Heart failure & cardiomyopathiesCohort study
Heart Failure Among 173,000 Community-Dwelling Participants From 25 Low-, Middle-, and High-Income Countries in the PURE Study
- Prospective cohort study
- multinational
- 8 geographic regions
- median follow-up 15 years
Authors' conclusion
HF incidence and associated mortality vary substantially across countries at different levels of economic development and by geographic region. Hypertension is the largest population-level risk factor for HF globally.
Study context
- Population
- Community-dwelling individuals from 25 high-income countries (HICs), upper middle-income countries (UMICs), lower middle-income countries (LMICs) and low-income countries (LICs) (PURE study)
- Participants
- 172,653 individuals · 25 countries
- Exposure
- Heart failure (HF) incidence and case fatality by country income group and geographic region
- Outcome
- Age- and sex-standardized HF incidence
- Follow-up
- Median 15 years
Main finding
As reported in the abstract
Standardized incident HF rate
- Overall standardized HF incidence per 1,000 person-years
- 0.39 (95% CI 0.36-0.41)
- Sub-Saharan Africa
- 1.18 (95% CI 0.95- 1.41)
- Europe and Central Asia
- 0.86 (95% CI 0.72-1.00)
- South Asia, lowest
- 0.19 (95% CI 0.15-0.22)
Observational data: associations, not effects.
Further findings
| Outcome | HICs | UMICs | LMICs | LICs |
|---|---|---|---|---|
| 30-day case fatality · highest in LICs, lowest in HICs | 11% | Not reported in the abstract | Not reported in the abstract | 59% |
| 5-year case fatality after HF diagnosis · highest in LICs, lowest in HICs | 28% | Not reported in the abstract | Not reported in the abstract | 77% |
- 30-day case fatality — South Asia
- 63%
- 30-day case fatality — Sub-Saharan Africa
- 63%
- 30-day case fatality — North America, lowest
- 12%
- 5-year case fatality after HF diagnosis — South Asia
- 81%
- 5-year case fatality after HF diagnosis — Sub-Saharan Africa
- 75%
- 5-year case fatality after HF diagnosis — North America, lowest
- 25%
PAF for incident HF from 13 modifiable risk factors
- PAF attributable to the 13 modifiable risk factors
- >71%
- Hypertension, largest PAF
- 25%
Original publication
Heart Failure Among 173,000 Community-Dwelling Participants From 25 Low-, Middle-, and High-Income Countries in the PURE Study. J Am Coll Cardiol. Published 22 April 2026. doi:10.1016/j.jacc.2026.02.5085
Summarised from the published abstract; every number is checked against it