Objective: to characterize the population of patients hospitalized for acute heart failure with an ejection fraction of less than 50% at Hospital Departamental de Villavicencio.Materials and method: this is a descriptive retrospective cohort study of patients hospitalized for acute heart failure with a left ventricular ejection fraction (LVEF) of less than 50% between January 1, 2020, and December 31, 2021.Results: a total of 206 participants were included, with a median age of 70 years.Altogether, 71.8% of the participants were men, and the most frequent comorbidities were hypertension (76.2%), coronary disease (47.1%), and diabetes (32%).The main etiologies of heart failure were ischemia (62.1%) and hypertension (27.2%), with 6.8% attributed to Chagas disease.The most common causes of decompensation were acute coronary syndrome (39.3%) and poor adherence to treatment (25.7%).The median hospital stay was 7.5 days, and the hospital mortality rate was 14.6%, with acute coronary syndrome being the leading cause of death (56.7%).There was a high need for intensive care unit (ICU) management (20.4%), which was higher in patients with slightly reduced LVEF compared to those with reduced LVEF (35.7% vs. 18%, RR = 1.98, p = 0.03).However, the mortality rate was similar between both groups (17.9% vs. 14%, RR = 1.32, p = 0.54).Conclusion: there was a high prevalence of ischemic heart disease, along with a high need for intensive care and high in-hospital mortality.