The benefits of nesiritide for the treatment of acute decompensated heart failure (ADHF) are discussed. In order to understand the goals of ADHF therapy, it is important to recognize the complex interplay between hemodynamic and neurohormonal abnormalities in patients suffering from heart failure. Goals of therapy include improvement in hemodynamic parameters, relief of symptoms, and minimization of adverse effects. Until recently, therapy with diuretics, positive inotropes, and intravenous vasodilators was the standard of care for treating ADHF. Nesiritide is the newest agent available for treating ADHF and may offer several benefits over standard of care therapy. It is important to remember that therapy for ADHF should not replace chronic oral heart failure therapy, nor should focus on prevention of ADHF episodes be lost.