OBJECTIVES:  Clinical trial outcomes can differ from the real-world setting due to study protocol and patient selection. The objective of this study was to understand the real-world mortality and hospitalisation outcomes for patients with HF managed with existing treatments in England. METHODS:  A retrospective observational cohort study (01/01/2005-31/12/2013) was conducted using the CPRD (Clinical Practice Research Datalink) database. Adults with a READ code corresponding to HF due to LVSD were eligible. Newly diagnosed HF patients were identified through first HF indicator in CPRD data. Prevalent population on a particular day (i.e., 1 January 2010, aligned with publication year of National Institute of Health and Care Excellence (NICE) HF guidelines) was defined as people who had HF before that day and were alive and active CPRD patients on that day. RESULTS:  Of patients with newly diagnosed HF, 22% had a first HF-hospitalisation and 68% were hospitalised for any cause in year 1, increasing to 39% and 94% in year 4, respectively. In year 1, 17% died of CV causes and 20% of any cause, increasing to 42% and 49% at year 5, respectively. Of the prevalent cohort, 11% had a first HF-hospitalisation and 49% were hospitalised for any cause in year 1 increasing to 46% and 88% in year 4, respectively. In year 1, 8% of these patients died of CV causes and 10% of any cause, increasing to 35% and 43% at year 5, respectively. CONCLUSIONS:  In England, both newly diagnosed and prevalent HF populations experience high HF-related morbidity and cardiovascular mortality rendering HF as a substantial burden on the National Health Service (NHS). New treatments to improve patient outcomes are needed.