INTRODUCTIONrnHeart failure (HF) is a complex clinical syndrome resulting from structural and functionalrnimpairment of ventricular filling or ejection of blood. It is one of the major public healthrnproblems worldwide.It is one of major public health problem worldwide. Acute Heart failure isrnbroadly defined as a rapid onset of new or worsening signs and symptoms of HF. Most ofrnregistries done in the developed world showed it is more common in elderly male, 66-75% of thernpatients has history of HF.rnIn Sub Saharan African countries, Unlike developed nations; the most prevailing causes of HF inrnAfricans remains largely non-ischemic, patients tend to be younger and most likely to presentrnwith severe symptoms.rnIn Ethiopia, there are few hospital-based studies done. One retrospective chart review done at thernUniversity of Gonder showed of 311 patients; HFpEF is more common (52.73%) and tends tornbe women (76.22%). They predominantly had etiologies of valvular and hypertensive heartrndiseases.Another prospective study done at TASH showed; among 128 patients, 75 (58.6%)female, CRVHD was the most common (52.3%).A recent prospective study done at showed:rnmedian age of 34 years. The leading precipitating factor and underlying disease at the time ofrnadmission were pneumonia (47.5%) and chronic rheumatic heart disease (48.5%), respectively.rnIn hospital, mortality was found to be 17.2%.rnIn this retrospective chart review 259 patients charts was revied of which 33 patients were diedrnand 226 were discharged improved. Mean age was 39 years and CRVHD was the commonestrncause of AHF. With regards to comorbidity Hypertension and DM was associated with it inrn25.5% and 19.7% of the cases. AF and CAP was the commonest identified precipitating factors.rnLow Hgb, lowsodium ,low potassium and increased creatine were predictors of mortality.