Progressive DSM programs in the outpatient setting have positively influenced HF patient QOL as reflected in improved exercise tolerance and a reduction in emergency care and hospital admissions. For programs to be effective, pharmacologic and nonpharmacologic therapies must be incorporated. Nurses are active team members and can influence the success of the program, especially if they are knowledgeable and technically capable in management processes. Use of practice guidelines, standards of care, or algorithms allow for increased nurse autonomy and improve patient access to care and response times. The need to expand the DSM concept throughout the continuum of care is great. Future program development and outcomes research is necessary to provide direction in the implementation of high-quality, cost-effective programs.