Findings in older patients with heart failure demonstrated their low ability to recognize their own comorbidities. A higher risk for a composite of all-cause mortality or heart failure rehospitalization may exist in patients with less accurate recognition of their comorbidities.

• This study included 1,234 patients hospitalized for heart failure aged ≥65 years (mean age: 80.1 ± 7.7 years; 531 females) divided into three groups depending on the number of agreements between self-reported comorbidities and provider-reported comorbidities: low (1–2, n = 19); fair (3–4, n = 376); and high (5–6, n = 839) agreement groups.

• A composite of all-cause death or heart failure rehospitalization at 1 year was the primary outcome.

• More comorbidities and a higher prevalence of a history of heart failure were present in the low agreement group.

• Good agreement for diabetes, moderate agreement for cancer and stroke, and poor-to-fair agreement for hypertension, chronic obstructive pulmonary disease, and coronary artery disease were observed.

• Poorer outcomes were observed in the fair and low agreement groups vs the good agreement group [fair agreement group: hazard ratio (HR): 1.25; low agreement group: HR: 2.74].