PurposePulmonary hypertension (PHT) is a predictor of mortality and morbidity in patients with chronic heart failure (HF). However, the prevalence, determinants, and prognostic significance of PHT in elderly patients admitted with acute decompensated HF are unclear.MethodsWe prospectively evaluated 401 patients aged ≥75 years (mean age 83 ± 5 years, 50% women) with acute HF, who were discharged alive, and whose tricuspid regurgitation (TR) gradient was measured by echocardiography during hospitalization. PHT was defined as a TR gradient ≥30 mmHg. The endpoint was all-cause mortality.ResultsPHT was found in 280/401 patients (69%), including in 67% of patients with HF with reduced ejection fraction (HFrEF) and 73% of patients with HF with preserved ejection fraction (HFpEF) (P = 0.19). Clinical characteristics and comorbidities were similar between patients with and without PHT. The prevalence of PHT increased with increasing severity of mitral regurgitation (MR) (mild: 65%; moderate: 67%; severe: 85%; P < 0.01). After a mean follow-up of 405 ± 399 days, 118 patients (30%) had died. In a multivariate Cox regression analysis, that included age, sex, serum creatinine, TR gradient, comorbidities, and medications at discharge, age (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.03–1.11, P < 0.001), serum creatinine (HR 1.41, 95% CI 1.15–1.73, P < 0.01), and PHT (HR 1.60, 95% CI 1.03–2.49, P < 0.01) were independent predictors of all-cause mortality.ConclusionIn elderly patients admitted with acute HF, PHT is common, mainly associated with the severity of MR and associated with a worse outcome after discharge.