OBJECTIVES: The study objective was to determine medical resource utilization and direct and indirect costs following hospitalization with chronic heart failure (HF). METHODS: Patients with ≥1 hospitalization with a chronic HF claim (ICD-9 428.22, 428.32 or 428.42) were identified in a US commercial insurance claims database from 2004-2008. Patients were observed from beginning of first hospitalization (index hospitalization) for chronic HF until disenrollment or end of data availability. Inpatient, outpatient, and prescription drug data were used to estimate per patient per month (PPPM) utilization rates. Costs (2009 USD) were calculated per hospitalization and PPPM for patients ≤65 years, and included insurers’ reimbursement, patient out-of-pocket and sick leave costs. RESULTS: There were 7,814 patients (mean age 73.2 years, 55.7% male) meeting inclusion criteria. Mean HF hospitalization length of stay increased from 6.7 days at index hospitalization to 8.2 days at fourth re-hospitalization. Rate of HF-related re-hospitalization remained over 0.045 PPPM throughout 24 months of follow-up, accounting for over 78% of all-cause hospitalizations. Rate of all-cause and HF-related outpatient visits peaked at 4.0 and 0.59 visits PPPM, respectively, within the three months after index hospitalization. Index hospitalization was most expensive (direct medical costs=$31,998). Patient out-of-pocket costs accounted for less than 10% of direct hospitalization costs and sick leave costs were less than $1,800 at any hospitalization. During the study period, outpatient cardiovascular drugs accounted for a small proportion of total pharmacy costs (approximately 20%); average PPPM cost varied from $88 to $124, representing less than 1% of the average cost of a HF-related hospitalization. CONCLUSIONS: Treating chronic HF patients is resource intensive. The greatest utilization and cost burden occur within the three months after index hospitalization and patients continue to be burdened after hospitalization by high inpatient and outpatient visit rates.