Heart failure (HF) is one of the most common cardiovascular diseases in the elderly. The article reviewed the pathophysiological mechanisms of HF in the elderly, revealed the roles of excessive sympathetic activation and energy metabolic remodeling in the development of HF, and evaluated the efficacy of renal denervation, and drugs such as trimetazidine and coenzyme Q10. Meanwhile, we also introduced the roles of pulmonary artery hypertension, ventricular-arterial coupling stiffness and systemic inflammation in the development and progress of HF with preserved ejection fraction.