Patient handout

Heart failure in the frail older adult (chronic, sub-population)

PRODUCTION

1. Your condition

This handout is for heart failure in the frail older adult (chronic, sub-population). Your care team identified this based on: heart failure in a frail older adult (hfpef-predominant).

Other reasons your team may use this plan: gdmt intolerance / symptomatic hypotension / falls on hf meds; high polypharmacy burden with hf regimen; recurrent falls / orthostatic hypotension.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
Clinical Frailty Scale + goals-of-care (what Matters) + prognosis framing	—	—	—	Frailty + goals determine disease-modifying vs symptom-focused intensity before any drug decision (2022 ACC/AHA HF; 4M)

Plan: Frail-elder HF — tolerability-weighted GDMT + deprescribing + goals (2022 AHA/ACC/HFSA HF; STOPP/START; REHAB-HF)

3. When to call your provider

Contact your care team if any of the following happen:

Iatrogenic hypotension/AKI/falls from over-treatment → deprescribe/de-escalate — STOPP/START
Decompensation → goals-concordant escalation vs comfort — 2022 ACC/AHA HF
Advanced frailty/declining trajectory → palliative-led care — 2022 ACC/AHA HF

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptomatic hypotension / pre-renal AKI / falls attributable to HF over-treatment (excess diuretic/RAS/BB) in a frail elder — DE-ESCALATE/deprescribe, do not intensify — STOPP/START; 2022 ACC/AHA HF
Severe frailty / limited prognosis / comfort-aligned goals — symptom-focused care, deprescribe disease-modifying when no longer aligned, palliative integration — 2022 ACC/AHA HF
Orthostatic hypotension / recurrent falls — individualise BP target, check orthostatic BP before RAS/BB titration, reduce over-diuresis, midodrine if HF therapy otherwise limited — geriatric practice

5. Follow-up

Periodic goals-of-care re-evaluation; caregiver support; re-phenotype if HF changes

6. Sources

Guideline: 2022 AHA/ACC/HFSA HF Guideline + 2023 ESC Focused Update on HF; REHAB-HF (Kitzman); STOPP/START