As the prevalence of systolic heart failure increases, the population of patients in need of advanced therapies becomes larger. As the number of transplants performed each year plateaus, the prevalence of community-dwelling patients with ventricular assist devices (VADs) increases. A broad range of physicians, including emergency physicians, general cardiologists, and generalists, will be exposed to these patients, and must be informed on the disease processes and complications specific to these devices. With an understanding of up-front evaluation and management, these patients may be triaged and stabilized, and will benefit before referral for definitive care by a VAD specialist.