Heart failure is a common and growing problem with a poor prognosis both in terms of morbidity and mortality. Furthermore, the natural history of heart failure can be modified dramatically by appropriate therapy. The purposes of this article are to (1) describe briefly the epidemiology and current therapy of heart failure; (2) examine potential differences between heart failure as studied in the clinical trials, compared with heart failure in the community; and (3) suggest a number of areas where improvements might be made or further research is required.