The prevalence of heart failure (HF) and the complexities of its management increase with age. Our city serves a population of 551,800inhabitants with a growing elderly population. The size of the 90years and above age group has increased by 26% since 2001 to 4300people.

Patients with suspected HF and a natriuretic peptide (NTproBNP) greater than 400pg/mL undergo an echo and are reviewed by a HF cardiologist. We characterised the patients aged 90–99years presenting to the diagnostic HF clinic between March 2012 and September 2014 by the diagnoses, co-morbidities, symptoms and whether the clinic changed their management.

Of 1785patients seen, 144patients (9%) were nonagenarians with HF. The male to female ratio was 1:1.38. The diagnoses were HF due to left ventricular systolic dysfunction (HF-LVSD) (44%), heart failure with preserved ejection fraction (HFPEF) (38%), pulmonary hypertension (12%), valve disease (5%) and heart failure due to right ventricular systolic dysfunction (HF-RVSD) in 1 patient (<1%). The average number of co-morbidities was four. The majority of patients (62%) had mild symptoms (New York Heart Association Class II). Management was changed in 92.4% of patients. Further follow-up was offered to 14% of patients at a HF nurse-led clinic and 9% at a cardiologist-led clinic.

HF-LVSD, and not HFPEF, is the most common HF diagnosis amongst nonagenarians presenting to the diagnostic HF clinic. Beyond making detailed diagnosis, the clinic changed the management of 92.4% of patients.