OBJECTIVES:  The aim of this study is to evaluate the impact that chronic kidney disease (CKD) and a history of stroke have on hospital cost, healthcare utilization, and mortality among Medicare patients hospitalized for heart failure (HF). METHODS:  Visit-level data from the 2013 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database was obtained. Visits were selected if the patient had a primary diagnosis of HF, was ≥18 years of age, and the primary payer of the visit was Medicare. Selected visits were then grouped into either the Triad cohort (HF, CKD, and History of Stroke) the Control cohort (HF, neither CKD nor History of Stroke), or excluded. (Excluded visits were those that had either CDK or History of Stroke, but not both.) Outcomes included total cost to the hospital, length of stay (LOS), and all-cause mortality. RESULTS: There were 61,719 inpatient visits that met inclusion criteria: 5,510 Triad and 56,209 Control. Triad visits had more chronic conditions (4.5 vs 2.9) and higher rates of both uncomplicated (38 vs 33.1%) and complicated diabetes (16.1 vs 5.3%), hypertension (81.3 vs 68.2%), deficiency anemias (44.1 vs 22%) and peripheral vascular disorders (20 vs 10.5%). On average, total costs for the Triad cohort were $1,523 less expensive than the Control cohort. Triad patients also experienced a shorter LOS (3.5 vs 4.3 days) and there was no difference in the likelihood of mortality (odds ratio for Triad vs Control = 0.86). CONCLUSIONS: The average number of comorbidities and chronic conditions was higher among the Triad cohort compared to the Control cohort. Despite this, costs were lower and LOS was shorter in visits among the Triad cohort, with no difference in mortality.