OBJECTIVES: "De Todo Corazón" (DTC) is a risk management program with the aim of reducing complications and improving the quality of life of patients with cardiovascular risks. The aim of this study was to compare the risk of first acute heart failure event in patients under program care. METHODS: We started follow-up of a cohort of 47.867 patients with hypertension and/or diabetes mellitus without previous history of confirmed cardiovascular events between June 2014 and December 2015. First event were considered to be first admissions due to acute heart failure. Incidence is reported by 100 person years follow-up. Kaplan-Meier curves were used to evaluate time a first acute heart failure event. Differences between survival curves were compared using Long-Rank test. Multivariate Cox proportional-hazards models were used to evaluate the risk for first acute heart failure event, on the basis of any potentially significant predictor. RESULTS:  The average age was 62.8 + 12.2 years and 67.6% female. Mean follow-up time was 11.6 + 6.1 months. The proportion of hypertension, diabetes mellitus and hyperlipidemia was 97.1%, 41.3% and 89.2%, respectively. Incidence of first acute heart failure event was 0.082 events per 100 person-years. At 18 months follow-up, the incidence of first acute heart failure event was higher in male compared with women (221 vs. 205 events; p <0.001; Long-Rank test). Age (HR 1.02; 95% IC 1.01-1.03), male (HR 1.8; 95% IC 1.5-2.2), blood pressure non-control >140/90 mmHg (HR 1.4; 95% IC 1.1-1.8), and high cardiovascular risk >20% Coronary heart disease (CHD) risk at 10 years (HR 1.90 95% IC 1.5-2.5) were significantly associated with the incidence of first acute heart failure event. CONCLUSIONS:  The incidence of the first acute heart failure event was significantly higher in patients with blood pressure non-control under program care