BACKGROUND: With introducing of effective medical and surgical treatment for heart failure, the prognosis of HF patients is progressively improved. But, heart failure with severe LV systolic dysfunction (LVEF less than 20%), so called ���End-stage heart failure��� is a clinically challenging situation and data for their prognosis is limited. METHODS: In Kor-HF registry, data of 3200 (1600 male, 67.6짹14.3 yrs) heart failure patients were collected from 23 university hospitals. With a criteria of left ventricular ejection fraction(LVEF) less than 20%, 338(10.6%) patients were analyzed for this study. RESULTS : Compared with overall registered patients, there were more male patients (228/338, 67.5%) and mean age was younger (57.9짹16.9 yrs, p<0.05) in severe LV systolic dysfunction group. Mortality during index admission was 7.9% (27/338) and compared with overall group (7.1%), there was no significant difference. During the follow up period, survival rate at 6,12,24 months were 87.7%, 84.2%, 79.4% respectively and there was no significant difference with overall group (88.2%, 84.8%, 78.6%). Death or rehospitalization free survival rate at 6,12,24 months were 75.2%, 67.1%, 55.9%. Ischemic etiology contributed in 116(34.3%) patients and hypertension accompanied in 122(36.1%), previous history of heart failure was reported in 98(29%) patients. Survival rate was not significantly different between ischemic vs non-ischemic group. Previous history of heart failure (OR 3.33, 95%CI 1.39-8.01, p<0.01), high blood urea nitrogen (OR 1.02, 95%CI 1.00-1.04, p<0.05), low serum sodium (OR 0.90, 95%CI 0.84-0.96, p<0.01) levels were adverse prognostic factors for mortality at index hospitalization. CONCLUSION: Recently, even in patients with severe LV systolic dysfunction, the survival was favorable but, morbidity was quite high. So, large amount of medical resources will be needed for management of heart failure patients with severe LV systolic dysfunction.