Objectives: To estimate direct and indirect costs associated to adult Portuguese patients with heart failure (HF) in 2014.MethOds: A prevalence-based approach was adopted to estimate costs associated to HF. Prevalence in 2014 by the New York Heart Association (NYHA) Functional Classification was estimated using micro-data from a previously conducted national community-based epidemiological survey. Only patients at NYHA classes II-IV were considered to have costs and it was conservatively assumed that patients were either followed in hospital ambu-latory care or in primary care. Primary care costs were estimated using a data-base covering a large population, with records of medications, medical visits and medical tests or diagnostic procedures for 25,337 patients with a HF diagnosis in 2014. Hospital resource consumption was estimated using national DRG microdata. Resource utilization in hospital ambulatory care and in emergency department (ED) episodes was estimated according to experts’ opinion and the national lit-erature, respectively. Unit costs were based on the official NHS tariffs. The indirect costs associated to patients’ absenteeism and early exit from the labour force were based on national sources and conservative assumptions.Results: The class II-IV prevalence rate in the population aged 25+ was estimated at 3.4%, corresponding to 249,592 patients in 2014. HF patients have about 1.1 million medical visits, over 36,000 hospitalizations and approximately 53,000 ED episodes. In 2014, the overall direct and indirect costs were estimated at €289.4M with an average annual cost per patient of €1,159. Medication, medical visits, exams/diagnostic procedures, hospitalization and ED episodes accounted for 29%, 20%, 21%, 26% and 2% of the €244.9M direct costs, respectively. The indirect costs associated to absenteeism and premature exit from the labour market were estimated at €16.4M and €28.1M, respectively.cOnclusiOns: Heart failure is a costly condition and should receive adequate attention from the Portuguese health policy makers.