At a time when death from myocardial infarction, hypertension and stroke is falling, the impact of chronic heart failure (CHF) is escalating relentlessly and it now constitutes a major public health problem. The clinical impact of CHF, both on quality of life and survival is enormous and, because of this, it is also of growing economic importance.Medical treatment, particularly with ACE inhibitors, improves symptoms and survival rate, and is cost effective. Somewhat surprisingly, ACE inhibitors are still underutilised. Other treatments may also be effective but at present their use in CHF is not clearly defined. Medical therapy in established left ventricular dysfunction may not ultimately be as important as strategies which aim to prevent its occurrence or progression. This article reviews the clinical trials data relating to the effectiveness of current and possible future treatments for CHF.