OBJECTIVES: The current study aimed to examine direct medical cost and humanistic outcome of diastolic heart failure (DHF) management in Hong Kong. Whether the presence of comorbidities, including hypertension, diabetes and renal impairment, affect the cost and humanistic outcome was also evaluated. METHODS: Retrospective, non-randomized study design was adopted.  Subjects were recruited from the Heart Failure Registry of the Prince of Wales Hospital in Hong Kong between 2006 and 2008 and completion of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) at 3 designated time pints to be eligible.  Patients with significant valvular disorder were excluded.  One year medical records since admission were reviewed.  Heart failure related admissions, clinic visits, cardiovascular drugs, laboratory and diagnostic tests were recorded.  The costs and MLHFQ scores in patients with or without hypertension, diabetes, and renal impairment were compared.   Non-parametric Wilcoxon Signed Rank and Mann-Whitney tests were used.  A p-value <0.05 was considered statistically significant. RESULTS: A total of 73 DHF patients were included. The mean 1-year direct medical cost was USD 20,098 (1 USD = 7.75 HKD), with in-patient care cost contributing to the largest proportion (72.2%) of the total cost. Patients with diabetes or renal impairment were associated with a higher cost of DHF management. Significant difference was found in the renal impairment group (median cost: USD 24,763 versus USD 12,789 in no impairment group, p=0.023). The mean MLHFQ scores of the subjects improved significantly from baseline 30.81±13.89 to 12 months 15.84 ±11.32 (p<0.0005). CONCLUSIONS: The cost of management of DHF was shown to be enormous and further increased in the presence of comorbidities. With the aging population in Hong Kong, the incidence of DHF is expected to increase progressively. Further studies are demanded to guide more optimal medical resource allocation for DHF management.