Background: Heart failure (HF) is a growing but frequently under-estimated problem. We tested the hypothesis that the prognosis for patients with HF severe enough to require hospitalisation is worse than that associated with the most common types of cancer (Ca). Methods: All patients with a first admission to a Scottish hospital in 1991 for HF, myocardial infarction (MI) or the four most common types of Ca specific to men and women were identified. Five-year survival rates and resultant loss of expected life-years (based on figures for the total Scottish population of 5.1 million) were then compared. Results: In 1991 a total of 16,224 men had an initial admission primarily caused by HF (n = 3,241), MI (n = 6,932) or Ca of the lung (n = 2.695), large bowel (n = 1,385), prostate (n = 1,211) or bladder (n = 760). Similarly, a total of 14,842 women were admitted for either HF (n = 3,606), MI (n = 4.916), or Ca of the breast (n = 2,902), lung (n = 1,490), large bowel (n = 1,402) or ovary (n = 526). With the exception of lung Ca. HF was associated with the worst 5-year survival rate overall, with 25% of men and women surviving the follow-up period. The adjusted, relative-to-HF risk of short (< 30-day) and longer-term (31 day to 5-year) mortality in men was 1.24 and 0.37 for MI, 0.27 and 0.70 for prostate Ca, 0.64 and 0.89 for large bowel Ca and 1.86 and 2.89 for lung Ca. In women, these figures were 0.71 and 0.51 for MI, 0.55 and 0.59 for breast Ca, 1.39 and 1.49 for ovarian Ca and 2.81 and 3.52 for lung Ca. In men, HF was associated with a loss of 16,400 expected life-years (median = 9 years/person) versus 22,900 for AMI and 29,700 and, 8,700 for Ca of the lung and large bowel. In women, these figures were 13.200 for HF (median = 7 years/person) versus 17,300 for MI and 18,300, 17,400 and 7,900 for Ca of the breast, lung and large bowel. Conclusions: A first admission for HF is associated with a worse prognosis than MI and nearly all of the most common types of Ca. It also results in a large number of life-years lost in both sexes. As such, HF represents a serious health issue for both men and women and deserves the kind of health-care response usually reserved for Ca.