Heart failure in the elderly is common and disabling but largely remains a neglected area of study. The elderly differ in many aspects from their younger counterparts. Interaction of the physiological processes of ageing with the pathophysiological processes of chronic heart failure may explain some of these differences. Elucidation of the basis of the age differences in the pathophysiology and treatment response in chronic heart failure is urgently required. This will require a greater awareness of and a greater effort to address the problem of heart failure in the elderly. It is still, sadly, the case that very few clinical trials are currently addressing the issue of chronic heart failure in the elderly in chronic heart failure.