OBJECTIVES: To analyze therapeutic pathways of patients with HF, and to estimate healthcare resources consumption. METHODS: An observational retrospective cohort analysis based on administrative databases of 1 Local Health Unit in Italy was performed. Patients ≥18 with a hospitalization discharge diagnosis of HF (ICD-9-CM 428.xx; 402.xx) from January 1st, 2010 to December 31st, 2014 (inclusion period) were included.The index-date (ID) was the first hospitalization for HF during inclusion period. All patients were characterized 12 months prior the ID and followed up after the ID for 12 months. Patients were excluded if not treated with specific drugs as: ACE-inhibitors, ARBs, diuretics, digitalics, beta-blockers. Two cohorts were built: patients with HF as primary and patients with HF as secondary diagnosis. RESULTS: A total of 2,669 patients with HF were enrolled in the study, 1,960 as primary and 709 as secondary diagnosis. About 49% and 55% males, mean age of 77.0±10.4/76.5±11.1 years in both cohorts. Mortality during 12 months of follow-up was 46% and 43% respectively. Charlson Index score was >0 for more than 90% of patients. In follow-up period, half of the patients present a switch from the original therapy, 10% of the patients requires an add-on. Healthcare resource consumption for patients discharged alive is 11,9006" for patients with primary diagnosis and 12,500f for patients with secondary diagnosis. Cost for a hospitalization is around 3,600€ for HF patients in primary diagnosis and 4,200€ in secondary diagnosis. CONCLUSIONS: Our findings highlight that, in real-world setting, HF has a strong impact on National Health Service. During follow-up period, a high percentage of patients were under-treated, more of half of the patients changed their therapy or added drugs. A big effort, by cardiologist should be done to give the right therapies to the right patients, in order to improve therapeutic pathways and quality life.