Heart failure (HF) is a complex clinical syndrome affecting multiple organs and systems, with high prevalence, mortality, and medical costs, making it a global public health concern. Asia, with its large population, diverse ethnicities, and complex healthcare systems, faces challenges in HF prevention and management. Limited data on HF epidemiology exist in Asia, prompting this review to summarize the burden of HF in Asia, including its occurrence, etiology, risk factors, outcomes, and management. The review highlights the high age-standardized prevalence of HF in Asia, with China, Indonesia, and Malaysia having the highest rates. HF prevalence has increased in Southeast Asia and South Asia from 1990 to 2019. Ischemic heart disease and hypertensive heart disease are the leading causes of HF globally and in Asia. HFpEF is becoming more prevalent, particularly in Japan, due to aging populations. Air pollution and ambient temperature variations are significant risk factors for HF. Despite some progress, guideline-directed medical therapy remains underutilized, and standardized management is needed. The review emphasizes the importance of controlling risk factors, improving primary and secondary prevention, and promoting standardized treatment to reduce HF burden and improve outcomes. Future directions include managing underlying diseases, enhancing HF care outside hospitals, and gathering more epidemiological data to develop region-specific strategies for HF prevention and management.Heart failure (HF) is a complex clinical syndrome affecting multiple organs and systems, with high prevalence, mortality, and medical costs, making it a global public health concern. Asia, with its large population, diverse ethnicities, and complex healthcare systems, faces challenges in HF prevention and management. Limited data on HF epidemiology exist in Asia, prompting this review to summarize the burden of HF in Asia, including its occurrence, etiology, risk factors, outcomes, and management. The review highlights the high age-standardized prevalence of HF in Asia, with China, Indonesia, and Malaysia having the highest rates. HF prevalence has increased in Southeast Asia and South Asia from 1990 to 2019. Ischemic heart disease and hypertensive heart disease are the leading causes of HF globally and in Asia. HFpEF is becoming more prevalent, particularly in Japan, due to aging populations. Air pollution and ambient temperature variations are significant risk factors for HF. Despite some progress, guideline-directed medical therapy remains underutilized, and standardized management is needed. The review emphasizes the importance of controlling risk factors, improving primary and secondary prevention, and promoting standardized treatment to reduce HF burden and improve outcomes. Future directions include managing underlying diseases, enhancing HF care outside hospitals, and gathering more epidemiological data to develop region-specific strategies for HF prevention and management.