Because much can be done now to block the devastating natural course of heart failure, it is important to understand the role of various treatment paradigms and to institute them in as many patients as possible, with the use of well-constructed practice guidelines to provide common themes for treating specific patients. However, guidelines cannot address all relevant clinical situations, consensus often cannot be reached because evidence is not always available regarding certain therapeutic strategies, and guideline development can be a slow, politically charged, and difficult process. In addition, one must assess compliance with guidelines and the impact of recommendations on outcomes. Continuous quality improvement initiatives in large group practices and hospitals achieve this goal most effectively. Assessment of the impact and accountability with regard to compliance can then be re-related to clinical experience and observation, triggering additional therapeutic developments and strategies that will focus on continued practice improvement. Continuous quality improvement initiatives in the hospital setting have many advantages and are generally seen as good business practice; because of the regulations hospitals are subject to, particularly the linking of payments to hospital accreditation, systems are in place to improve practice patterns.