OBJECTIVES: Cardiovascular death is an important endpoint in clinical trials. In health-economic analyses it also plays a key role in the calculation of the number of life years gained. Unlike other outcomes like myocardial infarction (MI) or stroke, not much research has been done on the assessment of specific resource use in patients dying of a cardiovascular cause. This study assessed the cost of cardiovascular death in Belgium. METHODS: In this cost-of-illness study, data on resource utilisation were retrospectively collected in patients with a history of MI who died in the hospital in the year 2002. Four hospitals were selected based on setting (community-university) and geographical region (north and south). Direct medical costs from the health care payer's perspective, as expressed by the intensity of medical resource consumption in physical units, times the direct cost or charge per unit, were considered. Costs were defined as cost of hospitalisation (basic care and nursing), drug use, diagnostic tests, physician consults and technical interventions. RESULTS: The charts of 60 patients were reviewed (mean age: 76 ± 11 years). The average length of stay was 5.28 days (St. Err. 0.64). The main causes of death were MI (37%), cardiogenic shock (22%) and ventricular fibrillation (20%). The average hospitalisation cost €2045 (St. Err. €215), the drug cost €383 (St. Err. €97), the cost of diagnostic tests €344 (St. Err. €42), the cost of physician consults €29 (St. Err. €7) and the cost of technical interventions €943 (St. Err. €207), resulting in a total cost of death from cardiovascular disease of €3744 (St. Err. €431). In the Northern part the average cost is about €1000 higher compared to the Southern part (€4284 vs. €3239) (NS). CONCLUSIONS: Cardiovascular death is not only an important clinical endpoint but also an important economic parameter due to its high cost.