OBJECTIVES: Examine gender differences in resource use, expenditures and mortality among U.S. Medicare patients following discharge from a hospital admission for congestive heart failure (CHF). METHODS: Analyses were conducted on national 5% sample of Medicare claims from January 1999 to December 2001. A cohort that had an initial hospitalization with a primary diagnosis of CHF was identified. Resource use at one year preceding and following the initial CHF admission was compared among males and females. Separate multivariate regression models were developed by gender to assess the factors associated with outcomes. Models included variables for patient characteristics, comorbidity, compliance with routine care and resource use in the year prior to CHF admission. RESULTS: A majority of the 34,540 CHF patients were white (86%), one-half were 80 years or older and approximately 58% were female. Male CHF patients had a higher Charlson comorbidity score compared to females (4.27 vs. 3.99; p<0.0001). Females were more likely than males to have an inpatient readmission within 365 days (58.6% vs. 41.2%; p=0.016), an emergency department visit within 180 days preceding (58.3% vs. 41.7%; p=0.0019) and following CHF admission (57.7% vs. 42.3%; p=0.035), physician office visits within 365 days preceding (58.5% vs. 41.5%; p=0.0001) and following CHF admission (57.7% vs. 42.3%; p=0.0001). Females were also more likely than males to die within 60 days (56.3% vs. 43.7%; p=0.009), 90 days (56.5% vs. 43.5%; p=0.006), 180 days (56.2% vs. 43.8%; p=0.0001) and 365 days (56.1% vs. 43.9%; p<0.0001) of the initial CHF admission. In multivariate models, factors associated with healthcare resource use, expenditures and mortality had similar trends in both gender models. CONCLUSION: There appears to be gender differences in resource use and outcomes among CHF patients. Effort to better target interventions, diagnostic and therapeutic, among patients at higher risk of adverse outcomes carries potential for cost-effective management of CHF patients.