In a large population-based study from the United States, the influence of heart failure (HF) on clinical and economic outcomes was evaluated among older adults ≥ 75 years of age during their acute myocardial infarction (AMI) admission. In addition, the clinical characteristics were determined that are linked with the presence of HF and the predictors of mortality, healthcare utilization, and cost among older adults with AMI.

• A total of 468,654 patients were examined; there was concomitant HF in 42,946 (9%) patients during their AMI admission.

• Higher risk of death was observed in patients ≥ 75 years of age in correlation with AMI with concomitant HF, but the risk difference diminishes at ages ≥ 85 years due to other competing risks.

• In addition, there was correlation of HF with longer hospital length of stay and higher likelihood of referral to hospice and rehabilitation facilities when compared with older patients without HF.

• Increased hospitalization costs were recorded in correlation with care for these older adults.

• Overall findings highlight the necessity for measures to identify HF in older adults during their AMI admission to optimize health outcomes, care delivery, and costs.