Objectives To estimate healthcare use and financial burden associated with heart disease among Indian households. Methods Data from the 2004 round household survey of the National Sample Survey in India were used to assess the implications of heart disease for out-of-pocket health spending, spending on items other than health care, employment and healthcare financing patterns, by matching households with a member self-reporting heart disease (cardiovascular disease (CVD)-affected households) to (control) households with similar socio-economic and demographic characteristics. Propensity score matching methods were used. Results Compared with control households, CVD-affected households had more outpatient visits and inpatient stays, spent an extra INT (International Dollars) 232 (P <0.01) per member on inpatient care annually, had lower non-medical spending (by INT 5 (P <0.01) per member for a 15-day reference period), had a share of out-of-pocket health spending in total household expenditure that was 16.5 higher (P <0.01) and relied more on borrowing and asset sales to finance inpatient care (32.7 vs. 12.8 , P <0.01). Members of CVD-affected households had lower employment rates than members of control households (43.6 vs. 46.4 , P <0.01), and elderly members experienced larger declines in employment than younger adults. CVD-affected households with lower socio-economic status were at heightened financial risk. Conclusion Non-communicable conditions such as CVD can impose a serious economic burden on Indian households.