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June 19, 2026Circulation
Strategies for Optimizing Heart Failure Care in the Older Adult: A Scientific Statement From the American Heart Association
Why the study?
Older adults face unique challenges in accessing guideline-directed therapies for heart failure, requiring tailored treatment plans to overcome barriers to effective care.
Key Points
- This statement aims to enhance heart failure care for older adults by identifying tailored treatment strategies.
- Review of literature on heart failure management for adults aged 65 and older.
- Discussion of effective therapies, management of multimorbidity, and shared decision-making frameworks.
- Practical guidance on care optimization considering advanced comorbidities and implementation strategies.
- Guideline-directed therapies show consistent treatment effects in older adults with heart failure.
- Structured frameworks improve management of multimorbidity and social needs in this population.
- Implementation strategies and supportive tools may enhance overall care effectiveness for older adults.
Structured PICO
P
Population
Older adults (≥65 years of age) living with heart failure.
I
Intervention
Care optimization strategies, tailored treatment plans, and guideline-directed therapies
This scientific statement provides practical guidance and a structured framework for optimizing heart failure care in older adults, addressing multimorbidity, polypharmacy, frailty, and social needs.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Class I–recommended GDMT has a consistent treatment effect across age groups, including in older adults. However, the burden of health deficits spanning multiple domains in older adults in clinical settings makes them vulnerable to side effects that are best mitigated by careful deployment of algorithmic titration and close monitoring to ensure tolerability. The Domain Management Framework provides a structured approach to optimizing HF care, addressing the complex interplay of medical, cognitive, physical, and social factors in older adults who are prone to falls, frailty, cognitive decline, and social isolation. Prescription subsidies, EHR alerts to clinicians, algorithmic uptitration of GDMT, and digital health tools to activate patients can increase the implementation of GDMT, which is underused across age groups, especially in older adults.”
“A multi-domain approach is needed to provide the best possible treatment to older adults with heart failure. Simply put, heart failure cannot be considered in isolation, without physical functioning, or the social, psychological, and behavioral dimensions of illness. A four-domain framework – involving medical, mind and emotion, physical function, and social environment – should be incorporated in routine clinical work in a tailored, individualized approach.”
Implication
Tailored plans needed to improve GDMT access in older HF patients; extends recommendations to address age-specific barriers.
Abstract
Heart failure prevalence is increasing and has a disproportionate burden on older adults. Older adults, however, may encounter unique challenges in accessing and navigating comprehensive disease-modifying, guideline-directed therapies, thus limiting use among those at highest risk of cardiovascular death or worsening heart failure. Care of the older adult with heart failure requires tailored treatment plans to overcome barriers to effective therapies in this population. This scientific statement reviews the literature on care optimization for older adults (≥65 years of age) living with heart failure and highlights strategies for clinicians who aim to deliver patient-centered, evidenced-based heart failure care in the context of common comorbidities seen in older adults. We discuss the consistent treatment effect and safety profiles of guideline-directed therapies for heart failure in older adults and how to manage multimorbidity, polypharmacy, frailty, and social needs using a shared decision-making framework. In consideration of the complexity of heart failure care of the older adult, we highlight a structured framework for therapeutic considerations in the context of benefit-to-risk ratio, multimorbidity, and social needs. We offer practical guidance on the care of older adults with advanced comorbidities who may not have been adequately represented in landmark trials. We also consider implementation strategies, health services interventions, and supportive tools that may foster optimal care in older adults with heart failure. This work is aimed at informing the practice of clinicians and health systems alike to improve outcomes and to reduce the morbidity of heart failure in older adults.
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Cite This Study
Lewsey et al. (2026) conducted a review in Heart failure. Guideline-directed therapies and care optimization strategies was evaluated. Guideline-directed therapies for heart failure maintain consistent treatment effect and safety profiles in older adults, requiring tailored treatment plans to manage multimorbidity and polypharmacy.