OBJECTIVES: Acute heart failure (AHF) is frequent, severe and costly, however detailed population-based epidemiological data are currently unavailable for the Netherlands. Our aim was to characterize the incidence, clinical features and outcomes of AHF, and estimate associated hospitalization costs in the Netherlands. METHODS: Using the 2010 Dutch Hospital Data (DHD), we identified all patients admitted to hospital with AHF as a primary diagnosis. DHD provide data on patient characteristics, primary diagnosis, date of admission and discharge, surgical procedures, prior location and discharge destination. We applied contemporary estimates of healthcare activity associated with AHF in order to calculate its cost in 2014. Major components of healthcare activity included in this estimate were hospital admissions associated with a primary diagnosis of AHF, associated drug utilization generally observed in those patients, major surgeries conducted during the hospital stay and autopsy associated with inhospital mortality. RESULTS: Primary analysis of the data  identified 7,717 patients to be admitted at least once into Dutch hospitals in 2010 due to primary diagnosis of AHF. The mean age of patients was 77.1 (±11.5) and 51% were women. The most common comorbid conditions were cardiac dysrhythmias, essential hypertension, old myocardial infarction, other diseases of endocardium and diabetes. The mean hospital length of stay was 8.67 days during the first admission. Inhospital mortality was 11.3% and readmission to hospital was observed in 13.8% of the patients. Finally, the cost of an AHF hospitalization in the Netherlands was estimated to be €4,623. CONCLUSIONS: Our study provided important insights into the clinical characteristics and costs of AHF hospitalizations in the Netherlands. Further analysis including secondary diagnosis will indicate what the exact number of AHF hospitalizations is, and whether this resembles previously published figures from the National Institute for Public Health and the Environment of 29,838 patients hospitalized and diagnosed with congestive HF.