Effect of Rapamycin to Improve Cardiac Function in Frail Older Adults

Inclusion Criteria:

Age ≥60 years
Diagnosis of HFpEF by either H2FEPF score of 6-9 or HFA-PEFF score of 5-6, or invasively confirmed diagnosis of HFpEF (resting pulmonary capillary wedge pressure ≥15mmHg or ≥25mmHg with exercise).
Diagnosis of computable phenotype of frailty rests on screening questions about ability to climb two flights of stairs, activities of daily living, living environment, wearing of dentures/hearing aids, and whether the patient uses assistive devices.

Exclusion Criteria:

Reduced ejection fraction (≤50%) with or without prior history of myocardial infarction
Acute coronary syndrome <3 months
Uncontrolled diabetes mellitus (HbA1C>8)
Uncontrolled hypertension (>160/100mmHg, despite 3 antihypertensive medications)
Nephrotic syndrome or eGFR <30mL/min/1.73m2
Cirrhosis
Hepatitis B/C positive
Elevated lived enzymes (AST/ALT>3ULN
Prior malignancy other than basal cell carcinoma
History of ongoing, chronic or recurrent infectious disease
Suspected/proven immunocompromised state
Uncontrolled hyperlipidemia (fasting TG >400 mg/dL (>4.5 mmol/L) or total cholesterol >300 mg/dL (>7.8 mmol/L) despite maximum lipid lowering therapy
Class IV HF symptoms