Heart failure is an increasingly prevalent chronic condition which causes substantial morbidity and mortality, placing an increasing economic burden on health care. Hospitalizations as a result of heart failure are projected to increase considerably over the next two decades. A robust restructuring of existing heart failure treatment models in the UK is needed to enable an integrated seamless transition of care across the community, primary care and hospital networks. This has to be achieved with the patient as a partner in health care as a part of a multidisciplinary approach. This uses innovative strategies such as ambulatory treatment (including intravenous diuretics, remote and telemonitoring) as well as shifting heart failure treatment to the community and to patients' homes. This article analyses the existing evidence for ambulatory management of acute decompensated heart failure and looks at future strategies for restructuring care.