In a super-aging society, the characteristics of acute heart failure （HF） are increasingly shaped by patients of advanced age who are rarely represented in clinical trials. We retrospectively evaluated patients aged ≥18 years hospitalized with acute HF between April 2016 and March 2021 at a single center and classified them as HF with reduced left ventricular ejection fraction （LVEF） （HFrEF, ≤40%） or non-reduced LVEF （HFnon-rEF, >40%）. Of 524 admissions, 437 patients were discharged （136 HFrEF, 301 HFnon-rEF）. The cohort had a median age of 85 years̶markedly older than typical trial cohorts̶and, overall, patients with HFnon- rEF were older. One-year composite outcomes （HF readmission and cardiovascular death） occurred in 37.7%, with higher rates in HFrEF than in HFnon- rEF （43.8% vs. 34.9%, P = 0.03）. One-year all-cause mortality was 19.7%. These event rates exceeded those reported in younger populations, and the use of guideline-directed therapies remained limited. Among patients with HFrEF, the use of ACEI/ ARB, beta-blockers, and MRAs was 61.0%, 72.8%, and 30.9%, respectively. The findings underscore a substantial evidence gap and indicate an increasing need for HF management strategies tailored not only to LVEF but also to patient age, particularly in older adults.