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[Heart failure in older people with multimorbidity]
Katharina Schmidt-Mende1, Karin Modig2
1med dr, docent och specialist i allmänmedicin, Akademiskt primärvårds-centrum; Karolinska -institute.
Lakartidningen
|January 20, 2026
Summary
This case study highlights how standard heart failure (HF) guidelines can cause adverse events in elderly patients with multiple conditions. Careful drug review and dose adjustment are crucial for managing complex patient care.
Area of Science:
- Geriatrics
- Internal Medicine
- Pharmacology
Background:
- Elderly patients often present with multiple comorbidities, complicating treatment.
- Standard treatment guidelines may not adequately address the needs of older adults with multimorbidity.
- Adverse drug events are common in this population, leading to significant morbidity.
Purpose of the Study:
- To describe a case study of an elderly patient with heart failure (HF) and multimorbidity.
- To illustrate the potential adverse effects of adhering strictly to HF guidelines in complex patients.
- To emphasize the need for individualized treatment and guideline adaptation in geriatric care.
Main Methods:
- A case study approach focusing on a 90-year-old female patient with heart failure and atrial fibrillation.
- Clinical monitoring of drug effects, including cognitive function (clock drawing test), renal function, and blood pressure.
- Analysis of treatment outcomes following drug discontinuation or dose reduction.
Main Results:
- Adherence to HF guidelines led to transient confusion, renal failure, and hypotension.
- Cognitive impairment resolved after adjusting medication regimen.
- The patient experienced dependency in daily life and an unplanned hospitalization.
Conclusions:
- Single-disease guidelines have limited applicability in older adults with multimorbidity.
- Close monitoring for side effects and clinical judgment are essential, sometimes requiring deviation from guidelines.
- General practitioners play a vital role in developing geriatric-specific treatment guidelines.
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