To study efficacy of mildronate in the treatment of elderly patients with cardiac failure (CF).A total of 91 patients with chronic CF (NYHA FC I-III) entered the study. The study group of 63 patients received standard therapy for a month and mildronate in a dose 750 mg/day. The control group of 28 patients was treated conventionally. Subjective and objective assessment of the patients' condition, quality of life questionnaire, ECG, 6-min walk test were used for evaluation of the treatment efficacy.In the study group daily frequency of anginal attacks reduced from 1.6 to 0.7 (in the control group from 1.46 to 1.25, p > 0.05), intensity of the attacks--from 1.4 to 0.7 points by 7-score scale (p < 0.05). Crepitation disappeared in 8 (12.8%) patients, edema of the legs--in 3 (4.8%) patients. Systolic blood pressure went down by 8 mmHg, diastolic one--by 4 mmHg. In the control group clinical changes were insignificant.Elderly patients tolerated mildronate well. It was a safe drug attenuating CF symptoms, increasing exercise tolerance and improving quality of life.