Despite advances in treatment, congestive heart failure (CHF) remains a major burden on healthcare budgets throughout the western world. Two main factors in the increasing incidence of CHF are the shift in the age distribution of the population and, paradoxically, an improvement in the management of other conditions, such as myocardial infarction. This increases the number of patients surviving acute cardiovascular events who proceed to develop CHF. Certain sub-populations of patients consume most of the healthcare resources devoted to CHF management, with some 90% of resources utilised by patients in NYHA classes III or IV, and hospitalisation accounting for 60 to 75% of overall costs. Management strategies aimed at reducing both disease severity and the need for hospitalisation are therefore likely to be most effective in reducing the economic burden of CHF on healthcare systems.