Schmidt IM, et al. – This cohort study examined heart failure (HF) epidemiology and treatment trajectories in centenarians vs nonagenarians (aged 90-99 years) and octogenarians (aged 80-89 years) with comorbid HF and kidney disease. Data showed lower prescription rates in centenarians despite a continuous increase in the prevalence of HF with age, and, for those with comorbid HF and kidney disease, a lower prevalence of kidney disease was observed among centenarians vs younger patients before death. Further, renin-angiotensin-system inhibitors were used to treat half of the patients in all three age groups with HF and kidney disease, and approximately 2 of 5 patients received beta-blockers, while prescription rates of aldosterone inhibitors were low. Overall, these findings call for disease management programs and trials to develop guidelines to address the medically challenging treatment for very old patients with comorbid HF and kidney disease.