Hosts Dr. Mitsuaki Sawano, Dr. Kentaro Ejiri, and Dr. Satoshi Shoji welcome Dr. Takeshi Kitai and Dr. Koshiro Kanaoka of the National Cerebral and Cardiovascular Center to discuss their JACC study, Heart Failure in the Oldest-Old: A Growing Clinical and Economic Burden in Aging Japan. Drawing on over 730,000 HF hospitalizations from the JROAD-DPC registry (2016–2022), they reveal how the proportion of patients ≥85 years rose to nearly half of all admissions, with associated costs surging from $870M to $1.03B. Despite lower per-admission costs, the sheer growth in cases has intensified the national burden, underscoring the urgent need for rethinking care models, from palliative care and goal setting to balancing home- and facility-based management in Japan’s rapidly aging society.