The chronic heart failure (CHF) is a chronic illness typically characterized by phases of clinical deterioration requiring hospitalitation. The relief continuity is a fundamental element to better the effectiveness of the sanitary intervention. The Day-Hospital (DH), particularly, could represent a valid tool to guarantee the relief continuity and to extend the phases of clinical stability in patients with CHF. OBJECTIVES: The aim of this study was to compare the managerial effectiveness and Cost/Utility ratio between heart failure management program delivered by day-hospital and usual care. METHODS: 234 consecutive patients (M/F: 196/38; 56±10 years) with chronic heart failure (EF 29±7%) referred to UHF were evaluated. After clinical evaluation and therapuetic optimization, 122 patients received usual care (UC) and follow-up (control every 6 months), despite 112 patients were activated in the DH. The DH program foresaw: 1) risk profile identification; 2) objectives definition; 3) sanitary run determination; 4) outcome markers measurement; and 5) territory interaction (physician of family and/ or cardiologist of reference). Management (optimezed therapy and Hospital readmission for heart failure (HRHF), functional (NYHA functional class, Left ventricular ejection fraction (LVEF)) and hard (cardiac death and urgent heart transplantation) outcomes during 258±88 days of follow-up were considered. Cost/utility ratio of two strategies were calcutated. RESULTS: At baseline not clinical and functional differences between two groups were found. Hard cardiac events occured in 21/122 (17.2% on usual care (UC) and in 4/112 (3.6%) in DH patients (p<.0007). The cost/utility ratio of two strategies was similar (UC 2409$ vs DH $2244). The incremental analysis pointed out for each gained Qaly in DH a cost-saving of $1068. The cost-utility ratio for integration of Day Hospital to manage chronic heart failure was $19462(13904-34048). CONCLUSIONS: heart failure management program delivered by day-hospital can reduce mortality and morbidity of CHF patients. This management strategy is cost-effective and has an equitable cost from a society point of view.