In Italy, the National Health System is funded from the taxation system of the state. It is organized by general practitioners in the community and specialists in the hospitals. All Italian citizens are registered with one of the general practitioners. Patients with suspected heart failure are generally referred from the family practitioner to a higher level of medical care. Only a minority of patients with heart failure are cared for by cardiologists, either as in- or outpatients. Echocardiography is widely available; nevertheless, few patients admitted to internal medicine divisions receive an echocardiogram compared to cardiology units. The ACE inhibitor usage by Italian cardiologists in patients with heart failure is satisfied, and the use of beta blockers is increasing in Italy at this time. Since only a small proportion of patients with heart failure are followed by cardiologists in Italy, further efforts are necessary until internists and general practitioners could be involved in treatment trials in heart failure. The aim of this approach is to transfer the beneficial effects observed in the trials to clinical practice.