The evidenced based health care (EBHC) movement has restructured the practice of medicine in recent decades. A direct result of this movement has been the trend of using evidence derived from clinical trials to develop best practice guidelines for clinical care. In recent years these guidelines have been at the forefront of an effort to improve outcomes and standardize care. A number of national organizations have led the effort to develop quality metrics thereby creating a heterogeneous landscape that at times contains redundancies. Nevertheless, recent trends have seen the gradual incorporation of heart failure quality metrics into “pay for performance” incentive schemes. The movement to broadly use heart failure quality metrics has not been without its limitations and challenges as collecting information to calculate quality metrics can be resource intensive and it is not entirely clear that tailoring care to satisfy these metrics results in consistently improved patient outcomes.