Heart failure is a clinical syndrome that encompasses numerous etiologies and pathophysiological mechanisms rather than being a singular disease. This disease remains a significant global health challenge, which necessitates continual advancements in its treatment approaches. This review explores the evolution of pharmacological strategies in HF management, comparing traditional therapies with contemporary approaches. By compiling findings from historical and recent clinical guidelines and notable studies, this thesis highlights the transition from conventional agents such as digitalis, organomercurial diuretics, thiazides and more to newer evidence-based treatment steps. With the adoption of classification of HF according to stages and LVEF, notable developments including the incorporation of guideline-directed medical therapy have been invaluable. According to Bozkurt, 2024 on his paper on “Contemporary pharmacological treatment and management of heart failure”, initial treatment of patients with HFrEF includes foundational agents like ACEI/ARBs, angiotensin receptor-neprilysin inhibitors, beta blockers, mineralocorticoid receptor antagonists and most notably sodium-glucose cotransporter 2 (SGLT2) inhibitors. For patients with HFmrEF and HFpEF, their treatment includes SGLT2 inhibitors and diuretics. There also has been an emphasis on timely initiation of treatment with patients in pre-HF stages, and also the tailoring of treatment according to specific patient needs. These new therapy guidelines have demonstrated substantial benefits in reducing cardiovascular mortality, improving quality of life, and slowing disease progression. This review stresses the importance of personalised pharmacological approach as the cornerstone of modern heart failure care.