Management of heart failure in older people

Heart failure contributes substantially to morbidity and mortality in older people. It is a chronic and progressive disease, with prevalence set to increase with the ageing population as incidence is strongly associated with age. There are many pharmacotherapies available for the treatment of heart failure which reduce morbidity and mortality. These include angiotensin converting enzyme inhibitors, beta-blockers, mineralocorticoid receptor antagonists and more recently angiotensin receptor-neprilysin inhibitor and sodium glucose co-transporter type 2 inhibitors. Older people are under-represented in large randomised clinical trials and therefore data supporting efficacy and safety of heart failure treatments for older people is not as strong as it is for younger people. Additionally, older people with heart failure have higher rates of polypharmacy, comorbidity, cognitive impairment and frailty. This article summarises the principles of heart failure therapy based on evidence-based guidelines as well as the challenges of appropriate management in older people.