In 1971, McKee et al. at the Framingham Heart Study published a seminal paper on the epidemiology of congestive heart failure. The authors proposed a set of standardized criteria for heart failure for use in research studies and described the risk factors for developing heart failure. Their data demonstrated the strong association between advanced age and increased incidence of heart failure and underscored the importance of hypertension as a precursor of heart failure in the community. The authors were also among the first to demonstrate the poor long-term outcomes of heart failure in the community, with 1 in 2 affected individuals dying within 5 years of the diagnosis. Subsequent Framingham studies have documented other predictors of new onset heart failure, including elevated plasma natriuretic peptide levels, asymptomatic left ventricular systolic dysfunction, and increased left ventricular diastolic dimension. These findings have highlighted potential opportunities for prevention based on the modification of risk factors such as hypertension, and they continue to provide a foundation for future investigations aimed at reducing the burden of heart failure.