For both, the therapeutic decision making and also for the patients and their families to make appropriate personal life plans, determination of outcomes in patients with heart failure remains one of the most important goals of therapy. This however remains a challenge for several reasons. As the understanding of the pathophysiology of heart failure evolves, newer risk factors are discovered calling into question the role of conventional risk factors. Also, the importance of these risk factors, single or in combination, needs to be reassessed on a continuous basis as newer therapeutic modalities emerge which are either not widely available e.g. cardiac transplantation, or are expensive, e.g. left ventricular assist devices. Considering that heart failure is a syndrome, risk for outcomes may be different based on which end of the spectrum of disease is assessed e.g. systolic vs. diastolic dysfunction or progressive pump failure death vs. sudden cardiac death. Despite the difficulties in determining the risk for heart failure progression and outcomes, a considerable body of data exists that helps guide physicians about the prognosis in these patients. In this review, we describe the risk factors for progression and prognosis determination in heart failure.