Introduction: Women with heart failure have been underrepresented in large clinical trials. Previously published data has suggested that there are significant gender differences in heart failure patients. Most of this data is taken from clinical trials. To determine whether these findings are reflected in real-world practice, we sought to investigate gender differences in a large community-based study of heart failure patients. Hypothesis: In the HF population, there will be significant gender differences in patient characteristics at first presentation as well as clinical outcomes. Methods: We conducted a retrospective study of all HF patients seen in a large multi-site health system from January 2008 through September 2015. Patients with an ICD-9-CM code for heart failure (codes 428.0, 428.1, 428.2, 428.3, 428.4, and 428.9) were included in our analysis. Study outcomes were HF readmission, all-cause readmission, and all-cause mortality. Results: During the study period, our system saw 21,339 unique patients with a primary diagnosis of HF. About 51% were females (10,907) and 49% were males (10,432). Female HF patients were significantly older (77.1 vs 72.3 years, P < .001); however, male HF patients had a significantly greater burden of all major comorbidities including higher prevalence of diabetes, ischemic heart disease, coronary atherosclerosis, peripheral vascular disease, renal failure, liver disease as well as a lower LVEF. Within one year after discharge, 55% had been readmitted for HF, 78% readmitted for any cause, and 34% died; despite the observed gender differences at first HF presentation, there were no significant differences by gender in the rate of HF readmission (55.2% vs 54.2%), allcause readmission (79.0% vs 77.6%), or mortality (33.7% vs 33.8%). Conclusion: There is significant gender-related heterogeneity in the heart failure population. Despite this heterogeneity outcomes after hospitalization for heart failure are similar between genders. Readmission and mortality rates after heart failure hospitalization remain quite high in both genders. Better understanding of these gender differences may provide more patient-specific targets for reducing readmission and mortality after HF admission.