Heart Failure Has Doubled in Numbers Since 1988 – European Medical Journal

Report on Heart Failure Trends in the USA and Implications for Sustainable Development Goals

Introduction: Aligning Health Trends with SDG 3

A comprehensive analysis of 35 years of health data from the United States reveals a significant shift in the landscape of heart failure (HF), a major non-communicable disease (NCD). These findings have direct implications for the achievement of Sustainable Development Goal 3 (Good Health and Well-being), particularly Target 3.4, which aims to reduce premature mortality from NCDs. The study, covering the period from 1988 to 2023, documents the evolving challenges and successes in managing cardiovascular health within the nation.

Key Findings on Disease Prevalence and Population Health

The report’s primary findings indicate a substantial increase in the total number of adults living with HF, though this is largely a consequence of demographic shifts rather than a decline in overall cardiovascular health.

• The absolute number of adults with HF more than doubled, rising from 3.3 million in 1988 to 7.4 million in 2023.
• Despite this increase, the age-standardised prevalence of HF remained stable over the 35-year period.
• This stability suggests that the growth in case numbers is primarily driven by population growth and an ageing demographic, key factors in long-term public health planning under SDG 3.

Evolving Risk Profiles: A Challenge to SDG 3 and SDG 2

The analysis highlights a profound transformation in the risk factors associated with HF, presenting a dual narrative of progress in some areas and emerging challenges in others, impacting multiple SDGs.

Progress in Managing Traditional Cardiovascular Risks

Significant advancements in preventive cardiology and treatment have successfully reduced several traditional risk factors, contributing positively to SDG 3.4.

1. Prevalence of elevated blood pressure among HF patients decreased from 80.7% to 49.1%.
2. Hypercholesterolaemia saw a dramatic fall from 71.5% to 22.6%.
3. The incidence of previous myocardial infarction declined from 59.3% to 42.1%.

The Rise of Metabolic Comorbidities

Conversely, the data show a sharp increase in metabolic conditions, which poses a significant threat to progress on both SDG 3 (Good Health and Well-being) and SDG 2 (Zero Hunger), specifically Target 2.2 concerning the eradication of all forms of malnutrition, including obesity.

• The rate of obesity among individuals with HF nearly doubled, increasing from 32.5% to 60.4%.
• The prevalence of diabetes rose substantially from 21.2% to 36.2%.
• Chronic kidney disease also became a more common comorbidity.

Analysis of Mortality, Well-being, and Economic Impact

Mortality Trends and Long-Term Health

Changes in mortality patterns reflect the complexity of managing NCDs in an ageing population. While progress has been made in reducing deaths directly related to cardiovascular causes, the overall burden of chronic disease persists.

• Both cardiovascular and all-cause mortality rates among HF patients declined.
• However, an increase in non-cardiovascular deaths limited overall gains in survival, indicating that patients are living longer but with a higher burden of other chronic conditions.

Impact on Quality of Life and SDG 8

The health burden of HF has a direct impact on individual well-being and economic productivity, a key concern of SDG 8 (Decent Work and Economic Growth).

• Patients reported improvements in general health and physical functioning over the study period.
• Despite these gains, persistent work limitations were noted, highlighting how NCDs can impede full and productive employment, a central tenet of SDG 8.

Conclusion and Future Directives

The report concludes that the phenotype of heart failure has evolved significantly, shifting from a condition dominated by traditional cardiovascular risk factors to one increasingly characterized by metabolic comorbidities. To continue making progress toward SDG 3 and related goals, future clinical trials and healthcare models must adapt to address this metabolic form of heart failure. An integrated approach that considers public health strategies for nutrition (SDG 2) and addresses the economic impact of chronic disease (SDG 8) is essential for sustainable health outcomes.

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.

Sustainable Development Goals (SDGs) Addressed in the Article

1. SDG 3: Good Health and Well-being

   • The entire article is focused on public health, specifically the trends in heart failure (HF), a major non-communicable disease (NCD). It discusses the prevalence, risk factors, comorbidities like diabetes and obesity, and mortality rates associated with this condition, all of which are central to SDG 3’s mission to ensure healthy lives and promote well-being for all at all ages.

Specific SDG Targets Identified

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   • This target is directly relevant as the article analyzes trends in heart failure, a primary NCD. It highlights the success of prevention and treatment strategies, noting that traditional cardiovascular risk factors like elevated blood pressure and hypercholesterolaemia have declined substantially due to “widespread use of antihypertensive therapies, statins, and modern preventive cardiology.” The article also explicitly states that “cardiovascular and all-cause mortality fell,” which aligns with the goal of reducing mortality from NCDs.

2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

   • While not explicitly mentioning universal health coverage, the article implies progress towards this target. The finding that risk factors like high blood pressure and high cholesterol have fallen dramatically is attributed to the “widespread use of antihypertensive therapies [and] statins.” This suggests that a large portion of the population has access to these essential medicines and preventive cardiology services, which is a core component of achieving universal health coverage.

Indicators for Measuring Progress

1. Indicators for Target 3.4

   • Official Indicator (3.4.1): Mortality rate attributed to cardiovascular disease. The article directly addresses this by stating that “cardiovascular and all-cause mortality fell,” providing a qualitative measure of progress.
   • Implied Indicators (Prevalence of risk factors): The article provides specific quantitative data that can be used as indicators to measure the burden of NCDs and the effectiveness of interventions. These include:
     • Prevalence of obesity among people with HF (rose from 32.5% to 60.4%).
     • Prevalence of diabetes among people with HF (increased from 21.2% to 36.2%).
     • Prevalence of elevated blood pressure among people with HF (fell from 80.7% to 49.1%).
     • Prevalence of hypercholesterolaemia among people with HF (fell from 71.5% to 22.6%).

2. Indicators for Target 3.8

   • Implied Indicator (Coverage of essential health services): The article’s reference to the “widespread use of antihypertensive therapies, statins, and modern preventive cardiology” serves as an implied, qualitative indicator of the population’s access to and coverage for essential treatments for cardiovascular conditions. This suggests that services to manage high blood pressure and high cholesterol are widely available and utilized.

Summary Table: SDGs, Targets, and Indicators

Source: emjreviews.com