OBJECTIVES: To develop a care map for Congestive Heart Failure (CHF) in the UK, covering diagnosis, progression and treatment of patients, focussing on points of interaction with the UK NHS. METHODS: Available literature was searched for national and local clinical guidelines and treatment algorithms for CHF in the UK. Ten experts were consulted to validate and complete the dataset. An interactive 1-year care map of CHF care in the UK was then developed in MS Excel. New York Heart Association (NYHA) bands I to IV were used to group patients by disease severity and costs were estimated from an NHS perspective for 2005. Patient transition between hospital (including readmissions), home and nursing home was modelled. Possible surgical interventions were: heart transplantation, valve repair and ICD. Summary statistics included: Patient disposition and location after 1 year, total estimated costs (including where accrued) and hospitalisation rates due to CHF. RESULTS: Over one year, 878,000 existing CHF patients plus 63,000 new cases would cost the NHS £896million. The total spend (and percentage) on patients in hospital, at home and in nursing homes were £550million (62%), £298million (33%) and £47million (5%) respectively. Surgery accounted for £13million of hospital costs. Of 941,000 CHF patients, 291,000 will be hospitalised due to CHF within the year and of these, over 36,930 will be readmitted within 2 months, (14,284 within 30 days). The annual hospitalisation rate ranged from 12% (NYHA stage I) to 88% (NYHA stage IV). Excluding surgery, the £536million spent on CHF in hospitals is comprised of £171million in A&E (including paramedic and ambulance costs), £314million in general ward costs and £51million in specialist ward costs. CONCLUSIONS: The cost of CHF to the NHS is considerable, with over 60% falling on hospital budgets and 40% of the total cost (£355million) being ward costs.