['Many assume that most patients hospitalized with heart failure (HF) are short of breath at rest (SOBAR). The National HF Audit for England and Wales suggests that this assumption is false, which has profound implications for management', 'A retrospective case-note review was carried out of patients hospitalized with HF to determine how many present with shortness of breath at rest or are comfortable at rest but breathless on slight exertion (CARBOSE). Vital signs were tracked for 24\u2009h and mortality for 180 days. Of 311 patients, those who were SOBAR (42%) had higher median heart rate (HR) (100 vs. 85 b.p.m.; P\u2009<\u20090.001), systolic blood pressure (SBP) (141 vs. 122\u2009mmHg; P\u2009<\u20090.001), and respiratory rate (RR) (24 vs. 18 breaths/min; P\u2009<\u20090.001) compared with those who were CARBOSE (56%). Vital signs changed little in those who were CARBOSE over the first 4-6\u2009h, but SBP (141-128\u2009mmHg; P\u2009<\u20090.001), HR (100-90 b.p.m.; P\u2009=\u20090.002), and RR (24-20 breaths/min; P\u2009<\u20090.001) fell in those who were SOBAR. At presentation, SBP was >125\u2009mmHg in 73% of patients who were SOBAR and in 46% who were CARBOSE, dropping to 52% and 37%, respectively, by 4-6\u2009h. Mortality amongst those who were SOBAR and those who were CARBOSE was, respectively, 19% and 34% (odds ratio 2.29; P\u2009=\u20090.005, 95% confidence interval 1.29-4.06).'] Is breathlessness at rest the dominant presentation of patients admitted with heart failure?