The majority of heart failure (HF) patients are older adults and most HF-related adverse events occur in these patients. However, the independent association of age and outcomes in HF is not clearly determined. We categorized 7788 ambulatory HF patients who participated in the Digitalis Investigation Group (DIG) trial as younger (< 65 years) and older (> or = 65 years). Propensity scores for older age were calculated for each patient and used to match 2381 pairs of younger and older patients. The associations of older age with mortality and hospitalization during a median 40 months of follow-up were assessed using matched Cox regression models. All-cause mortality occurred in 877 older patients versus 688 younger patients (hazard ratio when older age was compared with younger age (HR)=1.26; 95% confidence interval (CI)=1.12-1.41; p<0.0001). Older patients, when compared with propensity-matched younger patients, also had significantly higher mortality rates due to cardiovascular causes (HR=1.14; 95% CI=1.00-1.30; p=0.044) and worsening heart failure causes (HR=1.32; 95% CI=1.07-1.62; p=0.009). No significant association was found between age and hospitalization due to all causes (HR=1.08; 95% CI=0.99-1.18; p=0.084) and cardiovascular causes (HR=1.03; 95% CI=0.93-1.13; p=0.622). However, hospitalization due to HF was significantly increased in older patients (HR=1.14; 95% CI=1.01-1.28; p=0.041). In ambulatory HF patients, older age although associated with increased mortality, was not associated with increased hospitalizations except for those due to worsening HF.