The emergency department evaluation and management of patients who have potential acute heart failure syndromes (AHFS) has remained a significant challenge for decades. The emergency physician’s diagnostic tools for heart failure have remained limited, and the complexity of the syndrome itself has led to risk-averse practice styles with extremely high admission rates. Recently, new diagnostic markers and technology have become promising and even commonplace to assist emergency physicians in risk prediction for patients who have AHFS. Familiarity with these approaches is essential for improved care for patients who have heart failure and for resource use. This article reviews the available literature and describes patient features that need to be accounted for in disposition decision-making.