Care for Older People With Heart Failure - Not just an Affair of the Heart.

Frailty and comorbidity are among the most problematic expressions of advancing age. Frailty is defined as a state of increased vulnerability to disease resulting from a progressive physiological decline in the functional reserve of multiple organs and systems. The concept of frailty is distinct from, yet closely related to, that of comorbidity, defined as the coexistence of two or more diseases in the same individual. Older patients with heart failure, many of whom are frail and affected by multiple concomitant disorders requiring complex medication regimens, are at very high risk for adverse outcomes and, therefore, have the greatest need of assistance and care. Disappointingly, frail older adults with comorbidity and polypharmacy have been completely excluded from randomized clinical trials of heart failure, such that efficacy and safety of established heart failure therapies remain largely unproven in these patients. To derive benefits and avoid harms from existing treatment options, older patients should be managed pragmatically, tailoring strategies to their individual needs and taking into the greatest consideration the role of frailty and comorbidity as arbiters of clinical decision making