Be mindful of additional risks when using guideline-directed medical therapy to treat heart failure with preserved ejection fraction in older adults

The prevalence of heart failure with preserved ejection fraction (HFpEF) is greater in adults aged ≥ 60 years than in the general population; however, these patients are also at a greater risk of adverse effects from treatments for HFpEF, due to age-related physiological changes, comorbidities and conditions such as polypharmacy and frailty. Guideline-directed medical therapies recommend the use of loop diuretics and sodium‑glucose co‑transporter‑2 inhibitors for most patients. Some guidelines also carry recommendations for treating some patients with HFpEF with mineralocorticoid receptor agonists, angiotensin receptor blockers and angiotensin receptor-neprilysin inhibitors, although evidence supporting their benefit is weaker. Several new drugs are showing promise for the treatment of HFpEF, but data are lacking in older patients.