Abstract Heart failure is a clinical syndrome distinguished by dyspnoea, effort intolerance, fluid retention, and poor survival. Although the management of acute coronary syndromes (ACS) has improved, with a resultant decrease in mortality, the numbers of people who subsequently go on to develop chronic heart failure (CHF) are increasing. The prevalence of heart failure is around 2–3% in the overall population and approximately 900 000 people in the UK have heart failure. It is estimated that there will be an increase in prevalence of 50% in the next 20 years, attributed to better outcomes for CHF. The condition can occur in all age groups, however the incidence and prevalence steeply increases with age. The average age at first diagnosis is typically 76, with the prevalence in the 70–80 age groups, rising to between 10–20%. CHF has a poor prognosis, the mortality rate for CHF being worse than for many cancers. It is estimated that 70% of those hospitalized for the first time with severe heart failure will die within 5 years. However, this has been improving, with 6-month mortality rate decreasing from 26% in 1995, to 14% in 2005. This chapter outlines the aetiology, pathophysiology, and management of CHF, including considerations for palliative care.