Background: This study aimed to compare the clinical characteristics, diagnostic profiles, and outcomes of systolic heart failure (SHF) and diastolic heart failure (DHF) in elderly hospitalized patients at a tertiary care hospital.Materials and Methods: A total of 100 elderly patients (aged ≥60 years) diagnosed with heart failure were enrolled in this comparative study. Patients were divided into two groups: SHF (ejection fraction < 40%) and DHF (ejection fraction > 40% with diastolic dysfunction). Data were collected on demographic characteristics, comorbidities, laboratory results, echocardiographic findings, and clinical outcomes. Statistical analysis was performed using SPSS software with a significance level set at p < 0.05.Results: The study found no significant differences between SHF and DHF groups in terms of age, gender, or comorbidities such as hypertension and diabetes mellitus. However, SHF patients had significantly lower ejection fractions (32.5% vs. 55.2%, p < 0.001) and required longer hospital stays (9.2 ± 4.5 days vs. 7.8 ± 3.6 days, p = 0.04). SHF patients also had a higher rate of ICU admissions (30% vs. 15%, p = 0.04) but no significant difference in in-hospital mortality (p = 0.20).Conclusion: SHF patients exhibited more severe clinical outcomes compared to DHF patients, including lower ejection fractions, longer hospitalization, and increased ICU admissions. Both groups had similar comorbidities. The study highlights the need for tailored treatment strategies to address the distinct challenges posed by SHF and DHF in elderly heart failure patients.