Heart failure is a major and growing public health problem in the United States. Hospitalization and death for heart failure have risen dramatically and the proportion of women with heart failure, especially older women, is projected to be the predominant group in the next 3 decades. There is growing evidence that the etiology, pathophysiology, prognosis, and response to treatment may all be different in women. In addition, there is evidence that hypertension plays a more prominent role and that preserved left ventricular systolic function is more likely to be found in women. There are legitimate questions about the degree of benefit that women receive from standard medications. A major obstacle in our understanding of heart failure in women has been their underrepresentation in major clinical trials. Current emphasis on ensuring adequate representation in clinical trials should help to further our understanding of heart failure in women and its management.