Abstract Body (Do not enter title and authors here): Background: Heart failure (HF) poses a substantial and rising global burden, driving disability and healthcare costs across regions. While ischemic heart disease and hypertension are well-known contributors, chronic respiratory diseases (CRDs) are increasingly recognized as significant yet underexplored causes.

Method: We quantified the non-fatal burden of HF attributable to chronic respiratory diseases—COPD, interstitial lung disease (ILD) with sarcoidosis, and pneumoconiosis—across 204 countries from 1990 to 2021 using the Global Burden of Disease Study 2021. Burden estimates were derived by applying standardized severity distributions and disability weights to cause-specific prevalence. Age-standardized prevalence rates and annualized percentage changes were calculated by SDI, age group, and sex to assess temporal and demographic trends.

Results: Between 1990 and 2021, the global prevalence of HF attributable to ILD and pulmonary sarcoidosis surged from 20,228 (95% UI: 16,194–25,346) to 104,058 (80,411–130,772). HF due to COPD increased from 1.5 million (1.1–1.9 million) to 3.6 million (2.6–4.8 million), while pneumoconiosis-related HF rose from 6,201 (4,899–7,857) to 12,929 (10,012–16,448). The highest APC in total prevalence was observed in high SDI regions (3.61%), followed by low-middle SDI (3.00%) and middle SDI (2.86%). Regionally, Latin America and the Caribbean showed the steepest increase (4.14%), followed by North Africa and the Middle East (3.54%) and South Asia (3.43%). In terms of age-standardized prevalence rate, high-income regions recorded the highest annualized rise (1.43%), followed by Latin America and the Caribbean (0.43%) and MENA (0.31%). Age-wise analysis revealed the highest APC among individuals aged 55 years and older (2.99%), followed by those aged 20–54 years (2.01%), and <20 years (0.88%).

Conclusion: Heart failure due to chronic respiratory diseases has risen markedly over the past three decades, with the greatest growth observed in high-SDI regions, older adults, and areas undergoing rapid epidemiological transitions. COPD remains the dominant contributor, but the accelerating burden from interstitial lung disease and pneumoconiosis highlights shifting disease dynamics. These findings underscore the urgent need for integrated cardiopulmonary strategies, particularly in aging and high-risk populations, to address the evolving landscape of heart failure globally.