Patients with heart failure face a very high risk of hospitalizations and mortality. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors, ß-blockers, and aldosterone antagonists reduce hospitalizations and mortality in patients with heart failure, these life-saving therapies continue to be underutilized. A number of studies in a variety of clinical settings have documented that a significant proportion of patients with heart failure are not receiving treatment with these guideline-recommended, evidence-based therapies when guided by conventional care. Treatment gaps in providing other components of heart failure patient care, including patient education, have also been documented. The demonstration that initiation of cardiovascular protective medications prior to hospital discharge results in a marked increase in treatment rates, improved long-term patient compliance, and better clinical outcomes has led to the revision of national guidelines to endorse this approach as the standard of care. Recent studies demonstrated that ß-blocker therapy can be safely and effectively initiated in heart failure patients prior to hospital discharge, resulting in improved treatment rates and clinical outcomes. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) is a national collaborative designed to improve medical care and education of hospitalized heart failure patients and to accelerate initiation of evidence- based heart failure guideline-recommended therapies by administering them before hospital discharge. A registry focusing on hospital admission to discharge and 60–90 day follow-up is designed to evaluate the demographic, pathophysiologic, clinical, treatment, and outcome characteristics of patients hospitalized with heart failure. The aim of this program is to improve the standard of heart failure care in the hospital and outpatient settings and to increase the use of evidence-based therapeutic strategies to prolong life in the large number of heart failure patients hospitalized each year.