Heart disease is important in elderly patients. The treatment of myocardial infarction and heart failure are particularly important and will continue to play an important role across the globe. Advances in treatment of myocardial infarction have made tremendous inroads in the short and long term survival of patients, young and old, however, many currently employed strategies have not been tested in patients who are elderly, who paradoxically, form a growing subset of patients with heart disease. A similar paradigm exists in heart failure for both diagnosis and treatment. Attention to this issue is important when selecting treatment strategies and a focus on the goals of care is critical when decisions for care must be undertaken.