Heart failure (HF) is a major global health issue marked by inadequate heart function and systemic organ impairment. HF is a complex syndrome with multifactorial etiologies, including coronary artery disease, valvular heart disease, hypertension, and cardiomyopathies Objective: This research aimed at comparing outcomes between patients with reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF) presenting with congestive heart failure (CHF). Study design: An analytical cross-sectional study Place and Duration: This study was conducted in Civil Hospital Dow University Karachi from October 2022 to October 2023 Methodology: The study included patients aged 32 to 85 years diagnosed with CHF. Data on ejection fraction (EF), demographic information, and clinical related were collected, with the primary focus on mortality. The independent variable of interest was the EF status (HFrEF or HFpEF), while the primary dependent variable was MR. Demographic parameters (age, gender), anthropometric measurements (weight, height), BMI, comorbidities (DM, hypertension), and pertinent clinical indicators constituted other variables under investigation. Results: Out of total 200 patients, 94 (47%) had HFrEF, and 106 (53%) had HFpEF. Mortality was observed in 24 (12%) patients. Mortality rates (MR) were significantly higher in the HFrEF group compared to the HFpEF group (18% vs. 7%) (p=0.011). Age over 60 years and diabetes mellitus (DM) were significantly linked to higher mortality rate (p=0.001 and p=0.026). Conclusion: This study reveals that patients with HFrEF have significantly higher mortality rate compared to those with HFpEF. These findings emphasize the importance of EF status in evaluating prognosis and the management of patients with CHF