Top Things to Know: Strategies for Optimizing Heart Failure Care in the Older Adult
Updated: June 18, 2026
Prepared by Trejeeve Martyn, MD, MSc; Director, Heart Failure Population Health, Cleveland Clinic
- Heart failure prevalence is increasing globally and disproportionately impacts older adults (≥65 years of age), making age-specific care strategies essential.
- Evidence-based therapies, particularly guideline-directed medical therapy, are underutilized in older adults with heart failure.
- Heart failure guideline-directed medical therapy (GDMT) has shown consistent treatment benefit in subgroup analyses of key clinical trials, however, the presence of advanced co-morbidities, frailty, and goals of care make implementation of GDMT more nuanced in older adults.
- Consideration of multimorbidity, polypharmacy, frailty, and social needs, using a shared decision-making framework can lead to better outcomes and quality of life for older adults.
- Polypharmacy is a significant concern with every patient encounter being an opportunity to consider deprescribing medications that may not be additive or aligned with patient goals.
- Using a “domain management framework” provides a structured approach to optimizing HF care in older adults, incorporating medical, cognitive, physical, and social factors into a multidisciplinary approach.
- Values and patient preferences are important to ground decisions on medical and invasive care for older patients, particularly those with advanced frailty.
- Advanced care planning is meant to clarify patient goals with early referral to HF specialists and/or palliative care being helpful for those with challenging or refractory symptoms.
- There are several effective tools to improve GDMT implementation in older adults including prescription subsidies, EHR alerting, and algorithmic titration with frequent follow-up in the post-hospital period.
- Emerging digital tools to improve HF management should be evaluated across older populations to ensure equitable access and benefit.
Citation
Lewsey SC, Martyn T, Blumer V, Brownell NK, Denfeld QE, Dunlay SM, Goyal P, Halloway S, Matlock D, Vardeny O, Van Spall HGC; on behalf of the American Heart Association Cardiovascular Disease in Older Populations Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; Council on Basic Cardiovascular Sciences; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology. Strategies for optimizing heart failure care in the older adult: a scientific statement from the American Heart Association. Circulation. Published online June 18, 2026. doi: 10.1161/CIR.0000000000001437