https://doi.org/10.4081/gc.2026.11708
Heart failure patients: what does it change in the elderly?
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Published: 19 February 2026
Heart failure (HF) represents a growing public health challenge, particularly among older adults. Its prevalence increases with age and is frequently complicated by frailty, multimorbidity, and functional decline, all of which worsen prognosis and complicate management. The relationship between HF and frailty is bidirectional: HF promotes sarcopenia, cachexia, and inflammation, while frailty reduces resilience and tolerance to therapy.
The objective of the paper is to summarize current evidence on the management of HF in frail older adults, highlighting recent pharmacological advances, geriatric considerations, and emerging multidisciplinary strategies.
A narrative synthesis has been performed, including the most recent European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, position papers, and randomized controlled trials focusing on drug therapy, non-pharmacological interventions, and comprehensive geriatric care in older adults with HF. Guideline-directed medical therapy for HF with reduced ejection fraction—comprising sodium-glucose co-transporter 2 (SGLT2) inhibitors, angiotensin receptor-neprilysin inhibitors, β-blockers, and mineralocorticoid receptor antagonists—remains the cornerstone of treatment. Evidence for HF with mildly reduced ejection fraction and HF with preserved ejection fraction supports SGLT2 inhibitors and individualized management of comorbidities. Multidimensional interventions, including nutritional support, tailored physical rehabilitation, cognitive and psychological care, and telemonitoring, significantly improve outcomes. Structured transitional care and early palliative integration reduce readmissions and enhance quality of life.
Effective management of HF in frail older adults requires combining evidence-based pharmacological therapy with a holistic, geriatric, and multidisciplinary approach spanning hospital, transitional, and community settings. Strengthening randomized evidence and integrating comprehensive care models are essential to improving prognosis and functional independence in this vulnerable population.
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Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023;118:3272-87. DOI: https://doi.org/10.1093/cvr/cvac013
Díez-Villanueva P, Jimenez-Mendez C, Alfonso F. Heart failure in the elderly. J Geriatr Cardiol 2021;18:219-32.
McDonagh TA, Metra M, Adamo M, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2023;44:3627-39. DOI: https://doi.org/10.15829/1560-4071-2023-5168
Riccardi M, Pagnesi M. Refining the diagnosis of acute heart failure in the elderly. ESC Heart Fail 2024;11:3463-5. DOI: https://doi.org/10.1002/ehf2.15017
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-726. DOI: https://doi.org/10.1093/eurheartj/ehab670
Seo Y. Diagnosis of heart failure in the elderly: current status and future perspectives for echocardiographic diagnostic systems. J Med Ultrason 2022;49:381-8. DOI: https://doi.org/10.1007/s10396-022-01223-5
Pezzini S, Daus F, Galli G, et al. Cardiac magnetic resonance in heart failure: diagnostic and prognostic assessments. J Cardiovasc Dev Dis 2025;12:200. DOI: https://doi.org/10.3390/jcdd12060200
Savarese G, Stolfo D, Sinagra G, Lund LH. Heart failure with mid-range or mildly reduced ejection fraction. Nat Rev Cardiol 2022;19:100-16. DOI: https://doi.org/10.1038/s41569-021-00605-5
Tschöpe C, Elsanhoury A, Kristen AV. Transthyretin amyloid cardiomyopathy-2025 update: current diagnostic approaches and emerging therapeutic options. J Clin Med 2025;14:4785. DOI: https://doi.org/10.3390/jcm14134785
Tana M, Piccinini R, Moffa L, Tana C. Heart failure with preserved ejection fraction and cardiac amyloidosis in the aging heart. Int J Mol Sci 2024;25:11519. DOI: https://doi.org/10.3390/ijms252111519
Yasmin F, Shah SMI, Naeem A, et al. Artificial intelligence in the diagnosis and detection of heart failure: the past, present and future. Rev Cardiovasc Med 2021;22:1095:1113. DOI: https://doi.org/10.31083/j.rcm2204121
Alghamdi F, Chan M. Management of heart failure in the elderly. Curr Opin Cardiol 2017;32:217-23. DOI: https://doi.org/10.1097/HCO.0000000000000375
Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation 2022;145:e895-1032. Erratum in: Circulation 2022;145:e1033. Erratum in: Circulation 2022;146:e185. Erratum in: Circulation 2023;147:e674.
McMurray JJV, Packer M, Desai AS, et al. Dual angiotensin-receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the PARADIGM-HF trial. Eur J Heart Fail 2013;15:1062-73. DOI: https://doi.org/10.1093/eurjhf/hft052
Nadziakiewicz P, Szczurek-Wasilewicz W, Szyguła-Jurkiewicz B. Heart failure in elderly patients: medical management, therapies and biomarkers. Pharmaceuticals 2024;18:32. DOI: https://doi.org/10.3390/ph18010032
McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019;381:1995-2008. DOI: https://doi.org/10.1056/NEJMoa1911303
Jarocki M, Green S, Wu HHL, Chinnadurai R. Cardiorenal syndrome in the elderly: challenges and considerations. Geriatrics 2025;10:10. DOI: https://doi.org/10.3390/geriatrics10040104
Maidana D, Arroyo-Álvarez A, Barreres-Martín G, et al. Targeting inflammation and iron deficiency in Heart failure: a focus on older adults. Biomedicines 2025; 13:462. DOI: https://doi.org/10.3390/biomedicines13020462
Bakris GL, Agarwal R, Anker SD, et al. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med 2020;383:2219-29. DOI: https://doi.org/10.1056/NEJMoa2025845
Spadafora L, Bernardi M, Sarto G, et al. Towards the fifth pillar for the treatment of heart failure with reduced ejection fraction: vericiguat in older and complex patients. Am J Cardiovasc Drugs 2024;24:469-79. DOI: https://doi.org/10.1007/s40256-024-00652-6
Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med 2022;387:1089-98. DOI: https://doi.org/10.1056/NEJMoa2206286
Dunlay SM, Roger VL, Redfield MM. Epidemiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2017;14:591-602. DOI: https://doi.org/10.1038/nrcardio.2017.65
Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med 2021;385:1451-61. DOI: https://doi.org/10.1056/NEJMoa2107038
Žižka O, Haluzík M, Jude EB. Pharmacological treatment of obesity in older adults. Drugs Aging 2024;881-96. DOI: https://doi.org/10.1007/s40266-024-01150-9
Schulz-Menger J, Collini V, Gröschel J, et al. 2025 ESC guidelines for the management of myocarditis and pericarditis. Eur Heart J 2025;46:3952-4041. DOI: https://doi.org/10.1093/eurheartj/ehaf192
Goyal A, Tariq MD, Singh A, et al. Systematic review and meta-analysis comparing complete versus incomplete or culprit-only revascularization by percutaneous coronary intervention in elderly patients with acute coronary syndrome. Curr Probl Cardiol 2024;49:102790. DOI: https://doi.org/10.1016/j.cpcardiol.2024.102790
Wani F, Amir R, Aljadah M, et al. Implantable cardiac devices in geriatric patients: a primer for primary and geriatric physicians. Rev Cardiovasc Med 2021;22:39-50. DOI: https://doi.org/10.31083/j.rcm.2021.01.222
Praz F, Borger MA, Lanz J, et al. ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2025;46:4635-736. DOI: https://doi.org/10.1093/eurheartj/ehaf194
Boureau AS, Annweiler C, Belmin J, et al. Practical management of frailty in older patients with heart failure: statement from a panel of multidisciplinary experts on behalf the Heart Failure Working Group of the French Society of Cardiology and on behalf French Society of Geriatrics and Gerontology. ESC Heart Fail 2022;9:4053-63. DOI: https://doi.org/10.1002/ehf2.14040
Fønss Rasmussen L, Grode LB, Lange J, et al. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open 2021;11:e040057. DOI: https://doi.org/10.1136/bmjopen-2020-040057
Koehler F, Koehler K, Deckwart O, et al. Efficacy of telemedical interventional management in patients with heart failure (TIM-HF2): a randomised, controlled, parallel-group, unmasked trial. Lancet 2018;392:1047-57. DOI: https://doi.org/10.1016/S0140-6736(18)31880-4
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