Recent advances in pharmacological therapy have lead to an improvement in survival and quality of life in patients with heart failure. Despite the reductions in morbidity and mortality with pharmacotherapy; the prognosis of these patients remains poor. Use of various nonpharmacological interventions including device based therapies, coronary artery and valvular surgeries, ventricular assist devices and heart transplantation have lead to further reductions in morbidity and mortality in these patients. The major cause of mortality in patients with HF is either sudden cardiac death due to fatal arrhythmias or progressive pump failure. Implantable cardioverter-defibrillators reduce the incidence of sudden cardiac death and hence are used for primary and secondary prevention in patients with ischemic and nonischemic cardiomyopathy. Cardiac resynchronization therapy prevents and reverses left ventricular remodeling and results in improved ventricular function, functional status and survival. Development of implantable devices that are capable of monitoring fluid status and cardiac hemodynamics can help in preclinical detection of HF exacerbation and prevent hospitalizations. Surgical or percutaneous coronary revascularization of hibernating myocardium in patients with ischemic cardiomyopathy and repair of valvular regurgitant lesions improves left ventricular function, functional status and survival. Use of passive cardiac restraining devices limits ventricular dilatation, improves cardiac dimensions, prevents LV remodeling and improves functional status of HF patients. For patients with end stage heart failure, refractory to medical therapy, ventricular assist devices and cardiac transplantation are the only therapeutic alternatives available. Ventricular assist devices have been used as destination therapy, bridge-to-transplantation and bridge-to-recovery. Increasing surgical experience with device implantation and advances in device designs have lead to a decrease in the surgical complication rates and device failures. Orthotopic heart transplantation is the definitive therapy in patients with end-stage heart failure. Approximately 2200 patients undergo heart transplantation annually in the United States. Implementation of stringent donor and recipient selection criteria and use of potent antirejection therapy has resulted in excellent outcomes after heart transplantation with survival rates exceeding 80% at 10 years in selected patients. The use of stem cell therapy, gene therapy and new neurohormonal agents in the management of heart failure is currently being investigated.