Heart failure causes significant morbidity and mortality in women, especially elderly women. Risk factors for the development of heart failure in women differ from those in men, with hypertension and diabetes playing a greater role in women and ischemic heart disease a greater role in men. However, the risk of developing heart failure after symptomatic myocardial infarction is higher in women than in men. Data from the Studies of Left Ventricular Dysfunction Registry suggest that event rates after the diagnosis of heart failure are greater in women than in men. Only 13% of the patients included in the major heart failure mortality trails were women, and data for the women in these trials have not been reported separately. The survival of women who have undergone heart transplantation is similar to that of men; however, women have more rejection and are more likely to require maintenance corticosteroid therapy. Data are critically needed to determine whether the treatment of heart failure in women, whether medically or by heart transplantation, requires a special approach.