The incidence and prevalence of heart failure are increasing principally because heart failure increases with age. There are nearly one million people with heart failure in the UK, and most of them are treated exclusively in primary care. Patients are living longer with heart failure due to improved drug and nonpharmacological treatment. More patients can and should be diagnosed, treated and monitored in the community by well trained, experienced and energetic multi-disciplinary teams who are familiar with all aspects of heart failure management, and aware of the potential medical and psychological problems involved. Heart failure should be suspected if a patient has relevant symptoms and/or signs. Echocardiography can distinguish systolic and diastolic heart failure with assessments of systolic function and diastolic filling patterns. Even moderate hypertension increases the risk of developing heart failure; lowering blood pressure reduces the risk. Rational treatment of the syndrome of heart failure demands an understanding of its complex interrelated biochemical, neuroendocrine, structural and haemodynamic consequences.