Global Burden of Heart Failure in Adults Aged 20-49 Years, 1990-2021

Heart failure (HF) among young adults is a growing health concern, yet its global burden remains poorly understood.

This study aimed to analyze the prevalence, years lived with disability (YLD), and causes of HF in adults aged 20-49 years from 1990 to 2021, and to project trends through 2035.

Using data from the Global Burden of Disease Study 2021, we analyzed age-standardized HF prevalence and YLD rates across 204 regions. We used joinpoint regression to examine temporal trends and Bayesian age-period-cohort methodology for projections through 2035. The burden was stratified by age, sex, regions, and 20 major causes.

From 1990 to 2021, global HF cases among young adults increased from 3.36 to 6.14 million, with age-standardized prevalence rising from 159.98 to 182.89 per 100,000. Middle sociodemographic index regions experienced the fastest increases (average annual percentage change: 0.72; 95% CI: 0.70-0.75). Ischemic heart disease, cardiomyopathy and myocarditis, and hypertensive heart disease consistently ranked as top 3 causes. In 2021, cardiomyopathy and myocarditis showed high prevalence across all age groups, and ischemic and hypertensive heart diseases predominated in ages 40-49. Drug use disorders and endocrine-metabolic disorders showed the most substantial increases in prevalence (∼165% and 153%, respectively) from 1990 to 2021. Projections indicate continued growth in both prevalence and YLD through 2035.

HF burden among young adults varies geographically, with overall global increases but notable regional heterogeneity, including declines in some regions. These findings highlight the need for regionally tailored age-specific prevention strategies and emerging risk factor management.