Neurohormonal activation is well studied in chronic heart failure, and covers aspects such as abnormalities of plasma catecholamines, particularly since plasma noradrenaline levels have been found to predict impaired prognosis in heart failure patients. This review will concentrate on the information available on circulating levels of adrenaline and noradrenaline. It will discuss how catecholamine levels change during different disease stages from myocardial infarction to severe chronic heart failure. It has been clearly shown that angiotensin converting enzyme (ACE) inhibitors exert particularly beneficial effects in heart failure patients with raised catecholamine levels. Nevertheless, reviewing how a variety of drug and non-drug interventions affect catecholamine levels and patients' survival, it is concluded that the effect on catecholamine levels does not directly correlate with a survival benefit of the respective intervention. Despite their prognostic significance, due to the development of new prognostic markers for patients with chronic heart failure, the overall clinical value of spot catecholamine levels remains limited.