Heart failure is common and has a high mortality. These factors alone should make it an important public health issue. But the advent of new approaches to diagnosis and expensive forms of treatment have increased this importance to public health professionals. It has, however, received rather less attention than other manifestations of heart disease. This review summarises the major issues facing public health professionals seeking to develop strategies to tackle this condition. These include; what is known about diagnostic criteria, the prevalence of disease, including the important gaps in our knowledge about how it affects women, and the cost benefits, including the impact on quality of life, of emerging treatments. The review concludes with suggestions for research.