The heart failure and heart transplant program at St. Louis Children's Hospital and Washington University School of Medicine began as one cardiologist and nurse coordinator serving as consultants for heart transplant patients in the hospital. As patient volumes increased, the program grew accordingly and has developed into an integrated heart failure program, which is part of a larger multidisciplinary team. The heart failure and heart transplant program provides comprehensive care for patients both in the hospital and at home, from the initial diagnosis of cardiomyopathy, through advanced heart failure, heart transplant and post-transplant. Research is a vital part of the program, allowing for new and improved pathways for treatment and programmatic experience also lends to the development of new protocols. The program receives referrals from across the United States, working closely with the referring centers to establish close working relationships in order to provide excellent care for patients and return them to their home environment as soon as possible. An integrated approach has many benefits, including the ability to follow patients closely and quickly identify the appropriate timing for referral for transplantation.