Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent in the elderly, especially in women, and its diagnosis is complicated by complex causes including hypertension, diabetes, and renal dysfunction. The cardiac biomarkers BNP and NT-proBNP are essential markers for the diagnosis of HFpEF and provide strong prognostic value, although their interpretation in elderly patients may be influenced by renal function, age, and other diseases. High-sensitivity troponins indicate chronic damage to the heart muscle and are reliable predictors of mortality and re-hospitalization. sST2 reflects inflammatory and fibrotic remodeling of the heart and shows a consistent association with adverse outcomes, although it has limited diagnostic value. Galectin-3 captures ongoing myocardial fibrosis and structural remodeling, offering particularly powerful prognostic information in HFpEF. A multimarker strategy that integrates markers of wall stress, injury, inflammation, and fibrosis may increase diagnostic accuracy and risk stratification in elderly patients and lead to more personalized treatment approaches.