Objective:To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar.Methods:This retrospective observational study was conducted in department of Cardiology,Postgraduate Medical Institute,Lady Reading Hospital Peshawar,from March 2005 to September 2007.Relevant information regarding the risk factors of congestive cardiac failure were recorded on questionnaire prepared in accordance with the objectives of the study.Results:1 019 patients with established diagnosis of cardiac failure (based on clinical findings and relevant investigations) were included.Out of total sampling 583 (57.12%) were males and 436(42.78%) were females.The age range of the patients was from 6 years to 82 years with mean age of 48.5 years and mode of age was 45 years.The distribution of causative factors of CCF was:ischemic heart disease(IHD) 36.31%,hypertension 26.30%,dilated cardiomyopathy 10.10%,obstructve and restrictive cardiomyopathies 5.39%,valvular heart diseases(VHD) 9.32%,congenital heart disease like ventricular septal defects(VSD) 4.41%,atrial septal defects(ASD) 0.58%,atrial fibrillation (AF) 2.25%,constrictive pericardidtis 1.07%.Pericardial effusion 0.68%,chronic obstructive pulmonary disease and pulmonary hypertension 1.47%,thyrotoxicosis 0.68%,complete heart block 0.29%and paget disease in 0.09%cases.Conclusion:Ischemic heart disease,hypertension,cardiomypathies,valvular heart disease and congenital heart disease are major contributor to CCF in our patients. Objective: To determine the frequency of risk factors of congestive cardiac failure in a tertiary care hospital of Peshawar. Methods: This retrospective observational study was conducted in department of Cardiology, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2005 to September 2007. Relevant information regarding the risk factors of congestive cardiac failure were recorded on questionnaire prepared in accordance with the objectives of the study. Results: 1 019 patients with established diagnosis of cardiac failure (based on clinical findings and relevant investigations) were included. Out of total sampling 583 (57.12%) were males and 436 (42.78%) were females. age range of the patients was from 6 years to 82 years with mean age of 48.5 years and mode of age was 45 years. distribution of causative factors of CCF was: ischemic heart disease (IHD) 36.31%, hypertension 26.30%, dilated cardiomyopathy 10.10%, obstructve and restrictive cardiomyopathies 5.39%, valvular hea 9.32% of rt diseases (VHD), 4.41% of congenital heart disease like ventricular septal defects (VSD), 0.58% of atrial septal defects (ASD), 2.25% of atrial fibrillation (AF), 1.07% of constrictive pericardidtis pulmonary disease and pulmonary hypertension 1.47%, thyrotoxicosis 0.68%, complete heart block 0.29% and paget disease 0.09% cases.Conclusion: Ischemic heart disease, hypertension, cardiomypathies, valvular heart disease and congenital heart disease are major contributor to CCF in our patients .