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Aims This paper aimed to calculate the annual cost for heart failure (HF) patients in Lebanon. Methods and results Heart failure care can reach up to $31 billion annually in the USA. Data in Lebanon are lacking. Estimating it based on USA data is biased; hence, collecting data from all healthcare providers will reflect the actual cost in Lebanon. Data were collected from all healthcare providers on HF hospitalization during the year 2012. In addition, data from 600 outpatient visits were collected by medical students to estimate the cost for outpatient care. The total cost was calculated by adding up all hospitalization cost-plus outpatient-estimated cost. There were 72 000 individuals suffering from HF. The hospitalization care in Lebanon is largely delivered by the public sector (91% public vs 9% private). However, the outpatient care is largely paid cash by patients. The direct cost for HF hospitalizations paid by the public and the private sector was $38 081 535. The average cost for each HF hospitalization was $3769. The direct cost for outpatients care was estimated at $65 592 000. The average cost for outpatient care was $911 per patient per year. The annual total direct cost was calculated at $103 673 535. The true cost was almost one third the extrapolated cost based on US statistics ($103 673 535 vs 268 370 607, respectively). Conclusions The annual total direct cost for HF patients in Lebanon in 2012 was $103 673 535, which is much less than the extrapolated cost based on US statistics.