibitors — are reportedly only used by 18% of the more than 3 million patients with heart failure with reduced ejection fraction, according to real-world data.

There is a need to improve the initiation, titration, and long-term continuation of these highly effective interventions, suggested Thiru Chinnadurai, MD, and Tariq Ahmad, MD, MPH, both of the Yale School of Medicine in New Haven, Connecticut, in an accompanying editorial.

“Closing this gap will require implementation strategies that make evidence-based care easier to deliver and sustain, including EHR [electronic health record]-based decision support, multidisciplinary GDMT programs, and simplified medication regimens,” they wrote. “The therapeutic evidence is clear; the next challenge is ensuring that patients consistently receive and remain on the therapies proven to improve outcomes.”

Despite the low prevalence of heart failure in adults ages 20-39 (0.1% in men and 0.2% in women) and 40-59 (2.2% and 1.8%, respectively), Gorodeski and co-authors noted that younger adults should be a target for greater intervention.

While heart failure hospitalization rates are on the decline among adults 65 and older, they are rising among younger adults. Moreover, from 2001 to 2020, unadjusted heart failure mortality rates more than doubled (from 0.6 to 1.4 per 100,000) in those ages 25-44 years, and nearly doubled (from 6.4 to 12.5 per 100,000) in those ages 45-64.

The emphasis should be on risk factor screening and control in early adulthood, with greater use of risk scores and natriuretic peptide testing in patients with stage B heart failure, suggested Jerice Banola, MD, and Andrew Ambrosy, MD, MPH, of Kaiser Permanente San Francisco Medical Center, in a separate editorial.

Clinicians are also expected to do their part in managing racial and geographic disparities in heart failure care and a drying pipeline of advanced subspecialists.

“We have made extraordinary advances in our ability to treat heart failure, yet at the population level, the burden of heart failure continues to move in the wrong direction,” Gorodeski said in a press release. “These findings underscore the urgency of translating what we know into better prevention, earlier recognition, greater use of proven therapies, and continued research.”