Background: During the last few years, significant pathophysiological differences between heart failure (HF) patients with “normal” ejection fraction (EF) (50% to 64%) and those with supra-normal EF (≥65%) have been highlighted. However, these distinct EF phenotypes have been poorly investigated in elderly patients aged ≥70 yrs. Methods: All patients aged ≥70 yrs discharged from our Institution with a first diagnosis of HF with preserved EF (HFpEF) be-tween January 2020 and March 2021 entered the study. All patients underwent clinical evalua-tion, blood tests and transthoracic echocardiography. The primary endpoint was “all-cause mortality”, while the secondary one was the composite of “all-cause mortality or rehospitali-zation for all causes” over a mid-term follow-up. Results: A total of 200 HFpEF patients (86.4±6.6 yrs, 70% females) were retrospectively evaluated. The “normal” EF group (n=99) and the “supra-normal” EF one (n=101) were separately analyzed. Compared to patients with “normal” EF, those with “supra-normal” EF were older, with greater comorbidity burden and moderate-to-severe frailty status. During a mean follow-up of 3.6±0.3 yrs, 79 patients died and 73 were re-hospitalized. On multivariate Cox regression analysis, age (HR 1.09, 95% CI 1.03-1.16, p = 0.002), EF (HR 1.08, 95% CI 1.03-1.14, p = 0.004), tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio (HR 0.14, 95% CI 0.03-0.61, p = 0.009) and infectious disease (HR 7.23, 95% CI 2.41-21.6, p < 0.001) were independently as-sociated with all-cause mortality in the whole study population. EF (HR 1.04, 95% CI 1.01-1.07, p = 0.02) also predicted the secondary endpoint. EF ≥65% was the best cut-off to predict both endpoints. Conclusions: “Supra-normal” EF (≥65%) at hospital admission is independently associated with all-cause mortality and rehospitalization for all causes in elderly HFpEF pa-tients over a mid-term follow-up.