Abstract Aims Despite previous surveys regarding device implantation rates in heart failure (HF), insight into the real‐world management with devices is scarce. Therefore, we investigated device implantation rates in HF with reduced left ventricular ejection fraction (LVEF) in 34 Dutch centres. Methods and results A cross‐sectional outpatient registry was conducted in 6666 patients with LVEF < 50% and with information about device implantation available [74 (66–81) years of age; 64% male]. Patients were classified into conventional pacemakers (PM, n = 562), implantable cardioverter defibrillators (ICD, n = 1165), and cardiac resynchronization therapy with defibrillator function (CRT‐D, n = 885) or pacemaker function only (CRT‐P, n = 248), or no device (n = 3806). Centres were divided into ICD‐implanting and CRT‐implanting and referral centres. Overall, 17.5% had an ICD, 13.3% CRT‐D, 3.7% CRT‐P, and 8.4% PM. Of those with LVEF ≤ 30%, 42.5% had ICD or CRT‐D therapy. A large variation in implantation rates existed between centres: 3–51% for ICD therapy, 0.3–44% for CRT‐D therapy, 0–11% for CRT‐P therapy, and 0–25% PM therapy. Implantation centres showed higher implantation rates of ICD, CRT‐D, and CRT‐P compared with referral centres [36% vs. 25% for defibrillators (ICD or CRT‐D) and 17% vs. 9% for CRT devices (CRT‐D or CRT‐P), respectively, P < 0.001], independently of other factors. A large number of clinical factors were predictive for device usage. Among other, LVEF < 40% and male sex were independent positive predictors for ICD/CRT‐D use [odds ratio (OR) = 3.33, P < 0.001; OR = 1.87, P = 0.019, respectively]. Older age was independently associated with less ICD/CRT‐D (OR = 0.96 per year, P < 0.001) and more CRT‐P/PM use (OR = 1.03 per year, P = 0.006). Conclusions In this large Dutch HF registry, less than half of the patients with reduced LVEF received an ICD or CRT, even if LVEF was ≤30%, and a large variation between centres existed. Patients from implantation centres had more often ICD or ...