Although morbidity and mortality are improving, heart failure continues to present major challenges to healthcare systems. This affliction of mainly the elderly may be falling in incidence but is probably growing in prevalence, in part due to greater longevity resulting from evidence-based drug and device therapy for patients with a low ejection fraction (EF). New guidelines emphasize the...

Although morbidity and mortality are improving, heart failure continues to present major challenges to healthcare systems. This affliction of mainly the elderly may be falling in incidence but is probably growing in prevalence, in part due to greater longevity resulting from evidence-based drug and device therapy for patients with a low ejection fraction (EF). New guidelines emphasize the combination of an angiotensin-converting enzyme inhibitor and beta-blocker as the cornerstone of therapy, with the addition of either an angiotensin receptor blocker or aldosterone antagonist as the third disease-modifying agent in patients who remain symptomatic. An implanted cardioverter defibrillator should also be added in patients with a persistently low EF and life expectancy of reasonable quality of ≥12 months. In patients in sinus rhythm, New York Heart Association class III–IV, and a QRS duration ≥120ms, cardiac resynchronization therapy has substantial additional morbidity and mortality benefits. This evidence-based care should be delivered through an organized and seamless multidisciplinary framework with a focus on the patients’ and carers’ needs. Apart from transplantation, the place of any other surgical intervention remains uncertain. Unfortunately the success of treatment in low EF heart failure has not been replicated in patients with heart failure and a preserved EF, and treatment of these patients remains empirical. The same is largely true for the treatment of patients with acute heart failure, with no treatment yet shown to be superior to empirical therapy with diuretic, oxygen, and nitrates. In particular the role of inotropes remains uncertain....