Background. The aim of this study was to analyze the formalization of hospital pathways for patients with acute heart failure (AHF) and to describe standards of accreditation and funding of the providers. Methods. This study was carried out in 10 Italian Regions, through the analysis of regional determination and grey literature. Results. Pathway standardization is mainly present for patients with chronic heart failure; only the Piedmont and Emilia Romagna Regions provide a formal standardization for patients with AHF. Among the analyzed Regions, there were no differences in the start of the management process for AHF, including hospital admission. Conversely, several differences were observed among Regions in the organization of Short Way Observation (both in terms of duration and supply), the possibility of alternative modality of admission (e.g. "home hospitalization") and the funding rules of emergency departments. Conclusions. These above stressed differences are likely to have a significant impact on the optimal management of patients with AHF.