Heart failure management has undergone substantial advances, driven by the development of novel pharmacotherapies that have improved survival, reduced hospitalization rates, and enhanced quality of life. This talk will provide an overview of contemporary guideline-directed medical therapy, including angiotensin receptor–neprilysin inhibitors (ARNIs), sodium–glucose cotransporter-2 (SGLT2) inhibitors, mineralocorticoid receptor antagonists, and emerging agents. Their efficacy, safety, and real-world applicability in older adults will be discussed. The geriatric population presents unique challenges, including multimorbidity, polypharmacy, frailty, and age-related changes in pharmacokinetics and pharmacodynamics, all of which may influence treatment selection and tolerability. Evidence gaps, including the underrepresentation of older adults in clinical trials, will also be addressed. Practical strategies for individualized care, deprescribing, and shared decision-making will be highlighted to optimize outcomes. This session aims to equip clinicians with updated knowledge and a patient-centered framework for applying heart failure pharmacotherapy in the growing geriatric population.