Frailty in Older Adults with Heart Failure

Abstract

Heart failure (HF) and frailty are increasingly prevalent with population aging, frequently coexist, and share pathophysiological mechanisms. This review summarizes recent evidence on shared biological pathways and management strategies in patients with HF and frailty. Emerging data suggest that accumulation of damaged cellular components, mitochondrial dysfunction, cellular senescence, and chronic inflammation contribute to both conditions. Altered myokine-mediated signaling further highlights skeletal muscle as an important peripheral link between HF and frailty and as a potential therapeutic target. Frailty is increasingly recognized as a clinically relevant measure and potentially modifiable treatment target. Current evidence, largely derived from small or single-center studies, suggests that individualized multidomain interventions, including exercise training, nutritional optimization, and geriatric co-management, may improve patient-centered outcomes. Management should integrate guideline-directed HF therapy with targeted treatment of geriatric syndromes, guided by multidimensional assessment and individual patient goals. Multicenter trials in frail HF populations are needed to inform evidence-based management recommendations.