The global economic burden of heart failure (HF) reached an estimated $284.17 billion in 2021, highlighting a substantial and growing financial strain on healthcare systems and societies worldwide. A new systematic review reveals that indirect costs, such as productivity loss, now account for over half of this total, signalling a significant shift in the economic impact of the condition.¹

Researchers conducted a systematic review according to PRISMA guidelines, analysing 32 studies that reported on the costs associated with HF. The analysis calculated direct costs (DC), such as hospitalisations and treatments, and indirect costs (IC), including productivity loss and informal care. These costs were expressed as a percentage of current healthcare expenditure (CHE) and gross domestic product (GDP) for 2021, using data from the World Health Organization Global Health Expenditure Database. To compare economic burdens across different socioeconomic settings, countries were categorised by their Human Development Index (HDI).¹

The total estimated annual cost of HF was $284.17 billion. This comprised $136.86 billion (48.16%) in DC and $147.31 billion (51.84%) in IC. The findings represent a 123% inflation-adjusted increase from a previous global estimate for 2012.²

While countries with a very high HDI accounted for the largest share of absolute spending, the relative burden was disproportionately higher in low HDI countries. In low HDI nations, DC for HF represented 8.85% of their total CHE, compared to just 1.07% in very high HDI nations. Similarly, IC accounted for 0.29% of GDP in low HDI countries versus 0.09% in very high HDI countries.¹

This analysis underscores the immense and escalating economic impact of HF globally. The near-equal split between direct and indirect costs highlights the broad societal consequences of the condition, extending far beyond direct healthcare spending. The significant disparity in relative burden between high- and low-income nations reveals the critical challenge faced by healthcare systems with fewer resources.

The study authors noted a significant lack of economic data from low- and middle-income countries, which complicates accurate burden estimation and hampers the development of effective health policies in these regions. They call for proactive, cost-effective prevention and management strategies tailored to each country’s specific healthcare framework to address the growing challenge of HF worldwide.¹

The authors declared no funding for this study.

1. Darvish M, Shakoor A, Feyz L, et al. Heart failure: assessment of the global economic burden. Eur Heart J. 2025;46(31):3069–3078. https://doi.org/10.1093/eurheartj/ehaf323

2. Cook C, Cole G, Asaria P, et al. The annual global economic burden of heart failure. Int J Cardiol. 2014;171:368–76. https://doi.org/10.1016/j.ijcard.2013.12.028

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