Heart failure is the only cardiovascular disease that is increasing. The impact on the critical care environment and the health care system, as a whole, is significant from both a cost and burden to the system perspective. There are 6.5 million hospital days a year and nearly $40 billion dollars in yearly health care costs attributed to heart failure in the United States. There are more Medicare monies spent for diagnosing and treating heart failure than any other Diagnosis Related Group. There is a 24% hospital re-admission rate for this diagnosis which leads to financial implications for health care systems. The human cost is also significant. Less than half of Americans diagnosed with heart failure survive greater than 5 years. The ongoing health care needs and cost of this chronic disease takes a significant toll on patients' finances, time and quality of life. Over $2.9 billion dollars is spent annually on the pharmaceutical management of heart failure in the United States. This diagnosis is the leading cause of hospitalization for patients who are 65 years of age and older. Few health care providers in the critical care environment are not affected by heart failure on a routine basis. Caring for these patients and their families is both a challenging and yet a rewarding experience. This edition will provide critical care nurses with a comprehensive heart failure review which is essential in caring for this challenging population given the dynamic health and critical care environments.