Heart Failure in Older Adults: Real-World Outcomes and Patient Profiles by Admission Service and Sex

Objectives: This study aims to describe real-world clinical profiles, treatment patterns and one-year outcomes of older adults hospitalized for acute heart failure (HF) across different admission services, and to examine whether sex influences these characteristics and outcomes. Methods: We performed a retrospective study including 1226 patients aged ≥80 years hospitalized for acute HF between 2018 and 2021. Patients were categorized by admitting service (cardiology CAR or internal medicine IM) and sex. The primary endpoint was all-cause mortality at 12 months, with secondary endpoints including HF readmission and a composite of death or HF readmission. Results: The mean age was 87.4 ± 4.4 years, 65.8% were women, and 80% presented HF with preserved ejection fraction (HFpEF). Admission services reflected differing patient profiles: individuals admitted under IM were older, predominantly female, and more frequently presented with HFpEF and worse functional class, while CAR admissions included a higher proportion of patients with ischemic disease. Use of guideline-directed medical therapy varied according to clinical characteristics and admitting service. At 12 months, mortality and the composite endpoint differed across admission services, whereas HF readmission rates were similar. Sex-stratified analyses showed no difference in all-cause mortality or in the composite endpoint, but women experienced more frequent HF readmissions. Conclusions: Among very old adults hospitalized for acute HF, clinical profiles, therapeutic patterns, and outcomes differ according to patient characteristics and hospital admission pathways. Sex also shapes clinical presentation and readmission patterns. These findings highlight the importance of harmonized, multidisciplinary, and sex-sensitive HF care pathways to address the diverse needs of an aging HF population.