“The elderly patient with known or suspected heart failure should be assessed for relevant comorbid conditions … that may affect treatment, adherence to therapy, follow-up or prognosis” (level I, class C)

“In hospitalized elderly heart failure patients, delirium should be considered when clinically appropriate” (level I, class C)

“Elderly heart failure patients who are frail and have a high comorbid disease burden should be followed up in a disease management setting” (level I, class A)

“The primary care physician or provider should be involved in the disease management plan of frail elderly heart failure patients” (level I, class C)

“Psychosocial issues (eg, depression, fear, isolation, home supports and need for respite care) should be re-evaluated routinely” (level I, grade C)

“Caregivers of patients with advanced heart failure should be evaluated for coping and degree of caregiver burden” (level I, grade C)

Recommends different antibiotic regimen for those with comorbidities such as ischemic heart disease

Discusses knowledge gaps

Advises doctors to stop cholinesterase inhibitors if patients have comorbidities that make using medications risky

Discusses warnings regarding using medications in patients with comorbidities

“Older patients have a response rate with antidepressant therapy similar to younger adults. Clinicians should approach elderly depressed individuals with therapeutic optimism” (grade A)

“Antidepressants should be used when indicated, even in patients with multiple co-morbidities and serious illnesses, as they have similar efficacy rates compared with use in well elderly” (grade B)

“Adverse events in patients with multiple co-morbidities can be minimized by careful selection of drugs that are not likely to worsen or complicate patient-specific medical problems” (grade B)

“Clinicians should choose an antidepressant with the lowest risk of drug-drug interactions when patients are taking multiple medications. Good choices include citalopram, sertraline, venlafaxine, bupropion, and mirtazapine” (grade C)

“Tricyclic antidepressants (TCAs) should not be used in patients with conduction abnormalities on electrocardiogram (ECG) or postural hypotension” (grade B)

“Health care professionals and organizations should implement a model of care that addresses the physical/functional and the psychosocial needs of older depressed adults. Given the complex care needs of older adults, these are most likely to require interdisciplinary involvement in care, whether in primary care or specialized mental health settings” (grade B)

“Health care professionals and organizations should implement a model of care that promotes continuity of care as older adults appear to respond better to consistent primary care providers” (grade B)

Glycemic targets should be less stringent to avoid hypoglycemia and hyperglycemia (grade D, consensus)

Acetylsalicylic acid therapy can be considered in patients with stable cardiovascular disease (grade D, consensus)

People with diabetes and hypertension should be treated to attain systolic BP of < 130 mm Hg (grade C, level 3) and diastolic BP of < 80 mm Hg (grade B, level 2). These target BP levels are the same as the BP treatment thresholds (grade D, consensus)

Specific recommendations for those with acute coronary syndromes, congestive heart failure, and chronic kidney diseases are also provided

A list of comorbidities that require a screening lipid profile is included

Recommendations on when to initiate treatment are provided

Recommends treating systolic BP to < 130 mm Hg and diastolic BP of < 80 mm Hg for patients with diabetes

Specific therapy is provided for patients with the following: diabetes, diabetes with nephropathy, angina, previous myocardial infarction, heart failure, left ventricular hypertrophy, past stroke, chronic kidney disease, renovascular disease, peripheral vascular diseases, or dyslipidemia

Advises physicians to be aware of coexistence of relevant comorbidities, as they might affect treatment choice