Heart failure (HF) harbors a multiplicity of causes in its development and progression. Therapeutic interventions for its treatment are high-cost technologies, drugs, and procedures. With this review, we want to comprehensively evaluate the cost-effectiveness of therapeutic interventions used in the management of functional class II-IV HF. For this, a systematic review of economic evaluations of the cost-effectiveness and cost-utility type was carried out, for each of the therapeutic interventions for HF and risk of sudden death, during the period 2015-2021. The articles were searched in several databases, in English and Spanish. The data extraction was done through the PICO framework. The results were expressed in the incremental cost-effectiveness ratio. As a result, 162 clinical trials were obtained. It is concluded that the Cardioverter defibrillator in primary prevention, the resynchronisation therapy, the heart transplant, the optimal pharmacological treatment, the mitral valve surgery, the Intravenous therapy, the follow-up strategies, tele-rehabilitation, follow-up with laboratory and device such as the CardioMems they are cost-effective. While the resynchronisation therapy defibrillator, cardiac assist devices and catheter ablation for atrial fibrillation show limitations in their cost-effectiveness.Funding: This work was conducted with the main author's own resources, hence its strength, as it does not depend on pressure or bias resulting from support.Declaration of Interest: None declare.Ethical Approval: Ethical approval was obtained from the ethical review committee of Universidad del Bosque, and from the respective health care institutions, for studies involving medical records.