Objective To assess the aging burden of hospitalization for heart failure in Chinese populations in Macao.Methods The Macao Heart Failure Study consists of patients hospitalized with a diagnosis of acute heart failure (AHF) at Centro Hospitalar Conde de S(a)o Januário (the only public hospital that provides medical care for the approximately 600,000 residents of Macao) from January 2014 to December 2016.First,we investigated the relationship between socioeconomic development and epidemiological characteristics of HF in Macao.Then we assessed the patients clinical features and outcomes according to the age groups.Results A total of 967 patients were included in the final analysis.The median age at admission was 82 years old.The advanced age at the admission of HF in Macao was significantly associated with a high-income level and the aging population structure.Marked heterogeneity existed in the epidemiological characteristics,clinical features,utilization of evidence-based therapies,short-and long-term outcomes,and prognostic utility of clinical variables among the different age groups.Conclusion Rapid economic development and significantly aging populations have produced a profound impact on the epidemiologicai characteristics of HF in Chinese populations.Acute decompensated heart failure (ADHF) is predominantly a disease of the elderly in Macao,and a significant heterogeneity exists in the clinical features,managements,and outcomes among different age groups.Age-based risk stratification models and multidisciplinary HF teams are urgently needed to improve the management and outcomes of hospitalized heart failure (HHF) patients.