Urban areas are increasingly affected by extreme heat in the face of climate change, while the size and vulnerability of exposed populations are shifting due to economic development, demographic change, and urbanization. In addition to the need to assess future urban heat-related health risks, there is also an increasing need to design adaptation strategies that will be effective under varying levels of socioeconomic development and climate change. We use the case study of Houston, Texas, to develop and demonstrate a scenario-based approach to explore the effectiveness of both autonomous and planned heat-related adaptations under multiple plausible futures. We couple a heat risk model with urban climate projections (under the Representative Concentration Pathways) and vulnerability projections (under locally extended Shared Socioeconomic Pathways) to investigate the impact of different adaptation strategies under multiple scenario combinations. We demonstrate that, in the context of Houston, community-based adaptation strategies aiming to reduce social isolation are the most effective and the least challenging to implement across all plausible futures. Scenario-based approaches can provide local policymakers with context-specific assessments of possible adaptation strategies that account for uncertain futures.