Prioritising the primary prevention of heart failure

Heart failure remains one of the 21st century's greatest unmet clinical and public health challenges. Heart failure is a highly prevalent chronic condition that affects approximately 55 million people worldwide. Although heart failure can be prevented, the global burden of this condition continues to grow, fuelled by an ageing population, improved survival after myocardial infarction, and increasing prevalence of metabolic and kidney disease. Public health efforts for cardiovascular disease prevention to date have primarily targeted coronary heart disease. Despite overlapping prevention targets for coronary heart disease and heart failure, prevention of the latter requires tailored approaches to target its unique pathophysiology and heterogeneous subtypes. This Lancet Series serves as a call to action for clinicians, health systems, and governments to prioritise the primary prevention of heart failure. Herein, we review the epidemiology, pathophysiology, and risk factors of heart failure and propose a comprehensive framework for prevention of this condition that includes screening to assess risk of this condition (eg, multivariable risk equations) and detection of pre-heart failure (eg, biomarkers). Successfully reducing the burden of heart failure will require concerted efforts to define clinical workflows across the life course, scalable implementation strategies, and increased public awareness of this pressing crisis.