An external counterpulsation apparatus including a plurality of inflatable devices including a proximal inflatable device and a distal inflatable device and a source of compressed fluid in communication with the inflatable devices. A fluid distribution assembly distributes compressed fluid to the inflatable devices. A first sensor provides a systolic waveform and a controller is in communication with the fluid distribution assembly and controls inflation and deflation of the inflatable devices based on an approximation of an aortic valve closure. The controller adjusting the inflation of the inflatable devices to inflate the distal inflatable device when a pulse generated by inflation of the distal inflatable device arrives at the root of the aorta at approximately 25 to 50 percent of a pulse amplitude from end diastole to peak systole in a descending portion of the systolic waveform. Methods are also provided for the treatment of heart failure.