Background and Objectives: We evaluated 20-year trends in heart failure (HF) epidemiology in Korea to quantify changes in its burden from 2002 to 2023. Methods: A nationwide analysis was conducted using a random 50% sample from the Korean National Health Information Database linked to mortality records (2002–2023). HF was defined using diagnostic codes recorded as a primary or secondary condition. We calculated crude and age-standardized rates of prevalence, incidence, hospitalization, and mortality. Survival was assessed using the Kaplan–Meier method, stratified by inpatient versus outpatient diagnosis.Trends in heart transplantation and left ventricular assist device implantations were also examined. Results: By 2023, approximately 1,750,228 individuals had HF (3.41% prevalence). The age-standardized prevalence has more than doubled from 2002 to 2023. The crude incidence increased over time; the age-standardized incidence remained stable in men and declined in women.Hospitalization rates for any cause or secondary HF diagnoses have increased substantially, whereas primary HF hospitalization rates have remained relatively stable. The annual mortality rate in patients with HF was approximately 6.0% in 2023, being markedly higher in older adults.Although short-term survival has improved, particularly in hospitalized patients, long-term survival remains limited. Use of advanced therapies significantly increased. Conclusions The burden of HF in Korea has increased substantially over the past two decades, driven primarily by population aging and improved survival rather than increasing age-adjusted incidence. Despite therapeutic advances, hospitalization and long-term mortality rates remain high, highlighting the need for comprehensive HF strategies in aging societies.

Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent, is associated with high morbidity, and has very few effective treatments.Current Concepts: HFpEF is a heterogeneous syndrome arising from the interplay of cardiac (diastolic, systolic dysfunction, pulmonary hypertension, right ventricular dysfunction, left atrial dysfunction, and chronotropic incompetence) and extracardiac (endothelial dysfunction, skeletal muscle abnormality, pulmonary disease, and renal dysfunction) abnormalities. Although various pharmacological therapies of HFpEF have been introduced and studied, most of them showed a limited clinical benefit. With some advancement in the specific phenotype of HFpEF, diuretics, mineralocorticoid antagonists, sacubitril/valsartan, and lifestyle modifications are recommended as important treatments. Recently, EMPEROR-Preserved trials showed that empagliflozin reduced the combined risk of cardiovascular death or hospitalization for patients with HFpEF, regardless of the presence or absence of diabetes. Several non-pharmacological therapies, including interatrial septal shunt and pacing therapies, have been introduced and are under investigation.Discussion and Conclusion: HFpEF has been recognized as the single greatest unmet need in cardiovascular medicine. Further research is required to understand the concrete pathophysiology for each phenotype of HFpEF. Prevention and management of comorbidities and risk factors for HFpEF are of great importance. Sodiumglucose cotransporter 2 inhibitors may contribute to a change in clinical practice, given the lack of therapeutic options available for patients with HFpEF.