Heartfailureposesanincreasingproblemforglobalhealthcaresystems.Theepidemiologicaldatawhichhavebeenaccruedoverthelast30yearshavepredominantlybeenaccumulatedfromexperiencewithinNorthAmericaandEurope.TheEuropeanexperienceinheartfailure,althoughsimilartothatinNorthAmerica,hasrecentlydemonstrateddifferencesinhospitalizationwhichmayunderliethedifferencesbetweenhealthcaresystemconfigurations.Despitethepredictedincreaseinthenumberofpatientsaffectedbyheartfailure,overthelast30yearsaclearmanagementalgorithmhasevolvedfortheuseofpharmacotherapies,device-basedtherapies,andmechanicaltherapies,includingleftventricularassistdevicesandcardiactransplantation.Althoughthetreatmentofsuchpatientshasbeenclearlydelineatedinnationalandinternationalguidelines,theunderuseofallavailableandappropriatetherapiesremainsasignificantproblem.ThepurposeofthisreviewistoprovideaEuropeanperspectiveonmanagementofheartfailure.