OBJECTIVES: To identify and to explain the possible differences in resource use for the treatment of chronic heart failure (CHF) in France (F), Germany (G), Italy (I), the Netherlands (NL), Spain (S), and the United Kingdom (UK). METHODS: MAHLER was a multi-centric observational (non-interventional) study on the medical management, the health care resource use and the cost of CHF. A total of 1421 NYHA (New York Heart Association) class II to IV patients were included and were prospectively followed over 6 months. The frequencies of patients using a specific resource and the mean number of uses were computed for each country. Predictors of time to hospitalization for CHF were identified through a Cox regression model. RESULTS: Mean age at inclusion was 68.6 years and 31.1% of patients were female. 64% had a NYHA class II and 34.4% a NYHA class III while 42.4% had a history of MI. Rates of hospitalization for CHF ranged from 7.3% (NL) to 10.4% (S). The Cox model indicated that a patient with the same clinical characteristics had less chances to be hospitalized for his CHF in the Netherlands (HR: 0.397; p = 0.003). Individuals in the Netherlands were also more likely than the population as a whole to receive diuretics (89% vs. 79%; p = 0.0004), beta blockers (63% vs. 53%; p <0.0001), and spironolactone (44% vs. 28%; p<0.0001). CONCLUSIONS: Some differences in hospitalization rates between EU countries were identified. They may be related partly to differences in Health care systems and partly to differences in use of cardiovascular medications.