This review highlights recent contributions of the Framingham Heart Study to our understanding of the epidemiology of congestive heart failure (CHF). Given its uniform criteria for the diagnosis of CHF and its long duration of follow-up, the Framingham study has had a unique perspective on the short- and long-term risk of developing CHF, its predisposing risk factors, and its prognosis in a general, community-based population. Some recent studies from Framingham have provided important insights on CHF: the lifetime risk is estimated to be 20% for men and women; hypertension is the most important modifiable risk factor, with a population-attributable risk of CHF of 59% for women and 39% for men; a clinical prediction rule for development of CHF has recently been published; and the prognosis after development of CHF is grim, with a median survival of 1.7 years in men and 3.2 years in women.