Background Cardiopulmonary exercise testing (CPX) is a non-invasive tool to precisely define maximum exercise capacity with measurement of peak oxygen uptake (pVO2). Combined with other variables, CPX provides a comprehensive characterization of reserve capacity which can then guide the need for treatment. Purpose The purpose of this study was to evaluate findings in ambulatory heart failure patients undergoing CPX and assess heart failure severity/guide treatment. Methods A total of 96 patients were referred to the cardiology service for CPX testing at a local community hospital during the years of 2016 and 2017. All CPX data and results were interpreted/reported by the heart failure medical director. Results Of the 96 patients who underwent CPX testing, 50 were found to have cardio-metabolic impairment due to heart failure (HF). Of these patients, the mean findings were: age 69, BMI 28.6, mean ejection fraction 36.6%, and 35% female. CPX results were notable for average pVO2 of 1.24 L/min (65.85%), average weight adjusted VO2 of 14.56 mL/kg/min (67.76%) and average VE/VCO2 slope of 36.6. 22% of patients were referred to cardiac rehabilitation. 8% were referred to an LVAD/transplant program, while 32% received optimization of medication regimen in the hospital HF clinic. Primary all-cause of dyspnea was due to deconditioning (22%) compared to cardiac (30.2%), pulmonary (11.45%) or mixed (27.1%) etiology. 2 patients required the use of inotropes, 4 were readmitted for HF exacerbation and there was 1 recorded death. A total of 40 patients who did not follow up with a provider in our EMR were lost to follow-up. Discussion Using CPX we were able to capture the patients presenting with persistent dyspnea with a component of cardio-metabolic etiology. These patients were then referred to our HF program for further management based on symptomatology and response to therapy. Options for management included the addition/titration of evidence-based HF therapy, cardiac rehab, referral to stage D heart failure centers for evaluation of advanced therapies or intervention. We hypothesize that CPX is a valuable tool to discriminate HF severity in ambulatory patients in a community HF setting. Future directions include using CPX to guide HF management in NYHA I-III patients in HFrEF and HFpEF, and risk prediction of stage C patients based on the ability to identify patients for Stage D intervention versus optimization of medication regimen.