To assess te incidence, clinical characteristics and current strategies in the management of patients with acute heart failure, we conducted a prospective survey of all acute medical admissions with heart failure to a district hospital serving a city centre population of 300,000 people in a multiracial community. Of 7451 such admissions, 348 (4.7%) were diagnosed as having acute heart failure: 265 Caucasian (76.1%), 27 black/Afro Caribbean (7.7%), 56 Indo-Asian (16.1%). Complete clinical data were available from 260 patients. The main presenting symptom was dyspnoea in 233 patients (89.6%) and chest pain in 60 patients (23.1%); 139 patients (53.5%) had a history of ischaemic heart disease, 87 (33.5%) hypertension and 49 (18.8%) had diabetes; 103 patients (39.6%) had a previous history of heart failure; 75 patients (28.8%) were in atrial fibrillation. An echocardiogram was performed in 89 patients (34.2%). On admission, ACE inhibition was prescribed to only 78 patients (30.0). The diagnosis of heart failure was stated on the hospital inpatient data sheet (KMR-1) in only 170 patients (65.4%). Following admission, 50 patients (19.2%) died while in the wards. Heart failure is a common problem among acute medical admissions and has a poor prognosis. The KMR-1 diagnosis may underestimate the prevalence of heart failure.