OBJECTIVES: This study assessed the association between forced vital capacity (FVC) change post-diagnosis of idiopathic pulmonary fibrosis (IPF) and healthcare resource utilization (HRU) in patients with newly diagnosed IPF. METHODS: A retrospective chart review was conducted by US pulmonologists using an online case report form for patients diagnosed with IPF from 01/2011-06/2013. Patient eligibility criteria included: 1) ≥40 years old at IPF diagnosis; 2) IPF confirmed by lung biopsy and/or high-resolution computed tomography; 3) FVC results at diagnosis and ~6 months following diagnosis. Based on relative change in FVC percent predicted (FVC%pred), patients were categorized as stable (decline<5%), marginal decline (decline 5-9%), or significant decline (decline≥10%). Physician-reported IPF-related HRU included visits for urgent care or suspected acute exacerbation (AEx) and hospitalization. All outcomes were assessed from six months post-diagnosis to end of observation. HRU rates by FVC decline group were estimated and compared using unadjusted negative binomial regression, controlling for varying follow-up periods. A multivariable Cox model was constructed to assess risk of hospitalization post-FVC decline. RESULTS: The sample included 490 IPF patients from 168 pulmonologists with 250 (51%), 98 (20%), and 142 (29%) patients in the stable, marginal decline, and significant decline groups, respectively. At diagnosis, the mean age was 61±11 years, 68% were male, and the mean FVC%pred was 60±26%. The mean observation time across patients was 583±287 days. Groups with greater FVC decline exhibited higher rates of hospitalization and visits for urgent care or suspected AEx. Multivariable analysis showed that the significant (HR=3.6 [95%CI: 2.0-6.6]) and marginal decline (HR=2.4 [95%CI: 1.2-4.8]) groups were associated with higher risk of hospitalization than the stable group. CONCLUSIONS: Our findings suggest that greater FVC decline in the first six months post-diagnosis is associated with increased IPF-related HRU. Management options for IPF that slow FVC decline may help lessen future IPF-related HRU.