INTRODUCTION: Heart failure is a complex clinical syndrome that develops when adequate cardiac output cannot be maintained and can be accompanied by elevated intracardiac pressures. Advanced heart failure is a common cause of admission to hospital, and one with significant morbidity and mortality. ----- OBJECTIVE: The aim of the present study was to better understand the presentation and clinical features of advanced heart failure patients, as well as provide perspective on complications and mortality rate. ----- METHODS: This study was a prospective cohort study of patients presenting to the Emergency Department of Sisters of Charity University Hospital Centre, Zagreb, Croatia between February 23rd 2018 and March 29th 2019 for primary reason of presentation for acute heart failure. ----- RESULTS: The key clinical features that patients presented with were those of pulmonary congestion with dyspnea being present in 89.7% of all patients, and decreased exercise tolerance in 91.4%. The most common complications were cardiac arrhythmias (63.5%) and impaired kidney function (60.3%). Patients had an average three, six and twelve-month mortality rate of 23.9%, 34.8% and 43.5% respectively. ----- CONCLUSION: Identifying the presenting clinical features and complications of advanced heart failure may help reduce its mortality, which is fairly high. Mortality rates are greater in HFpEF group of patients, suggesting these patients may need closer observation and management.