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Introduction Liver dysfunction frequently accompanies acute heart failure (HF) via venous congestion, hypoperfusion and systemic inflammation. Contemporary national estimates of established liver disease and its prognostic impact during HF hospitalisation are limited.Aim To quantify prevalence, predictors and in-hospital outcomes associated with liver disease among adults hospitalised with HF.Methodology Retrospective cohort analysis of the US National Inpatient Sample (2016–2021). Adult HF admissions (ICD-10 I50.x) were identified. Liver disease was defined by ICD-10 K70–K77 and B15–B19 (alcoholic liver disease, cirrhosis, viral hepatitis, liver failure, chronic hepatic congestion, hepatorenal syndrome). Multivariable logistic and linear regressions adjusted for demographics, comorbidities and hospital characteristics assessed associations with in-hospital mortality, length of stay (LOS) and cost. Data are de-identified and publicly available; ethics approval not required.Results Among 31,157,300 weighted HF admissions, 8.4% had liver disease. Compared with those without, these patients were younger (median 66 vs 74 years) and more likely to have alcohol misuse (6.0% vs 1.5%) (all p<0.001). Crude outcomes were worse with liver disease: mortality 10.8% vs 4.6%, median LOS 5 vs 4 days, and median cost USD 13,706 vs 10,528 (all p<0.001). After adjustment, liver disease independently predicted mortality (OR 2.37, 95% CI 2.23–2.39), longer LOS (+1.46 days, 95% CI 1.44–1.48) and higher cost (+USD 6,389, 95% CI 6,039–6,470) (all p<0.001). Sensitivity analyses showed strongest mortality associations for liver failure (OR 6.92), hepatorenal syndrome (OR 3.51) and alcoholic liver disease (OR 2.61), consistent across HF phenotypes.Conclusions About 1 in 12 HF hospitalisations have co-existing liver disease, which confers >2-fold higher in-hospital mortality and greater resource use. Systematic hepatic assessment and integrated cardio-hepatic care pathways may improve outcomes in acute HF care.