Recent studies have suggested some gender-related differences in the incidence, quality of care, response to therapy, and outcome in heart failure patients. The majority of studies have proposed a better survival for women compared to men. However, the under-representation of women in clinical trials leads to some uncertainty regarding the survival benefit. Some data suggest the possibility that ACE-inhibitors may be less beneficial in women as compared to men. Beta-blockers seem to be effective both in women and men. Further studies are needed to clarify whether these differences may have a pathophysiological basis.