Observation units (OUs) for acute heart failure syndromes (AHFS) have proven to be effective in reducing heart failure admissions and may reduce costs. Goals for risk-stratifying patients with AHFS in OUs include determining patients suitable for OU management and determining end points of treatment. Although many provider models and settings exist, management algorithms common to most OUs include monitoring/nursing care, diagnostic procedures, therapy, and educational/social services. The focus of OU management involves an assessment of the factors that led to the decompensation and identification of the predominant clinical features such as hypertension and congestion. Acute therapy still leans heavily on symptom relief with diuretics and nitroglycerin. For newly diagnosed patients, initiation of guideline-recommended therapies like angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and beta-blockers is an integral part of OU protocols. Patient education and coordination of outpatient care continues to be paramount in preventing early readmission in this patient population.