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To review current issues in the management of acute decompensated heart failure (ADHF), focusing on the early initiation of intravenous (i.v.) vasoactive therapy and including the effects of vasoactive drugs on patient outcomes and the benefits and limitations of each medication class.Review of the worldwide scientific literature on ADHF.The management of ADHF may be improved by early initiation of i.v. vasoactive therapy, reduced use of inotropic agents, and judicious use of diuretics. Data to date suggest that early treatment with the natriuretic peptide nesiritide reduces duration of hospitalization, in-hospital mortality, and requirements for i.v. inotropes and diuretics.Advance practice nurses play an integral role in the management of patients with ADHF from initial triage in the emergency department through final discharge from the hospital. Because they are typically responsible for administering medications and monitoring patient status, nurses need to be familiar with the benefits and limitations of each class of vasoactive agent. They need to recognize that prompt initiation of i.v. vasodilator therapy is important for improving patient outcomes. Further, advance practice nurses should participate in team management that promotes the use of evidence-based ADHF care by developing, using, and assertively communicating the need for processes of care that facilitate best practices.