Heart failure (HF) is a heterogeneous clinical syndrome marked by substantial morbidity and mortality. The natural history of HF is well established; however, epidemiological data are continually evolving owing to demographic shifts, advances in treatment and variations in access to health care. Although the incidence of HF has stabilized or declined in high-income countries over the past decade, its prevalence continues to increase, driven by an ageing population, an increase in risk factors, the effectiveness of novel therapies and improved survival. This rise in prevalence is increasingly noted among younger adults and is accompanied by a shift towards HF with preserved ejection fraction. However, disparities exist in our epidemiological understanding of HF burden and progression in low-income and middle-income countries owing to the lack of comprehensive data in these regions. Therefore, the current epidemiological landscape of HF highlights the need for periodic surveillance and resource allocation tailored to geographically vulnerable areas. In this Review, we highlight global trends in the burden of HF, focusing on the variations across the spectrum of left ventricular ejection fraction. We also discuss evolving population-based estimates of HF incidence and prevalence, the risk factors for and aetiologies of this disease, and outcomes in different geographical regions and populations.

心力衰竭（HF）是一种异质性临床综合征，其发病率和死亡率很高。心力衰竭的自然史已很明确；然而，由于人口结构的变化、治疗的进步以及获得医疗保健的机会的变化，流行病学数据不断变化。尽管过去十年来高收入国家心力衰竭的发病率已经稳定或下降，但由于人口老龄化、危险因素增加、新疗法的有效性和生存率提高，其患病率仍在继续上升。这种患病率的上升在年轻人中越来越受到关注，并伴随着射血分数保留的心力衰竭的转变。然而，由于缺乏这些地区的全面数据，我们对低收入和中等收入国家心力衰竭负担和进展的流行病学理解存在差异。因此，当前心力衰竭的流行病学状况凸显了针对地理脆弱地区进行定期监测和资源分配的必要性。在这篇综述中，我们强调了心力衰竭负担的全球趋势，重点关注左心室射血分数范围内的变化。我们还讨论了不断变化的基于人群的心力衰竭发病率和患病率估计、该疾病的危险因素和病因，以及不同地理区域和人群的结果。