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ObjectivesTo analyze the impact of incorrectly diagnosing precipitating factors (PFs) after an emergency department (ED) visit on outcomes in older patients admitted for acute heart failure (AHF).MethodsA retrospective multicenter cohort study was conducted in the emergency and geriatric departments of six university hospitals in the Paris region. The study population consisted of older patients who presented to the ED with AHF and were subsequently admitted to the geriatric department. Medical records were reviewed to assess the diagnosis of AHF and its PFs, as determined by ED physicians and an expert panel. A poor outcome was defined as a composite endpoint including in-hospital mortality, readmission, and/or death within 30 days of discharge.ResultsDuring the study period, of the 4,163 patients over the age of 75 admitted to the ED, 234 were transferred to the geriatric department with an AHF diagnosis. A PF was identified in 170 patients (73%), mainly infections (52%), arrhythmia (14%), anemia (9%), acute coronary syndrome (6%), and medication non-adherence (6%). An inaccurate diagnosis of the PF during the ED stay was not associated with a poor outcome (OR: 0.77 [0.36–1.63], p = 0.49), unlike elevated serum creatinine levels at admission (OR: 1.01 [1.00–1.01] per 1 μmol/L increase, p < 0.001).ConclusionMost older patients admitted for AHF have an identifiable PF, with infections being the most common. An incorrect diagnosis of the PF in the ED was not significantly associated with a poor outcome.