Within the medical career covering the past 3–4 decades, heart failure (HF) management has been transformed from that of resignation and mainly palliative treatments to options of proactive prophylactic pharmacological, device and interventional treatments. The prognosis and quality of life of HF patients have also significantly improved over the same period, although they are generally still far below that of normal healthy subjects. A most gratifying of triumphs is that of observing occasionally reversals of severe failure towards normality in cardiac function. However, we are far from being able to ensure such a process in every patient, perhaps until cardiac or myocardial replacement therapy can in practice be as standard a procedure as valve or pacemaker replacement therapies.