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Guidelines help clinicians to deliver high-quality care with therapies based on up-to-date evidence. There has been significant progress in the management of heart failure with regards to both medication and cardiac device therapy. These advances have been incorporated into national and international guidelines with varying degrees of success. This article reviews current guidance from the National Institute of Health and Care Excellence in the UK and compares this with European Society of Cardiology guidelines, and evaluates how differences between them may impact on clinical practice., Competing Interests: Disclosure: AR has received honoraria from Medtronic, Boston Scientific, Phillips and Novartis, and has served on the expert consensus committee for leadless pacemakers on behalf of the British Heart Rhythm Society. All other authors have no conflicts of interest to declare., (Copyright © 2023, Radcliffe Cardiology.)