Congestive heart failure (CHF), a state of abnormal cardiac function. is a common end-stage of heart disease, greatly shortening survival. In the US, as in many countries, it is an increasingly major burden on families and the healthcare system. Nearly 5 million people have CHF, it is the leading diagnosis in hospitalisations of persons aged 65 years and over, 13% of all deaths in 1993 had CHF mentioned on the death certificate, and healthcare expenditures amounted to $US17.5 billion in 1993.Prevalence, mortality, hospitalisations and visits to physicians for CHF are increasing. They are expected to continue increasing as the numbers of older persons in the population increase and as survival following coronary heart disease continues to improve. In a community cohort study, median survival following initial CHF was only 1.7 years in men and 3.2 years in women.The risk of CHF depends on a person's status with respect to predisposing diseases and risk factors. Hypertension, which is present in 50 million people, carries the largest attributable risk of CHF. Myocardial infarction carries the next highest attributable risk, followed by diabetes. Means for early detection and control of hypertension and myocardial infarction have been proven effective, however, they are not being fully utilised. The goal should be to prevent or limit myocardial damage before CHF ensues. Using ordinary office procedures, high risk candidates for CHF can be detected before overt manifestations present. Treatment of hypertension and left ventricular dysfunction can decrease incidence of CHF, and use of ACE inhibitors or vasodilators can prolong survival.