Clinicians caring for patients with heart failure appreciate that their patients are surviving longer in this century. This has been shown for patients discharged after heart failure hospitalization in Scotland1 and Sweden,2 for the Framingham community,3 and for outpatients with reduced ejection fraction in Olmsted County.4 The current UK-HEART study by Cubbon and colleagues, published in this issue of Circulation: Heart Failure , provides convincing evidence of improved outcomes, particularly for reduced sudden death, after outpatient referral for predominantly New York Heart Association class II heart failure (mean ejection fraction, 0.30), showing a 38% decrease in 1-year mortality rate from 12.5% to 7.8%.5 Although increasing awareness of the diagnosis may trigger earlier referral, patients from the 2 eras evaluated here appear similar in terms of objective disease severity. The average ejection fraction is similar, and a lower loop diuretic dose in the recent cohort is rendered more potent by the broader use of aldosterone antagonists. The major progress in therapy in this population of mild-moderate heart failure was an almost 10-fold increase in the use of β-blockers. When evaluating absolute survival, it should be noted that both cohorts excluded atrial fibrillation and diabetes, which affect approximately one-third of patients with heart failure and are generally associated with higher mortality rates. Article see p 396 This improved journey aligns with the impression that the heart failure journey has become a different one. Many patients even with advanced disease return for longer than 10 years to heart failure referral clinics where 2-year survival was rare when we began 25 years ago. The data reported in this study of mild-moderate outpatient heart failure parallel the experience of more advanced heart failure reported by Pande from Brigham and Women's Hospital, comparing patients referred with class III–IV symptoms before 2000 …