OBJECTIVES: To assess clinical characteristics, hospitalizations, and hospitalization charges among a contemporary, real world cohort of HFrEF patients.  METHODS: A retrospective cohort study of HFrEF, identified by ICD-9 code 428.x with a left ventricular ejection fraction (LVEF) ≤ 40% between 01/01/08 to 12/31/13 (study period) were identified using an AMC enterprise data warehouse (EDW) that includes electronic health records and billing/administrative claims. Demographic, clinical, and hospitalization/charge data were extracted. The index date was defined as the first mention of an ICD-9 of 428.x within the study period. A subset of prevalent HFrEF underwent chart review to obtain detailed medication and medical histories.   RESULTS: The cohort comprised 1931 HFrEF with a mean age of 63±15 years, prevalently Caucasian (70%) males (70%). The average LVEF was 28±9%.  Medication data and etiology was assessed in prevalent HFrEF (n=989). The prevalent HFrEF cohort was predominantly ischemic etiology (67%) and ACEi/ARB/aldosterone antagonists were prescribed in 53%/16%/29%, respectively. Eighty percent were on β-adrenergic blockers.  Atrial fibrillation and renal insufficiency were present in 45% and 42%, respectively. Devices were present in 34% (Implantable Cardioverter-Defibrillator) and 16% (Cardiac Resynchronization Therapy) of patients. In the full sample, during a mean follow up period of 34±26 months, all-cause mortality was 18% (13% CV death) at one-year and 23% (16% CV death) at two-years. There were 2106 all-cause hospitalizations of which 972 (46%) were for heart failure (HF). The median length of stay for HF hospitalizations was 4.3 days and the median charge was $27,230. Among the HF hospitalizations 30-day readmission rates were 167 (21%) for all-cause, and 111 (13%) for HF.  CONCLUSIONS: In an AMC-based EDW, HFrEF was well treated, resulting in a 1-year mortality and 30-day re-admission rates similar to published data. The median charge for a HF hospital stay was $27,230.