Background/Aim <p>Congestive Heart Failure (CHF) is a major contributor to emergency department (ED) visits and mortality. Traditional diagnostic tools may not fully capture systemic venous congestion, which is a critical factor in CHF prognosis. The Venous Excess Ultrasound Score (VExUS) is a novel ultrasonographic tool that systematically evaluates venous congestion. This study aimed to assess the effectiveness of VExUS scores in predicting 30-day mortality in patients presenting to the ED with CHF symptoms.</p> Methods <p>This was a prospective, cross-sectional study involving 47 adult patients presenting to the ED with clinical signs of CHF. Patients were assigned VExUS scores of 1, 2, or 3 based on ultrasonographic findings. Laboratory values, PV Doppler flow patterns, and diameters were recorded. Logistic regression and ROC curve analyses were conducted to evaluate the predictive value of VExUS scores and PV diameter on 30-day mortality.</p> Results <p>Higher VExUS scores were associated with increased mortality. Specifically, patients with a VExUS score of 3 had significantly higher 30-day mortality compared to those with a score of 1 (OR = 15.92, <i>p</i> = 0.037). A PV diameter ≥ 10&#xa0;mm predicted mortality with 92.31% sensitivity. Significant correlations were also found between VExUS scores and PV Doppler findings, PV diameter, and other ultrasonographic parameters.</p> Conclusion <p>Higher VExUS scores appear to be associated with increased 30-day mortality in CHF patients presenting to the emergency department, supporting its potential utility as a noninvasive prognostic tool. Its integration into routine ED assessment may help support risk stratification and guide more targeted management strategies.</p> Clinical trial number <p>Not applicable.</p>