OBJECTIVES: Update epidemiology and estimate Chronic Heart Failure (CHF) related costs in general practice setting METHODS: We used Health Search, an Italian general practice database formed by about 1,000 GPs. We collected demographics, clinical informations, drug prescriptions, co-morbidities, and lifestyle measurements, reflecting "real world" practice. RESULTS: We analyzed data of 13,633 CHF (mean age was 76.78 years) patients that resulted in a prevalence of 1.25%. We observed similar prevalence in men and women; prevalence increased significantly with age, in both men and women. There were some substantial differences across regions (eg.: Emilia Romagna 1.54% vs. Sardinia 0.61%). Incidence rate was slightely lower than that reported in the literature (1.99*1000 person-years) with some regional diffrences: 3.24*1000 Emilia Romagna as oposed to 1.21*1000 in Puglia and Marche. Women had a higher incidence rate than men (2.05*1.000 vs. 1.92*1000). Overall, mean cost in a cohort of 7.710 patients (excluding 67,7% of patients that had a null cost registrated by phisicians) was 950.22€/patient/year (DS: 1135,27), while median cost was 643,16€. Age and NYHA class seemed to influence costs for elderly patients, while ex-smokers, alcohol abusers  and patients with alcohol related diseases had a significant reduction of costs.   CONCLUSIONS: Real world data is needed to understand the epidemiology of and costs due to CHF in primary care. The epidemiology of CHF here reported is in line with current literature. Concerning CHF-related costs and the respective determinants, this is the first study examining the Italian general practice setting. The present analysis gives an important contribution in updating epidemiology and estimating CHF-related costs.