Multidimensional and Multidisciplinary Management of Heart Failure Patients with Frailty

This paper discusses the considerations for multidimensional and multidisciplinary management of heart failure (HF) patients with frailty. Frailty is a multidimensional, dynamic and potentially reversible state, defined by clinical, functional, psycho-cognitive and social domains. Frailty is seldom systematically assessed in clinical practice in HF patients. Paradoxically, although the absolute benefit of HF guideline-directed medical treatment in frail HF patients seems greater, it is under-prescribed. This therapeutic gap could be related to different reasons, such as concerns about safety, polypharmacy and the lack of specific evidence-based data. Frail HF patients require a comprehensive, multidimensional therapeutic strategy that integrates available evidence-based pharmacological interventions with targeted non-pharmacological modalities across multiple clinical disciplines to optimise patient outcomes. The four domains of frailty should be objectively and routinely assessed with a multidimensional approach to facilitate a more individualised and comprehensive care plan delivered by a multidisciplinary team. In the future, we need more dedicated studies and randomised clinical trials that include frail HF patients.