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Background: Respiratory compromise requiring ventilatory support is common in acute decompensated heart failure (ADHF). Noninvasive ventilation (NIV) may improve outcomes and reduce mortality compared with invasive mechanical ventilation (IMV). This study evaluated the association between ventilation modality and 30-day all-cause readmission. Methods: Using data from the 2016–2017 Nationwide Readmissions Database, adults aged 18 years or older who were hospitalized with a principal diagnosis of ADHF and received ventilatory support were identified. The primary outcome was 30-day all-cause readmission. Secondary outcomes included in-hospital mortality, length of stay, hospitalization charges, and discharge disposition. Results: Among 74 431 included patients, IMV use was linked to significantly worse in-hospital outcomes. In-hospital mortality was higher with IMV (33 vs. 6.6%; P < 0.001). Median length of stay was longer (10 vs. 5 days; P < 0.001), and hospitalization charges were greater ($124 832 vs. $43 298; P < 0.001). Non-home discharges were more frequent in the IMV group (62 vs. 34%; P < 0.001). Despite these adverse findings, IMV patients had lower 30-day all-cause readmission rates compared with NIV (14 vs. 19%; P < 0.001). Conclusion: IMV in ADHF is associated with higher mortality, longer hospitalizations, and increased costs but lower 30-day readmissions. Hospitals caring for these sicker patients, often teaching institutions, may face disproportionate financial penalties. Risk adjustment of Hospital Readmission Reduction Program metrics for ventilation modality and discharge disposition should be considered.