Objective: This study examined the clinical characteristics, management strategies, and outcomes of heart failure (HF) patients in the Lebanese population to address knowledge gaps regarding comorbidities, adherence to guideline-directed medical therapy, and mortality. Methods: The study included 835 patients aged 18 years or older who were hospitalized for HF at a tertiary center between January 2020 and December 2023. Data encompassed demographics, medical history, treatments, and all-cause mortality. Results: The median age was 70.0 years (IQR: 62.0–79.0), with males comprising 60.8%. The most common comorbidities were hypertension (84.2%), coronary artery disease (74.6%), diabetes mellitus (55.2%), and atrial fibrillation (33.4%). Males had more ICD (17.1% vs. 8.6%, p < 0.001) and CRT-D implants (8.9% vs. 3.7%, p = 0.004), and higher coronary artery disease frequency (78.3% vs. 68.8%; p = 0.002), whereas females had higher rates of atrial fibrillation (39.4% vs. 29.5%; p = 0.003). HF patients with reduced ejection fraction were the most common (56.4%), followed by HF with preserved ejection fraction (30.1%). HF with preserved ejection fraction had the highest rates of hypertension (89.6%) and atrial fibrillation (39.4%). Utilization of ARNI (β = −0.423, HR = 0.655, p = 0.041, 95% CI: 0.437–0.983) and SGLT2i (β = −0.432, HR = 0.649, p = 0.035, 95% CI: 0.435–0.969) were linked to 34.5% and 35.1% reductions in mortality risk, respectively. Conclusions: These results highlight the substantial burden of HF in Lebanon. Distinct demographic and clinical patterns were identified by gender and left ventricular ejection fraction groups. The findings underscore the need for population-specific screening, management strategies, and targeted interventions to improve HF outcomes.