Abstract Body (Do not enter title and authors here): Heart failure (HF) is a growing global health concern, and cirrhosis is an increasingly recognized non-cardiac contributor through mechanisms like volume overload, systemic inflammation, and cirrhotic cardiomyopathy. As the global prevalence of liver disease rises, especially from nonalcoholic fatty liver disease (NAFLD), alcohol use, and viral hepatitis, understanding the burden of HF due to cirrhosis is essential.


We estimated the non-fatal burden of HF attributable to cirrhosis across five etiologies—NAFLD, alcohol use, hepatitis C, hepatitis B, and other causes—in 204 countries and territories from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Non-fatal burden was estimated by applying standardized severity distributions and disability weights to the prevalence of each cause to quantify impairment. Age-standardized prevalence rates (ASPRs) and annualized percentage changes (APCs) were calculated by SDI, age, and sex. Future prevalence to 2050 was projected using a log-linear regression model.


Between 1990 and 2021, total prevalence counts rose substantially across all cirrhosis subtypes. NAFLD-related HF increased from 9,202 (95% UI: 6,417–12,641) to 30,092 (20,452–42,009); alcohol-related from 35,701 (27,666–45,427) to 82,258 (61,635–108,803); hepatitis C from 47,484 (37,044–60,873) to 92,079 (70,272–120,432); hepatitis B from 59,974 (47,824–74,529) to 112,111 (87,717–142,335); and other causes from 99,977 (77,246–129,309) to 133,311 (102,461–169,414). The highest ASPR increase was seen in low SDI regions (APC: 2.49%), followed by high SDI (2.24%), middle (1.73%), high-middle (1.67%), and low-middle SDI (1.60%) regions. In 2021, children aged 5–9 years exhibited the highest burden within the under-20 group (26,749 cases), while adults aged 65–69 years had the peak burden among older individuals (51,379 cases). Females showed a marginally higher annual growth in total prevalence (APC: 0.79%) and ASPR (0.04%) compared to males (0.78% and 0.01%, respectively). Projections estimate the prevalence of heart failure due to cirrhosis will increase to 788,332 cases globally by 2050.


HF attributable to cirrhosis is a growing global health concern with rising prevalence across all etiologies, disproportionately impacting low-SDI regions and older adults. The projected surge by 2050 underscores an urgent need for integrated liver-cardiac care, early detection, and policy interventions targeting modifiable liver disease risk factors.