Background: In the treatment of AML, 7+3 (seven days of standard-dose cytarabine and three days of anthracycline therapy) has long been the standard for attempted remission induction. Recently published studies have explored the efficacy and tolerability of decitabine and venetoclax as a favorable alternative regimen in older adults with AML. However, there has not yet been a head-to-head study in the literature comparing real world outcomes for both regimens. Here we present a retrospective database analysis comparing remission status and mortality among elderly patients treated with 7+3 versus decitabine and venetoclax. Methods: The TriNetX research network was used for this study. Two patient cohorts were created by utilizing International Classification of Disease 10 (ICD-10) codes and medication codes in the TriNetX platform. Both cohorts had patients age 65 and up with a diagnosis of AML (C92.0) and who started treatment within six weeks of diagnosis. The 7+3 cohort received cytarabine and either idarubicin or daunorubicin, while the other cohort received decitabine and venetoclax. Each cohort was excluded from the other treatment to remove crossover as a confounding factor. The cohorts were balanced for age, race, gender, and ethnicity by propensity score matching and the greedy nearest neighbor algorithm. This resulted in 519 patients in each arm. They were then evaluated for the outcome of AML in remission (C92.01) and for death within 12 months. Results: Patients treated with 7+3 were more likely to obtain remission status (54.5% vs 34.7%, RR 1.57, 95% CI (1.36,1.81), P value < 0.0001). The 7+3 cohort also had a lower rate of mortality at 12 months (37% vs 54%, RR 0.69, 95% CI (0.60,0.79), P value < 0.0001). Conclusions: These results show that among elderly patients with AML, treatment with 7+3 is associated with statistically higher remission rates and lower mortality when compared with decitabine and venetoclax therapy. One limitation of our study was that we were not able to determine the cytogenetics in either arm. These results should be taken into consideration when choosing an induction regimen in this population.