Acute heart failure syndromes (AHFS) are characterized by a gradual or rapid progression of the signs and symptoms of heart failure (HF), resulting in a need for urgent therapy. Patients with AHFS comprise approximately 20% of all HF patients and represent the most severely ill and undermanaged subpopulation of patients with HF. Despite the rising prevalence and costs associated with AHFS, the disease remains largely undermanaged, partially as a result of a failure to initiate treatment with proven therapies, such as beta-blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, during hospitalization or soon after discharge. Although professional organizations have been striving to improve the state of care for AHFS by providing at least some level of consensus and evidence-based treatment recommendations, the gap between the clinical evidence and actual practice is growing. Appropriate disease assessment, followed by the implementation of life-saving therapies, is the key to improving outcomes. Managed care initiatives, such as improved quality measures, disease management programs, patient education efforts, hospital discharge checklists, and pharmacy-led interventions to enhance medication compliance, provide potential solutions for combating the alarming rise of morbidity, mortality, and costs associated with this disease.