Abstract Body: Background:
Cardiomyopathy (CM) and myocarditis are critical contributors to non-ischemic heart failure and sudden cardiac death, particularly in young adults and children. Despite advancements in diagnostic modalities and management strategies, the epidemiological burden of these diseases in the North Africa and Middle East (NEMA) region remains poorly quantified over time.

Methods:
Using the Global Burden of Disease (GBD) 2021 framework, we estimated the fatal and non-fatal health outcomes of CM and myocarditis across the NEMA region from 1990 to 2021. Non-fatal outcomes were derived through systematic reviews, hospital discharge records, and survey data, modeled using Bayesian meta-regression (DisMod-MR 2.1). Mortality estimates were generated using the Cause of Death Ensemble model (CODEm). We analyzed both all-age counts and age-standardized rates per 100,000 population. Trends were assessed across sex, age group, year, and country. To quantify temporal changes, we calculated the Annualized Percentage Change (APC) in incidence, mortality, and YLDs using a log-linear regression approach.

Result:
From 1990 to 2021, the burden of cardiomyopathy and myocarditis in NEMA rose markedly. Prevalence increased from 122,268 (100,704–149,767) to 249,222 (200,993–303,892) (APC: 2.32%), deaths from 7,631 (5,301–10,723) to 9,973 (8,378–14,408) (APC: 0.87%), and YLDs from 10,768 (7,013–15,629) to 21,858 (13,794–31,127) (APC: 2.31%). In 2021, the highest age-standardized incidence rate (ASIR) was in Iran (12.75) and UAE (12.64) per 100,000. Prevalence rate peaked in UAE (109.8) and Bahrain (97), while mortality was highest in UAE (6.67), Oman (5.55), and Saudi Arabia (5.22). By age, in 2021, the prevalence rate per 100,000 was highest in <20 years (56.94), followed by 55+ years (45.12) and 20–54 years (25.84). Death rates were 8.02 in 55+, 0.71 in 20–54, and 0.70 in <20. YLDs rates were 5.14 in <20, 3.60 in 55+, and 2.24 in 20–54. Males showed a higher burden: incidence rose 113% vs 110%, deaths 51% vs 6%, and YLDs 121% vs 77%, compared to females.

Conclusion:
The burden of CM and myocarditis in the NEMA region has significantly increased over the past three decades, with a notable rise in prevalence and disability, particularly among males and younger populations. Persistently high mortality in older adults and widening sex disparities underscore the urgent need for targeted prevention, early detection, and region-specific management strategies.