Table 12

Specific Patient Cohorts in HF Care

Patient CohortsDescriptionEvidence-Based RecommendationsRisksUncertainties
African AmericansSelf-identifiedGDMTACEI, ARB, and ARNI: higher risk of angioedema compared with Caucasian patients
Uncertain risk of hypotension when combining new drugs with HYD/ISDN
Expected outcomes of ARNI and/or ivabradine in those treated with HYD/ISDN
Older adults≥75 yearsAttempt to establish GDMT; however, doses utilized might need to be lower. Device therapy should be carefully considered due to possibly higher risk for complications in older patientsFalls, worsening of renal function, polypharmacy, costs, comorbidityEfficacy of lower-dose GDMT on outcomes
FrailMeets established frailty criteria (83)GDMT as toleratedUncertain response to GDMT, increase risk for adverse drug reactionsAbility to impact natural history in the frail with HF

ACEI = angiotensin converting enzyme inhibitors; ARB = angiotensin receptor blockers; ARNI = angiotensin receptor-neprilysin inhibitor; GDMT = guideline-directed medical therapy; HF = heart failure; HYD/ISDN = hydralazine/isosorbide dinitrate.