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Limited data are available describing the clinical characteristics, hospital treatment practices, and hospital and long-term death rates of patients hospitalized with decompensated heart failure (HF). To examine the descriptive epidemiology of acute HF in residents of a large New England metropolitan area during the 2 study years of 1995 and 2000, we reviewed the medical records of patients hospitalized with acute HF at 11 medical centers in the Worcester, Massachusetts, metropolitan area during 1995 and 2000 for purposes of collecting information about patients' sociodemographic and clinical characteristics, hospital management approaches, and hospital and postdischarge mortalities. The mean age of 4,537 residents of the Worcester metropolitan area hospitalized with decompensated HF was 76 years, 57% were women, and most study patients had been previously diagnosed with several co-morbidities. The average duration of hospitalization was 6.3 days and 6.8% of patients died during hospitalization. Diuretics (98%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (54%) were the most common medications used to treat acutely ill patients. The 1- and 5-year death rates of hospital survivors were 39% and 77%, respectively, with no change observed in these death rates between our 2 study years. In conclusion, the results of this observational study in residents of a central New England metropolitan area provide insights into the characteristics, treatment practices, and short- and long-term death rates associated with this increasingly prevalent clinical syndrome.