BACKGROUND Since epidemiological studies on congestive heart failure (CHF) have shown somewhat contradictory results, detailed analyses of local trends may be useful in order to plan health strategies. METHODS All patients discharged from public hospitals between 1996 and 2001 with a DRG 127 were evaluated. For patients living in the city of Turin, 1- and 12-month survival analysis was performed. Multivariate analysis was performed for both the total DRG 127 discharges and patients without acute CHF (ICD9CM 785). RESULTS During the 6-year period 56292 discharges were classified as DRG 127. Hospital discharges for CHF increased until 1999, and then remained stable. Because of the progressive decrease of total number of hospital discharges, the percentage of DRG 127 increased from 1.3 to 2%. Mean age increased from 72.8 to 75.4 years in men and from 77.9 to 80.0 years in women. The average hospital stay decreased from 10.8 to 9.9 days in men, from 11.5 to 10.7 days in women. Within 12 months 17.4% of patients were re-hospitalized. The in-hospital mortality decreased from 17.3 to 14.3% in men and from 20.1 to 14.6% in women. For urban population both 1-month and 12-month mortality (from 40.5 to 35.5% in men, from 33.5 to 28.7% in women) decreased. The subgroup with acute CHF within DRG 127 decreased from 11.8 to 4.8%. At multivariate analysis in-hospital mortality is logically correlated with the age of patients and an increase of the mortality, both in women and men, is shown for patients not admitted in a cardiology department. CONCLUSIONS The number of CHF hospital discharges, between 1998 and 2001, remained stable, but increased with respect to total admissions. The reduction of in-hospital, 1-month, and 12-month mortality seems to be more dependent on different patient characteristics than to a real effect.