HF affects more than 10% of adults aged 70 years or older and is associated with significant morbidity, mortality and frequent hospital admissions. Research efforts mainly focus on left ventricular (LV) dysfunction, while the syndrome of right heart failure (RHF) is overlooked. The prevalence and significance of predominantly right versus left sided heart failure in a cohort admitted with decompensated symptoms remains poorly described. To describe the prevalence of predominantly RHF in a cohort admitted for decompensated symptoms, and to assess for differences in clinical characteristics and length of stay (LOS) in those with predominantly RHF vs. LHF. 442 patients hospitalized for decompensated HF between January 2010 and January 2011 were identified and the health records retrospectively analyzed as part of a larger ongoing study. Based on signs and symptoms, a diagnosis of predominantly RHF or LHF was determined according to current guidelines. The prevalence of RHF was 22% and LHF was 78%. RHF was associated with fatigue (p<0.0001), pre-syncope/ syncope (P<0.01), loss of appetite (p=0.01), increased abdominal girth (p<.0.0001) and abdominal discomfort (p<0.001). LHF was associated with orthopnea (P=0.0003), PND (p=0.003), and chest pain (p<0.001). RHF patients had more hepatomegaly (p=0.0001), ascites (p<0.0001) and anasarca (p=0.0006) while LHF patients more often had rales (p<0.0001) and pulmonary edema (p<0.0001). Both a longer mean duration of HF symptoms prior to admission (46.7 ± 81.6 vs. 21.0 ± 37.6, p<0.0001) and a longer LOS (18.0 ± 20.5 vs. 14.6 ± 12.6, p=0.04) was observed among those with RHF. More than one in five patients admitted with decompensated symptoms had predominantly RHF. The clinical syndromes of predominantly right and left sided HF are associated with distinct sets of presenting features. Patients with RHF had a significantly longer LOS.