Progress in the treatment of cardiovascular diseases and the ageing population are increasing the prevalence of heart failure like an epidemic of the century. Older age and comorbidity in the chronic heart failure patients often need treatment of non-cardiac conditions including surgery. Nearly half of all perioperative deaths are related to cardiac events, and the degree to which heart failure contributes to this reality is greatly underestimated. Preoperative risk stratification is an important step in reducing morbidity and mortality in patients undergoing non-cardiac surgery. The goal of the appropriate perioperative management of a chronic heart failure patient should be not only to improve immediate periprocedural outcomes but also to improve long term clinical outcome.