Cardiovascular diseases are increasingly recognised as an important cause of morbidity and mortality in developing countries. This is due to the ageing of the population and better control of communicable disease and malnutrition. We review the published data on the epidemiology of heart failure in such countries. Rheumatic heart disease remains a major cause of heart failure in Africa and Asia, especially in the young. Hypertension is an important cause of heart failure especially in the African and African-American population. Chagas' disease is still a cause of heart failure in South America. However, as countries go through epidemiological transition and undergo socio-economic development, the epidemiology of heart failure becomes increasingly similar to that of Western Europe and North America with coronary artery disease being the single most common cause of heart failure. Preventive and public health strategies need to be specific to the local epidemiological characteristics.