The purpose of this review is to provide insight and a comparison of the current status of district heating (DH) systems for selected Baltic Sea countries (Denmark, Germany, Finland, Latvia, Lithuania, Poland, and Sweden), especially from viewpoints of application and solutions of novel smart asset management (SAM) approaches. Furthermore, this paper considers European projects ongoing from 2016, involving participants from the Baltic Sea Region, concerning various aspects of DH systems. The review presents the energy sources with particular attention to renewable energy sources (RES), district heating generations, and the exploitation problems of DH systems. The essential point is a comparison of traditional maintenance systems versus SAM solutions for optimal design, operating conditions, and controlling of the DH networks. The main conclusions regarding DH systems in Baltic Sea countries are commitment towards a transition to 4th generation DH, raising the quality and efficiency of heat supply systems, and simultaneously minimizing the costs. The overall trends show that applied technologies aim to increase the share of renewable energy sources and reduce greenhouse gas emissions. Furthermore, examples presented in this review underline the importance of the implementation of a smart asset management concept to modern DH systems.