UK Biobank analysis of 1,104 older heart failure patients revealed that metabolic markers—particularly citrate, omega-3 fatty acids, and specific HDL fractions—significantly enhance 10-year mortality prediction beyond standard clinical assessments. The metabolite-enhanced model achieved 69.1% predictive accuracy versus 66.2% for clinical factors alone, with substantially better calibration reliability. This metabolomic approach represents a meaningful evolution in cardiovascular risk assessment, shifting focus from short-term symptom management to mechanistic understanding of underlying dysfunction. The identified biomarkers illuminate critical pathways: citrate levels reflect mitochondrial energy production capacity, while omega-3 status indicates inflammatory resolution potential—both fundamental to cardiac longevity. For aging adults with heart failure, this precision medicine approach could enable earlier interventions targeting metabolic dysfunction before irreversible decline occurs. However, the modest improvement in predictive accuracy suggests metabolomics complements rather than revolutionizes existing risk tools. The real value lies in actionable insights: patients with poor omega-3 or citrate profiles might benefit from targeted nutritional interventions or mitochondrial support therapies, transforming heart failure care from reactive treatment to proactive metabolic optimization.