Nearly one million patients will be hospitalized with acute decompensated heart failure (ADHF) this year, and despite aggressive therapies, one in five patients die within one year of diagnosis. Choosing the most appropriate therapy for patients with ADHF is challenging because only a few outcome studies—some of which are controversial—have been published, no consensus guidelines are available in the United States, and there is a wide variance in the cost of the different therapeutic options. This program will explore these and other emergent issues influencing the management of patients with ADHF, beginning with an overview of the pathophysiology of ADHF and an update on current treatment options. Challenges involved in evaluating treatments for ADHF will be discussed, including attributes of good study design, limitations of published studies, and the lack of studies with outcome data. In addition, emerging therapies and their likely role in treating ADHF will be presented. The faculty will offer suggestions for developing and implementing critical care pathways, as well as using pharmacoeconomics and consensus guidelines, to guide ADHF treatment decisions.