OBJECTIVES: Acute heart failure (AHF) is life a threatening disease which includes variable causes and complications. The aim was to assess clinical characteristics, medication and costs during hospitalization in patients with AHF. METHODS: Patients hospitalized in a cardiological dpt. of the Faculty Hospital Brno in January 2005–July2007 were classified according to the Guidelines on the diagnosis and treatment of AHF by the European Society of Cardiology and their medication was followed at admission and during the stay. In-patient care costs include flat rate of admission, stay and medicinal procedures. (1€=25CZK) RESULTS: In total, 1213 patients (57.5% male, mean age 72.5 years) with AHF were analyzed. The chronic medication involved diuretics in 51%, less than half used antiplatelet drugs, beta-blockers and ACE-I; statins (28.3%), nitrates (23.6%), digoxin (21.8%). Positive inotropics were indicated in acute state: norepinephrine (20.4%), dopamine (11.4%), dobutamine (10%), epinephrine (9.5%) and levosimendan (4.8%). New-onset AHF (57%) was more common than decompensated AHF and was concerned with higher costs. AHF with mild signs and symptoms prevailed (49.3%), pulmonary oedema and cardiogenic shock were both in 13%. Total direct in-hospital expenses were € 4.4 million; mean in-patient cost was €3621. The most expensive were patients in cardiogenic shock with only 3 days of hospitalization (overall mean length-of-stay 8.2 days). The predictors of high costs were antiarrhythmic interventions (PM and ICD; 5.9% patients) making up to 21% of total expenses and revascularizations (coronary angiography followed by PCI in 31.5% patients) which made 41% of total expenses. CONCLUSIONS: The treatment of heart failure patients uses 1-2 % of health care budget in developed European countries of which 2/3 are being spent on hospitalizations. AHF hospitalization is more frequent as the population ages (62% patients were more than 70 years old) and is associated with poor prognosis (in-hospital mortality 14.5%).