More than a million patients are admitted annually to U.S. hospitals with acute heart failure. Multicentered hospital-based registries and surveys in the United States and Europe have shown that the typical patient is >70 yrs of age, with a history of heart failure, coronary artery disease, and hypertension. There are an equal number of men and women. Patients typically spend several days on the intensive care unit, with longer admissions in Europe than the United States. The in-hospital mortality rate is around 4% to 7%. The risk of subsequent hospital readmission is high. The elderly, those with comorbidities, and those with cardiogenic shock or renal failure do particularly badly. Better treatment by those with expertise in the management of this syndrome and good follow-up care are likely to improve the outcome for this large group of patients.