Ruzzell C. Flores, Fatin Shadab Talukder, Inna Rabinovich-Nikitin
Heart failure (HF) represents a major and escalating public health challenge in the aging population. Older adults with HF frequently present with coexisting conditions such as hypertension, diabetes mellitus and obesity, which substantially influence disease pathophysiology, clinical presentation, therapeutic response and prognosis. The complex interplay between HF risk factors and comorbidities complicates diagnosis, limits the applicability of guideline-directed therapies and contributes to increased symptom burden, recurrent hospitalizations, higher healthcare utilization and reduced quality of life. In this Review, we examine the mechanisms through which common risk factors and comorbidities modify HF progression and outcomes in elderly patients, highlighting their impact on disease severity and treatment effectiveness. We emphasize the need for individualized, patient-centered management strategies that move beyond a single-disease framework and incorporate multidisciplinary care models. Early identification of comorbidities tailored pharmacological and non-pharmacological interventions, and longitudinal monitoring are essential to address the dual burden of HF and multimorbidity. Finally, we discuss current knowledge gaps and future research priorities, including the need to elucidate shared pathophysiological pathways and to develop integrated therapeutic approaches. Advancing our understanding of HF in the context of aging and risk factor/comorbidity is critical for improving clinical outcomes and informing healthcare policy in this growing patient population.