Heart failure contributed to 452,573 U.S. deaths in 2023, a new peak, and the disease is increasingly affecting younger adults, a new Heart Failure Society of America report found.
The “HF Stats 2026: An Updated Report on Heart Failure Epidemiology and Outcomes Statistics from the Heart Failure Society of America” report compiles principal findings for a comprehensive picture of the changing state of heart failure in the U.S., according to an Oct. 5 association news release.
Here is what to know.
1. Nearly 1 in 4 Americans will develop heart failure in their lifetime, the report found. Heart failure contributed to 452,573 deaths in 2023, representing 14.6% of all-cause deaths. Age-adjusted heart failure mortality rose approximately 37% from 2010 to 2023 — reversing more than a decade of progress. Early 2024 data suggest the increase is continuing.
2. Between 2010 and 2022, heart failure hospitalization rates rose in adults younger than 65 but declined in adults over 65.
3. Between 2001 and 2020, crude heart failure mortality rates jumped 121% for adults 25 to 44 and 96% for those 45 to 64. By comparison, older adults saw an increase of 21% to 23%, “signaling a fundamental shift in the epidemiological landscape of heart failure,” the report said.
4. In 2020, direct and indirect heart failure-related costs totaled about $46 billion. All healthcare costs incurred by adults with heart failure reached $312 billion annually, with hospitalizations accounting for nearly 40% of those costs. Direct heart failure costs are estimated to reach $142 billion by 2050.
5. About one-third of American adults without symptomatic heart failure met criteria for being at risk for heart failure, and an additional 24% to 34% had pre-heart failure. Heart failure prevalence is estimated to be around 3%, or 7.7 million people, and is projected to rise to 3.2%, or 8.7 million people, by 2030. By 2050, projections show 3.8%, or 11.4 million people, could have heart failure. The increase is driven by an aging population, as well as rising rates of obesity, hypertension and other cardiometabolic risk factors.
6. Age-adjusted incidence of heart failure were higher among Black people than any other racial group, with a rate of 41.7 per 100,000.
7. Black men and women had heart failure hospitalization rates approximately 2.4-fold higher than white men and women in 2022.
8. Heart failure prevalence varied widely by state, from 8% in Hawaii to 15% in Oklahoma. States in the Deep South, Appalachian and lower Midwest had the highest concentration of heart failure. From 1999 to 2020, Alabama, Arkansas, Mississippi and Oklahoma repeatedly ranked among the top five states for highest age-adjusted heart failure mortality rates.
9. Between 2010 and 2022, rural heart failure hospitalization rates declined from 249 to 176 per 100,000 — driven in part by rural hospital closures and reduced healthcare access. Rural patients were less likely to receive optimal guideline-directed medical therapy (GDMT) post-discharge, had fewer post-discharge cardiology visits and higher 30-day mortality at critical access hospitals.
10. Only 18% of more than 3 million patients with heart failure with reduced ejection fraction were receiving all four recommended classes of guideline-directed medications, according to electronic medical record data. Full implementation of GDMT would save more than 94,7000 lives each year. Prescribing all four therapies costs less than $5,000 per quality-adjusted life year gained, the report found.
11. Specific cardiomyopathies are underdiagnosed. Transthyretin amyloid cardiomyopathy prevalence among Medicare beneficiaries rose more than fivefold from 2010 to 2021, going from 15.8 to 85.6 per 100,000. Yet, the true prevalence is unknown due to underdiagnosis, the report said.
12. Heart failure disproportionately affects several vulnerable populations. Older adults with heart failure have a high burden of multidomain health deficits, including frailty, cognitive impairment and depression. Cancer survivors face a 1.4- to 1.6-fold higher relative risk of incident heart failure, and those with heart failure face higher mortality. Pregnancy-associated heart failure contributes to more than 10% of pregnancy-related deaths.
13. Advanced heart failure and cardiogenic shock have surpassed acute myocardial infarction as the leading shock etiology in registries. Advanced heart failure affects an estimated 350,000 to 500,000 U.S. adults, while cardiogenic shock complicates an estimated 60,000 to 120,000 hospitalizations a year. “This high-acuity population represents both the greatest unmet need in heart failure care and a critical target for future research and therapeutic development,” the report said.
14. The advanced heart failure workforce includes 1,523 Advanced HF and Transplant Cardiology-certified physicians as of June 2025, with declining Match applicants per position since 2020. Most heart failure clinics use advanced practice providers, who are associated with significant reductions in admissions and mortality, but the majority of programs lack psychological staff, dietitians, social workers and dedicated pharmacy support.
15. End-of-life care is poorly integrated for heart failure patients. More than 80% of patients are hospitalized in the final year of life, advanced care planning is documented in only 34% of patients and implantable cardioverter defibrillator deactivation prior to death occurred in about 40% of patients.
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