Background Evidence suggests differences in clinical characteristics, causes, and prognoses between heart failure with reduced ejection fraction ( HF r EF ) and heart failure with preserved ejection fraction (HFpEF). Most studies have failed to support the prognostic relevance of anxiety in HF r EF or unclassified HF with mean left ventricular ejection fraction <40%. Meanwhile, the association between anxiety and prognoses in HF p EF remains unexamined. This study compared the prognostic value of anxiety between HF r EF and HF p EF . Methods and Results A total of 158 patients with HF r EF (left ventricular ejection fraction=28.51±7.53%) and 108 patients with HFpEF (left ventricular ejection fraction=64.53±9.67%) were recruited between May 2012 and December 2014. Demographic and clinical characteristics, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory- II scale, and 18-month follow-up outcomes were recorded during the hospital stay. There were significant differences in age, sex, comorbidities, laboratory biomarkers, discharge medications, and unhealthy behaviors, which supported the contention that HF r EF and HF p EF represent 2 distinct phenotypes, although there were no significant differences in anxiety and 18-month outcomes. Multiple logistic regression yielded no significant associations between anxiety and 18-month outcomes in HF r EF . By contrast, trait anxiety could predict 18-month all-cause mortality (odds ratio, 1.429; 95% CI, 1.020-2.000; P=0.038), all-cause readmission or death (odds ratio, 1.147; 95% CI , 1.036-1.271; P=0.008), and cardiac readmission or death (odds ratio, 1.133; 95% CI , 1.031-1.245; P=0.010) in HF p EF after adjusting for possible confounders. Conclusions Trait anxiety was independently associated with 18-month all-cause mortality, all-cause readmission or death, and cardiac readmission or death in HF p EF , but not in HF r EF .