OBJECTIVES: Patients hospitalized for Heart Failure (HF) continue to have high re-admission and mortality rates in the 30 days following discharge. Cardiac parameters such as left ventricular function (LVF) and inferior vena cava (IVC) size are predictors of mortality and readmission, and are presently assessed by 2-dimensional echocardiography (2DE). Pocket-sized ultrasound (PSU) devices for LVF and IVC assessment offer potential advantages of lower cost, increased availability, and portability as compared to 2DE. The study objective was to develop a model to assess the clinical and economic impact of PSU versus 2DE for HF hospitalizations in Italy. METHODS: The model was developed from an Italian hospital perspective, and timeframe was during HF hospitalization to 30 days post-discharge. The clinical scenario evaluated the impact of LVF assessment on mortality, while the economic scenario incorporated the impact of IVC size on costs (2010 Euros). Our model assumed 100% of PSU patients would undergo evaluation, as compared to only 68% who currently undergo 2DE. We assumed abnormalities identified by PSU would require subsequent 2DE evaluation while lack of abnormalities would not require 2DE. Model outputs of number of deaths, readmissions, and costs were calculated using a sample of 186,000 HF hospitalizations. One-way sensitivity analyses were conducted to evaluate the robustness of model outcomes. RESULTS: A PSU strategy yielded a 19.1% (7.2% vs. 8.1%) reduction in the 30-day mortality rate, as compared to the 2DE strategy, and a 33.4% (26.0% vs. 39.1%) reduction in 30-day readmissions leading to a cost savings of €55 million (€297/ HF admission). Models were robust to changes in model inputs with reduction in deaths from 2-37%, and cost savings from €63-315 per HF admission.  CONCLUSIONS: Use of a PSU device to visualize key cardiac parameters for HF hospitalizations in Italy may afford reduction in deaths and cost-savings.