Introduction. The increasing burden of morbidity from heart failure, which is determined to be an age-related disease, new information about sex differences of this pathology determines the need of reviewing existing data on this problem particularly in older patients. The objective is to systematize data on gender differences in heart failure among older patients.Materials and methods. A search of literature for 2011–2023 was conducted in the PubMed, Cochrane Library, Embase, Google Scholar databases, eLibrary. Data on sex and age differences of heart failure was included. The preferred languages were Russian and English. During the initial search, 4,228 sources were found. Full-text peer reviewed journal publications with the results of randomized and non-randomized clinical trials, meta-analyses, systematic reviews, and observational studies were selected.Results and discussion. Gender differences in risk factors, epidemiology, pathophysiology, clinical manifestations, treatment of heart failure (HF), particularly in older and oldest-old patients were characterized. Presented information proves the need for a differentiated approach for managing patients of both sex with HF in advanced age.Conclusion. It is necessary to develop new scientific programs and clinical recommendations for the differentiated management of patients with HF, including older and oldest-old patients in order to improve the prognosis and quality of life.