We conducted a multi-hospital population-based study of 2445 residents of a large New England metropolitan area hospitalized with acute heart failure and found that the long-term prognosis for these patients remains poor. More than one third of patients died in the first year after hospital discharge,and nearly 4 of 5 patients died over the 5-year follow-up period. Several demographic and clinical factors were associated with an adverse prognosis. It is important to know the factors that negatively affect long-term survival after hospital discharge for decompensated heart failure so that treatment can be directed toward specific high-risk groups.