[Guidelines, heart failure and the elderly]

Area of Science:

• Cardiology
• Geriatrics
• Pharmacology

Background:

• Recent heart failure (HF) guidelines emphasize intensified medical therapy for reduced ejection fraction (HFrEF).
• Sodium-glucose cotransporter 2 inhibitors show promise for HF with preserved ejection fraction (HFpEF).
• Geriatric complexities and specific cardiomyopathies present challenges to guideline implementation.

Purpose of the Study:

• To critically analyze current HF guidelines.
• To illustrate the limitations of guideline applicability in real-world clinical practice.
• To re-evaluate HF management through a cardio-geriatric lens.

Main Methods:

• Review of recent pharmacological therapeutic innovations in HF guidelines.
• Analysis of challenges in applying intensive HF therapy to elderly populations.
• Examination of evidence for sodium-glucose cotransporter 2 inhibitors in HFpEF and specific cardiomyopathies.

Main Results:

• Intensive HF therapy initiation and up-titration are difficult in the elderly due to frailty, comorbidities, and drug side effects.
• Sodium-glucose cotransporter 2 inhibitors are effective for HFpEF but lack data in certain cardiomyopathies.
• Current guidelines may not fully address the needs of diverse patient groups.

Conclusions:

• A cardio-geriatric perspective is crucial for adapting HF guidelines to complex patient populations.
• Further research is needed to optimize HF management in the elderly and in specific cardiomyopathies.
• Real-world application of HF guidelines requires careful consideration of individual patient factors.