Nesiritide mimics the actions of endogenous B-type natriuretic peptides. Clinical studies on patients who had acute decompensated heart failure demonstrated rapid-onset dose-related vasodilatory effects. Nesiritide reduces pulmonary capillary wedge pressure and improves dypsnea. These effects compared favorably to standard treatments. It decreases preload and afterload and suppresses the renin-angiotensin-aldosterone axis and the release of norepinephrine. Nesiritide also promotes diuresis and has no proarrhythmic effects. Nesiritide is a valuable therapeutic option in the treatment of patients hospitalized for decompensated heart failure. On-going studies target the examination of its long-term effects on mortality and morbidity and its pharmacoeconomic benefits to the healthcare system.