Heart failure patients: what does it change in the elderly?

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.