Early diagnosis and treatment of acute decompensated heart failure (ADHF) results in improved clinical outcomes, reduced resource utilization, improved quality of life, and lower treatment costs. Currently, heart failure results in nearly 1 million hospitalizations annually in the United States, and 50% of hospitalized patients are readmitted within 6 months of initial discharge. The costs associated with resource utilization are substantial. Despite the personal and societal burden of this condition, until recently, very little progress had been made in optimizing treatment of ADHF. Nesiritide, a human recombinant B-type natriuretic peptide, is a safe, effective vasodilator that can be easily used early in the emergency department to improve outcomes in ADHF.