<p><strong><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">Background and Aim: </span></strong><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-ascii-theme-font: major-bidi; mso-fareast-font-family: 宋体; mso-hansi-theme-font: major-bidi; mso-bidi-theme-font: major-bidi; mso-ansi-language: EN-GB; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">Ivabradine is indicated in chronic heart failure (HF) and reduced ejection fraction (EF) of &lt; 35% and resting heart rate (HR) of &gt; 70 bpm. However, role of Ivabradine in acute decompensated chronic HF (ADCHF) is not well known. The aim of this study was to evaluate one-year outcomes of ADCHF patients discharged with and without Ivabradine. <strong>Materials and Methods: </strong>This is a prospective observational cohort study of ADCHF patients from January 2016 to January 2018. Main exclusion criteria was new onset de-novo acute HF, those with EF &gt; 50% and atrial fibrillation. Data were analysed from 130 patients who were discharged with (62 patients) or without Ivabradine (68 patients). The primary end points were one-year re-hospitalization and cardiovascular mortality between two groups. <strong>Results:</strong> The mean age of patients were 56 &plusmn; 15 years and 61 &plusmn; 17 years between Ivabradine and Non-ivabradine groups. EF upon discharge was 37.48% &plusmn; 5.34% vs 40.01% &plusmn; 8. 12%, with <em>p</em>-value of 0.036. At discharge, higher HR was noted in patients with Ivabradine 84 &plusmn; 13 bpm compared to 77.84 &plusmn; 12. 13 bpm in patients without Ivabradine (<em>p</em>-value = 0.006). After a year, HR in Ivabradine group was low compared to non-Ivabradine group, but was not statistically significant, 66.15 &plusmn; 8 vs. 69.29 &plusmn; 11.3 bpm, respectively. In the Ivabradine group 27.4% of patients visited emergency room (ER) more than once compared to 60.2 % without Ivabradine (<em>p</em>-value = 0.0001). 9.7% of patients in Ivabradine group required one readmission compared to 55.9% without Ivabradine (<em>p</em>-value = 0.0001). <strong>Conclusions: </strong>In ADCHF patients there was significant reduction in ER room visit and re-admission rate in patients discharged with Ivabradine. Hence Ivabradine therapy may be considered in patients with ADCHF with EF &lt; 50% and HR &gt; 70 bpm to prevent re-hospitalization and save hospitalization costs.</span><span lang="EN-GB" style="font-size: 10.0pt; line-height: 115%; font-family: 'Times New Roman',serif; mso-fareast-font-family: 'Times New Roman'; mso-ansi-language: EN-IN; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;"> </span></p>