IntroductionAcute heart failure is a significant global public health problem with an annual mortality rate of 10%. To investigate the predictive factors for mortality in acute heart failure patients can lead to improvement of patient care, including enhancing quality of life, reducing readmission rate, and reducing mortality.ObjectiveTo identify risk factors that impact the 30-day mortality rate among acute heart failure patients who visited the emergency department, Siriraj HospitalMethodWe conducted this retrospective case-control study on patients with acute heart failure who visited Siriraj Hospital. We collected data from June 1, 2018, to December 31, 2022, and used univariate analysis to identify factors influencing 30-day mortality. We further analyzed the significant factors through multiple logistic regression analysis.ResultsAmong 450 acute heart failure patients, 300 patients survived (control group), and 150 patients died within 30 days (case group). Multiple logistic regression analysis identified significant risk factors for 30-day mortality, including valvular heart disease (adjusted OR 1.91, 95% CI 1.08–3.39) and cardiogenic shock (adjusted OR 3.30, 95% CI 1.56–7.12). On the contrary, systolic blood pressure (adjusted OR 0.99, 95% CI 0.98–0.99) and pre-existing statin use (adjusted OR 0.56, 95% CI 0.33–0.94) associated with decreased 30-day mortality.ConclusionThe significant factors associated with 30-day mortality in acute heart failure patients included valvular heart disease, and cardiogenic shock. Meanwhile, systolic blood pressure and pre-existing use of statins were the protective factors that reduced the likelihood of 30-day mortality.