Objectives: To investigate temporal trends in the clinical characteristics and treatments of heart failure (HF) after acute myocardial infarction (AMI). Methods: We retrospectively analyzed 1427 patients with acute myocardial infarction in the five university hospitals in Seoul at two points in time (1998 and 2008). Heart failure was defined as ejection fraction by echocardiography less than 40 % or dyspnea with congestion on chest X-ray. Results: Overall, 364 (59.9 %) patients received revascularization procedures, such as percutaneous coronary intervention or coronary artery bypass graft in 1998 and 706 (86.4%) patients received that in 2008. 228 patients (37.5%) in 1988 and 324 patients (39.5%) in 2008 had a hospital diagnosis with HF. Patients with HF in 2008 were older, had more hypertension and more previous AMI than those with HF in 1998. Patients with HF in 2008 received more aldosterone antagonists, rennin-angiotensin system blockers in combination with beta-blockers, and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation, and percutanous cardiopulmonary support. However, in-hospital death rate was similar between the two. Age, heart rate, elevated cardiac enzyme, and anteroseptal infarction were significant independent predictors of developing HF after AMI in total patients. Conclusions: More revascularization, more mechanical supports, and more medications used in 2008 than in 1998, but there were no differences in rates of developing heart failure after AMI and in-hospital death.