This study examines the problems of the district heating systems current state. The causes of extreme operating conditions of district heating systems in Ukraine and in the Eastern European region have been analyzed. Considered are the main factors influencing the district heating systems stability in extreme conditions. Promising approaches are proposed to increase the reliability of district heating systems operation. It is found that the use of electricity generation reserve sources in cogeneration mode with simultaneous release into system of utilized heat provides significant savings in costs for their operation. It is proven that the district heating system readiness for proper operation should be assessed by the number of the heating network, thermal energy source and thermal energy consumers expected readiness hours in relation to the heating season duration. It is shown that the consumption efficiency coefficient does not directly correlate to the generation efficiency and heat supply to consumers but influences the entire heating system efficiency.