Heart failure is a common clinical syndrome in which left ventricular dysfunction results in vasoconstriction, volume overload, activity intolerance, reduced quality of life, and high mortality. Recognition of the role of neurohormonal activation in the progression of heart failure has led to more effective treatment. Integral to optimal treatment of heart failure is maximization of both pharmacologic and nonpharmacologic therapy. This article presents information important to maximizing both types of therapy in the advanced heart failure patient. The importance of effective patient and family education is emphasized.