The appreciation that congestive heart failure is not merely a disorder of myocardium has led to a substantial alteration in the treatment of this disease. The use of angiotensin-converting enzyme inhibitors is increasing as their well-demonstrated mortality and symptomatic benefits become better publicized and known. Although diuretics and digoxin continue to remain standard additions to angiotensin-converting enzyme inhibitors for the therapy of congestive heart failure, investigations of these and other agents continue. For example, acceptance of beta-blockade as a potentially beneficial therapeutic intervention increased in the past year with the publication of the Cardiac Insufficiency Bisoprolol Study (CIBIS), the largest controlled trial to date. Similarly, survival studies of vasodilators and positive inotropic agents such as vesnarinone are ongoing. Even the effects of exercise in severely ill patients (who were previously advised to be sedentary) are being studied. With the understanding that heart failure is a systemic disease and that controlled trials are needed because many of our assumptions prove to be incorrect, we can expect continued improvement in the management of heart failure.