Abstract Aims Outcomes reported for patients with hospitalization for acute heart failure (AHF) treatment vary worldwide. Ethnicity‐associated characteristics may explain this observation. This observational study compares characteristics and 1‐year outcomes of Kyrgyz and Swiss AHF patients against the background of European Society of Cardiology guidelines‐based cardiovascular care established in both countries. Methods and results The primary endpoint was 1 year all‐cause mortality (ACM); the secondary endpoint was 1 year ACM or HF‐related rehospitalization. A total of 538 Kyrgyz and 537 Swiss AHF patients were included. Kyrgyz patients were younger (64.0 vs. 83.0 years, P mild aortic stenosis was more prevalent (P