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Heart failure (HF) accounts for 6.5 million hospital days per year. It remains unknown if socioeconomic factors are associated with hospital length of stay (LOS). We analyzed predictors of longer hospital LOS [mean (days), 95% confidence interval (CI)] among participants with incident hospitalized HF (n= 1,300) in the Atherosclerosis Risk in Communities (ARIC) cohort from 1987 to 2005. In a statistical model adjusted for median household income, age, gender, race/study community, education level, hypertension, alcohol use, smoking, Medicaid status, and Charlson comorbidity index score, Medicaid recipients experienced a longer LOS (7.5, 6.3–8.9) compared to non-Medicaid recipients (6.2, 5.7–6.7), and patients with a higher burden of comorbidity had a longer LOS (7.5, 6.4–8.6) compared to patients with a lower burden (6.2, 5.7–6.9). Median household income and education were not associated with longer LOS in multivariable models. Medicaid recipients and patients with more comorbid disease may not have the resources for adequate, comprehensive, out-of-hospital management of HF symptoms, and may require a longer LOS due to the need for more care during the hospitalization because of more severe HF. Data on out-of-hospital management of chronic diseases as well as HF severity are needed to further elucidate the mechanisms leading to longer LOS among subgroups of HF patients.