Heart failure is one of the most common conditions affecting older patients seen by clinicians in routine office practice. This article reviews the clinical features, diagnosis, and management of heart failure in elderly patients evaluated in the ambulatory care setting, and provides concise, practical information relevant to all major aspects of care. Specific topics include the role of diagnostic testing, such as echocardiography and B-type natriuretic peptide; principles of nonpharmacological management, including patient education, diet, exercise, and daily weights; drug therapy for systolic heart failure as well as heart failure with preserved left ventricular systolic function; end-of-life issues; and when to refer the patient to a specialist. Although heart failure in the elderly differs in many important respects from heart failure occurring in middle-aged patients, the general approach to diagnosis and management is similar in younger and older patients.