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Background Heart failure (Heart Failure) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries differ from those identified in well-resourced countries. This study therefore presents the cardiovascular risk factors and the causes of HF among admitted patients in a teaching Hospital in Ghana. Method The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical department of the Korle Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk factors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient’s age and gender. Results The mean age of the study participants was 51.3 ± 16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major causes of HF were hypertensive heart disease (30.7%), dilated cardiomyopathy (29.3%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). HF caused by hypertensive heart disease (88.4% vs 11.6%; p = 0.015), dilated cardiomyopathy (58.5% vs 41.5%; p = 0.004) and ischaemic heart disease (100.0% vs 0.0%; p = 0.004) were high in patients aged 40 years and above compared to those below 40 years. Conclusion The major causes of heart failure in adults admitted to Korle Bu Teaching Hospital were hypertensive heart disease, dilated cardiomyopathy, ischaemic heart disease and valvular heart disease significantly high among patients aged 40 years and above. The main cardiovascular risk factors identified among the heart failure patients were hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis.