Objective: To investigate whether the extent of systolic dysfunction is a useful predictor of the costs of healthcare and social support for patients With heart failure. Design: Cross-sectional study with collection of cost data attributed to management of heart failure in the previous year. Setting: Four primary-care practices in Scotland. Patients: Patients receiving long term therapy with loop diuretics for suspected heart failure. Interventions: Two-dimensional and Doppler echocardiography. Main outcome measures and results: Two hypotheses were tested: (i) the proportion of patients incurring costs is higher in patients with abnormal left ventricular (LV) function; and (ii) the median cost per patient that incurs costs is higher in patients with abnormal LV function. Of the 226 patients in the study, 67 (30%) had abnormal systolic function. In comparison with the remaining 159 patients, they had higher healthcare costs [£560 vs £440 per patient year (1994/1995 values)], were more likely to incur hospital inpatient or outpatient costs [Odds ratio (OR): 2.02; 95% confidence interval (CI): 1.06 to 3.84] and had significantly higher primary-care costs (mean £292 vs £231 per patient year; p = 0.02, Mann Whitney test). In contrast, they were no more likely to incur social support costs (OR: 1.22; 95% CI: 0.52 to 2.86) and the mean cost of social support per patient year was lower (£234 vs £373). Conclusions: Patients with objectively measured systolic dysfunction incurred significantly higher healthcare costs in the year before diagnosis. This suggests that treatment that improves systolic function will reduce healthcare costs, even in a primary-care population with relatively mild congestive heart failure.