With the aging population and the rise in lifestyle-related diseases, the number of heart failure (HF) patients has been increasing worldwide including Japan. Japan has been already into the era of super-aged society and its progress is faster than anywhere in the world. Therefore, the development of effective and efficient strategies is urgently needed. The pathophysiology for elderly HF patients is quite variable because of the multiple comorbidities, the difficulty of evidence-based pharmacological and non-pharmacological therapy, and higher readmission rate due to the worsening HF. This is not only due to the medical factors such as sarcopenia, frailty and dementia that is specific to the elderly, but also the social factors such as solitude or elderly care by elderly. In order to improve the effective and efficient treatment for elderly HF patients, it is essential to understand the current status and optimize the treatment based on the highly accurate prediction of outcomes. To achieve this, we have to develop a patient registry that can enroll a wide range of HF patients and identify novel factors including biomarkers. Furthermore, taking into account the complexity of elderly HF patients, a comprehensive registry should not be limited by medical institutions or geographical locations. In this symposium, we are going to discuss the need for HF registry and its findings to support the optimization of HF treatment in the elderly.