OBJECTIVES: To estimate productivity loss/indirect costs in the first year after an acute coronary syndrome (ACS) or stroke in Spain. METHODS: Patient productivity loss (absenteeism and presenteeism) and caregiver help in the previous 4 weeks were collected through the Productivity Cost Questionnaire administered to patients working post-event, during a routine cardiologist/neurologist visit 3-12 months after index ACS/stroke hospitalization. Reported hours lost were averaged across patients, extrapolated to 1 year, combined with initial hospitalization and sick leave, and valued according to the Spanish labour cost (€21.4/hour; €2017). RESULTS: Sixty Spanish patients were included [33 ACS (mean left ventricular ejection fraction: 57%), 27 stroke (Modified Rankin Scale 0-1: 85%); 87% men; mean age 51 years]. For ACS patients, mean (SD) work-days missed during the first year post-event was 66 (52); including 60 (49) work-days lost at index hospitalization and sick leave, 6 (28) work-days lost due to presenteeism and 0 (2) work-days lost due to caregiver help. ACS patients reported no missed work-days after returning to work. Average productivity loss on the first year after stroke was 58 (64) work-days. Stroke patients lost 34 (10) work-days due to index hospitalization and sick leave, 2 (10) work-days due to absenteeism after returning to work and 11 (29) work-days due to presenteeism. Additional 10 (36) work-days were lost by caregivers. Average total indirect costs were €11,366 (8,844) for ACS and €9,922 (10,994) for stroke. CONCLUSIONS: Our results suggest that productivity loss in Spain is substantial in the first year after a mild ACS/stroke, amounting to approximately 25% of annual work-days lost by patients. Absenteeism immediately following the event is the main driver for productivity loss, especially in ACS. While ACS patients report scarce caregiving needs, over 17% of productivity loss in stroke accounts for caregiver time.