[Heart failure in older people with multimorbidity].

This primary care case study describes a 90-year old woman with heart failure (HF), atrial fibrillation and other comorbidities. The use of multiple drugs prescribed in accordance with HF guidelines resulted in transient confusion, renal failure and hypotension leading to dependency in daily life and an unplanned hospitalisation. Cognitive impairment was confirmed through a pathological result on the »clock drawing test« normalizing after discontinuation or dose reduction of several drugs. Single disease guidelines have limited evidence in older adults with multimorbidity who are systematically excluded from randomized controlled trials, and serious adverse events are common. This underscores the necessity of closely monitoring side effects and deviating from guidelines when clinically appropriate. General practitioners should actively contribute to the development of treatment guidelines to better address the complexities of care for older adults with multimorbidity.