Background: Heart failure (HF) is a major public health problem, responsible for numerous hospitalizations and a substantial economic burden. This study aimed to assess the direct cost of inpatient management of HF at the Abidjan Heart Institute. Methods: Prospective cross-sectional descriptive and analytical study conducted from January 1 to May 31, 2025. Adults ≥18 years hospitalized for HF in medical wards and intensive care units were included. Two hundred patients were interviewed; healthcare and associated costs were collected; indirect costs were excluded. The mean total cost incurred during hospitalization was estimated in West African CFA francs (XOF). Results: The mean total cost of inpatient care was 439,560.75 XOF (US$724.15), with values ranging from 303,171 XOF (US$499.45) to 1,340,306 XOF (US$2,200.10). The mean length of hospital stay was 7.1 ± 2 days. Medication costs averaged 169,038.15 XOF (38% of total cost). Diagnostic investigations accounted for 183,832.60 XOF (42% of total cost), and accommodation/hospitalization costs averaged 86,690 XOF (20% of total cost). In multivariable analysis, overall cost was significantly associated with underlying cardiac disease: ischemic heart disease (OR 3.20; 95% CI 1.6–6.5; p = 0.001) and valvular heart disease (OR 4.08; 95% CI 1.1–14.4; p=0.029). Conclusion: The direct cost of inpatient management of HF is substantial in our setting. Strengthening prevention and management of cardiovascular risk factors and improving access to health insurance may help reduce the financial burden associated with HF.