Given the rising prevalence of heart failure (HF), our objective is to explore the relationships between meteorological events and acute HF (AHF) globally.We used data from 30 countries participating in the ASCEND-HF trial. Parameters including temperature were normalized by location for the 37days prior to the HF event. Meteorological events were classified as a change that occurred <10% compared to baseline. The 7days prior to the HF event was subdivided: T1: the day of and −1day; T2: 2 and 3days; T3: 4 and 5days; and T4: 6 and 7days. Results are reported as ratios of observed to expected weather events at the time of AHF presentation.From 7141 patients, median age was 67 (IQR 56–76) with 66% male patients and 60% of patients with ischemic cardiomyopathy. In T1, temperatures were warmer than expected with 10% fewer decreases in average [OR 0.91 95% CI (0.83–0.98)] and minimum [OR 0.90 95% CI (0.82–0.97)] temperature. In T2, temperatures were again warmer than expected with an excess number of increases in maximum [OR 1.18 95% CI (1.06–1.30)] and average [OR 1.21 95% CI (1.10–1.32)] temperature. In T4 temperatures were cooler than baseline with fewer increases [OR 0.84 95% CI (0.74–0.95)] in average temperature.Meteorological fluctuations appear most relevant in the 3days (T1 and T2) prior to the HF hospitalization with temperature demonstrating a bidirectional relationship with AHF. Continued validation of biometeorological trends in HF will contribute to healthcare system planning globally.