A MAJOR new analysis of 35 years of national health data reveals that the number of USA adults living with heart failure (HF) has more than doubled, rising from 3.3 million in 1988 to 7.4 million in 2023. Despite the rising case numbers, age-standardised prevalence has remained stable, suggesting the increase is due to population ageing and growth rather than worsening cardiovascular health.
The study examined 83,552 adults from repeated USA health surveys, including more than 3,000 individuals with diagnosed HF. The findings show a dramatic shift in the underlying risk profile of HF over time, reflecting both clinical advances and emerging metabolic challenges.
Rise in Heart Failure, Diabetes, and Kidney Disease
Rates of obesity among people with HF nearly doubled, rising from 32.5% to 60.4%. Markers of impaired glucose control climbed sharply as well, with diabetes increasing from 21.2% to 36.2%. Chronic kidney disease also became more common. Researchers note that HF patients today are far more likely to have metabolic comorbidities than their counterparts three decades ago.
Positive Impact of Antihypertensive Therapy and Statins
In contrast, traditional cardiovascular risk factors declined substantially. Elevated blood pressure fell from 80.7% to 49.1%, hypercholesterolaemia from 71.5% to 22.6%, and previous myocardial infarction from 59.3% to 42.1%. These shifts are attributed to widespread use of antihypertensive therapies, statins, and modern preventive cardiology.
Mortality patterns also changed. Although cardiovascular and all-cause mortality fell, increases in non-cardiovascular deaths limited overall survival gains, reflecting older adults living longer with chronic disease. Patients reported better general health and physical functioning over time, though work limitations persisted.
Together, the findings highlight a profound evolution in HF phenotypes and risk factors. Researchers emphasise that future HF trials and care models must adapt to this increasingly metabolic form of heart failure.
Reference
Sayed A et al. Trends in the Prevalence, Associated Risk Factors, and Health Burden of Heart Failure in the United States, 1988 to 2023. JACC. 2025;DOI:10.1016/j.jacc.2025.09.1503.
