The article provides an overview of the epidemiology of heart failure, highlighting its evolving trends and future directions. Heart failure, a heterogeneous syndrome, has been described as an emerging epidemic for about 25 years. The total number of heart failure patients continues to rise due to an aging and growing population, but the case mix is changing. Incidence has stabilized or decreased in some populations, while it has increased in younger individuals, possibly linked to rising obesity rates. There is a clear transition towards heart failure with preserved ejection fraction (HFpEF), which may be partially artificial but reflects the growing burden of obesity-related diseases. The number of heart failure cases is also increasing in low-income countries, where communicable diseases and Western-type lifestyle-related conditions are prevalent. Despite a decline in mortality rates, the epidemic is not yet over. The article discusses the challenges in measuring heart failure prevalence and incidence, the heterogeneity of the syndrome, and the impact of various risk factors and comorbidities. It also explores the evolving case mix, the increasing burden of HFpEF, and the need for better understanding of hospital admissions and readmissions in heart failure patients. Finally, it emphasizes the importance of addressing risk factors and improving primary prevention and treatment adherence, especially in low-income nations.The article provides an overview of the epidemiology of heart failure, highlighting its evolving trends and future directions. Heart failure, a heterogeneous syndrome, has been described as an emerging epidemic for about 25 years. The total number of heart failure patients continues to rise due to an aging and growing population, but the case mix is changing. Incidence has stabilized or decreased in some populations, while it has increased in younger individuals, possibly linked to rising obesity rates. There is a clear transition towards heart failure with preserved ejection fraction (HFpEF), which may be partially artificial but reflects the growing burden of obesity-related diseases. The number of heart failure cases is also increasing in low-income countries, where communicable diseases and Western-type lifestyle-related conditions are prevalent. Despite a decline in mortality rates, the epidemic is not yet over. The article discusses the challenges in measuring heart failure prevalence and incidence, the heterogeneity of the syndrome, and the impact of various risk factors and comorbidities. It also explores the evolving case mix, the increasing burden of HFpEF, and the need for better understanding of hospital admissions and readmissions in heart failure patients. Finally, it emphasizes the importance of addressing risk factors and improving primary prevention and treatment adherence, especially in low-income nations.