The incidence and prevalence of heart failure (HF) gradually increase with age. Studies have shown that aging can cause myocardial injury independent of other diseases and eventually lead to HF. This article reviews structural, functional and phenotypic changes of heart caused by aging with emphasis on the research progress in the mechanism of HF caused by aging, including cardiomyocyte senescence, vascular senescence, extracellular matrix remodeling, neuroendocrine imbalance, and non-coding RNA changes. It also introduces several new therapeutic measures for aging-related HF.