The purpose of this study was to compare in-hospital time, medical costs, and patient satisfaction before and after the introduction of a nurse practitioner in a chronic heart failure clinic. The records of all patients who attended the NP chronic congestive heart failure clinic were reviewed. Questionnaires were mailed to all available patients to evaluate satisfaction. We compared the number of hospitalizations, inpatient hospital days, and total yearly cost, 1 year before and 1 year after the institution of the chronic congestive heart failure clinic. Fifteen patients were seen an average of every 3 weeks for 7 to 48 months for a mean follow-up period of 24 months. Ages ranged from 48 to 86 years, for a mean age of 65. All but three patients had class IV congestive heart failure. Twelve patients had coronary disease, two valvular heart disease and one congestive cardiomyopathy. Seven of the 15 patients died during the follow-up period, all but one of progressive congestive heart failure. The number of yearly hospitalizations per patient decreased from 2.8 to 0.7 and yearly hospitalized days per patient from 62 to 9 (p less than .01). Total yearly medical cost decreased $131,175. Patient satisfaction was unanimous. In-hospital time and yearly medical costs decreased markedly and patient satisfaction increased after institution of the NP chronic congestive heart failure clinic.