Acute and chronic heart failure results in significant morbidity and mortality to patients and is a major concern for the healthcare systems. Various randomized controlled trials have demonstrated an improvement in morbidity and mortality for patients with heart failure. However, the findings of these trials are often applicable to a limited population. Several large-scale registries are now shedding insight as to the treatment, outcomes, and follow-up of patients in a real-life clinical setting. The objective of this review is to examine some of the heart failure therapies, such as cardiac resynchronization therapy, implantable cardioverter defibrillators and medications, in the context of randomized trials versus clinical registries. This review will also identify how registries are improving patient outcomes and how they are uncovering differences and gaps in treatment in non-randomized trial settings.