The New England Journal of Medicine (2002;347:1397-402) reports on long-term trends in the incidence and survival of heart failure in the Framingham Heart Study. Over 50 years, from 1950 to 1999, the incidence of heart failure declined among women but not among men. Survival after the onset of heart failure improved in both sexes. The study analyzed 1075 cases of heart failure, with incidence rates for women decreasing by 31-40% between 1950-1969 and 1990-1999. Age-adjusted mortality rates for men and women also declined over time, with survival rates improving by 12% per decade. The study found that the 30-day, 1-year, and 5-year mortality rates for men and women decreased significantly. The decline in mortality was attributed to improvements in the treatment of hypertension, better management of myocardial infarction, and the use of pharmacologic therapies. However, heart failure remains a highly fatal condition, with over 50% of patients dying within five years of diagnosis. The study highlights the importance of primary prevention and further research to understand the factors contributing to these trends. The study was supported by the National Heart, Lung, and Blood Institute.The New England Journal of Medicine (2002;347:1397-402) reports on long-term trends in the incidence and survival of heart failure in the Framingham Heart Study. Over 50 years, from 1950 to 1999, the incidence of heart failure declined among women but not among men. Survival after the onset of heart failure improved in both sexes. The study analyzed 1075 cases of heart failure, with incidence rates for women decreasing by 31-40% between 1950-1969 and 1990-1999. Age-adjusted mortality rates for men and women also declined over time, with survival rates improving by 12% per decade. The study found that the 30-day, 1-year, and 5-year mortality rates for men and women decreased significantly. The decline in mortality was attributed to improvements in the treatment of hypertension, better management of myocardial infarction, and the use of pharmacologic therapies. However, heart failure remains a highly fatal condition, with over 50% of patients dying within five years of diagnosis. The study highlights the importance of primary prevention and further research to understand the factors contributing to these trends. The study was supported by the National Heart, Lung, and Blood Institute.