Furthermore, medication and dosing decisions should be made in a holistic context of the pa- tient. At times, deprescribing, or the process of medi- cation withdrawal or dose reduction to correct or prevent medication-related complications, is an appropriate ac- tion (138). Frailty. Frailty is a speci c pathophysiological entity affecting at least 20% of those over the age of 80 years and ampli es cachexia, muscle wasting, and neurological decline. Frailty increases the risk for HF and, when HF is already present, exaggerates both morbidity and mortal- ity. No evidence exists to suggest that any current ther- apies should be withheld or doses modi ed in the setting of frailty. Potential interventions include multidomain rehabilitation along with cognitive and nutritional sup- port programs to accompany standard GDMT for HFrEF (139,140). Standard assessments of frailty are available (134). 5.7. How to Manage Your Patients Costs and Access to HF Medications The economic burden of HF is substantial and is expected to increase markedly in parallel with increases in HF prevalence. Between 2012 and 2030, total direct medical costs for HF are projected to increase from $21 billion to $53 billion (141), while total costs (including indirect outlay) are estimated to increase from $30.7 billion to $69.8 billion (5). After hospital costs, the cost of CV medications is the second most important cost for pa- tients with HF, accounting for 15.6% of direct costs (142). This creates a nancial barrier for many patients, which is compounded by the fact that most patients with HF also have several comorbidities requiring additional medica- tions. For example, diabetes is present in over 40% of all patients with HF, and polypharmacy for diabetes treat- ment is also growing rapidly (143). 