What are the considerations when determining optimal doses of GDMT for older adults with HFrEF?
Older adults, especially the very elderly, represent yet another conundrum for treatment of HF. Target doses for GDMT should be attempted in older patients, with close surveillance for any adverse drug reactions. The pharmacokinetic profile for GDMT as a function of age is not known, and higher risks of adverse events (133) have been described in older populations. Accordingly, optimal doses for older patients may be lower than those studied in trials or tolerated in younger patients. Furthermore, medication and dosing decisions should be made in a holistic context of the patient.