Acute heart failure syndrome (AHFS) patients represent the mostseverely ill and undermanaged subpopulation of patients with heartfailure (HF). Causing significant concern in managed care, thepercentage of patients hospitalized for HF is dramatically on the risedespite the advent of modern managed care–up 171% from 1979 (400,000)to 2005 (>1 million). The increasing prevalence of AHFS becomes evenmore alarming considering the overwhelming morbidity and mortalityassociated with the condition. In addition to the significant morbidityof AHFS in terms of hospitalizations, the disease is characterized bychronic persistence, since approximately 30% of patients with AHFSdischarged from the hospital are readmitted within 60 to 90 days.Likewise, mortality associated with AHFS is significant, withapproximately 10% of patients dying within 60 to 90 days of discharge.Despite the rising prevalence and costs associated with AHFS, thedisease remains largely undermanaged, partially as a result of afailure to initiate treatment with life-saving therapies duringhospitalization or soon after discharge. Although professionalorganizations have been striving to improve the state of care for AHFSby providing at least some level of consensus and evidence-basedtreatment recommendations, the gap between the clinical evidence andactual practice is growing. This supplement will define the appropriatecourse of therapy in AHFS and establish treatment goals. In addition, areview of current literature will assist in analyzing the current stateof care for AHFS and identifying potential shortcomings. Finally, thissupplement will propose and evaluate novel managed care interventionsto improve the quality of care for AHFS and manage the financial burdenof the disease; this latter portion will include a review of emergingtherapies such as vasopressin antagonists, which have demonstratedpromise in clinical trials for treating the hyponatremia associatedwith worsening outcomes in AHFS.