Table 2. Common challenges in treating elderly patients with acute heart failure.

Specific issues	Potential causes	Potential solutions
HF: heart failure; ICU: intensive care unit; LD: loop diuretics.
Hypotension	Nitrates Large volume shifts	Low dose nitrates only in selected patients Single LD boluses or continuous infusion Stop antihypertensives without benefit in HF
Polypharmacy	Multiple comorbidities Harmful drugs Unnecessary drugs	Accurate checking of medications Deprescribing
Delirium	Bladder catheter Sedatives Electrolyte disturbances Immobilisation ICU admission Non-invasive ventilation	Avoid bladder catheter Careful use of sedatives Diagnose and treat electrolyte disturbances Early mobilisation Carefully weigh risk vs. benefits regarding ICU admission and non-invasive ventilation Use specific anti-psychotics in selected patients
Sarcopenia, cachexia, frailty	Chronic HF Multiple comorbidities Immobilisation Malnutrition	Optimise HF therapy Treat comorbidities accordingly Early mobilisation and exercise Nutritional advice, supplementation