As the population ages, so the prevalence of chronic heart failure (CHF) will rise. The majority of CHF patients in the future will be elderly, yet most of our current evidence for the management of this serious condition arises from trials that have largely excluded older patients. As a consequence, older patients who may derive the greatest benefit from treatments known to reduce morbidity and mortality in CHF, are often denied such treatments. The effects on quality of life of both the syndrome of CHF and its treatment in older CHF patients must be borne in mind, as must issues of compliance, prevalence of comorbidity, and requirement for physical and emotional support. We review the current epidemiology of CHF, and focus on the applicability and use of contemporary non-pharmacological and pharmacological therapy to older patients with CHF. The potential use of devices and surgery in older CHF patients is also discussed.