Background Studies on outcomes among patients with heart failure (HF) with preserved left ventricular ejection fraction (HF p EF), borderline left ventricular ejection fraction (HF b EF), and reduced left ventricular ejection fraction (HF r EF) remain limited. We sought to characterize mortality and readmission in patients with HF in the contemporary era. Methods Get With The Guidelines–HF was linked to Medicare data for longitudinal follow-up. Patients were grouped into HF p EF (left ventricular ejection fraction EF ≥50%), HF b EF (40% ≤ EF < 50%), and HF r EF (EF <40%). Multivariable models were constructed to examine the relationship between EF and outcomes at 30 days and 1 year and to study trends over time. Results A total of 40,239 patients from 220 hospitals between 2005 and 2011 were included in the study: 18,897 (47%) had HF p EF, 5,626 (14%) had HF b EF, and 15,716 (39%) had HF r EF. In crude survival analysis, patients with HF r EF had slightly increased mortality compared with HF b EF and HF p EF. After risk adjustment, mortality at 1 year was not significantly different for HF r EF, HF b EF, and HF p EF (HF r EF vs HF p EF, hazard ratio HR 1.040 95% CI 0.998-1.084, and HF b EF vs HF p EF, HR 0.967 95% CI 0.917-1.020). Patients with HF p EF had increased risk of all-cause readmission compared with HF r EF. Conversely, risk of cardiovascular and HF readmissions were higher in HF r EF and HF b EF compared with HF p EF. Conclusions Among patients hospitalized with HF, patients with HF p EF and HF b EF had slightly lower mortality and higher all-cause readmission risk than patients with HF r EF, although the mortality differences did not persist after risk adjustment. Irrespective of EF, these patients experience substantial mortality and readmission highlighting the need for new therapeutic strategies.