While the 30-day metric for HF readmissions is the focus of CMS financial penalties, all physicians who care for HF patients understand that these patients are at risk for readmission well beyond the first 30 days after they leave the hospital.  Most studies of the lifetime risk of admission for HF patients highlight at least two distinct peaks in readmission rates.^[2]  The first happens early (up to 60 or 90 days) after hospitalization, as patients transition to care in the ambulatory setting;  There is a plateau in the rates of readmission as the disease is stabilized and patients are engaged with longitudinal HF management, and then as the disease advances toward the end-stage and patients approach the end of life, there is a spike again in the rates of hospitalization.