Summary: Elderly patients constitute a large proportion among patients with heart failure (HF), especially HF with preserved ejection fraction (HFpEF). Treatment of HF in the elderly is challenging due to many concomitant diseases which may imitate or exacerbate HF symptoms, and worsen prognosis. Co-existing diseases may also necessitate modifications in HF treatment. This article provides information on the specificities of HF diagnosis and treatment in elderly patients burdened with numerous concomitant diseases, both cardiac and extracardiac.