Global heart failure incidence rate: an updated systematic review and meta-analysis

Introduction Heart failure (HF) affects 64 million people worldwide, yet updated global estimates of its incidence are lacking. Objective Conduct a systematic review (SR) and meta-analysis to estimate the global incidence of heart failure and analyze its variations according to geographic region, sex, age, and clinical characteristics. Methodology A SR was performed in MEDLINE (PubMed), Scopus, EMBASE, and Web of Science (including SciELO) for observational studies published between 2000 and 2025 reporting HF incidence rates in the general population. Studies with recognized diagnostic criteria (Framingham, ESC, ACC/AHA) or standardized codifications (ICD) were included. The meta-analysis employed a random-effects model with the REML method. Subgroup analyses (sex, age, region, phenotypes) and meta-regression were conducted to explore temporal trends. Results Forty-two studies (2001–2025) from 18 countries were included, with 57% categorized as low risk of bias. The combined global incidence was 2.72 cases per 1,000 person-years (95% CI: 1.95–3.81), being higher in North America (6.06) than in Europe (2.65) and Asia (4.08). Incidence was higher in men (1.93) than in women (1.62), and substantially higher in the population >50 years (12.38). Meta-regression by publication year showed no significant temporal trend ( p = 0.255); however, when the midpoint of the data collection period was used, a significant declining trend was identified ( p = 0.009, R 2 = 23.75%). Conclusions This meta-analysis provides updated global HF incidence estimates, revealing significant regional disparities and rates quadrupling in the population over 50 years. However, the pooled estimate is predominantly derived from high-income countries, limiting generalizability to low- and middle-income settings.