Confronting 3.4% National Prevalence of Heart Failure: Are We Ready?

The Korean Society of Heart Failure has long been committed to advancing the understanding of heart failure (HF) through the establishment of multi-center registries for hospitalized patients and the regular publication of HF Statistics.¹,²,³⁾ These enduring initiatives are pivotal for securing indigenous epidemiological data and facilitating scientific exchange. More importantly, they provide the essential evidence base required to shape national health policies and establish treatment guidelines tailored to the specific needs of the Korean population.

Building upon these foundational efforts, in this issue of International Journal of Heart Failure, Lee et al.⁴⁾ release of the HF Statistics 3^rd edition 2025 Update. As of 2023, the prevalence HF in Korea has reached 3.42%, translating to approximately 1.75 million individuals. This figure represents a dramatic shift, with the age-standardized prevalence more than doubling since 2002. Notably, this estimate exceeds or parallels those of many Western populations, such as the United States (approximately 1.9–2.6%), placing Korea at the forefront of the global HF epidemic.⁵⁾ This breach of the 3% threshold is not merely a statistical milestone; it serves as a “canary in the coal mine” for the healthcare system. It is a siren warning of an impending medical crisis if the structural unpreparedness of our current health infrastructure is not addressed.

The explosive growth in HF prevalence is, ironically, a byproduct of medical success. The data indicates that the surge is driven primarily by rapid population aging and improved survival from competing cardiovascular risks rather than an intrinsic increase in age-adjusted incidence, which has remained stable in men and declined in women. Notably, the 5-year survival rate for HF, which began at less than 50% in the early 2000s, has steadily improved and has now surpassed 60%. As mortality rates for acute cardiovascular events decrease and life expectancy extends, a larger cohort of elderly individuals survives long enough to develop HF.⁶⁾ Furthermore, advancements in cancer therapy, while improving survival rates, may also contribute to the pool of susceptible individuals through cardiotoxic side effects, although this specific factor warrants further investigation in the context of the current statistics.⁷⁾ The burden is disproportionately concentrated in the elderly; among those aged 80 years or older, the prevalence has reached a staggering 26.48%. This statistic confirms that HF has transitioned into a ubiquitous health challenge for the geriatric population.⁸⁾

Beneath the quantitative increase lies a more complex qualitative burden. The report highlights a divergence in hospitalization patterns: while admission rates for primary HF have remained relatively stable, hospitalizations for any cause or with HF as a secondary diagnosis have increased substantially. This suggests that HF is increasingly functioning as a chronic comorbid condition within a complex multimorbidity framework rather than as an isolated acute illness.

This trend underscores the growing relevance of Cardiovascular-Kidney-Metabolic (CKM) syndrome. The comorbidity profile of Korean HF patients has evolved, with the prevalence of atrial fibrillation doubling to 20.6% over the past 2 decades. Coupled with high rates of hypertension (77.9%) and diabetes mellitus (66.5%), these findings indicate that simple, heart-centric treatment models are no longer sufficient. The current healthcare system, predominantly designed for acute care, is ill-equipped to handle this shift toward chronic, multimorbid complexity.⁹⁾

The reality of 1.75 million patients necessitates a fundamental paradigm shift. HF must be redefined from a condition treated episodically during hospitalization to a chronic complex disease requiring lifelong, integrated management. To address this, we need a comprehensive national strategy.

First, a government-led prevention and management system, similar to those for cancer or stroke, is imperative to monitor and manage this growing population. Second, policy support for multidisciplinary care teams and transitional care programs is essential to manage CKM syndrome and reduce readmissions. Finally, as the population of patients with advanced HF grows, access to advanced therapies must be strengthened. While the use of left ventricular assist devices has increased following reimbursement expansion, the absolute numbers remain small relative to the total burden.

The prevalence rate of 3.42% is likely not a ceiling, but a baseline for the super-aged society of tomorrow. If we fail to overhaul our healthcare infrastructure now, the system may not withstand the rising tide of HF that this statistic predicts.