Heart Failure Report: U.S. Headed For Dangerous Territory

TL;DR

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The Heart Failure Society of America projects that 11.4 million U.S. adults will have heart failure by 2050, up from an estimated 7.7 million today. Its HF STATS 2026 report also documents rising mortality and low use of recommended medicines, including among patients with reduced ejection fraction.

The Heart Failure Society of America’s HF STATS 2026 report projects that heart failure will affect 11.4 million U.S. adults by 2050, compared with an estimated 7.7 million today. The report also describes rising mortality and low use of recommended medicines, warning that the growing burden coincides with gaps in prevention and care.

The report estimates that 3% of U.S. adults, or 7.7 million people, currently have heart failure. It projects prevalence will reach 3.2% (8.7 million) by 2030, 3.6% (10.3 million) by 2040 and 3.8% (11.4 million) by 2050. The authors attribute the projected increase to an aging population and rising levels of obesity, hypertension and other cardiometabolic risk factors. They also estimate that about one in four Americans will develop heart failure during their lifetime.

Mortality has worsened across several measures in the report. Age-adjusted heart failure mortality rose about 37% from 2010 to 2023, reversing more than a decade of prior progress, the authors wrote. Among adults ages 25 to 44, unadjusted mortality increased from 0.6 to 1.4 deaths per 100,000 between 2001 and 2020. For those ages 45 to 64, it rose from 6.4 to 12.5 per 100,000 over the same period.

The report identifies a gap between recommended care and treatment in practice. Among more than 3 million patients with heart failure with reduced ejection fraction, real-world data cited by the report show that 18% receive all four recommended medication classes: beta-blockers, renin-angiotensin system inhibitors, mineralocorticoid receptor antagonists and SGLT2 inhibitors. The authors call for better initiation and continuation of guideline-directed medical therapy.

Rising Burden Meets Treatment Gaps

The projections point to a larger population needing diagnosis, ongoing care and treatment as the country ages. The mortality figures add urgency: the report describes worsening outcomes overall, while deaths among adults under 65 also rose over the 2001–2020 period. These measures cover different age groups and time windows, but together they show that heart failure is not solely a concern of older adults.

The treatment figures highlight a possible opportunity to improve care. The report says established medicines are underused despite their benefits and relatively low costs. In an accompanying editorial, Yale School of Medicine physicians Thiru Chinnadurai and Tariq Ahmad argue that health systems need practical ways to help clinicians start and maintain recommended therapies. Their examples include electronic health record decision support, multidisciplinary programs and simpler medication regimens.

The report also points to racial and geographic disparities in heart failure care and a shrinking pipeline of advanced subspecialists as challenges for clinicians and health systems. It does not quantify those issues in the supplied findings, but it includes them among concerns that may complicate efforts to improve outcomes as prevalence grows.

How the Trends Differ by Age

The report describes different patterns by age. Heart failure prevalence remains low among adults ages 20 to 39—0.1% in men and 0.2% in women—and is higher among those ages 40 to 59, at 2.2% in men and 1.8% in women. Even so, the authors argue that younger adults should receive more attention because heart failure hospitalization rates are declining among adults 65 and older but rising among younger adults.

Two accompanying editorials discuss possible responses. Chinnadurai and Ahmad focus on helping patients receive and stay on recommended medicines. Jerice Banola and Andrew Ambrosy, of Kaiser Permanente San Francisco Medical Center, call for more risk-factor screening and control in early adulthood. They also suggest greater use of risk scores and natriuretic peptide testing for patients with stage B heart failure. Those are recommendations from the editorialists, not findings that the report says have already been adopted nationally.

“HF STATS 2026 reports a condition at a critical inflection point: rising mortality, younger age at onset, an expanding at-risk population, and widening gaps between evidence and practice.”

— HF STATS 2026 authors, chaired by Eiran Gorodeski

What the Projections Cannot Settle

The prevalence figures are projections, not counts of future cases. The report attributes expected growth to population aging and risk factors, but the supplied material does not specify how much each factor contributes or how changes in prevention and treatment could alter the estimates. The projected lifetime risk of about one in four Americans is also an estimate, not a prediction about any individual.

The report documents the share of patients receiving all four medication classes, but the supplied findings do not explain why the other patients are not receiving them. They do not establish whether individual patients were eligible for every medicine, whether access or clinical decisions account for the gap, or how much wider use would change population-level outcomes. The authors describe the treatment gap as actionable; the scale and effects of specific proposed programs remain uncertain here.

Although the report identifies racial and geographic disparities and a limited subspecialist pipeline, the supplied source material provides no detailed breakdown of those trends. It is not clear which communities face the largest gaps or how those differences have changed over time.

Turning Recommendations Into Care

The report authors call for coordinated work across medical specialties, health institutions, payers, policymakers and communities. They say priorities include prevention, earlier recognition and wider use of proven therapies, alongside continued research. The accompanying editorials offer potential approaches, such as clinic programs and electronic health record prompts, but the supplied material does not identify a national rollout or a specific next implementation milestone.

Further reporting and follow-up data will be needed to show whether treatment use improves, whether younger adults’ hospitalization and mortality trends change, and how closely future prevalence tracks the projections. For now, the HFSA report sets out the scale of the projected burden and the care gaps its authors say require attention.

Key Questions

How many U.S. adults are projected to have heart failure by 2050?

The HFSA report projects 11.4 million U.S. adults, or 3.8% of adults, by 2050. Its current estimate is 7.7 million, or 3%.

How much did age-adjusted heart failure mortality rise?

The report says age-adjusted heart failure mortality increased by approximately 37% between 2010 and 2023. Separately, it reports increases in unadjusted mortality among adults ages 25 to 44 and 45 to 64 from 2001 to 2020.

What does the report say about heart failure medicines?

Real-world data cited in the report show that 18% of more than 3 million patients with heart failure with reduced ejection fraction receive all four recommended medication classes. The report calls for better initiation and continuation of guideline-directed therapy.

Are younger adults included in the report’s concerns?

Yes. The report says heart failure hospitalizations are declining among adults 65 and older but rising among younger adults. It also reports that unadjusted mortality increased among people ages 25 to 44 and 45 to 64 from 2001 to 2020.

Source: rss